Graves' Disease Following SARS-CoV-2 Vaccination: A Systematic Review

Area of Science:

• Endocrinology
• Immunology
• Vaccinology

Background:

• Autoimmune diseases, including autoimmune endocrine diseases (AIED), arise from genetic predisposition and environmental triggers.
• Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are a potential new environmental factor for AIED.
• Graves' disease (GD) is a specific AIED of concern post-vaccination.

Purpose of the Study:

• To investigate the association between SARS-CoV-2 vaccination and the onset or recurrence of Graves' disease (GD).
• To review existing literature on thyroid dysfunction following COVID-19 vaccination.

Main Methods:

• Literature search of MEDLINE/PubMed databases from January 2020 to July 2022.
• Inclusion criteria: cases of thyrotoxicosis meeting American Thyroid Association criteria for GD, occurring after SARS-CoV-2 vaccination.
• Analysis of case reports and case series.

Main Results:

• 27 articles were identified, detailing 48 new GD diagnoses and 12 GD recurrences post-vaccination.
• An additional 3 papers reported 3 cases of GD relapse after vaccination.
• The majority of identified cases involved new-onset or recurrent Graves' disease.

Conclusions:

• Healthcare providers should be vigilant for Graves' disease and other autoimmune conditions following SARS-CoV-2 vaccination.
• Individual genetic susceptibility appears crucial for developing post-vaccination autoimmune sequelae.
• Potential mechanisms include autoimmune/inflammatory syndrome induced by adjuvants (ASIA), cytokine induction, molecular mimicry, and cross-reactivity.