Casey Caoimhe, Higgins Tom
1University Hospital Kerry, Tralee, Co. Kerry, Ireland.
Endocrinol Diabetes Metab Case Rep. 2022 Sep 1;2022. doi: 10.1530/EDM-21-0193.
Subacute thyroiditis is an inflammatory disorder of the thyroid gland that has previously been described following viral illnesses and occasionally post vaccination such as influenza vaccine. 2021 was a revolutionary year for the development of SARS-CoV-2 vaccinations with multiple different vaccines now available. There are increasing numbers of case reports of thyroiditis following these vaccinations. We report a case of a 50-year-old female who developed subacute thyroiditis 6 days post ChAdOx1 nCoV-19 vaccine (AZD1222 produced by AstraZeneca Vaxzevria). The initial thyrotoxic phase was followed by overt hypothyroidism. This resolved spontaneously within 5 months without levothyroxine replacement. We hope that our case will add to the growing literature of cases of thyroiditis occurring after multiple different types of SARS-CoV-2 vaccination and create awareness of this rare but treatable adverse effect. We also review the literature on the proposed mechanisms behind this adverse effect.
Subacute thyroiditis is an inflammatory disorder of the thyroid gland that can occur after a viral illness or vaccination against certain infections. Subacute thyroiditis is a rare adverse effect that has been reported to occur after different types of SARS-CoV-2 vaccinations. Subacute thyroiditis post vaccination is relatively straightforward to manage, with some patients requiring non-steroidal anti-inflammatory drugs and beta-blockers, while more severe cases may require corticosteroid therapy. This adverse effect should not dissuade vaccination use at a population level. There are many postulated mechanisms for the development of subacute thyroiditis following vaccination including the presence of the ACE-2 receptor for SARS-CoV-2 on the thyroid gland, an inflammatory/immune response as is seen in COVID-19 infection itself and molecular mimicry between SARS-CoV-2 spike protein and healthy thyroid antigen.
亚急性甲状腺炎是一种甲状腺的炎症性疾病，此前曾在病毒感染后以及偶尔在接种疫苗（如流感疫苗）后出现。2021年是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗研发具有变革性的一年，现在有多种不同的疫苗可供使用。接种这些疫苗后，甲状腺炎的病例报告越来越多。我们报告一例50岁女性，在接种ChAdOx1 nCoV-19疫苗（阿斯利康公司生产的AZD1222，商品名Vaxzevria）6天后发生亚急性甲状腺炎。最初出现甲状腺毒症期，随后发展为明显的甲状腺功能减退。这在5个月内自发缓解，无需左甲状腺素替代治疗。我们希望我们的病例能为越来越多的关于多种不同类型SARS-CoV-2疫苗接种后发生甲状腺炎的文献增添内容，并提高对这种罕见但可治疗的不良反应的认识。我们还回顾了关于这种不良反应背后潜在机制的文献。
亚急性甲状腺炎是一种甲状腺的炎症性疾病，可在病毒感染或接种针对某些感染的疫苗后发生。亚急性甲状腺炎是一种罕见的不良反应，已报道在不同类型的SARS-CoV-2疫苗接种后出现。接种疫苗后发生的亚急性甲状腺炎相对易于处理，一些患者需要非甾体抗炎药和β受体阻滞剂，而更严重的病例可能需要皮质类固醇治疗。这种不良反应不应在人群层面上劝阻人们使用疫苗。关于接种疫苗后发生亚急性甲状腺炎的潜在机制有很多推测，包括甲状腺上存在SARS-CoV-2的血管紧张素转换酶2（ACE-2）受体、如在2019冠状病毒病（COVID-19）感染本身中所见的炎症/免疫反应以及SARS-CoV-2刺突蛋白与健康甲状腺抗原之间的分子模拟。
