Risk of developing thyroid eye disease in patients with thyroid dysfunction that received a COVID-19 vaccination.

Objective: To assess the risk of developing thyroid eye disease (TED) after mRNA COVID-19 vaccination in patients with thyroid dysfunction.

Design: A retrospective cohort study.

Participants: All patients with hyperthyroidism with no history of TED prior to March 2021 and no history of another orbital inflammatory disease.

Methods: The rates of TED in patients that received or did not receive any type of COVID-19 vaccination were compared. TED incidence was also compared in those receiving influenza and Tdap vaccines. All patient records were identified using the TriNetX network (Cambridge, MA). Propensity score matching (PSM) was done to control for differences in baseline demographics and medical comorbidities. The primary outcome was the relative risk of developing TED after COVID-19 vaccination.

Results: A total of 373,909 patients with hyperthyroidism and no signs of TED were identified. After matching and assessing for vaccination status, 69,378 patients were in the COVID-19 vaccine and no COVID-19 vaccine cohorts. We found that COVID-19 vaccination resulted in an increased risk of developing TED when compared with the no COVID-19 vaccine (RR = 1.49, 95% CI: 1.39-1.58), Tdap (RR = 1.80, 95% CI: 1.56-2.06), and influenza cohorts (RR = 1.68, 95% CI: 1.49-1.88).

Conclusions: Patients with underlying hyperthyroidism demonstrated an increased risk of developing TED following COVID-19 vaccination. Although further studies are required to confirm these findings, patients with underlying autoimmune thyroid dysfunction should receive education on the signs and symptoms of TED and be monitored for the development of TED after COVID-19 vaccination.