ESPE Abstracts

Introduction: Increased frequency of Grave’s disease (GD) has been reported both in adults and youth during the COVID-19 pandemic. Aim: To compare the frequency of GD prior and during the COVID-19 pandemic.

Methods: Retrospective analysis of children diagnosed with GD over the last 13 years in our Department.

Results: A total of 22 children (31.8% boys) with a mean age of 10.55±3.37 years were diagnosed with GD; 9 were diagnosed from January 2010 until December 2019 (0.69 children/year), whereas 13 (4 children/year) were diagnosed during the pandemic. However, only 4 of them had a confirmed COVID-19 infection prior to diagnosis. One child, diagnosed during the pandemic without prior COVID-19 infection, had a relapse 6 months after the initial remission and 2 years after a COVID-19 infection that occurred 3 months after the diagnosis of GD. Among 9 children with GD diagnosis prior to 2020, two had a relapse during the pandemic. Of those, one had been infected with COVID-19 4 months earlier. An adolescent had a flair-up of TSI antibodies after COVID-19, while under treatment. Within the same group and after a follow-up period of 4.58±2.65 years, only one other child had a relapse 4 years after diagnosis and 1 year after treatment discontinuation. The number of children is too small to yield results of statistical significance, however, among children diagnosed during the pandemic, 38.5% were boys (vs 22.2%), mean age of diagnosis was 11.2±3.19 years (vs 9.76±3.66), 53.9% had a family history of thyroid disease (vs 66.8%), TSH level was significantly lower (0.005±0.001 vs 0.011±0.007 IU/ml), fT4 4.08±2.77 (vs 3.01±2.23) ng/dl and TSI level 13.3±13.69 (vs 8.52±8.07) U/l. Seven children (53.9% vs 33.3%) were symptomatic at diagnosis and 2 children (15.4% vs 11.1%) required additional treatment with b-blockers. Discussion: Current findings indicate increased frequency of new diagnoses and the aggravation of pre-existent GD during the pandemic. Both direct damage of thyroid cells by circulating cytokines, as well triggering of autoimmunity have been suggested as possible mechanisms. However, not all children in our cohort had a documented prior infection, although asymptomatic disease cannot be excluded, especially since data were collected retrospectively. Stress during confinement could also be considered as a trigger.

Conclusion: Although a causal relationship between COVID-19 infection and GD could not be established, an undisputable increase of GD was observed during the pandemic.