Has COVID-19 Changed Pediatric Graves' Disease? A Study Investigating Post-Pandemic Trends

Naim Alessandro; Merlo Silvia; Viviana Zonca; Sara Naim; Mariagrazia Calevo; Carolina Varotto; Emilio Casalini; Daniela Fava; Maria Allegri Anna Elsa; Alessia Angelelli; Flavia Napoli; Caterina Tedesco; Iorgi Natascia Di; Roberto Gastaldi; Mohamad Maghnie

Introduction: Graves'disease (GD) is the most common cause of hyperthyroidism in pediatric populations. Recent observations at our tertiary center suggest a potential increase in pediatric GD cases following the COVID-19 pandemic. This single-center study aims to investigate the potential increase in GD cases and explore any significant differences in clinical presentation and outcomes before and after the onset of COVID-19 pandemic.

Methods: A retrospective analysis was conducted on pediatric patients diagnosed with GD from 2013 to 2023. The cohort was divided into two groups based on the diagnosis timeline: pre-COVID (2013-2019) and post-COVID (2020-2023). Data on demographics, clinical presentation, laboratory findings, treatment and outcomes were collected and analyzed.

Results: A total of 50 patients were identified, with 23 cases in the pre-COVID period and 27 cases in the post-COVID period. The incidence of new cases increased from 0.27 cases per month pre-COVID to 0.59 cases per month post-COVID. No significant differences were found in initial TSH, fT3, fT4 and TRAb levels between the two periods. Notably, orbitopathy was more prevalent in the pre-COVID group (57.1%) compared to the post-COVID group (18.5%, P = 0.007). The incidence of goiter was significantly higher pre-COVID (70%) than post-COVID (37%, P = 0.04). Furthermore, an increase in the percentage of patients with positive anti-thyroglobulin (anti-Tg) and anti-thyroid peroxidase (anti-TPO) antibodies was observed in the post-COVID group compared to the pre-COVID group (anti-Tg:33.3%vs.63.6%, P = 0.10;anti-TPO:75%vs.91.3%, P = 0.20). There was also a notable increase in male cases in the post-COVID period (pre-COVID:4/23males, post-COVID:12/27 males, P = 0.07).


Parameter at onset	Pre-COVID (n = 23)	Post-COVID (n = 27)	P-value
Age-years	11.52 ± 3.11	12.08 ± 3.08	0.44
Males-%	17.4 (4/23)	44.4 (12/27)	0.07
Height-SDs	0.25 ± 1.30	1.00 ± 1.88	0.18
BMI-SDs	0.20 ±1.81	-0.26 ± 1.63	0.38
TSH-uU/ml	0.13 ± 0.33	0.01 ± 0.02	0.09
fT3-pmol/L	22.89 ± 14.17	17.06 ± 9.72	0.21
fT4-pmol/L	49.56 ± 25.09	36.75 ± 20.32	0.08
TRAb-IU/L	9.21 ± 9.30	6.75 ± 4.62	0.88
TRAb after 6 months-IU/L	6.25 ± 9.31	4.77 ± 3.86	0.21
TRAb after 1 year-IU/L	2.69 ± 3.98	2.99 ± 3.89	0.18
Orbitopathy-%	57.1	18.5	0.007
Goiter-%	70	37	0.04
Anti-Tg + (%)	33.3	63.6	0.10
Anti-TPO + (%)	75	91.3	0.20

Conclusions: Our findings suggest an increase in the frequency of pediatric GD cases following the COVID-19 pandemic. Although the overall clinical presentation remained similar across the two periods, a notable decrease in the prevalence of orbitopathy and goiter was observed in post-COVID cases. An increase in the percentage of patients with positive thyroid autoantibodies at onset was observed in the post-COVID population, suggesting a possible interaction between viral infections and autoimmunity that requires further research.

ESPE Abstracts

P1-286