Are Thyroid Functions Affected in Multisystem Inflammatory Syndrome in Children?

Objective: 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. Methods: 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. Results: 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). Conclusion: 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.

Elevated neurotensin levels among obese adolescents may be related to emotion dysregulation and impulsivity: a cross-sectional, case-control study

Obesity can affect 5.0 % of children worldwide, especially among the economically disadvantaged.1 It may affect children across all age groups and there seems to be a temporal trend of increase within the last 40 years.1,2 The current consensus is that pediatric obesity may arise due to interactions between biological, developmental, behavioral, genetic and environmental factors.3 The ongoing COVID-19 pandemic may also contribute to the emergence and persistence of pediatric obesity.4 Neurotensin (NT) is a 13 amino acid peptide secreted from the enteroendocrine cells in the small intestine and the central nervous system.5 It may modulate the dopaminergic, serotonergic and glutamatergic function in the nigro-striatal and meso-cortical limbic systems and may have an anorexigenic effect via the lateral hypothalamic region.6,7 Various pre-clinical studies suggest that it may have a role in anorexia as a response to stress, emergence of anxiety- like behavior, hedonic eating, reward/ reinforcement and memory.8-11 A recent review suggested that NT may have therapeutic potential12 and another study suggested that elevated levels of its precursor may predict weight gain and associated metabolic abnormalities among children.13 Butler et al. (2015) found that plasma NT levels were elevated among children with PraderWilli syndrome characterized by hyperphagia via decreasing gastric motility.14 Available studies suggest that pediatric obesity at least in a subgroup of patients may be associated with elevated levels of anxiety, impulsivity and emotional eating.15-17 Despite the importance of NT functioning in those constructs, no study up to now has evaluated the relationships between NT levels and anxiety, impulsivity and emotion regulation among obese children. [...]in this study, we aimed a) to compare serum NT levels among obese and healthy adolescents b) to compare self-reported emotion regulation, anxiety and impulsivity scores among obese and healthy adolescents, and c) to investigate the relation of NT with emotional regulation, anxiety and impulsivity among obese adolescents. Obese adolescents with a body mass index (BMI) >95 percentile and healthy adolescents with a BMI between 3 and 85 percentiles, according to the data of Turkish National Growth Charts [A], who had similar age and gender distribution and admitted for routine control were enrolled in the study.19 Patients with underlying endocrine (hypothyroidism, Cushing syndrome, etc.) or non-endocrine (hypothalamic dysfunction, drug use, syndromic diseases) pathologies were excluded from the study. Anthropometric Evaluation Height (cm), body weight (kg) and waist circumference (cm) of all cases included in the study were measured after an overnight fast in the morning.