University of Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, İzmir, Turkey
University of Health Sciences Turkey, İzmir Tepecik Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
J Clin Res Pediatr Endocrinol. 2022 Dec 1;14(4):402-408. doi: 10.4274/jcrpe.galenos.2022.2022-4-7. Epub 2022 Jun 30.
Multisystem inflammatory syndrome in children (MIS-C), associated with Coronavirus disease-2019, is defined as the presence of documented fever, inflammation, and at least two signs of multisystem involvement and lack of an alternative microbial diagnosis in children who have recent or current Severe acute respiratory syndrome-Coronavirus-2 infection or exposure. In this study, we evaluated thyroid function tests in pediatric cases with MIS-C in order to understand how the hypothalamus-pituitary-thyroid axis was affected and to examine the relationship between disease severity and thyroid function.
This case-control study was conducted between January 2021 and September 2021. The patient group consisted of 36 MIS-C cases, the control group included 72 healthy children. Demographic features, clinical findings, inflammatory markers, thyroid function tests, and thyroid antibody levels in cases of MIS-C were recorded. Thyroid function tests were recorded in the healthy control group.
When MIS-C and healthy control groups were compared, free triiodothyronine (fT3) level was lower in MIS-C cases, while free thyroxine (fT4) level was found to be lower in the healthy group (p<0.001, p=0.001, respectively). Although the fT4 level was significantly lower in controls, no significant difference was found compared with the age-appropriate reference intervals (p=0.318). When MIS-C cases were stratified by intensive care requirement, fT3 levels were also lower in those admitted to intensive care and also in those who received steroid treatment (p=0.043, p<0.001, respectively).
Since the endocrine system critically coordinates and regulates important metabolic and biochemical pathways, investigation of endocrine function in MIS-C may be beneficial. These results show an association between low fT3 levels and both diagnosis of MIS-C and requirement for intensive care. Further studies are needed to predict the prognosis and develop a long-term follow-up management plan.
与 2019 年冠状病毒病相关的儿童多系统炎症综合征（MIS-C）被定义为患有最近或目前严重急性呼吸系统综合征-冠状病毒 2 感染或接触的儿童，其存在记录的发热、炎症和至少两个多系统受累的体征，且无其他微生物诊断。在这项研究中，我们评估了儿科 MIS-C 病例的甲状腺功能测试，以了解下丘脑-垂体-甲状腺轴如何受到影响，并检查疾病严重程度与甲状腺功能之间的关系。
这项病例对照研究于 2021 年 1 月至 2021 年 9 月进行。患者组包括 36 例 MIS-C 病例，对照组包括 72 例健康儿童。记录了 MIS-C 病例的人口统计学特征、临床发现、炎症标志物、甲状腺功能测试和甲状腺抗体水平。在健康对照组中记录了甲状腺功能测试。
当将 MIS-C 组和健康对照组进行比较时，MIS-C 组的游离三碘甲状腺原氨酸（fT3）水平较低，而健康组的游离甲状腺素（fT4）水平较低（p<0.001，p=0.001）。虽然对照组的 fT4 水平明显较低，但与年龄相应的参考区间相比无显著差异（p=0.318）。当按需要重症监护进行分层时，MIS-C 病例的 fT3 水平也较低，在需要重症监护和接受皮质类固醇治疗的患者中也较低（p=0.043，p<0.001）。
由于内分泌系统至关重要地协调和调节重要的代谢和生化途径，因此对 MIS-C 中的内分泌功能进行研究可能是有益的。这些结果表明，低 fT3 水平与 MIS-C 的诊断和需要重症监护之间存在关联。需要进一步的研究来预测预后并制定长期随访管理计划。
