Thyroid disturbances after COVID-19 and the effect of vaccination in children: a prospective tri-center registry analysis.

Rapidly evolving clinical data suggest that the novel coronavirus (SARS-CoV-2) and vaccination against COVID-19 might be associated with thyroid disturbances. However, studies remain limited among the pediatric population. Our aim was to assess the prevalence and permanence of thyroid autoimmunity (TA) and dysfunction in children after an acute infection and its potential association with vaccination. A prospective, multicenter registry analysis was performed among 458 children (mean age: 12.4 ± 3,8 years, 45.4% male) with preceding COVID-19. Patient inclusion lasted from 24th March, 2021 to 23rd March, 2022 at three pediatric outpatient facilities at Semmelweis University, Budapest. Primary outcomes were the rate of thyroid disturbances assessed by laboratory parameters (thyroid function tests, antithyroglobulin [ATG] and anti-thyroid peroxidase [ATPO] antibodies) and thyroid ultrasound. TA rate among vaccinated and unvaccinated children was determined. Children with newly diagnosed thyroid alterations were followed up for 12.7 ± 4.3 months. Six children had previous thyroid disease. Out of 452 children, 30 cases (6.6%) of newly diagnosed TA (six of them had abnormal thyroid-stimulating hormone [TSH] levels) and eight cases (1.8%) of isolated TSH elevation were observed. Ultrasound-proven autoimmune thyroiditis (AIT) was 4.0%. No association was found between COVID-19 vaccination and thyroid autoimmunity (χ2(1,N = 452) = 0.138, p = 0.815). Among children with TA, 73.3% had long-lasting alterations.  Conclusion: Vaccination had no effect on the prevalence of TA. Until further controlled studies state otherwise, children with preceding COVID-19 might benefit from thyroid screening. What is Known: • Numerous case reports implicate that coronavirus disease-2019 (COVID-19) and vaccination against SARS-CoV-2 can be responsible for thyroid disturbances. • Thyroid alterations discovered during acute COVID-19 tend to cease by time and only incidental thyroid autoimmunity (TA) is diagnosed after COVID-19. In adults, no increase in vaccine-related hyper- or hypothyroidism was found. What is New: • TA rate after COVID-19 vaccination among children was not increased. TA had no role in long COVID syndrome. • We discovered a considerable rate of TA (6.6%) and ultrasound-proven autoimmune thyroiditis (AIT) (4.0%) after SARS-CoV-2 infection, and the majority of these alterations remained positive after 6 months.

Diagnostics and follow-up strategy for Silver­Russell syndrome based on a case report showing familial accumulation / A Silver­Russell-szindróma diagnosztikai lépései és terápiás lehetoségei egy családi halmozódást mutató eset kapcsán

"Characterized by both intrauterine and postnatal growth retardation, and consequent small stature, Silver­Russell syndrome is associated with typical minor anomalies (relative macrocephalia, protruding forehead, downturned corners of mouth, micrognathia, low set ears, facial, skeletal and limb asymmetry) and findings involving mainly the endocrine system. The molecular background of the syndrome is complex, but it is most often caused by the involvement of critical regions of chromosome 11 and/or chromosome 7. Beside the molecular diagnosis, the Netchine­Harbison clinical scoring system aims to contribute to the successful diagnosis of Silver­Russell syndrome. Although Silver­Russell syndrome is mostly sporadic, in our case report we present an extremely rare familial accumulation, where three of four siblings are affected by Silver­Russell syndrome. Early diagnosis is important to initiate adequate feeding and nutritional guidance, enhance early development and start growth hormone therapy as soon as possible. We would like to emphasize that management and long-term follow-up is crucial to prevent potential complications and treat specific issues appropriately."

Skeletal-related side effects of acute lymphoblastic leukemia treatment in children / Az akut lymphoblastos leukaemiával kezelt gyermekek csontrendszerét érinto mellékhatások.

Összefoglaló. Bevezetés: A gyermekkori akut lymphoblastos leukaemia kezelése napjainkban 80% feletti túlélést tesz lehetové, de fontos cél a kezelés okozta mellékhatások kivédése és a gyermekek hosszú távú életminoségének javítása is. Célkituzés: A kemoterápia csontrendszerre kifejtett mellékhatásainak vizsgálata és a prognosztikai tényezok feltárása, a rizikófaktorok összegyujtése. Módszerek: Retrospektív vizsgálatunkba a Semmelweis Egyetem II. Gyermekgyógyászati Klinikáján 2007 és 2016 között kezelt 215, akut lymphoblastos leukaemiás gyermek közül a csontelváltozást észlelt betegeket vontuk be a következo, csontrendszert érinto megbetegedésekkel: 38 gyermeknél csökkent csontásványianyag-tartalom, 5 fonél osteonecrosis, 3 fonél osteomyelitis és 2 fo esetében patológiás fractura volt detektálható. Különbözo követési idopontokban gyujtöttünk oszteodenzitometriai adatokat, D-vitamin-, foszfát-, alkalikusfoszfatáz- és lipidszinteket is. Eredmények: Az oszteodenzitometriai értékek már a diagnóziskor csökkent értéket mutatnak, az intenzív vénás kemoterápia hatására pedig további csökkenés figyelheto meg (a lumbális gerinc Z-score-értéke a kezelés kezdetén: -1,5 ± 1,02, az intenzív vénás kezelés végén -1,8 ± 0,5). A Z-score-értékek a fenntartó terápia végére javuló tendenciát mutattak (-1,6 ± 0,5; p<0,05), majd az utánkövetés során ismételt javulás (-1,2 ± 0,4 [p<0,01] és -0,9 ± 0,4) figyelheto meg. A D-vitamin-szintek esetében az intenzív vénás kemoterápiát követoen fokozatos javulást láthattunk (20 ± 3,1 ng/ml vs. többéves utánkövetéskor 31 ± 2,6 ng/ml; p<0,001). A foszfát- és alkalikusfoszfatáz-szintek nem változtak számottevo mértékben a vizsgált idotartam során. A koleszterinszintek a terápia során folyamatos növekedést mutattak (a kemoterápia kezdetén 3,28 ± 0,3 mM/l vs. a fenntartó kezelés végén 4,62 ± 0,2 mM/l; p<0,0001). A HDL-koleszterin esetében szintén hasonló tendenciát figyelhettünk meg (a diagnóziskor 0,53 ± 0,09 mM/l vs. a fenntartó kezelés végén 1,48 ± 0,14 mM/l). Következtetés: Kiemelendo, hogy a gyógyult gyermekek utánkövetése, az oszteodenzitometriai mérések és a laborparaméterek ellenorzése rendkívül fontos, mivel csontelváltozásokkal a leukaemiás betegek esetén számolni kell. Orv Hetil. 2020; 161(49): 2086-2093. INTRODUCTION: Current treatment of pediatric acute lymphoblastic leukemia allows survival above 80%, but it is also very important to prevent treatment-related side effects and to improve long-term quality of life. OBJECTIVE: Our aim was to assess the side effects of chemotherapy on the skeletal system and to identify prognostic and risk factors. METHODS: Between 2007 and 2016, 215 children were treated with acute lymphoblastic leukemia at the 2nd Department of Paediatrics, Semmelweis University. In our retrospective study, we analyzed data of these children with skeletal-related side-effects (38 children with reduced bone mineral density, 5 with osteonecrosis, 3 with osteomyelitis and 2 with pathologic fracture). RESULTS: Osteodensitometric data, vitamin D, phosphate, alkaline phosphatase and lipid levels were collected at different follow-up times. Osteodensitometric values were already reduced at the time of diagnosis (lumbar spine Z-score: -1.5 ± 1.02) and intensive venous chemotherapy caused further decrease (-1.8 ± 0.5). Z-score showed an improving tendency at the end of the maintenance therapy (-1.6 ± 0.5; p<0.05), followed by further improvement later (-1.2 ± 0.4 [p<0.01] and -0.9 ± 0.4). Vitamin D levels showed improvement after intensive venous chemotherapy (20 ± 3.1 ng/ml vs. 31 ± 2.6 ng/ml at multi-year follow-up; p<001). Phosphate and alkaline phosphatase levels did not change considerably during the period considered. Cholesterol levels increased continuously during treatment (at the time of diagnosis 3.28 ± 0.3 mM/l vs. at the end of the maintenance therapy 4.62 ± 0.2 mM/l; p<0.0001). A similar trend was observed with HDL cholesterol levels (0.53 ± 0.09 mM/l vs. 1.48 ± 0.14 mM/l). CONCLUSION: In summary, we can conclude that follow-up of these children, osteodensitometric measurements and monitoring of laboratory parameters are extremely important, as bone abnormalities can occur in leukemia patients. Orv Hetil. 2020; 161(49): 2086-2093.