Increased Incidence and Severity of New Graves Disease Diagnoses in Youth During the COVID-19 Pandemic

Donner, Julia; Has, Phinnara; Topor, Lisa Swartz

doi:10.1016/j.eprac.2023.01.011

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…In a matched cohort study of 641 704 patients with COVID-19, researchers found the infected groups had a higher likelihood of acquiring autoimmune diseases [ 19 ]. A retrospective review found similar results in the onset of GD in a pediatric population, in which the incidence of new GD diagnosis doubled from 1.3% to 2.6% during the pandemic [ 20 ]. Although cases like ours suggest a relationship between SARS-CoV-2 infection and autoimmune thyroid disorders after infection, long-term data sets must be analyzed to understand any correlation fully.…”

Section: Discussionmentioning

confidence: 86%

Graves\' Disease Exacerbation with Impending Thyroid Storm After SARS-CoV-2 Infection: A Case Report

Sebastian,

Parisa,

Pandya

et al. 2023

Am J Case Rep

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Patient: Female, 42-year-old Final Diagnosis: Graves disease Symptoms: Bilateral eye pressure • fatigue • muscle weakness • palpitations • goiter Clinical Procedure: — Specialty: Endocrinology and Metabolic • General and Internal Medicine Objective: Rare coexistence of disease or pathology Background: Since the COVID-19 pandemic, several cases of COVID-19 have been linked to the development of autoimmune disorders, including of the thyroid. Graves’ disease (GD) is a rare complication that can occur following SARS-CoV-2 infection. Reports have linked COVID-19 to new onset and exacerbation of GD. We present a case of a 42-year-old woman with a history of GD presenting with impending thyroid storm 3 weeks following a diagnosis of COVID-19. Case Report: A 42-year-old woman with a history of GD presented to the Emergency Department (ED) for an acute exacerbation of hyperthyroidism 3 weeks after SARS-CoV-2 infection was diagnosed on a home test. Symptoms included daily headaches, increased bilateral eye pressure, fatigue, muscle weakness, episodes of confusion and agitation, persistent heart palpitations, and goiter. Elevated free T4 of 5.57, free T3 of 15.68, total T3 of 4.43, and near-absent thyroid stimulating hormone were noted. The Burch-Wartofsky scale was 40, which was concerning for an impending thyroid storm; however, at the time of admission, she was not in a thyroid storm. Treatment included propylthiouracil, potassium iodide oral solution, and propranolol, with symptom improvement. Due to prior history of intolerance to antithyroid medications and recent exacerbation, a thyroidectomy was performed once she was in a euthyroid state. Conclusions: Our case demonstrates the importance of recognizing COVID-19 as an etiology or a trigger for new onset or exacerbation of GD. Our case highlights that being vigilant to recognize the association between COVID-19 and thyroid abnormalities for early diagnosis and treatment is imperative.

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Section: Discussionmentioning

confidence: 86%

Graves\' Disease Exacerbation with Impending Thyroid Storm After SARS-CoV-2 Infection: A Case Report

Sebastian,

Parisa,

Pandya

et al. 2023

Am J Case Rep

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“…Genetic, infectious, immune and environmental factors are all thought to possibly play a role in the disease [3]. One proposed trigger of autoimmunity is viral-induced immune dysregulation [4 ▪ ]. Interestingly, COVID-19, caused by SARS-CoV-2, has been associated with the development of de novo autoimmune disease in general, and this has led to the thought of whether this viral infection could also predispose patients to development of GD.…”

Section: Text Of Reviewmentioning

confidence: 99%

“…Interestingly, COVID-19, caused by SARS-CoV-2, has been associated with the development of de novo autoimmune disease in general, and this has led to the thought of whether this viral infection could also predispose patients to development of GD. A recent retrospective study investigated new diagnoses of GD from January 2018 to December 2021 at a large academic pediatric hospital [4 ▪ ]. In their cohort, they noted a doubling in the incidence of GD diagnoses during the pandemic years compared to that in prior years (2.6% vs. 1.2%, P = 0.01).…”

Section: Text Of Reviewmentioning

confidence: 99%

The management of pediatric Graves’ disease

Quintanilla-Dieck

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Graves’ disease (GD) constitutes a significant proportion of thyroid disorders seen during childhood. Several specialties may be closely involved in the management of pediatric patients with GD and emerging research in each field contributes to variations in the approach over time. Here we review the recent literature on the management of the disease, with the hope that this can be a valuable resource for treating specialists who need to be continuously updated on new data obtained in relevant fields. Recent findings Genetic, postinfectious and environmental factors may play a role in the immunological pathophysiology of GD. Research performed during the COVID-19 pandemic supports that viral-induced immune dysregulation may be a possible trigger for the disease. The various current treatment options all have positive and negative factors to consider. Antithyroidal drug therapy (ATD) is generally recommended as the initial treatment, although remission rates are only 20–30% at 2 years and 75% at 9 years. Unfortunately, about half of patients will relapse within 1 year of discontinuing therapy. Radioactive iodine therapy (RAI) is an effective treatment option and can be considered in certain pediatric patients. There continues to be no definitive evidence that the doses used for GD lead to a higher risk of cancer. Surgical treatment via thyroidectomy is effective and safe when performed by a high-volume surgeon. Recent studies show improvement in quality-of-life after surgery in adolescents and young adults. Future medical treatment options for GD currently being studied include antigen-specific immunotherapy and monoclonal antibodies. Summary Although the future holds promising new therapeutic options for autoimmune diseases including GD, the current choices continue to be ATD, usually first-line, and definitive treatments including RAI and surgery. While all three offer the possibility of remission or cure, drug therapy and RAI have a possibility of relapse. Risks of each approach should be broached in detail with patients and their families, and the nuances of treating this disease specifically in children should be familiar to all treating providers.

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“…Additionally, individuals with GD, like any other chronic medical condition, should follow general guidelines for preventing COVID-19 transmission, such as practicing good hand hygiene, wearing masks, and maintaining physical distance [8] . Some articles have reported there's no changes in the incidence of hyperthyroidism before and after COVID-19 [9] . And some studies have reported that COVID-19 vaccines can cause GD [10] .…”

Section: Introductionmentioning

confidence: 99%

A retrospective clinical study in Graves disease with COVID-19 infection in China

Zhang,

Feng,

et al. 2024

Preprint

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Background Corona Virus Disease 2019 (COVID-19) is the most prevalent global pandemic in recent times. Graves disease (GD), an autoimmune thyroid disease, is a clinical syndrome caused by excessive thyroid hormones. Our study is to understand the current epidemiological situation of COVID-19 infection in GD patients, and to analyze whether COVID-19 will affect the thyroid function, thyroid autoantibody and metabolism of GD patients. Methods 109 GD patients were followed by Shanghai General Hospital Thyroid Disease Center (TDC) from November 2022 to June 2023. There were three groups defined, i.e., pre, one-month after and three months after infection with COVID-19. SPSS was used to analyze the recruited data. Results 109 GD patients are infected with COVID-19 (72.48%), uncontrolled GD patients with high FT3 had a higher COVID-19 infection rate (79.31%). As for thyroid function in 35 GD patients with antithyroid drug (ATD) maintenance stage, there were significant differences in FT3, FT4, TT3 and TT4 before and after being infected with COVID-19. What’s more, there’s a significant difference between GD patients in one month and three months after COVID-19 infection of high TSAb group (p = 0.048) but no significant difference between pre and one month. What’s more, there were significant differences in TT3, TT4 of GD patients after infected COVID-19 in non. And Phosphorus (P), 25-hydroxyvitamin D (25-OH-D3), Procollagen type 1 N-terminal propeptide (P1NP) in GD patients were be affected by COVID-19 infection. Conclusion GD patients with uncontrolled thyroid function group are susceptible to COVID-19. COVID-19 may affect the thyroid function of GD in TT3, TT4, TSAb high level group infection. COVID-19 vaccine is conducive to the stability of GD patients' condition. And COVID-19 may affect the bone metabolism in GD patients before and after COVID-19 infection. But there is no effect on glucose metabolism or lipid metabolism.

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Increased Incidence and Severity of New Graves Disease Diagnoses in Youth During the COVID-19 Pandemic

Cited by 5 publications

References 16 publications

Graves\' Disease Exacerbation with Impending Thyroid Storm After SARS-CoV-2 Infection: A Case Report

Graves\' Disease Exacerbation with Impending Thyroid Storm After SARS-CoV-2 Infection: A Case Report

The management of pediatric Graves’ disease

A retrospective clinical study in Graves disease with COVID-19 infection in China

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