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.

Foreign body type reaction causing differential diagnostic difficulty after appendectomy / Differenciáldiagnosztikai nehézséget okozó fonálgranuloma appendectomia után.

Összefoglaló. Az appendectomia szövodményei a leggyakrabban a korai posztoperatív idoszakban jelentkeznek. A mutét után évekkel megjeleno szövodmény ritka. Egy 11 éves kislányt vizsgáltunk 2 hete fennálló hasi panaszok miatt. Anamnézisében 8 évvel ezelott hagyományos módon elvégzett appendectomia szerepel. Az Ausztriában készült elso hasi ultrahangvizsgálat eltérést nem talált. Az intézetünkben elvégzett képalkotó vizsgálatok - hasi ultrahang, MR-vizsgálat - ileocoecalisan elhelyezkedo szolid terimét igazoltak, és felvetették a folyamat gyulladásos eredetét. A szerteágazó klinikai tünetek, a laboratóriumi és a képalkotó diagnosztikai eltérések kapcsán differenciáldiagnosztikai szempontból a gyulladásos bélbetegség lehetosége is felmerült, és biztonsággal a tumoros folyamatot sem sikerült kizárni. A rosszabbodó status miatt mutét történt. Ennek során a colon ascendenssel összefüggo, makroszkóposan tumoros megjelenésu elváltozást távolítottak el. A szövettani vizsgálat malignitást nem igazolt, a folyamat idegen test okozta - varróanyag-granuloma - krónikus gyulladásos jellegét erosítette meg. A vizsgálatok kapcsán coeliakia is igazolódott. A hasi mutétek ritka szövodménye a Schloffer-tumor, melyet idegen test típusú - gyakran sebészi varróanyag-maradvány körüli - granulomatosus gyulladásos folyamat jellemez. Az entitás ismerete differenciáldiagnosztikai szempontból fontos. Nehezítette a diagnózist az elso hasi ultrahangvizsgálat negatív eredménye és az egyidejuleg manifesztálódó coeliakia. Orv Hetil. 2021; 162(3): 112-115. Summary. Generally, complications with appendectomy occur during the early postoperative stage and are quite rare years after the operation. In case of late manifestation of complications, the clinical signs are generally unspecific. We report a case of an 11-year-old girl - who underwent an appendectomy 8 years ago - with abdominal pain during the last 2 weeks. The first ultrasound examinations were carried out in Austria with normal results. In our department, the ultrasonography and the MR examinations showed an inhomogeneous abdominal mass which was connected to the abdominal wall and with the suspicion of inflammation. Because of the diversified results of radiology imaging and laboratory test, inflammatory bowel disease and tumor were considered in the differential diagnosis. During the operation, a tumor-like lesion related to the ascending colon was found. The histopathological examination revealed a foreign body type suture granuloma with a central abscess. Malignancy was not found. The clinical investigation proved celiac disease, too. The Schloffer tumor is a rare complication after abdominal surgery. This is a foreign body type inflammatory granuloma mainly around a surgical thread. The knowledge of the entity is important in differential diagnostic aspect. The presence of celiac disease in combination with the negative result of the first ultrasound examination made the exact diagnosis more difficult. Orv Hetil. 2021; 162(3): 112-115.