施打新冠肺炎疫苗後新診斷的葛瑞夫茲氏病併甲狀腺風暴

New onset of Graves’ disease with thyroid storm after adenovirus-vectored

目前有案例報告在使用新冠滅活或mRNA疫苗後出現葛瑞夫茲氏病，但其中在使用腺病毒載體新冠疫苗後，新診斷的葛瑞夫茲氏病併甲狀腺風暴卻是從未被報告。我們報告一名女士在接受腺病毒載體新冠疫苗六天後，根據其臨床病況診斷為甲狀腺風暴，進一步檢驗得知甲促素結合體抗體陽性和高濃度甲狀腺刺激免疫球蛋白，其甲狀腺超音波亦與診斷葛瑞夫茲氏病相符合。目前對於腺病毒載體新冠疫苗是否能引起葛瑞夫茲氏病並不明確，但疫苗賦形劑成分中的聚山梨醇酯80（Polysorbate 80）被認為是對此案例引起葛瑞夫茲氏病最可能的原因。至目前為止，這是第一次描述接受腺病毒載體新冠疫苗後，引發的葛瑞夫茲氏病併甲狀腺風暴。

 

A few cases of Graves’ disease after inactivated or messenger RNA(mRNA) vaccine had been reported. However, new onset of Graves’ disease with thyroid storm after adenovirus-vectored vaccination had not been reported in the literature. We de-scribed a case of newly onset of Graves’s disease with thyroid storm after adenovi-rus-vectored coronavirus disease 2019(COVID-19) vaccination (Vaxzevria) 6 days later. Thyroid storm was diagnosed based on thyrotoxicosis and clinical manifestations. Positive anti-thyroid-stimulating hormone receptor antibody, higher titer of thyroid-stimulating immunoglobulin and thyroid ultrasound competitive with the di-agnosis of Graves’ disease. How adenovirus-vectored COVID-19 vaccine can induce Graves’ disease remained unanswered. The excipient with polysorbate 80 of adenovi-rus-vectored COVID-19 vaccine may act as the key which induced Graves’ disease on top of our patient’s genetic background of hyperthyroidism. To our knowledge, this is the first case of Graves’ disease with thyroid storm secondary to adenovirus-vectored COVID-19 vaccine.