Endocrine Abstracts

Controversy exists as to the best way to determine which thyroid nodules we should have fine needle aspiration (FNA). The lack of consensus in the British and American Thyroid Association guidelines has not helped to clarify this. The use of ultrasound scan (USS) determined U grading versus a composite of nodule size and pre-determined number of suspicious features continues to be debated. We therefore set out to compare the accuracy of U grading with other identified USS feat...

Perturbations in thyroid function are common in older individuals but their significance in the very old is not fully understood. We examined thyroid hormone status (serum TSH, FT4, FT3, rT3) at baseline in a cohort of 643 85-year-olds and followed their mortality and disability outcomes for 9 years. All cause mortality, cardiovascular mortality and disability according to categorical thyroid disease status and baseline thyroid hormone paramete...

Thyroid hormones are important regulators of fetal growth, although their mechanism of action remains unclear. In the sheep fetus, thyroid hormone deficiency increases plasma insulin and leptin concentrations. This study investigated the effects of hypothyroidism on perirenal adipose tissue (PAT) development and adipose insulin signalling pathways in fetal sheep.All procedures were performed under the UK Animals (Scientific Procedures) Act 1986. In 10 tw...

Background: Clinically significant Graves’ orbitopathy (GO) develops in 20% of those with Graves’ Disease (GD). Up to 90% of cases present at the same time as, or after, hyperthyroidism develops. Most cases of GD in the UK are managed in endocrinology clinics. Despite this, patients report significant delays before a correct diagnosis of GO is made. We argued that measures to increase awareness of the early signs of GO in those with GD and establishing a fast-track r...

Maternal thyroid hormones play a critical role in foetal brain development in the first 12 weeks of gestation. Children born to hypothyroid mothers, especially those undertreated, are more likely to suffer lower IQ. Based on BES guidance 2007 and NICE 2011 at confirmation of pregnancy a woman with hypothyroidism should immediately increase the dose of levothyroxine by 25–50 mcg with aim TSH of less than 2.5 mu/l as soon as possible with monitoring of TFT every 4 weeks.</p...

Background: Radioiodine is used as a method of treating hyperthyroidism secondary to Grave’s disease and toxic goitres. Radioiodine therapy most often results in patients becoming hypothyroid, however a small percentage of patients (around 10–20%) require repeated doses to treat persistent hyperthyroidism.Aim: The aim of this audit was to determine the outcome of patients who received radioiodine for hyperthyroidism over 5 years period.<p c...

Introduction: Graves’ disease is the commonest cause of hyperthyroidism accounting for 80% of all cases. The first line treatment for Graves’ disease in the UK is medical therapy, most frequently using a ‘dose-titration’ regimen. Currently, there is a lack of guidance to aid clinicians in carrying out optimal dose-titration of carbimazole, resulting in a risk of under- or over-treatment. Thus, we aimed to develop a carbimazole dosing-algorithm for the medic...

Background: Graves’ disease is the commonest cause of hyperthyroidism. Although first line and definitive treatment options are clearly defined, management practices and the natural history in terms of outcomes of treatment in a large consecutive cohort of Graves’ disease has not been well characterised.Aims: To describe incidence, presentation, diagnosis, management strategies and medium term outcomes following anti-thyroid drug treatment, rad...

Resistance to Thyroid Hormone alpha (RTHα) is characterised by tissue-selective hypothyroidism with near-normal thyroid function tests, and is due to thyroid receptor α gene mutations. We sought to correlate the clinical characteristics and response to thyroxine treatment of two RTHα patients with the properties of their defective TRα proteins.Clinical, biochemical and physiological parameters were assessed in each patient at baseline...

Purpose: To evaluate the impact of thyroid eye disease (TED) on occupational disability and access to psychological input. Previous European studies have demonstrated a negative effect of TED on occupation but there are no similar UK studies.Methods: 102 outpatients under the age of 75 were identified for participation from a joint thyroid eye clinic at a tertiary centre. 42 completed a standardised fixed-choice questionnaire about occupational disabilit...

Background: TSH receptor antibody (TRAb) measurement, with a sensitivity of >97% and specificity of 100%, is considered the gold standard investigation for diagnosing Graves’ disease (GD).Aim: To evaluate clinical diagnosis of GD or non- GD hyperthyroidism at a University Teaching Hospital compared to TRAb result.Methods: Electronic records of patients who had a TRAb measurement between December 2009 and October 2015 were ...

Background: The autoimmune thyroid diseases, primary autoimmune hypothyroidism (AH) and Graves’ hyperthyroidism (GD), represent the most prevalent endocrine disorders. Although clinically distinct, they share several genetic susceptibility loci, many of which remain unidentified.TIGIT (T cell immunoreceptor with immunoglobulin and ITIM domains), expressed on the surface of T-cells, interacts with CD-155 on dendritic cells to form an alternative cost...

Background: An association between breast cancer (BC) and thyroid autoimmunity has been frequently observed, and several small-scale studies correlated the presence of autoantibodies to thyroid peroxidase (TPOAb) with an improved BC outcome. We aimed to clarify in a large cohort of patients whether circulating TPOAb are prognostic for BC recurrence.Materials and methods: Available plasma samples for patients with node-positive or high-risk node-negative ...

Despite extensive genomic profiling a better understanding of the contributory factors that promote aggressive thyroid cancer is urgently needed. The proto-oncogenes PBF and PTTG have been implicated in thyroid cancer but there is a lack of information regarding their co-expression and specific roles in tumour progression. Separate studies have previously indicated that PBF and PTTG may disrupt pathways associated with the tumour suppressor p53 that are central to DNA-damage r...

Context: Serum TSH reference range increases with age but target TSH is similar in younger and older hypothyroid patients on treatment. It is unknown if quality of life (QoL), hypothyroid symptoms and cardiovascular (CV) risk factors change in older patients in whom a higher serum TSH is aimed for.Objective: To assess if a higher target serum TSH of 4.01–8.0 mU/l is feasible in and acceptable to older treated hypothyroid patients.<p class="abste...

Background: Accurate diagnosis of an underlying cause of thyrotoxicosis is critical for targeted therapy. Thyroid radionuclide uptake scan is a useful second line investigation in patients who lack TSH receptor antibody. The uptake scan patterns identify patients who can be preferentially treated with anti-thyroid drugs (diffuse pattern - Graves’ disease) or radio-iodine treatment (patchy uptake - multinodular or localised uptake – toxic adenoma) or simple monitoring...

Introduction: Approximately 25% of medullary thyroid cancer (MTC) cases arise in a familial setting, either as MEN2 or fMTC. While most of these are caused by mutations in the RET gene, a few families have unidentified mutations. Recently, a frameshift mutation in the ESR2 gene (coding oestrogen receptor beta) was found in a family with RET-negative fMTC associated with C-cell hyperplasia. In vitro, transfection of mutant ESR2 led t...

Objectives: To evaluate outcomes post radioiodine (I-131) therapy for hyperthyroidism at a tertiary hospital in a two-year period.Method: The local database (Leicester Clinical Workstation) was used to identify patients with hyperthyroidism who had received radioiodine therapy (RAI) between January 1st 2010 and December 31st 2011 and their records were retrospectively analysed.Results: 84 patients were identif...

Background: Diagnosing secondary hypothyroidism can be challenging, particularly for patients with low-normal free T4 (fT4). Thyroid hormone replacement (THR) in these cases is guided by the normal population fT4 range. The aim of this study was to compare thyroid function tests in thyroid cancer patients on THR and patients with pituitary diseases with or without central hypothyroidism.Methods: We retrospectively collect...

Introduction: Weight concerns are common in endocrine outpatients. Weight indices seem to have a complex interaction with thyroid function. The two have not been studied in eastern Mediterranean populations.Methods: Prospective collection of baseline data on weight, BMI and thyroid function on consecutive patients presenting to an endocrinology outpatients. The setting included a medical centre in Limassol, Cyprus. Exclusion criteria were as follows: age...

A prolonged course of antithyroid drugs (ATD) is commonly used as first line treatment in patients with hyperthyroidism, although long term cure rates are poor – 40–50%. We performed a longitudinal analysis of outcomes in patients treated with a complete course of ATD and identified factors predicting remission.583 consecutive patients with newly diagnosed hyperthyroidism presenting between 2005 and 2014 and treated with ATD for a minimum of 6 ...

Background/Aim: Radioactive-iodine (RAI) therapy aims to cure hyperthyroidism, with some International authorities recommending a sufficient RAI dose to render patients hypothyroid. An audit on low dose RAI (<400 MBq) at our University Hospital in 2014 suggested above national average rates of Thyrotoxicosis relapse (24%) and lower rates of hypothyroidism (41%) 6-months post RAI. From 2015, a fixed dose (555 MBq) RAI was utilised and we present the audit outcomes using thi...

Aim: Patients with thyroid nodules, usually undergo FNA, prior to considering surgery however the results may not be conclusive. Our aim is to compare the cytology results in patients who have had two FNA’s with post-operative histology.Methods: All patients who have had thyroidectomy and two pre-operative FNA’s over 7 years were identified. Post-operative histology and FNA cytology was collected from pathology records. Standard ‘Thy’...

Aim: Investigation of thyroid nodules usually involves an ultrasound and fine needle aspiration (FNA); however it could still be challenging to devise a management plan based on these. The aim of our study was to compare the reliability of two thyroid FNA’s and ultrasound in comparison to post-operative histology in managing thyroid nodules.Methods: The data on patients who had underwent thyroidectomy and had at least two FNAs and Ultrasound pre-ope...

Background: Graves’ disease (GD) is an auto-immune condition where the thyroid gland produces excess hormones due to stimulation of the TSH receptor. Treatments for GD have largely remained unchanged for over 60 years. The commonest treatment strategy is to use anti-thyroid drugs (ATD) which has limited efficacy and may have serious side-effects. Newer therapies are required that will supplement existing therapies and impact on the underlying immune mechanisms of GD. Vita...

TSH receptor antibodies (TRAb) are autoantibodies directed against the TSH receptor, predominantly located on the thyroid epithelial cell surface. Two types of TSH receptor antibody have been found to exist in patients with autoimmune thyroid disease: thyroid stimulating antibodies (TSAb) and TSH-stimulation blocking antibodies (TSBAb). It has generally been felt that patients with positive TSAbs develop Graves’ hyperthyroidism and those with TSBAb antibodies develop hypo...