Endocrine Abstracts

Background: Coronavirus 2019 (Covid-19), an infectious disease caused by SARS-CoV-2 virus has been linked to autoimmunity. Graves’ disease (GD) is a common subtype of paediatric hyperthyroidism and an autoimmune condition, where antibodies stimulate the thyroid-stimulating hormone receptor on the thyroid gland to produce excess thyroid hormone. Although, paediatric GD is rare, incidence have risen before the pandemic, and this rise has accelerated since the Covid-19 pandemic.

Objectives: To compare incidence, severity, and healthcare access of newly diagnosed paediatric patients with GD before and during the pandemic.

Method: We analysed retrospective data of newly diagnosed patients between period A: October 2017-January 2020 (pre-pandemic) and period B: February 2020-May 2022 (pandemic). Data was gathered from two large Welsh centres (University Hospital of Wales and Royal Gwent Hospital) using the Paediatric Endocrinology Database and Welsh Clinical Portal. The parameters compared were age, demographic, clinical presentation, treatment, remission, and relapse.

Results: The study including 29 patients saw increased cases of GD, from 31% in period A, pre-pandemically to 69% in period B, during the pandemic. In period A, 78% patients reported familial autoimmunity, which decreased to 35% in period B. Psychological and toxic symptoms such as thyroid eye disease (TED) increased in period B. TED occurred in 1 in 9 patients in period A, compared to 1 in 5 in period B with a 9% incidence increase in period B. 1 patient had thyroid storm in period B. TPOAb levels were also higher in period B. GP and A&E referrals increased by 26% and 9% respectively in period B. In period A, patients continued one regime, titration (78%) or block and replace (22%). In period B, 32% patients changed from titration to block and replace, of which 33% had TED. 11% patients from period A relapsed during the pandemic. 5% patients diagnosed in period B achieved remission, no relapses were recorded.

Conclusion: The study showed increased incidence of GD during the pandemic suggesting possible association of Covid-19 and GD. A shift in the mode of accessing healthcare and rise in severity and prevalence of psychological symptoms were seen.