A 57-year-old man presented to the outpatient clinic with tremor, palpitations, weight loss and fatigue 1 week after receiving the first dose of the Oxford-AstraZeneca SARS-CoV-2 vaccine (ChAdOx1 nCoV-19). Laboratory studies showed a suppressed TSH with elevated total and free T4. Thyroid peroxidase and thyroglobulin antibodies were elevated but thyrotropin receptor autoantibodies were indeterminate. Thyroid scintigraphy with technetium Tc-99m pertechnetate revealed increased diffuse, symmetric uptake. The patient was treated with thiamazole 15 mg three times a day and propranolol with resolution of his symptoms and normalization of his thyroid function tests until discontinuation of the antithyroid drug 6 months after symptom onset.
Learning points:
Thyroid autoimmunity triggered by SARS-CoV-2 vaccines is being increasingly recognized among patients with and without a history of autoimmune thyroid disease.Symptoms and signs of thyrotoxicosis, including fever and tachycardia, can be wrongly attributed to the systemic adverse events of these vaccines.Early recognition of this condition is mandatory to allow proper treatment with anti-thyroid medications and radioactive iodine when necessary.