Iwamoto Hideyuki, Kimura Tomohiko, Nakao Erina, Tatsumi Fuminori, Kaneto Hideaki
Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, JPN.
Cureus. 2025 May 26;17(5):e84863. doi: 10.7759/cureus.84863. eCollection 2025 May.
Graves' disease is an autoimmune thyroid disorder characterized by the production of thyroid-stimulating hormone receptor antibodies and is one of the leading causes of hyperthyroidism. While both genetic and environmental factors are involved in its onset, the detailed mechanisms remain unclear. The COVID-19 pandemic led to the development and global distribution of mRNA vaccines, such as BNT162b2, to combat SARS-CoV-2. However, concerns have arisen regarding the potential exacerbation of autoimmune diseases following vaccination. This report presents a case of a 48-year-old male with Graves' disease, treated with 2.5 mg/day of thiamazole (MMI), who developed symptoms such as fatigue, hand tremors, and exertional dyspnea on the seventh day after receiving the first dose of the BNT162b2 vaccine. Laboratory findings confirmed severe thyrotoxicosis, and he was diagnosed with an exacerbation of Graves' disease. His condition improved with an increased MMI dosage and supportive therapy. The possible mechanisms for Graves' disease exacerbation include molecular mimicry between the SARS-CoV-2 spike protein and thyroid antigens, as well as immune activation by vaccine adjuvants. Several recent reports, including this case, highlight the importance of careful monitoring of patients with pre-existing autoimmune diseases after vaccination. This case underscores the need for early diagnosis and prompt intervention in managing post-vaccination autoimmune disease exacerbations. Further research is required to clarify the causal relationship between vaccines and autoimmune disease flares, identify risk factors, and establish preventive measures. Additionally, both healthcare providers and patients must remain vigilant for potential health changes following vaccination and seek medical attention promptly.
格雷夫斯病是一种自身免疫性甲状腺疾病，其特征是产生促甲状腺激素受体抗体，是甲状腺功能亢进的主要原因之一。虽然遗传和环境因素都与该病的发病有关，但其详细机制仍不清楚。2019冠状病毒病大流行促使了mRNA疫苗（如BNT162b2）的研发和全球分发，以对抗严重急性呼吸综合征冠状病毒2。然而，人们对疫苗接种后自身免疫性疾病可能加重表示担忧。本报告介绍了一例48岁患有格雷夫斯病的男性病例，该患者每天服用2.5毫克甲巯咪唑（MMI）进行治疗，在接种第一剂BNT162b2疫苗后的第七天出现疲劳、手部震颤和劳力性呼吸困难等症状。实验室检查结果证实为严重甲状腺毒症，他被诊断为格雷夫斯病加重。增加MMI剂量并给予支持性治疗后，他的病情有所改善。格雷夫斯病加重的可能机制包括严重急性呼吸综合征冠状病毒2刺突蛋白与甲状腺抗原之间的分子模拟，以及疫苗佐剂引起的免疫激活。包括本病例在内的最近几份报告强调了对已有自身免疫性疾病的患者在接种疫苗后进行仔细监测的重要性。该病例强调了在处理疫苗接种后自身免疫性疾病加重时进行早期诊断和及时干预的必要性。需要进一步研究以阐明疫苗与自身免疫性疾病发作之间的因果关系，确定危险因素，并制定预防措施。此外，医疗保健提供者和患者都必须对接种疫苗后潜在的健康变化保持警惕，并及时寻求医疗帮助。
