Distinct clinical features of post COVID-19 vaccination early-onset Graves' disease (PoVEO GD)

Luigi di Filippo, Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Laura Castellino, Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Agnese Allora, Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Stefano Frara, Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Roberto Lanzi, Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Francesca Perticone, Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Fanny Valsecchi, Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Alberto Vassallo, Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Raffaele Giubbini, Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Clifford J. Rosen, Maine Medical CenterFollow
Andrea Giustina, Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.

Document Type

Article

Publication Date

9-21-2022

Institution/Department

Endocrinology

Journal Title

The Journal of clinical endocrinology and metabolism

Abstract

CONTEXT: Several case reports of Graves' disease (GD) occurrence after COVID-19 vaccination were recently published and possibly related to the autoimmune syndrome induced by adjuvants (ASIA). The aim of our study was to evaluate possible distinctive features in the presentation and clinical course of patients with GD occurring early (within 4 weeks) after COVID-19 vaccination who attended our Endocrine Unit in 2021. DESIGN: Patients with first episode of GD attending a tertiary endocrine center between January 1st and December 31st 2021 were included. RESULTS: Sixty-four patients with first episode of GD were seen in 2021: 20 (31.2%) of them had onset within 4 weeks following vaccine administration. Compared to the other 44 patients, the 20 patients with post-vaccine early-onset (PoVEO) GD were older (median age: 51 years vs 35 years, p = 0.003) and more likely male (40.0% vs 13.6%, p = 0.018). At diagnosis, the biochemical and immune profiles were similar between the two groups. However, at 3 months after starting methimazole, PoVEO GD patients had significantly lower TRAb titer and were taking lower doses of methimazole than the other GD patients. None in the PoVEO group had sustained fT3 elevation. CONCLUSIONS: This relatively large series suggests that in 2021, PoVEO GD may be a new nosological entity representing one third of patients evaluated for new-onset GD in our center. Distinctive features included older age at onset, higher male prevalence and a better initial biochemical and immunological response to treatment. Further studies are warranted to clinically and biochemically differentiate these cases from sporadically occurred GD.

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