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Review
. 2024 Jul;47(7):1633-1640.
doi: 10.1007/s40618-024-02331-4. Epub 2024 Mar 8.

Thyroiditis and COVID-19: focus on pediatric age. A narrative review

F d'Aniello  1   2 , M E Amodeo  3   4 , A Grossi  3 , G Ubertini  3
Affiliations
Review

Thyroiditis and COVID-19: focus on pediatric age. A narrative review

F d'Aniello et al. J Endocrinol Invest. 2024 Jul.

Abstract

Purpose: In light of the growing concern over the possible link between SARS-CoV2 infection and autoimmune diseases, we conducted a review to investigate the impact of the pandemic outbreak on thyroid diseases.

Methods: We carried out a narrative review of all pediatric cases described in the literature, mainly focusing on the possible association of COVID-19 with the incidence of autoimmune and post-infective thyroid diseases (namely Hashimoto's Thyroiditis (HT), Grave's Disease (GD) and Sub-Acute Thyroiditis (SAT)). We also felt it was necessary to provide a brief review of Non-thyroidal Illness Syndrome (NTIS) and Multisystem Inflammatory Syndrome in Children (MIS-C) because of their overlap with thyroiditis.

Results: There is currently no conclusive evidence linking SARS-CoV-2 infection with an increased incidence of autoimmune thyroiditis (AT) in pediatric age. However, SAT may be a mild complication of SARS-CoV-2 infection, as is the case with other viral infections. SAT typically resolves on its own and does not require treatment. NTIS may be associated with inflammatory complications, such as MIS-C, and admission to intensive care. It may also be considered a prognostic risk factor for severe disease. The hypothesized pathogenetic mechanisms of thyroid damage in COVID-19 include direct damage due to the significant expression of angiotensin-converting enzyme 2 (ACE2) in the thyroid gland, which is a ligand for the virus, and indirect damage due to immune dysregulation, such as the overproduction of IL-6, which is thought to be part of the pathogenesis of thyroiditis.

Conclusion: However, due to the limited evidence available, further prospective longitudinal studies are required to clarify the relationship between COVID-19 and thyroid disease in children and adolescents, as well as to investigate any potential long-term consequences.

Keywords: Autoimmune diseases; COVID-19; Pediatric age; SARS-CoV2; Thyroid diseases; Thyroiditis.

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Supplementary concepts