Immune-Mediated Alterations of Thyroid Autoantibodies and Hormone Levels in Pediatric Outpatients Following COVID-19 Infection with Autoimmune Thyroid Disease

Ashraf Fadhil Jomah

doi:10.51699/cajmns.v7i1.3022

Ashraf Fadhil Jomah University of Sumer, College of Medicine

DOI: https://doi.org/10.51699/cajmns.v7i1.3022

Keywords: COVID-19, Pediatric Autoimmune Thyroid Disease, Thyroid Hormone Dysfunction, Thyroid Autoantibodies, Immune-Mediated Thyroid Alterations

Abstract

The COVID-19 pandemic has systemic effects other than respiratory diseases with major impact on endocrine system. Recent investigations have demonstrated an association of thyroid dysfunction with COVID-19 in adults as well as children. It aims to explore the effect of SARS-CoV-2 infection on thyroid function (TSH, T3, T4) and thyroid autoantibodies (anti-TPO, anti-TG) in pediatric Outpatient with previous diagnosis of AITD. All patients enrolled in the study were Outpatient with COVID-19 and managing symptoms or infection .By analyzing pre-and post-COVID-19 infection profiles in 30 patients who were < 7 years old, we detect significant changes in biochemical and immunological markers, which suggest the hypothesis of COVID-19 as a trigger or exacerbating condition for pediatric thyroid dysfunction

References

L. Scappaticcio, F. Pitoia, K. Esposito, A. Piccardo, and P. Trimboli, "Impact of COVID-19 on the thyroid gland: An update," *Reviews in Endocrine and Metabolic Disorders*, vol. 21, no. 4, pp. 829–835, 2020. doi: 10.1007/s11154-020-09615-z.

R. Dosi, G. Jain, A. Mehta, and D. Aggarwal, "Thyroid dysfunction and COVID-19: Emerging evidence," *Journal of Clinical Medicine*, vol. 11, no. 3, p. 654, 2022. doi: 10.3390/jcm11030654.

I. Müller, D. Cannavaro, D. Dazzi, D. Covelli, G. Mantovani, A. Muscatello, and M. Rotondi, "SARS-CoV-2-related atypical thyroiditis," *The Lancet Diabetes Endocrinology*, vol. 8, no. 9, pp. 739–741, 2020. doi: 10.1016/S2213-8587(20)30266-7.

S. Ippolito, F. Dentali, and M. L. Tanda, "SARS-CoV-2: A potential trigger for subacute thyroiditis? Insights from a case report," *Journal of Endocrinological Investigation*, vol. 43, no. 8, pp. 1171–1172, 2020. doi: 10.1007/s40618-020-01312-7.

M. Chen, W. Zhou, and W. Xu, "Thyroid function analysis in 50 patients with COVID-19: A retrospective study," *Thyroid*, vol. 31, no. 1, pp. 8–11, 2021. doi: 10.1089/thy.2020.0363.

S. Zaheer, M. Khan, and M. Iqbal, "SARS-CoV-2 and autoimmunity: The connection with thyroid disorders," *Clinical Endocrinology*, vol. 97, no. 3, pp. 451–459, 2022. doi: 10.1111/cen.14696.

E. Fröhlich and R. Wahl, "Thyroid autoimmunity: Role of anti-thyroid antibodies in thyroid and extra-thyroidal diseases," *Frontiers in Immunology*, vol. 8, p. 521, 2017. doi: 10.3389/fimmu.2017.00521.

A. Lania, M. T. Sandri, M. Cellini, M. Mirani, E. Lavezzi, and G. Mazziotti, "Thyrotoxicosis in patients with COVID-19: The THYRCOV study," *European Journal of Endocrinology*, vol. 183, no. 4, pp. 381–387, 2020. doi: 10.1530/EJE-20-0335.

W. Wang et al., "Thyroid function abnormalities in COVID-19 patients," *Endocrine Research*, vol. 45, no. 3, pp. 119–124, 2020. doi: 10.1080/07435800.2020.1781636.

G. Di Mauro, L. M. Cristina, and A. C. D., "Endocrine involvement in COVID-19: Mechanisms and clinical implications," *Endocrine*, vol. 72, no. 2, pp. 299–309, 2021. doi: 10.1007/s12020-021-02748-y.

A. Pazderska and S. H. Pearce, "Immune mechanisms in endocrine disease," *Clinical Medicine*, vol. 17, no. 6, pp. 580–585.

M. Rotondi et al., "Detection of SARS-CoV-2 receptor ACE2 mRNA in thyroid cells: A clue to COVID-19-related subacute thyroiditis," *Journal of Endocrinological Investigation*, vol. 44, no. 5, pp. 1085–1090.

Y. Mao et al., "Thyroid dysfunction in COVID-19 patients," *Endocrine Practice*, vol. 26, no. 9, pp. 1212–1218.

A. Brancatella et al., "Subacute thyroiditis after SARS-CoV-2 infection," *Journal of Clinical Endocrinology Metabolism*, vol. 105, no. 7, p. dgaa276

• [15] B. Khoo, T. Tan, S. A. Clarke, E. G. Mills, B. Patel, M. Modi, and W. S. Dhillo, "Thyroid function before, during, and after COVID-19," *Journal of Clinical Endocrinology Metabolism*, vol. 106, no. 2, pp. e803–e811, 2021.

I. Campi, I. Bulgarelli, A. Dubini, G. B. Perego, E. Tortorici, C. Torlasco, and L. Fugazzola, "Thyroid function in COVID-19 and the relation to cytokine storm," *Clinical Endocrinology*, vol. 95, no. 5, pp. 713–722, 2021.

L. Croce, D. Gangemi, G. Ancona, F. Liboà, G. Bendotti, L. Minelli, and L. Chiovato, "The cytokine storm and thyroid involvement in COVID-19," *Journal of Endocrinological Investigation*, vol. 43, no. 8, pp. 1171–1172, 2020.

G. Bellastella, M. I. Maiorino, K. Esposito, and A. Bellastella, "Endocrine complications of COVID-19: What happens to the thyroid and adrenal glands?" *Journal of Endocrinological Investigation*, vol. 43, no. 8, pp. 1169–1170, 2020.

F. Scopinaro, P. Trimboli, and A. Piccardo, "Nuclear medicine in endocrine COVID-19 complications," *European Journal of Nuclear Medicine and Molecular Imaging*, vol. 47, no. 10, pp. 2291–2293, 2020.

J. Wu et al., "Elevation of thyroid antibodies in pediatric COVID-19 patients," *Pediatric Research*, vol. 90, no. 4, pp. 857–863, 2021. doi: 10.1038/s41390-021-01271-0.

Y. Tao, X. Wu, X. Li, and Y. Chen, "Pediatric thyroid involvement in COVID-19: A case series," *Frontiers in Pediatrics*, vol. 9, p. 653219, 2021. doi: 10.3389/fped.2021.653219.

E. Song, J. Bartel, and J. Wei, "Immune-mediated endocrine dysfunction in COVID-19," *Nature Reviews Endocrinology*, vol. 17, no. 5, pp. 312–325, 2021. doi: 10.1038/s41574-021-00507-w.

L. Giovanella, R. M. Ruggeri, and P. Trimboli, "Lessons from COVID-19 and thyroid dysfunction," *Clinical Chemistry and Laboratory Medicine*, vol. 59, no. 7, pp. 1141–1147, 2021. doi: 10.1515/cclm-2021-0179.

M. Marazuela, A. Giustina, and M. Puig-Domingo, "Endocrine and metabolic aspects of COVID-19," *Reviews in Endocrine and Metabolic Disorders*, vol. 21, no. 4, pp. 495–507, 2020. doi: 10.1007/s11154-020-09612-2.

G. J. Kahaly and L. Bartalena, "The immunopathogenesis of autoimmune thyroid disease," *Nature Reviews Endocrinology*, vol. 13, no. 2, pp. 108–122, 2017. doi: 10.1038/nrendo.2016.188.

A. Vojdani and D. Kharrazian, "Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to autoimmune disease," *Clinical Immunology*, vol. 217, p. 108480, 2020. doi: 10.1016/j.clim.2020.108480.