The effect of COVID-19 on the presentation of thyroid disease in children

Abstract

Introduction: Although studies suggest a potential link between COVID-19 and thyroid dysfunction in adults, there are insufficient data to confirm that association in children, and whether there is any effect on presentation to healthcare services.

Aims: To identify whether presentations of thyroid dysfunction in children to a tertiary paediatric hospital changed as a result of the COVID-19 pandemic.

Methods: A retrospective case note review was conducted of all children with abnormal thyroid function tests between 1^st January 2016 and 31^st December 2021 at a tertiary paediatric endocrine centre in the United Kingdom.

Results: Overall, 244 children whose first presentation was within the timeframe of interest were included in this study, with a median age (range) of 11.5 (6.1, 16.8) years. Of these, 43 (18%) were hyperthyroid and 201 (82%) were hypothyroid. The greatest number of thyroid presentations occurred in 2021 (n=60, 25% of total over time period) and the fewest in 2020 (n=10, 4% of total over time period). Prior to this, the median (range) number of presentations per year was 34 (28, 39). There were no statistically significant differences in biochemistry, antibody status or other clinical characteristics between those who presented with hyperthyroidism prior to the pandemic or after. In those with hypothyroidism, baseline biochemistry was similar between the 2 groups, but the presence of other autoimmune conditions was greater pre-pandemic (17.2% vs 15.0%, p=0.03). In addition, patients were more likely to have transient thyroid dysfunction, which did not require treatment post-pandemic (70.0% vs 49.6%, p=0.0086).

Conclusions: Although overall rates of presentation with thyroid dysfunction have not altered since the first wave of the COVID-19 pandemic, presentations with transient thyroid dysfunction, not requiring ongoing treatment have increased. Further research regarding the relationship between COVID-19 and thyroid function in children and young people, is needed.

Keywords: antibodies; coronavirus; hypothyroidism; thyrotoxicosis; virus.

Figure 1

Flow diagram detailing the inclusion and exclusion of patients. ‘Pre-pandemic’ refers to the period 1^st January 2016 to 1^st March 2020. ‘Post-pandemic’ refers to the period between 2^nd March 2020 and 31^st January 2021.

Figure 2

Number of presentations with thyroid dysfunction. (A) Number of children presenting with thyroid dysfunction per year. (B) Number of presentations of hyperthyroidism and hypothyroidism per 10,000 population. Years 2016-2019 used the mid-2016 population estimate for 5-15year olds in Greater Glasgow. Years 2020-2021 used the mid-2020 population estimate for 5-15year olds in Greater Glasgow. Population data from the National Records of Scotland (15).