NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu 214063, China.
NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu 214063, China; Department of Radiopharmaceuticals, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China; School of Life Science and Technology, Southeast University, Nanjing 210096, China.
Vaccine. 2023 Aug 31;41(38):5648-5654. doi: 10.1016/j.vaccine.2023.07.053. Epub 2023 Aug 4.
SARS-CoV-2 vaccination has been reported to be associated with the induction of thyroid disorders. To investigate the influence of SARS-CoV-2 vaccination on the disease course of patients who were undergoing treatment for Graves' disease (GD), a total of 651 consecutive GD patients who attended follow-up visits in Jiangyuan Hospital were enrolled in this retrospective study, including 443 inactivated SARS-CoV-2 vaccine recipients and 208 unvaccinated participants. The changes in serum levels of free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH) and TSH receptor antibody (TRAb) were analyzed. Crude and adjusted hazard ratios (HRs) were estimated using Cox regression models to investigate the risks in incident TRAb positivity and hyperthyroidism recurrence following vaccination. The median levels of TRAb and fT3 significantly decreased in both vaccinated and unvaccinated groups during the GD hyperthyroidism treatment. The fT4 levels of both groups were well within normal limits and presented downward trends simultaneously. Although the present study observed an increasing trend of TSH level during follow-up, significant difference was not seen in both vaccinated and unvaccinated groups. Except for newly diagnosed GD patients, vaccinated participants had significantly lower risks of incident TRAb positivity (adjusted HR = 0.22; 95%CI: 0.10-0.48, P < 0.001) after adjusted for sex, age, disease duration and MMI dose at baseline. Besides, vaccination was unlikely to serve as a risk factor for hyperthyroidism recurrence (adjusted HR = 1.20; 95%CI: 0.51-2.83, P = 0.678). Notably, newly diagnosed patients who received vaccination were just as likely to achieve remission of thyrotoxicosis as those not receiving the vaccination at any time. Our results concluded that inactivated SARS-CoV-2 vaccination would not disturb the treatment course among GD hyperthyroidism patients.
SARS-CoV-2 疫苗接种已被报道与甲状腺疾病的发生有关。为了研究 SARS-CoV-2 疫苗接种对正在接受 Graves 病（GD）治疗的患者疾病进程的影响，本研究共纳入了 651 例连续在我院就诊的 GD 患者，包括 443 名接种灭活 SARS-CoV-2 疫苗的患者和 208 名未接种疫苗的参与者。分析了游离三碘甲状腺原氨酸（fT3）、游离甲状腺素（fT4）、促甲状腺激素（TSH）和促甲状腺激素受体抗体（TRAb）的血清水平变化。采用 Cox 回归模型估计粗和调整后的危险比（HR），以研究接种疫苗后 TRAb 阳性和甲亢复发的风险。
在 GD 甲亢治疗期间，两组患者的 TRAb 和 fT3 中位数水平均显著降低。两组的 fT4 水平均在正常范围内，同时呈下降趋势。尽管本研究观察到随访期间 TSH 水平呈上升趋势，但两组之间无显著差异。除新诊断的 GD 患者外，接种组患者发生 TRAb 阳性的风险显著降低（调整后的 HR=0.22；95%CI：0.10-0.48，P<0.001），调整后的因素包括性别、年龄、疾病持续时间和基线时 MMI 剂量。此外，接种疫苗不太可能成为甲亢复发的危险因素（调整后的 HR=1.20；95%CI：0.51-2.83，P=0.678）。值得注意的是，任何时间接受疫苗接种的新诊断患者与未接种疫苗的患者一样有可能实现甲状腺毒症缓解。
我们的研究结果表明，SARS-CoV-2 灭活疫苗接种不会干扰 GD 甲亢患者的治疗过程。
