Graves' disease after exposure to the SARS-CoV-2 vaccine: a case report and review of the literature.

BACKGROUND: Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is characterized by immune system dysregulation after exposure to adjuvants, such as aluminum. Although cases of autoimmune thyroid diseases caused by ASIA have been reported, Graves' disease is one of the rarer diseases. There are some reports that vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause ASIA. Here, we describe a case of Graves' disease following SARS-CoV-2 vaccination and a review of the literature. CASE PRESENTATION: A 41-year-old woman was admitted to our hospital because of palpitations and fatigue. Two weeks after receiving the second SARS-CoV-2 vaccine (BNT162b2, Coronavirus Modified Uridine messenger RNA (mRNA) Vaccine, Pfizer), she developed fatigue and gradually worsened. On admission, she exhibited thyrotoxicosis (thyroid-stimulating hormone (TSH) < 0.01 mIU/L (0.08-0.54), free triiodothyronine (FT3) 33.2 pmol/L (3.8-6.3), and free thyroxine (FT4) 72.1 pmol/L (11.6-19.3)) and palpitations associated with atrial fibrillation. TSH receptor antibody (TRAb) was positive (TRAb 5.0 IU/L (< 2.0)), and 99mTc scintigraphy showed diffuse uptake in the thyroid gland, suggesting that the thyrotoxicosis in this case was caused by Graves' disease. Thiamazole was prescribed to correct her condition, and soon after this treatment was initiated, her symptoms and thyroid hormone levels were significantly reduced. CONCLUSIONS: This case report reinforces the potential correlation between ASIA affecting the thyroid and SARS-CoV-2 mRNA vaccines. The clinical course suggests that it is essential to consider the possibility of developing ASIA, such as Graves' disease, after exposure to the SARS-CoV-2 vaccine.

Cardiovascular monitoring in patients with hypertrophic obstructive cardiomyopathy in a prone position: A report of 2 cases.

Supine positioning in patients with hypertrophic obstructive cardiomyopathy (HOCM) can affect their preload, afterload, and heart rate, potentially leading to cardiovascular collapse. Here, we report the successful anesthetic management of two patients with HOCM who underwent spinal surgery in a prone position. The approximate values of the systemic vascular resistance index (SVRI) were continuously calculated without measuring the central venous pressure. Intraoperative monitoring of the SVRI estimates may be helpful in patients with HOCM so as to avoid cardiovascular collapse when monitoring with both transesophageal echocardiography and a central venous catheter is clinically inappropriate.