Thyrotoxicosis following SARS-COV-2 vaccination: a case series and discussion.

AIM: To describe a case series of thyrotoxicosis likely triggered by SARS-CoV-2 vaccination and to warn physicians about this potential correlation. To report clinical, laboratory and imaging findings and provide further information that goes in line with the underlying mechanisms. METHODS: Single-center case series based on all the information collected in the hospital medical records, as well as the temporal sequence between the onset of symptoms and COVID-19 vaccination. RESULTS: We report 8 cases with thyrotoxicosis after SARS-CoV-2 vaccination. 4 cases of Graves' disease (GD), 2 cases of subacute painful thyroiditis (SAT), 1 case of concurrent GD and SAT and 1 case of atypical subacute thyroiditis. Five patients received BNT162b2 mRNA vaccine, 3 patients 1273 mRNA vaccine. The onset of symptoms following vaccination ranged from 10 to 14 days in six of eight patients and from 7 to 8 weeks in two patients. CONCLUSIONS: Several hypotheses have been proposed to explain the potential correlation between SARS-CoV-2 vaccination and thyrotoxicosis, including immune system hyper-stimulation, molecular mimicry and Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). We should pay greater attention to thyroid disorders in patients receiving vaccine against SARS-CoV-2.

[Endemic goiter and iodine deficiency: are they still a reality in Spain]. / Bocio endémico y déficit de yodo: 'sigue siendo una realidad en España?

OBJECTIVE: To estimate the prevalence of goiter and iodine deficiency in a health district in the Autonomous Community of Valencia, given the absence of data in this region of Spain. MATERIAL AND METHODS: We conducted a descriptive, epidemiologic, cross-sectional study, stratified by age and sex, in four interior regions of the province of Valencia. We selected students aged from 6 to 14 years old in 20 centers. Thyroid examination was performed by means of palpation and inspection (goiter > or = 0B). Urinary iodine excretion was analyzed in a routine urine sample. Sociodemographic and anthropometric data, as well as nutritional iodine status, were recorded in a standardized survey. In children with goiter, thyroid-stimulating hormone (TSH), free T4, and antithyroid antibodies were determined. RESULTS: We studied 928 children (478 boys and 450 girls). The prevalence of goiter was 33.7 % (95 % CI: 30.7-36.9 %). There were no significant differences in the prevalence of goiter by age or sex, but an inverse correlation was detected between the prevalence of goiter and parental socioeconomic position. Mean urinary iodine excretion was 155 .g/l, with no significant correlation with the prevalence of goiter. In children with goiter, 13 had positive antithyroid antibodies, 18 had high TSH (subclinical hypothyroidism), and one had suppressed TSH (subclinical hyperthyroidism). CONCLUSIONS: There is endemic goiter in the region studied. Urinary iodine levels were in the normal range and could be interpreted as indicating a transition phase to an improvement in iodine deficiency. Autoimmune diseases would only explain 4 % of cases of goiter.

Bocio endémico y déficit de yodo: ¿sigue siendo una realidad en España? / Endemic goiter and iodine deficiency: are they still a reality in Spain?

Objetivo Determinar la prevalencia de bocio y déficit de yodo en comarcas del interior de la Comunidad Valenciana, dada la ausencia de datos en esta comunidad autónoma. Material y métodos Se trata de un estudio epidemiológico, descriptivo, transversal, estratificado por sexo y edad en cuatro comarcas del interior de la provincia de Valencia. Se estudiaron escolares de 6 a 14 años en 20 centros. La exploración tiroidea se realizó mediante palpación e inspección (bocio ≥ 0B). Se determinó la yoduria en una muestra de orina casual. Se recogieron datos de filiación, antropométricos, y una encuesta sobre el estado nutricional de yodo. En niños con bocio se determinó la hormona tiroestimulante (TSH), la tiroxina libre (T4L) y los anticuerpos antitiroideos. Resultados Se estudiaron 928 niños (478 varones y 450 mujeres). La prevalencia de bocio fue de 33,7 % (IC 95 %: 30,7-36,9). No se hallaron diferencias significativas por edad ni por sexo, aunque sí una correlación inversamente proporcional entre prevalencia de bocio y nivel instrucción paternos. La mediana de yoduria fue 155 μg/l, sin observar una correlación significativa con la prevalencia de bocio. Entre los niños con bocio 13 presentaron los anticuerpos antitiroideos positivos, 18 la TSH elevada (hipotiroidismo subclínico) y uno la TSH suprimida (hipertiroidismo subclínico). Conclusiones Existe una endemia bociosa en las comarcas estudiadas de la Comunidad Valenciana. Los valores de yodurias normales podrían interpretarse como una fase de transición hacia una mejoría del déficit de yodo en esta zona. La patología autoinmune explicaría sólo un 4 % de bocios

Objective To estimate the prevalence of goiter and iodine deficiency in a health district in the Autonomous Community of Valencia, given the absence of data in this region of Spain. Material and methods We conducted a descriptive, epidemiologic, cross-sectional study, stratified by age and sex, in four interior regions of the province of Valencia. We selected students aged from 6 to 14 years old in 20 centers. Thyroid examination was performed by means of palpation and inspection (goiter ≥ 0B). Urinary iodine excretion was analyzed in a routine urine sample. Sociodemographic and anthropometric data, as well as nutritional iodine status, were recorded in a standardized survey. In children with goiter, thyroid-stimulating hormone (TSH), free T4, and antithyroid antibodies were determined. Results We studied 928 children (478 boys and 450 girls). The prevalence of goiter was 33.7 % (95 % CI: 30.7-36.9 %). There were no significant differences in the prevalence of goiter by age or sex, but an inverse correlation was detected between the prevalence of goiter and parental socioeconomic position. Mean urinary iodine excretion was 155 μg/l, with no significant correlation with the prevalence of goiter. In children with goiter, 13 had positive antithyroid antibodies, 18 had high TSH (subclinical hypothyroidism), and one had suppressed TSH (subclinical hyperthyroidism). Conclusions There is endemic goiter in the region studied. Urinary iodine levels were in the normal range and could be interpreted as indicating a transition phase to an improvement in iodine deficiency. Autoimmune diseases would only explain 4 % of cases of goiter