Late diagnosis of severe long-standing autoimmune hypothyroidism after the first lockdown for the Covid-19 pandemic: clinical features and follow-up.

BACKGROUND AND AIM: Hashimoto's thyroiditis (HT) is a common endocrinopathy in children, particularly in females. Clinical overt presentation of hypothyroidism in HT includes mild to very severe forms, characterised by impairment of many body functions and organs, such as heart, brain, muscles, ovaries and liver. CASE: we report the case of a 14-year-old girl, with severe hypothyroidism due to a late diagnosis of HT during the Covid-19 pandemic. Routine biochemical and hormonal exams were carried out at presentation. Moderate pericardial effusion was detected by echocardiography and polycystic ovarian morphology (PCOM) was found on the pelvic ultrasound. Furthermore, high levels of creatine phosphokinase (CPK), Lactic Acid Dehydrogenase (LDH) and hepatic liver enzymes, associated with muscular pseudohypertrophy and bilateral weakness of the lower limbs, were suggestive of a rare presentation of long-standing hypothyroidism defined Kocher-Debre-Semelaigne syndrome (KDSS). Levothyroxine replacement therapy was started immediately, leading to a rapid improvement of symptoms and a progressive normalization of the biochemical parameters. Due to persistent lower limb weakness, further neurological investigations were performed, showing bilateral peripheral polyneuropathy (PNP), ascribable to the longstanding and severe hypothyroidism. A pelvic ultrasound, performed after thyroid hormones had normalised and menses had turned to be regular, showed normal ovarian features supporting the hypothesis of the Van Wyk and Grumbach syndrome in a post-menarcheal girl. CONCLUSIONS: although clinical manifestation of hypothyroidism are usually mild, more severe and rare presentations such as ovarian dysfunction and myopathy are possible, particularly if the diagnosis is delayed and replacement therapy is not promptly administered.

Bimodal Distribution of Thyroid Dysfunction Triggered by Covid-19 Infection. An Experience From a Single Endocrine Centre. A Short Report & Literature Review (preprint)

Purpose: Covid-19 infection has been spreading across the globe since the end of 2019 and it continues to cause chronic multi-system sequalae, of which thyroid dysfunction appears to be a major one. We aim to present cases Methods: : Case series report. Results: : Over the period from October 2020 to July 2021, a series of 10 cases of thyroid dysfunction due to Covid-19 infection were seen and managed in a single outpatient endocrine centre in Doha, Qatar. These are 6 cases of Graves hyperthyroidism, two cases of chronic primary hypothyroidism including one with GD treated by RAI therapy, two cases of subacute thyroiditis and one case with ‘Thyroxin Thyrotoxicosis’, and finally one case of central hypothyroidism. Conclusion: This report is the largest to be reported from a single centre so far, and it points to a bimodal distribution of thyroid dysfunction in patients with covid-19 infection. A review of the literature and discussion of possible pathophysiological mechanisms is presented. We stress the importance of screening for thyroid dysfunction in post-Covid cases, as the prevalence may be underestimated.

From smart working to smart Co-working in the COVID-19 era: a pilot program of cooperation on chronic endocrinological and rheumatological disease (preprint)

Background: The last months were signed by the pandemic diffusion of COVID-19, with the need to minimize the inflow of children and adolescents affected by chronic diseases into the hospitals. Otherwise, paediatricians had to limit visits and to consider a new setting for febrile children.Patients were assisted by telephonic consultations guaranteed by the paediatricians of free choice and by the paediatric specialists. However, patients frequently needed a direct specialistic evaluation in the case of flares, abnormal laboratory parameters and adverse reactions to drugs.Another frequent question was the differential diagnosis of febrile episodes, to distinguish a recurrent fever, linked to autoinflammation, from an infectious disease.We proposed to paediatricians of free choice in west-Sicily a questionnaire about difficulties met in the follow-up of children with rheumatologic diseases, autoinflammatory syndromes, congenital hypothyroidism.Results: 55 questionnaires were collected: the most frequent recorded conditions were periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA syndrome) and Familial Mediterranean Fever; Juvenile Idiopathic Arthritis, congenital hypothyroidism.All the paediatricians needed specialistic support to adequately control flares, adjustment of drugs dosage.Conclusions: Patients and paediatricians need a specialistic support for the follow-up and to reach a good compliance to treatment.This period characterized by smart working, telemedicine, strategies to monitor remotely the patients, can find the winning strategy in the approach of the “Co-working”, a new cooperation between hospital and paediatricians of free choice, in the global follow-up of paediatric chronic diseases.