With the onset of the COVID-19 pandemic and the development of widespread vaccination strategies, there have been case reports in the adult literature suggesting an increase in thyroiditis after COVID-19 vaccination. We herein describe 2 children who presented with thyroiditis after COVID-19 vaccination. Two children who received Pfizer-BioNTech COVID-19 messenger RNA vaccines later developed symptoms of thyroid hyperactivity, had positive thyroid-stimulating immunoglobulin (TSI) levels and received treatment directed toward Graves disease. Our case series is the first to demonstrate Graves disease after COVID-19 vaccination in the pediatric population. Given this possibility, it is important for pediatricians to be watchful for symptoms of thyroiditis post vaccination to prevent treatment delays.
Background: Children with type 1 diabetes (T1D) require frequent outpatient evaluation to assess glucose trends, modify insulin doses, and stay up to date with screening. Continuous glucose monitoring (CGM) has become more prevalent in recent years and provides a detailed glycemic control assessment. Telemedicine is increasingly utilized in lieu of in-person visits, especially since the onset of the COVID-19 pandemic. Objective: To assess a difference in CGM profile parameters in the periods immediately before and after T1D follow-up visits and determine whether being seen by telemedicine versus in-person impacts this difference. Methods: A dual center retrospective chart review was conducted including outpatient T1D follow up visits for patients aged 5-21 years old utilizing Dexcom CGM during the 2021 calendar year. CGM profile parameters assessed were Time in Range (TIR) and Glucose Management Indicator (GMI) during the period 4-weeks leading up to each outpatient visit, compared to the 2-week and 4-week period immediately following. Results: A total of 269 outpatient visits (41.2% telemedicine) among 135 patients were included from both study sites. Mean TIR increased by 1.63 and 1.35% during the 2-week and 4-week period after each visit, respectively (p = 0.003, 0.013). Mean GMI also improved, decreasing by 0.07% and 0.06% during the 2-week and 4-week period after each visit, respectively (p = 0.003, 0.021). These changes in TIR and GMI were not statistically different between telemedicine versus in-person visits (p = 0.40, 0.29). Conclusions: This study detected a small, but statistically significant improvement in CGM profile parameters immediately after outpatient visits. Telemedicine versus in-person visits were comparable. These findings suggest that multiple visits over time are needed to obtain a sustainable, clinically relevant change in glycemic control, and telemedicine can be utilized just as effectively as traditional visits to achieve this goal. Disclosure C. J. Ferber: None. H. Wilhalme: None. S. Mittelman: None. T. Moin: None. R. A. Hicks: None.
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