Endocrine Abstracts

Objective: Graves’ disease (GD) occurs as a result of genetic and environmental factors that trigger autoimmunity. Some pro-inflammatory cytokines have already been linked to an increased susceptibility of developing GD. Recently, it has been reported that Covid-19 infection and SARS-CoV-2 vaccination trigger the emergence of new GD cases or disease recurrence as environmental factors due to the pandemic. However, there is no data in the literature reporting the effects of this pandemic in GD patients who are newly diagnosed and followed up under medical treatment. Here, we aimed to report the effect of the pandemic (vaccination/infection) on the prognosis while examining the cytokine level changes in patients with newly diagnosed GD and receiving treatment.

Material and method: Between December 2019 and June 2021, 41 newly diagnosed GD patients (30 Female/11 Male) were included in the study. The control group consisted of 38 age and gender matched healthy individuals. Cytokine (TNF-alpha, IFN-gamma, IL-10, IL-13, IL-17, IL-22, IL-23 and IP-10) levels were measured by ELISA method from serum samples at baseline and at 6th and 12th months of antithyroid drug (ATD) treatment.

Results: The mean age of the patients was 41.02±11.6 years. Baseline serum TNF-alpha (P=0.11) and IP-10 (P=0.003) levels were higher in GD patients than in controls. As seen in the Table below, serum IFN-gamma, IL-13, IL-17, and IP-10 levels were significantly decreased compared to baseline under ATD treatment. In contrast, other cytokine levels did not differ statistically with treatment. Of the patients who had both clinical and hormonal control under ATD treatment, 90% (n=37) were vaccinated, and 41% (n=17) had Covid-19 infection. In both cases, there was no increase in either ATD doses or TSH receptor antibody levels.

Conclusions: The significant decrease in IP-10, IFN-gamma, IL-13 and IL-17 levels with antithyroid treatment showed that these cytokines may play a role in GD in our population. In addition, it was observed that neither Covid-19 infection nor vaccination adversely affected disease activity in GD patients who were newly diagnosed and whose disease was controlled by ATD treatment.