Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Via Aselli 2, 27100, Pavia, Italy.
Pediatric Department, "V. Buzzi" Children's Hospital, 20154, Milan, Italy.
J Endocrinol Invest. 2022 Jan;45(1):199-208. doi: 10.1007/s40618-021-01647-9. Epub 2021 Jul 26.
COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C, evaluating its impact on disease severity.
We retrospectively considered children admitted with MIS-C to a single pediatric hospital in Milan (November 2019-January 2021). Non-thyroidal illness syndrome (NTIS) was defined as any abnormality in TF tests (FT3, FT4, TSH) in the presence of critical illness and absence of a pre-existing hormonal abnormality. We devised a disease severity score by combining severity scores for each organ involved. Glucose and lipid profiles were also considered. A principal component analysis (PCA) was performed, to characterize the mutual association patterns between TF and disease severity.
Of 26 (19 M/7F) patients, median age 10.7 (IQR 5.8-13.3) years, 23 (88.4%) presented with NTIS. A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%). Mutually correlated variables related to organ damage and inflammation were represented in the first dimension (PC1) of the PCA. FT3, FT4 and total cholesterol were positively correlated and characterized the second axis (PC2). The third axis (PC3) was characterized by the association of triglycerides, TyG index and HDL cholesterol. TF appeared to be related to lipemic and peripheral insulin resistance profiles. A possible association between catabolic components and severity score was also noted.
A low FT3 level is common among MIS-C. TF may be useful to define the impact of MIS-C on children's health and help delineate long term follow-up management and prognosis.
COVID-19 疾病可能导致儿童严重多系统炎症综合征（MIS-C），进而可能改变甲状腺功能（TF）。我们评估了 MIS-C 中的 TF，评估其对疾病严重程度的影响。
我们回顾性地考虑了 2019 年 11 月至 2021 年 1 月期间在米兰的一家儿科医院因 MIS-C 住院的儿童。非甲状腺疾病综合征（NTIS）定义为在存在严重疾病但无预先存在的激素异常的情况下 TF 测试（FT3、FT4、TSH）的任何异常。我们通过组合每个受累器官的严重程度评分来制定疾病严重程度评分。还考虑了血糖和血脂谱。进行了主成分分析（PCA），以描述 TF 与疾病严重程度之间的相互关联模式。
在 26 名（19 名男性/7 名女性）患者中，中位年龄为 10.7（IQR 5.8-13.3）岁，23 名（88.4%）出现 NTIS。15/23（65.3%）患者存在 FT3 水平低，而其他患者存在各种激素异常（8/23，34.7%）。与器官损伤和炎症相关的相互关联变量在 PCA 的第一维（PC1）中表示。FT3、FT4 和总胆固醇呈正相关，构成第二轴（PC2）。第三轴（PC3）的特征是甘油三酯、TyG 指数和 HDL 胆固醇的关联。TF 似乎与脂血症和外周胰岛素抵抗谱有关。还注意到分解代谢成分与严重程度评分之间的可能关联。
MIS-C 中 FT3 水平低很常见。TF 可用于确定 MIS-C 对儿童健康的影响，并有助于描绘长期随访管理和预后。
