Graves’ disease Induced by Sars-Cov-2 Vaccination

Background: Several cases of Graves’ disease were recently reported in individuals vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: To determine characteristics and patterns of Graves’ disease occurring following SARS-CoBV-2 vaccination. Methods: PubMed search up to March 31st, 2022. Search terms are Graves’ disease, SARS-Cov-2, vaccine, COVID-19. Case reports, case series, review articles and pertinent in vitro studies are reviewed. Results: Review of literature revealed 28 cases (19 women) of new onset and 5 cases (4 women) of relapses of Graves’ disease after receiving different types of vaccines against coronavirus disease 2019 (COVID-19). Onset of hyperthyroid symptoms started 2-60 days after vaccination and occurred more frequently after the first vaccine dose (n=13) than after the second dose (n=5). In 70% of cases (23 of 33), the implicated agent was the m-RNA based vaccine of Pfizer-BioNtech. Severity of Graves’ disease symptoms was generally moderate and controlled by anti-thyroid medications (mainly methimazole) and beta-adrenergic blockers. The course of Graves’ disease is unclear as patients are still receiving therapy. No specific risk factors could be defined that may increase predisposition to the COVID-19 vaccine-induced Graves’ disease. Mechanisms of development of Graves’ disease after COVID-19 vaccination are unclear but may be related to the phenomena of molecular mimicry or autoimmune/inflammatory syndrome by adjuvants (ASIA). Conclusions: The timing of onset of symptoms of Graves’ disease in relation to the administration of COVID-19 vaccine strongly suggests a causal relationship. Physicians should be aware of the occurrence of this uncommon adverse effect.