New Graves Disease Diagnoses in Youth Before and During the COVID-19 Pandemic

ABSTRACT

Objectives The relationship between Coronavirus disease 2019 (CV-19) and thyroid disease remains undefined. Given reports of increasing incidence of autoimmune disease and observed trends in new Graves Disease (GD) diagnoses since the start of the CV-19 pandemic, we sought to assess the incidence and characteristics of new GD diagnoses in youth prior to and during the CV-19 pandemic. We hypothesized that there was an increased incidence in new onset GD in youth during the pandemic, and that patients with new onset GD were more symptomatic during the pandemic compared to those diagnosed prior to the pandemic. Methods We performed a retrospective chart review of all patients ages 0-18 years old with new onset GD diagnosed at a tertiary care pediatric hospital between 1/1/2018-8/31/21. March 1, 2020 was considered the start of the pandemic period. We ran two tailed t-tests and Pearson's chi-square tests using Microsoft Excel to compare findings between the pre-pandemic and pandemic groups and set significance to a p-value of 0.05. Results Over a 44-month period, 44 patients were diagnosed with GD at an average age of 13.5 years (SD 4.3). Most (81.8%) were female. There were gradually increasing numbers of new GD diagnoses over time 8 in 2018 (average rate of 0.667 new diagnoses/month), 9 in 2019 (0.75 new diagnoses/month), 14 in 2020 (1.167 new diagnoses/month), and 13 in the first 8 months of 2021 (1.625 new diagnoses/month). Age, gender frequency, TSH levels, and free T4 levels did not differ before and during the pandemic (Table 1). A greater proportion of patients required beta blockade at time of diagnosis in the pandemic period (65.4%) compared to the prepandemic period (22.2%) (p = 0.0048) (Figure 1). Methimazole doses (mg/kg) did not differ by year. None were treated with radioactive iodine or surgery at diagnosis. Conclusions We observed a rise in the annual number of youth diagnosed with GD during the CV-19 pandemic. Youth with GD required treatment with beta blockers more during the CV-19 pandemic compared to prior, suggesting more symptomatic and/or later presentations. Further work is needed to understand the relationship between CV-19, the CV-19 pandemic, and GD in youth.