Scientific letter
Subacute thyroiditis after anti-SARS-CoV-2 (Ad5-nCoV) vaccine
Tiroiditis subaguda después de la vacuna anti-SARS-CoV-2 (Ad5-nCoV)
Armando Flores Rebollar
Departamento de Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Mexico City, Mexico
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White colonies of <span class="elsevierStyleItalic">Actinomyces neuii</span> isolated on blood agar after 48<span class="elsevierStyleHsp" style=""></span>h of incubation (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elisa Nuez-Zaragoza, Isabel Sanfeliu" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Elisa" "apellidos" => "Nuez-Zaragoza" ] 1 => array:2 [ "nombre" => "Isabel" "apellidos" => "Sanfeliu" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X22001915?idApp=UINPBA00004N" "url" => "/2529993X/0000004000000008/v1_202210061342/S2529993X22001915/v1_202210061342/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Subacute thyroiditis after anti-SARS-CoV-2 (Ad5-nCoV) vaccine" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "459" "paginaFinal" => "460" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Armando Flores Rebollar" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Armando" "apellidos" => "Flores Rebollar" "email" => array:1 [ 0 => "afcalatrava@yahoo.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Mexico City, Mexico" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tiroiditis subaguda después de la vacuna anti-SARS-CoV-2 (Ad5-nCoV)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Subacute thyroiditis (SAT) is a self-limiting inflammatory disease of the thyroid. It is a rare cause of thyrotoxicosis and is also associated with respiratory virus infections in genetically predisposed people, including influenza virus, adenovirus, coxsackie virus, measles virus and Epstein–Barr virus<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. During the current SARS-CoV-2 pandemic, thyroid disorders related to infection with this virus have been reported, particularly cases of SAT<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>. The new SARS-CoV-2 vaccines in use have also had the adverse effects of triggering SAT and Graves’ disease<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a>. These thyroid disorders seem to be independent of the mechanism of action of the SARS-CoV-2 vaccination (cases have been reported with mRNA-based vaccines, inactivated SARS-CoV-2 vaccines and vector-based vaccines)<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–6</span></a>. I present a case diagnosed with SAT after receiving the Cansino Biologics single-dose Ad5-nCoV vaccine.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This was a 53-year-old woman with no previous history or illnesses related to the condition reported here, who was given the Cansino Biologics Ad5-nCoV vaccine. Twenty-four hours later, she developed general malaise, asthenia, myalgia, arthralgia and low-grade fever. Fifteen days after being vaccinated, she developed pain at the base of her neck, which increased in intensity, radiating to her right jaw and ear. The initial assessment revealed tachycardia and distal tremor, no eye symptoms, but diffuse goitre with significant pain on palpation. The ultrasound showed an increase in thyroid volume with bilateral diffuse areas of hypoechogenicity and decreased vascularity. The blood results were as follows: TSH 0.095 mIU/l (ref. 0.5–4.5); free T4 1.22 ng/dl (ref. 0.7–1.48); free T3 352 pg/dl (ref. 158–391); ESR 51 mm/h (ref. <15); CRP 10 mg/l (ref. <1.5); anti-TPO antibodies 1.42 IU/ml (ref. <5.61); anti-Tg antibodies 8.4 IU/ml (ref. <4.11); and anti-TSH receptor antibodies (TRAb) 1.0 IU/l (ref. <1.5). The patient was treated solely with non-steroidal anti-inflammatory drugs (NSAID). When the patient returned after four weeks she was asymptomatic, with no goitre and TSH 31.35 mIU/l and free T4 0.7 ng/dl; she remains in follow-up and is currently untreated.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Ad5-nCoV uses the non-replicating adenovirus-5 (HAd5) as a vector, which carries the gene that codes for the SARS-CoV-2 S protein. The vaccine does not contain adjuvants or preservatives. The possible relationship between TSA and Ad5-nCoV is the involvement of a molecular mimicry of the SARS-CoV-2 S glycoprotein, which shares a genetic similarity with human protein heptapeptides<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>, and the cross-reaction between the antibodies directed against the SARS-CoV-2 S protein and numerous autoimmune target proteins, including thyroid TPO<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. Furthermore, adenovirus vectors are highly immunogenic <span class="elsevierStyleItalic">per se</span>; adenovirus stimulates innate immune cells by activating various innate immune signalling pathways and inducing the secretion of various proinflammatory cytokines and chemokines<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>. This altered innate immune environment effectively induces a robust humoral and cellular adaptive immune response. All of this can stimulate inflammation and autoimmunity in genetically susceptible groups.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our case was positive for anti-Tg antibodies and the absence of anti-thyroid antibodies was considered typical for SAT. However, due to improvements in the sensitivity of modern equipment it is now common to find them and, in the case of anti-Tg antibodies, 52.5% positivity has been reported in SAT<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">One particularity of the treatment of SAT triggered by anti SARS-CoV-2 vaccines is the limitation in the use of glucocorticoids (GC) for SAT with pain which does not respond to NSAID. It is possible that the immunosuppressive effect of GC reduces the immunogenicity of the SARS-CoV-2 vaccine used; at least this has been found in patients with autoimmune rheumatic diseases: GC reduce seropositivity (IgG S1/S2) induced by the SARS-CoV-2 mRNA vaccine up to 66% with an average dose of 6.2 mg/day of prednisone<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">SAT is not a common disorder but it is listed as an undesirable effect in all forms of COVID-19 vaccines. As it is usually self-limiting and mild in terms of symptoms, it can go unnoticed in most patients. The use of glucocorticoids in the management of SAT after these vaccines could be associated with a lower immunogenic response.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethics</span><p id="par0035" class="elsevierStylePara elsevierViewall">All the procedures performed in the course of this retrospective study were carried out in accordance with institutional and national research committee ethical standards, and the study was conducted in accordance with World Health Organization (WHO) standards for biomedical and scientific research in humans. Case reports do not require independent ethics committee approval. Informed consent was obtained from and signed by the study participant.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study received no specific funding from public, private or non-profit organisations.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The author has no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethics" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Flores Rebollar A. Tiroiditis subaguda después de la vacuna anti-SARS-CoV-2 (Ad5-nCoV). Enferm Infecc Microbiol Clin. 2022;40:459–460.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SARS-COV-2-related immune-inflammatory thyroid disorders: facts and perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M. Ruggeri" 1 => "A. Campennì" 2 => "D. Deandreis" 3 => "M. Siracusa" 4 => "R. Tozzoli" 5 => "O.P. 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Levartovsky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2021-220647" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2021" "volumen" => "80" "paginaInicial" => "1330" "paginaFinal" => "1338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34127481" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000004000000008/v1_202210061342/S2529993X22001101/v1_202210061342/en/main.assets" "Apartado" => array:4 [ "identificador" => "63562" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000004000000008/v1_202210061342/S2529993X22001101/v1_202210061342/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X22001101?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 0 | 4 |
| 2024 October | 13 | 0 | 13 |
| 2024 September | 39 | 2 | 41 |
| 2024 August | 31 | 5 | 36 |
| 2024 July | 24 | 4 | 28 |
| 2024 June | 11 | 1 | 12 |
| 2024 May | 8 | 9 | 17 |
| 2024 April | 28 | 0 | 28 |
| 2024 March | 29 | 5 | 34 |
| 2024 February | 13 | 1 | 14 |
| 2024 January | 27 | 2 | 29 |
| 2023 December | 24 | 2 | 26 |
| 2023 November | 40 | 17 | 57 |
| 2023 October | 25 | 6 | 31 |
| 2023 September | 11 | 1 | 12 |
| 2023 August | 18 | 1 | 19 |
| 2023 July | 10 | 2 | 12 |
| 2023 June | 10 | 2 | 12 |
| 2023 May | 19 | 2 | 21 |
| 2023 April | 12 | 0 | 12 |
| 2023 March | 1 | 0 | 1 |
| 2022 November | 0 | 1 | 1 |
| 2022 October | 1 | 0 | 1 |
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