Endocrine Abstracts

Purpose: Hypothyroidism has been associated with atrial fibrillation (AF) in some studies. This study aimed to characterize thyroid related genetic variants that may change susceptibility to AF in patients on thyroid hormone replacement therapy (levothyroxine).Methods: A case-control study was done among patients of European Caucasian ethnicity from the Genetics of Diabetes Audit and Research Tayside (GoDARTS) recruited in Tayside (Scotland...

Aim: We aimed to undertake a population-based approach to describing the prevalence and incidence of chronic hypoparathyroidism. There are very few reports on the epidemiology of this condition.Methods: Data linkage of all biochemistry, hospital admissions, prescribing and death records was undertaken in Tayside Scotland (population 400,000) from 1988 to 2015. Patients with at least 3 serum calcium concentrations below the reference range f...

Worldwide, ˜300,000 new cases of differentiated thyroid cancer are reported per annum and thyroid cancer now represents the most rapidly increasing cancer in the US and in the UK. In general terms, outcome is good (10-year survival >90%). However, up to 25% of patients develop local or regional recurrences, and have a significantly reduced life expectancy. We hypothesise those thyroid tumours which subsequently recur display a distinct pattern of driver ...

Background: Maternal severe iodine deficiency has been associated with pregnancy and neonatal loss but the impact of mild-moderate iodine deficiency on pregnancy is not well-documented. Mild-moderate iodine deficiency during pregnancy is common even in iodine replete countries. In the UK women of reproductive age have been found to be mildly-to-moderately iodine deficient. UI/C is an optimal indicator for iodine status in pregnancy.Aims: We...

Context: Subclinical hypothyroidism is a common clinical problem defined as an elevation in serum thyrotrophin (TSH) with normal circulating free thyroid hormone levels. Empiric treatment of mild subclinical hypothyroidism (mSCH) is controversial.Objective: To evaluate the change in the levothyroxine prescribing rate and TSH testing following a decrease in the TSH reference range from 6 to 4 mU/L in a large urban center.<p class="abstex...

Introduction: Thyroid dysfunction is common affecting 5–10% of the adult population. Cardiovascular disease, including acute myocardial infarction (AMI), has been suggested as one of the adverse outcomes of thyroid disease. Furthermore, individuals with thyroid dysfunction at the time of AMI have worse outcomes. Despite this, there is scarce data on the prevalence of thyroid dysfunction in patients with AMI. We conducted a prospective observational multi-cen...

Introduction: The Oxford multidisciplinary thyroid eye disease (TED) clinic comprising an oculoplastic surgeon, rheumatologist and endocrinologist with access to orthoptics, neuroradiology and radiotherapy was established in 2013. The aim of the service is to facilitate rapid referral and treatment in a specialist centre in keeping with the Amsterdam Declaration. Early use of steroid sparing agents (SSA) and recently rituximab form part of the treatment regimen.<...

Introduction: Thyroid quality indicators were removed from the Quality Outcome Framework (QOF) targets in 2014, resulting in discontinuation of statutory system alerts to remind GPs to check annual thyroid function in patients with primary hypothyroidism treated with levothyroxine.Aim: To investigate the impact of the discontinuation and reinstitution of the QOF thyroid e-alerts on the management of hypothyroidism in primary care.<p cla...

Aim: We aimed to investigate mortality and morbidity in patients who were identified with primary hypoparathyroidism, post-surgical and non-surgical hypoparathyroidism.Methods: The patients who were previously identified with hypoparathyroidism, were linked to hospital admission dataset, renal registry, biochemistry dataset and prescribing dataset. In this study, death and 6 morbidities; cataract, circulatory system, infection, fracture, me...

Introduction: Following treatment of Graves’ disease (GD), levels of thyrotropin receptor autoantibodies (TRAb) tend to decrease depending on treatment modality and length of follow up. We have assessed TRAb biological activity at follow up, years after GD treatment.Subjects and methods: TRAb concentration and biological activity were measured in 69 GD patients (59 females; 10 males; median age 59 years; TRAb positive at diagnosis), with follow up r...

Iodine is a trace element required for thyroid hormone production. Requirements increase in pregnancy, when even mild deficiency may affect offspring neurocognitive development.The gold standard for assessing iodine status is population surveys of urinary iodine concentration (UIC). The WHO also suggests a population prevalence of >3% of TSH values > 5 mIU/L indicates deficiency. A recent UK survey of 700 teenage girls demonstrated ...

Background: The third generation thyrotropin receptor antibodies (TRAb) assay has high sensitivity and specificity in diagnosing Graves’ disease (GD). Circulating levels of TRAbs predict the disease course of Graves’ orbitopathy (GO) and remission rates in GD. However, the relationship between TRAb and thyroxine (FT4) and the factors affecting their interaction are unclear.Method: A prospective cohort study was conducted to evalua...

Background: Thionamides are a safe and effective treatment for Graves’ thyrotoxicosis and tend to be favoured over radioiodine in the UK. Risk of recurrence following cessation of thionamides is high although most studies tend to have short duration of follow up. We have previously published follow-up data to 4 years in this cohort and now present follow-up out to 7 years.Methods: Retrospective review of first presentation Graves’...

Purpose: Early diagnosis and treatment of Graves’ orbitopathy (GO) are essential to prevent physical and psychological burdens of advanced disease. MRI diffusion weighted imaging (DWI) is an emerging modality to assist with timely diagnosis. We investigated the value of DWI in early diagnosis and monitoring and its relationship with the clinical activity score (CAS) and quality of life (QoL) scores in a joint endocrine/ophthalmology clinic.<p class="abst...

Background: The cost of liothyronine (T3) has significantly increased, possibly affecting prescription practices.Methods: An online questionnaire was designed to assess current T3 use by UK endocrinologists and to determine whether the price increase resulted in a change in primary care prescription practices. Consultant grade members of the Society for Endocrinology Thyroid Network were invited to partake.Results: Re...

Introduction: B lymphocyte activating factor (BAFF), a member of the tumour necrosis factor family, is essential for B cell activation, differentiation and survival. It promotes autoantibody production and as Graves’ disease is caused by thyroid stimulating autoantibodies, it is an excellent functional candidate gene. Indeed, elevated serum BAFF levels have been found in patients with several autoimmune diseases, including Graves’ disease (GD). The T al...

The optimum approach to long-term follow-up of well differentiated thyroid cancer (DTC) remains unclear. We assessed the outcome of DTC patients followed in primary care (PrC) from Edmonton, AB with tertiary care (TrC) settings from Halifax, NS and London, ON. Patients who met the following criteria were identified: a) Initial diagnosis between January 1, 2006 to December 31, 2011, b) primary tumourA total of 317 patients, (PrC=93 and TrC=2...

Introduction: Autoimmune thyroid disease is a multifactorial disorder, which has been linked to the exposure of certain environmental factors.Aims and Objectives: To investigate whether thyroid autoimmunity (TAI) is significantly associated with identifiable and potentially modifiable environmental factors in Maltese individuals.Materials and Methods: A case-control observational study was conducted among 324 Maltese ...

Background: Alemtuzumab (ALTZ) is a humanised monoclonal anti-CD52 antibody used as effective treatment for relapsing/remitting multiple sclerosis (MS), causing panlymphopenia with subsequent lymphocyte repopulation. Unfortunately, around 40% of patients develop secondary humoral autoimmunity, mainly affecting the thyroid gland. Anti-thyrotropin-receptor (TSHR) autoantibodies (TRAb) can stimulate (TSAb), block (TBAb) or not affect (‘neutral’) TSHR function, with TSAb...

Background: Sporadic and familial autosomal dominant non-autoimmune hyperthyroidism (S/FANH) is caused by activating germline mutations in the TSH Receptor (TSHR) gene. These patients lack TSHR-Ab, show diffuse uptake on radionuclide thyroid scan and often lack positive family history due to variable penetrance. Because of these overlapping features, S/FANH is difficult to distinguished from Graves’ disease without autoimmune features. Ther...

Background: Patients being treated for differentiated thyroid cancer (DTC) receive a dose of Radioiodine for remnant ablation. Occasional patients appear to have little or no iodine uptake at all in the thyroid bed or else where even shortly after thyroidectomy.Objective: To evaluate the influence of ‘Coexisting Thyroiditis’ on radioiodine uptake in thyroid cancer ablation doses.Methods and Design: Retrospec...

Objectives: The aim of the study was to evaluate the normal reference values for thyroid uptake using Technetium-99 m (Tc-99 m) pertechnetate.Methods: Sixty-seven euthyroid patients with primary hyperparathydism who underwent parathyroid imaging with Tc-99 m pertechnetate between January 2012 to April 2014 at the Nuclear Medicine department, Newcastle upon Tyne Hospitals was studied. Electronic medical records and biochemical thyroid functi...

Background: Subacute thyroiditis is a self-limited inflammatory thyroid disorder with a triphasic clinical course of thyrotoxicosis, hypothyroidism, and return to euthyroidism. Whilst glucocorticoid (GC) treatment is advocated for managing moderate-to-severe symptoms, the ideal initiating dose and titration regime is unclear. Traditionally, doses of up to 40 mg of prednisolone have been used. More recently, to minimize adverse effects, a 15 mg initiation dose of ...

Background: We previously reported that a high number of synacthen tests are carried inaccurately within our trust with a significant delay in sample collection after tetracosactide injection. We also reported a high number of patients having Synacthen tests unnecessarily. In light of this we introduced a Synacthen proforma and re-audited our results.Method: A retrospective study was carried out on 36 patients undergoing Synacthen tests bet...

Background: Grave’s Disease (GD) is the most common cause of hyperthyroidism and its effect of health status is well known. Beta blockers (BB) are routinely used to control thyrotoxic symptoms in initial phase of treatment of GD.Objective: To study the effect of BB on quality of life (QOL) in patients with GD using different BB; propranolol, nebivolol and metoprolol succinate.Method: A cohort prospective study was conducted on...

Introduction: Radioiodine is used for the treatment of Thyrotoxicosis when medical treatment (anti-thyroid drugs) has failed or cannot be tolerated and surgical treatment is not an option. Our previous audit in 2011 demonstrated substantial adherence to the Royal College of Physicians (RCP) guidelines for Radioiodine treatment, but one patient was lost to follow-up. It was recommended that we improve our re-call system. We aimed to re-audit our service.<p ...

Introduction: Radioiodine (RAI) is safe and effective but further information to predict outcomes, specifically treatment failure and residual symptoms following treatment of hypothyroidism, may help improve outcomes.Methods: Retrospective, observational, single-centre study. Electronic medical record review (n= 664) and patient questionnaire (n= 174).Results: Complete cohort: Analysis of outcomes li...

Introduction: Nowadays, thyroid Ultrasound (US) is a reference exam and the best way for detection, diagnosis and monitoring of thyroid nodules suspect of malignancy. It allows selection of suspicious thyroid nodules for malignancy.Our aim was to assess contribution of this exam using the TI-RADS score in order to establish the correlation with cytological results.Materials and methods: A prospective study of 395 pati...

Introduction: Graves’ disease is an autoimmune disorder of the thyroid gland causing over-production of thyroid hormone. Although this disorder can lead to systemic changes throughout the body, the most common extrathyroid manifestation of Graves’ disease is ophthalmopathy. Patients can have significant ocular prominence from the increase in intraconal and extraconal fat and muscular hypertrophy. This can lead to vision changes, decreased ocular motilit...

Background: The British Thyroid Association’s thyroid cancer guidelines (2014) advocate the U1-5 nodule grading system as a primary diagnostic and classification tool.Aims: We assessed whether practice reflected guidelines, and examined patient outcomes.Methods: Patients with a thyroid ultrasound, undertaken by radiographers or general radiologists, in January-June 2015 were identified. Investigation and outcomes...

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Moyamoya disease is a progressive chronic neurological disease due to multiple narrowing of the carotid arteries. It can be seen in association with atherosclerosis, vasculitis, haematological conditions, connective tissue disease, neurocutaneous syndromes and certain autoimmune diseases. Very few cases have been reported in association with Graves disease and the majority being in the East Asian population. We present a rare case of this association in a young C...

Background: Radioiodine treatment (RIT) for benign functioning thyroid disease is an effective treatment for patients with hyperthyroidism. The safety, preparation, administration and follow-up of treatment demands time and organisation. The planning of this elective treatment is affected by the patient’s availability which makes adequate and timely treatment of the subsequent hypothyroidism challenging. A quality improvement project was therefore set up to mitigate this....

65 yr female presented with headaches, heat intolerance and loose stools. She had cerebrovascular accident, osteoporosis and vitiligo. A 24 hr ECG revealed atrial flutter with heart rate upto 117 beats /minute. Her medications include warfarin and bisoprolol.A Thyroid function test (TFT) revealed Free T4 (Ft4): 32 pmol/L (9-19) Free T3: 7.97 pmol/L (3.6–6.5), TSH: 5.7 mU/L (0.35–4.94). Other anterior pituitary function tests were ...

Antithyroid drugs can cause hepatic dysfunction, from mild derangement to severe, fulminant failure. It is well known that propylthiouracil may cause fulminant liver failure yet we present an exceptionally rare case of this type of adverse drug reaction with carbimazole.A 75 year old woman presented to hospital with a fall and a two day history of jaundice. Six weeks earlier, she had been diagnosed with both congestive cardiac failure and G...

Severe hyperthyroidism, along with several other endocrinopathies, is well recognised as a cause of myopathy. This myopathic clinical picture varies from mild myasthenia to profound muscular weakness. We present the case of a 61 year old female (Ms SM), with learning difficulties, who presented with a short history of reduced mobility and anorexia. She was noted to have hypernatraemia and acute kidney injury on admission, secondary to poor oral intake and new ons...

Many patients continue complaining of subjective symptoms of hypothyroidism despite being on adequate doses of levothyroxine. There are about 14 studies involving T3+T4 combination including 7 which were rigorously conducted. Majority of them (11 studies) did not show any benefit of combination therapy. But our local experience has been a little different. We looked at small cohort of 15 patients who were on combination T3+T4 for more than 6 months and were asked...

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