{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T20:36:08Z","timestamp":1789504568329,"version":"build-2803163510"},"reference-count":14,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2022,5,1]],"date-time":"2022-05-01T00:00:00Z","timestamp":1651363200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>We report a 26-year-old Japanese man who visited our outpatient clinic presenting fever immediately after i.m. injection of the second dose of a coronavirus disease 2019 (COVID-19) vaccine (Moderna\u00ae). At the first visit, the patient had a fever of 37.7\u00b0C and a swollen thyroid gland with mild tenderness. He was diagnosed with subacute thyroiditis (SAT) based on the presence of thyrotoxicosis (free tri-iodothyronine, 32.3 pg\/mL; free thyroxine, &gt;7.77 ng\/dL; and thyroid-stimulating hormone (TSH) &lt; 0.01 \u03bcIU\/mL), high C-reactive protein level (7.40 mg\/dL), negative TSH receptor antibody, and characteristic ultrasound findings. His HLA types were A*02:01\/24:02, B*15:11\/35:01, Cw*03:03, DRB1*09:01\/12:01, DQB1*03:03, and DPB1*05: 01\/41:01. He was initially administered prednisolone 15 mg\/day, following which the fever subsided. After 10 days, he developed limb weakness and could not walk. The serum potassium level decreased to 1.8 mEq\/L, which confirmed the diagnosis of thyrotoxic periodic paralysis (TPP). Potassium supplementation was initiated. The muscle weakness gradually decreased. Prednisolone therapy was terminated 6 weeks after the first visit. His thyroid function returned to normal 5 months after the first visit, through a hypothyroid state. To our knowledge, this is the first reported case of TPP-associated SAT following COVID-19 vaccination. Persistent fever following vaccination should be suspected of SAT. Additionally, TPP may be associated with SAT in Asian male patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Following coronavirus disease 2019 (COVID-19) vaccination, subacute thyroiditis may develop regardless of the vaccine type.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>If persistent fever, anterior neck pain, swelling and tenderness of thyroid gland, and symptoms of thyrotoxicosis are observed immediately after the COVID-19 vaccination, examination in consideration of the onset of subacute thyroiditis is recommended.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>HLA-B35 may be associated with the onset of subacute thyroiditis after the COVID-19 vaccination.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Although rare, subacute thyroiditis can be associated with thyrotoxic periodic paralysis, especially in Asian men.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Glucocorticoid therapy for subacute thyroiditis may induce thyrotoxic periodic paralysis through hypokalemia.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-22-0236","type":"journal-article","created":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T04:22:37Z","timestamp":1652761357000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":3,"title":["Subacute thyroiditis associated with thyrotoxic periodic paralysis after COVID-19 vaccination: a case report"],"prefix":"10.1530","volume":"2022","author":[{"given":"Mone","family":"Murashita","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9796-4890","authenticated-orcid":true,"given":"Norio","family":"Wada","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhei","family":"Baba","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Sugawara","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5839-7448","authenticated-orcid":true,"given":"Arina","family":"Miyoshi","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Obara","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Internal Medicine","doi-asserted-by":"publisher","first-page":"725","DOI":"10.2169\/internalmedicine.47.0740","article-title":"Clinical characteristics of 852 patients with subacute thyroiditis before treatment","volume":"47","author":"Nishihara","year":"2008","unstructured":"Nishihara EOhye HAmino NTakata KArishima TKubo TIto MKubota SFukata SMiyauchi A. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Internal Medicine200847725\u2013729. (https:\/\/doi.org\/10.2169\/internalmedicine.47.0740)10.2169\/internalmedicine.47.0740"},{"key":"bib2","series-title":"Expert Review of Clinical Immunology","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1080\/1744666X.2021.1932467","article-title":"SARS-COV-2-related immune-inflammatory thyroid disorders: facts and perspectives","volume":"17","author":"Ruggeri","year":"2021","unstructured":"Ruggeri RMCampenn\u00ec ADeandreis DSiracusa MTozzoli ROv\u010dari\u010dek PPGiovanella L. SARS-COV-2-related immune-inflammatory thyroid disorders: facts and perspectives. Expert Review of Clinical Immunology202117737\u2013759. (https:\/\/doi.org\/10.1080\/1744666X.2021.1932467)10.1080\/1744666X.2021.1932467"},{"key":"bib3","series-title":"Journal of Clinical Endocrinology and Metabolism","doi-asserted-by":"publisher","first-page":"2600","DOI":"10.1210\/clinem\/dgab373","article-title":"Three cases of subacute thyroiditis following SARS-CoV-2 vaccine: postvaccination ASIA syndrome","volume":"106","author":"\u0130remli","year":"2021","unstructured":"\u0130remli BG\u015eendur SN\u00dcnl\u00fct\u00fcrk U. Three cases of subacute thyroiditis following SARS-CoV-2 vaccine: postvaccination ASIA syndrome. Journal of Clinical Endocrinology and Metabolism20211062600\u20132605. (https:\/\/doi.org\/10.1210\/clinem\/dgab373)10.1210\/clinem\/dgab37333584709"},{"key":"bib4","series-title":"Journal of Endocrinological Investigation","first-page":"1","article-title":"SARS-CoV-2 vaccine-associated subacute thyroiditis: insights from a systematic review","volume":"Online ahead of print","author":"Ippolito","year":"2022","unstructured":"Ippolito SGallo DRossini APatera BLanzo NFazzino GFMPiantanida ETanda ML. SARS-CoV-2 vaccine-associated subacute thyroiditis: insights from a systematic review. Journal of Endocrinological Investigation20221\u201312. Online ahead of print(https:\/\/doi.org\/10.1007\/s40618-022-01747-0)32771076"},{"key":"bib5","series-title":"Cureus","article-title":"A literature review on thyrotoxic periodic paralysis","volume":"12","author":"Iqbal","year":"2020","unstructured":"Iqbal QZNiazi MZia ZSattar SBA. A literature review on thyrotoxic periodic paralysis. Cureus202012 e10108. (https:\/\/doi.org\/10.7759\/cureus.10108)29581918"},{"key":"bib6","series-title":"Frontiers in Immunology","first-page":"617089","article-title":"Reaction of human monoclonal antibodies to SARS-CoV-2 proteins with tissue antigens: implications for autoimmune diseases","volume":"11","author":"Vojdani","year":"2020","unstructured":"Vojdani AVojdani EKharrazian D. Reaction of human monoclonal antibodies to SARS-CoV-2 proteins with tissue antigens: implications for autoimmune diseases. Frontiers in Immunology202011617089. (https:\/\/doi.org\/10.3389\/fimmu.2020.617089)"},{"key":"bib7","series-title":"Circulation Research","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1161\/CIRCRESAHA.121.318902","article-title":"SARS-CoV-2 spike protein impairs endothelial function via downregulation of ACE 2","volume":"128","author":"Lei","year":"2021","unstructured":"Lei YZhang JSchiavon CRHe MChen LShen HZhang YYin QCho YAndrade LSARS-CoV-2 spike protein impairs endothelial function via downregulation of ACE 2. Circulation Research20211281323\u20131326. (https:\/\/doi.org\/10.1161\/CIRCRESAHA.121.318902)10.1161\/CIRCRESAHA.121.318902"},{"key":"bib8","series-title":"Reviews in Endocrine and Metabolic Disorders","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1007\/s11154-021-09648-y","article-title":"New aspects in the pathogenesis and management of subacute thyroiditis","volume":"22","author":"Stasiak","year":"2021","unstructured":"Stasiak MLewi\u0144ski A. New aspects in the pathogenesis and management of subacute thyroiditis. Reviews in Endocrine and Metabolic Disorders2021221027\u20131039. (https:\/\/doi.org\/10.1007\/s11154-021-09648-y)10.1007\/s11154-021-09648-y33584709"},{"key":"bib9","series-title":"European Journal of Endocrinology","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1530\/EJE-13-0381","article-title":"A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants","volume":"169","author":"Chang","year":"2013","unstructured":"Chang CCCheng CJSung CCChiueh TSLee CHChau TLin SH. A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants. European Journal of Endocrinology2013169529\u2013536. (https:\/\/doi.org\/10.1530\/EJE-13-0381)10.1530\/EJE-13-038132771076"},{"key":"bib10","series-title":"Clinical Medicine and Research","doi-asserted-by":"publisher","first-page":"148","DOI":"10.3121\/cmr.2021.1610","article-title":"Thyrotoxic periodic paralysis: a case report and literature review","volume":"19","author":"Patel","year":"2021","unstructured":"Patel MLadak K. Thyrotoxic periodic paralysis: a case report and literature review. Clinical Medicine and Research202119148\u2013151. (https:\/\/doi.org\/10.3121\/cmr.2021.1610)10.3121\/cmr.2021.161029581918"},{"key":"bib11","series-title":"Clinical Endocrinology","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1111\/j.1365-2265.1994.tb02444.x","article-title":"The HLA association with Graves\u2019 disease is sex-specific in Hong Kong Chinese subjects","volume":"40","author":"Cavan","year":"1994","unstructured":"Cavan DAPenny MAJacobs KHKelly MAJenkins DMijovic CChowt CCockramt CSHawkins BRBarnett AH. The HLA association with Graves\u2019 disease is sex-specific in Hong Kong Chinese subjects. Clinical Endocrinology19944063\u201366. (https:\/\/doi.org\/10.1111\/j.1365-2265.1994.tb02444.x)10.1111\/j.1365-2265.1994.tb02444.x"},{"key":"bib12","series-title":"Acta Medica","first-page":"91","article-title":"Thyrotoxic hypokalemic periodic paralysis triggered by dexamethasone administration","volume":"63","author":"Polamaung","year":"2020","unstructured":"Polamaung WKongkit JYimnoi PBoonchaya-Anant PSnabboon T. Thyrotoxic hypokalemic periodic paralysis triggered by dexamethasone administration. Acta Medica20206391\u201393. (https:\/\/doi.org\/10.14712\/18059694.2020.24)"},{"key":"bib13","series-title":"Cureus","article-title":"Steroids and thyrotoxicosis precipitate periodic paralysis","volume":"10","author":"Ahamed","year":"2018","unstructured":"Ahamed RMcCalley SSule AA. Steroids and thyrotoxicosis precipitate periodic paralysis. Cureus201810 e2106. (https:\/\/doi.org\/10.7759\/cureus.2106)"},{"key":"bib14","series-title":"American Journal of Case Reports","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.12659\/AJCR.911270","article-title":"A rare case of thyrotoxic periodic paralysis after epidural steroid injection: a case report and literature review","volume":"19","author":"Affram","year":"2018","unstructured":"Affram KOReddy TLOsei KM. A rare case of thyrotoxic periodic paralysis after epidural steroid injection: a case report and literature review. American Journal of Case Reports2018191453\u20131458. (https:\/\/doi.org\/10.12659\/AJCR.911270)10.12659\/AJCR.911270"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2022\/1\/EDM22-0236.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2022\/1\/EDM22-0236.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2022\/1\/EDM22-0236.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:47:54Z","timestamp":1784555274000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3327"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,1]]},"references-count":14,"URL":"https:\/\/doi.org\/10.1530\/edm-22-0236","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,1]]}}}