Pediatric Hyperthyroidism in the Time of COVID-19: An Updated Presentation Analysis

Ventura Paula Sol; Alba Gonzalez; Aina Valls; Marta Murillo

Abstract: The SARS-CoV-2 virus uses ACE2 combined with the transmembrane-protease TMPRSS2 to enter and infect thyroid follicular cells. Studies have reported a higher incidence of hyperthyroidism cases during the COVID-19 pandemic compared to pre-pandemic periods. Studies have also been reported cases of thyroid dysfunction early after mass covid vaccinations. However, there are insufficient data to confirm these associations in children.

Aims: To identify whether presentations of thyroid dysfunction tests suggestive of hyperthyroidism in children to a tertiary paediatric hospital changed as a result of the COVID-19 pandemic and after SARS-CoV-2-mRNA-vaccination.

Methods: A retrospective case note review was conducted of all children with thyroid function tests suggestive of hyperthyroidism between 1stJanuary 2014 and 31stMay 2023 at a tertiary paediatric endocrine center in Barcelona.

Results: The greatest number of thyroid alterations occurred in 2020 (n=7; 40% of total). Prior and after to this, the number of presentations was 1 or 2 cases per year (5.6-11.1%). All cases were female. There were statistically significant differences in fT4, fT3 and TRABs (P<0.05).

Table: Characteristics of hyperthyroid patients (n=18) prior to the pandemic and during the pandemic
	Pre-Pandemic n=9 (50%)	Pandemic n=9 (59%)	P-value
Year	2014-2019	2020-2023	NA
Female sex (%)	9 (100)	9 (100)	NA
Median BMI (Kg/m2) (range)	20.3 (17.1-23.7)	22.8 (18.6-23.7)	0.606**
Median age (years) (range)	12 (11.5-15)	16 (13-16)	0.113*
Median TSH (mU/l) (range)	0.004 (0.004-0.009)	0.004 (0.004-0.027)	1.000*
Median fT4 (pmol/l) (range)	2.54 (2.28-3.1)	1.35 (0.85-2.48)	0.024*
Median fT3 (pmol/l) (range)	3.60 (2.68-6.25)	1.35 (1-1.80)	0.020*
Median TPO antibodies (U/ml) (range)	659 (99-1500)	112 (5-713)	0.222*
Positive TPO antibodies (%)	8 (89)	7 (78)	1**
Median Tg antibodies (U/ml) (range)	166 (17-961)	28 (5-112)	0.161*
Positive Tg antibodies (%)	7 (78)	7 (78)	1**
Median TRABs (U/ml) (range)	5.71 (1.50-11.76)	1.07 (0,03-3.04)	0.031*
Positive TRABs (%)	9 (100)	4 (57)	0.063**
Autoinmune history (%)	1 (11.1)	1 (11.1)	0.765**
Treated (%)	9 (100)	6 (66.7)	0.103**
Thyroid dysfunction prior to SARS-CoV-2-mRNA vaccine	NA	6 (86)	NA
Thyroid dysfunction post to SARS-CoV-2-mRNA vaccine	NA	0 (0)	NA
TSH:Thyroid Stimulating Hormone; fT4:thyroxine; T3:triiodothyronine; TPO:thyroid peroxidase; TRAB:thyroid-receptor antibody. Tg:thyroglobulin. Mann–Whitney U.test; *Fisher Exact-Test

Conclusion: The highest number of cases of hypertoidism was observed at the peak of the pandemic. However, thyroid dysfunction since the start of the pandemic appears to be milder and no cases were reported after mass vaccinations.

ESPE Abstracts

P2-248