Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Advertise | Login 
 
Search Article 
  
Advanced search 
  Users Online: 692 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  

 
Table of Contents
LETTER TO THE EDITOR
Year : 2018  |  Volume : 22  |  Issue : 5  |  Page : 713-714

Occurrence of subacute thyroiditis following influenza vaccination


1 Department of Nuclear Medicine, AIIMS, New Delhi, India
2 Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
3 Department of Endocrinology, Apex Hospital, Rohtak, Haryana, India

Date of Web Publication18-Sep-2018

Correspondence Address:
Nishikant A Damle
Department of Nuclear Medicine, AIIMS, Ansari Nagar, New Delhi - 110 029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijem.IJEM_237_18

Rights and Permissions

How to cite this article:
Passah A, Arora S, Damle NA, Reddy KS, Khandelwal D, Aggarwal S. Occurrence of subacute thyroiditis following influenza vaccination. Indian J Endocr Metab 2018;22:713-4

How to cite this URL:
Passah A, Arora S, Damle NA, Reddy KS, Khandelwal D, Aggarwal S. Occurrence of subacute thyroiditis following influenza vaccination. Indian J Endocr Metab [serial online] 2018 [cited 2018 Oct 22];22:713-4. Available from: http://www.ijem.in/text.asp?2018/22/5/713/241481



Sir,

We want to discuss a case scenario of a 35-year-old woman who presented with palpitations, weight loss, increased sweating, and tremors for 2 weeks. Thyroid function test revealed a thyrotoxic profile (T3: 2.42 ng/mL, T4: 18.92 μg/dL, and thyroid stimulating hormone (TSH): <0.005 μIU/mL) at that time. On examination, the patient had mild tenderness on the thyroid region and also gave history of central lower neck pain that radiated to both ears. Her symptoms worsened over the next one month. For thyrotoxicosis workup, she underwent technetium-99m pertechnetate scan, which revealed decreased radiotracer uptake in both lobes of thyroid gland with preserved salivary background activity, as shown in [Figure 1]. During interpretation of the scan, a detailed history was sought by the nuclear medicine physician from the patient. There was no antecedent history of viral infections, sore throat, or any drug/iodine interference to explain low uptake in the scan. These are the common causes that are considered for explaining the thyroiditis picture in the scan. But on further enquiring, she gave history of being vaccinated with a live attenuated influenza vaccine, 8 weeks prior to onset of symptoms. The patient reported some symptomatic improvements with atenolol. Over the next one month, her toxicosis gradually decreased, she reported weight gain and reduced tremors, and her thyroid profile showed subclinical hypothyroidism (T3: 1.06 ng/mL, T4 7.29 μg/dL, and TSH: 8.22 μIU/mL). She became euthyroid at the end of 23 weeks (T3: 1.07 ng/mL, T4: 7.32 μg/dL, and TSH: 4.15 μIU/mL).
Figure 1: Technetium-99m pertechnetate scan showing negligible radiotracer uptake in both lobes of thyroid gland. There is normal background and salivary gland radiotracer activity

Click here to view


Subacute thyroiditis (De Quervain thyroiditis) and autoimmune thyroid diseases are frequently associated with viral infections.[1] Thyroid inflammation is caused due to cross recognition of virus and thyroid cell antigens by the cytolytic T cells. Subacute thyroiditis following viral vaccines has been reported previously with vaccines against influenza virus. One such reported case was of a 28-year-old woman who presented with pain and swelling in the thyroid 2 weeks post vaccination against influenza with symptomatic relief after methyl-prednisolone.[2] In another report, a 36-year-old patient presented with palpitation, anxiety, neck pain, and symptoms of thyrotoxicosis 1 month after she received H1N1 vaccine. There was no antecedent thyroid disease or viral infection prior to the episode.[3] Similarly, in another reported case, a 25-year-old woman had episodes of fever, left neck swelling. She also had a history of having received vaccine against influenza virus before this episode. The patient recovered after receiving a course of nonsteroidal antiinflammatory drugs and steroids.[4] The time between vaccination and thyroiditis was higher in our case compared to other published cases. There are also reports of subacute thyroiditis post vaccine against hepatitis B.[5] The etiology of subacute thyroiditis remains unclear many a times, but as in this case, considering temporal association between the vaccination and onset of thyrotoxicosis, lack of any other precipitating factor coupled with lack of any other cause for negligible 99m-Tc pertechnetate uptake on scan, a diagnosis of subacute thyroiditis probably post influenza vaccination was favored. Hence these findings emphasize that history of recent live attenuated vaccination should also be enquired as one of the possibility along with other more common causes during interpretation of thyroid scan showing thyroiditis picture.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Prummel M, Strieder T, Wiersinga WM. The environment and autoimmune thyroid diseases. Eur J Endocrinol 2004;150:605-18.  Back to cited text no. 1
    
2.
Altay FA, Güz G, Altay M. Subacute thyroiditis following seasonal influenza vaccination. Hum Vaccin Immunother 2016;12:1033-4.  Back to cited text no. 2
    
3.
Girgis CM, Russo RR, Benson K. Subacute thyroiditis following the H1N1 vaccine. J Endocrinol Invest 2010;33:506.  Back to cited text no. 3
    
4.
Hsiao JY, Hsin SC, Hsieh MC, Hsia PJ, Shin SJ. Subacute thyroiditis following influenza vaccine (Vaxigrip) in a young female. Kaohsiung J Med Sci 2006;22:297-300.  Back to cited text no. 4
    
5.
Toft J, Larsen S, Toft H. Subacute thyroiditis after hepatitis B vaccination. Endocr J 1998;45:135.  Back to cited text no. 5
    


    Figures

  [Figure 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

   Article Figures
  In this article
 References

 Article Access Statistics
    Viewed139    
    Printed1    
    Emailed0    
    PDF Downloaded57    
    Comments [Add]    

Recommend this journal