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Endocrine Abstracts

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Society for Endocrinology Endocrine Update 2019

Clinical Update

Additional Cases

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Workshop H: Miscellaneous endocrine and metabolic disorders
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ea0062cb1 | Additional Cases | EU2019

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ea0062cb2 | Additional Cases | EU2019

Persistent hyperthyroidism post-total thyroidectomy

Mangion Jessica , Montebello Annalisa , Vella Sandro

A 51-year-old lady known to suffer from Graves’ disease with associated orbitopathy since the age of 29 years, presented to endocrine outpatient clinic in view of recurrent symptoms of hyperthyroidism. She complained of heat intolerance, lethargy, tremor and diarrhoea. Appetite was normal and her weight remained stable. She had no worsening of visual symptoms. She was on carbimazole 5 mg daily since a year before. She had multiple courses of carbimazole in the past with s...
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ea0062cb3 | Additional Cases | EU2019

Endocrinopathies post immune check point inhibitors

Hamza Malak , Van Heeswijk Isabelle , Yahia Seif , Fernando Devaka , Abdulla Haitham , Muraleedharan Vakkat

Introduction: Immune adverse related events are commonly recognized complications of immune check point inhibitors. Here we identify multiple endocrinopathies occurring concurrently in the same patient. In addition to highlighting the common immune adverse effects seen in other cases.Case 1: 33F Refractory Hodgkins Lymphoma tried on several therapies. She was started on Nivolumab (PD-1) with remarkable response. She developed symptoms of Amenorrhea, gala...
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ea0062cb4 | Additional Cases | EU2019

Propylthiouracil-induced ANCA-associated vasculitis and agranulocytosis in a patient with Graves’ disease

Tomkins Maria , Smith Diarmuid , Agha Amar

42-year-old female with relapsing Graves’ disease treated with propylthiouracil (PTU) presented to the Emergency Department with a two-week history of fevers, night sweats, transient rash, arthralgia and fatigue. Five years previously she presented with Graves’ disease, TSH <0.02 mIU/l, FT4 of 39.8 pmol/l (9–16 pmol/l) and TSH receptor antibody positive with a titre of 11.3 IU/l. Initially treated with carbimazole therapy but developed an urticarial rash, lo...
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ea0062cb5 | Additional Cases | EU2019

The double edge sword steroid facilitated diagnosis of primary thyroid lymphoma

Ali Mudassir , Pervez Muhammed , Mounter Philip , Shanker Vivek , Kamaruddin Shafie

Introduction: Primary thyroid lymphoma (PTL) is a rare cause of malignancy, accounting for <5% of thyroid malignancies and < 2% of extra-nodal lymphomas. Most thyroid lymphomas are non-Hodgkin’s lymphomas of B-cell origin. Patients with Hashimoto’s thyroiditis are at greater risk for developing PTL. We report a rare case of primary thyroid lymphoma in a patient presenting with a rapidly enlarging thyroid goitre highly suspicious of anaplastic thyroid carcinom...
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ea0062cb6 | Additional Cases | EU2019

Resistant Grave’s disease not amenable to Thionamides, Thyroidectomy and Radioactive iodine

Haider Najaf , Sim Sing , Butt Nouman , Cranston Iain

Grave’s disease is an auto-immune condition associated with hyperthyroidism caused by TSH-receptor antibodies (TRAB) expressed by follicular cells of the thyroid gland. Grave’s ophthalmopathy has been reported in 25% of the patients and is rarely associated with dermopathy and thyroid acropachy. Management is by anti-thyroid drugs, radioactive iodine ablation or surgery, either alone or in combination. We present a rare case of resistant Graves who has detectable ant...
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ea0062cb7 | Additional Cases | EU2019

Autoimmune thyroiditis with fluctuating antibodies

Kumar Ramesh , Saraf Sanjay

This is the case 32y old Asian lady, who first presented to her GP in October 2013 with weight loss, palpitations and fatigue and found to have overactive thyroid. She has not experienced any neck pain or systemic illness. She has some neck tenderness but not goitre or any extra-thyroidal manifestation of Graves’ disease, hence the thyroid nucleotide scan was requested. His scan was consistent with thyroiditis. By January 2014 her thyroid function test normalized with TSH...
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ea0062cb8 | Additional Cases | EU2019

Interpretation of bilateral petrosal sinus sampling in Cushing’s disease

Almazrouei Raya , Hatfield Emma , Martin Niamh , Meeran Karim

Case: A 46-year-old woman was initially investigated for right sided intermittent headaches for one year. Her MRI head revealed a pituitary adenoma. She had no history of vomiting with the headache episodes and had no history of visual acuity or field defect. She had amenorrhoea for the past 10 months. Prior to this, she had regular periods following her menarche at the age of 12 years. She admitted to easy bruising but had no hirsutism or acne. She did not report any weight g...
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ea0062cb9 | Additional Cases | EU2019

To treat or not to treat: Two interesting cases of Alemtuzamab related Thyroid disorder

Zaman Shamaila , Khalid Neelam , Behary Preeshila , Todd Jeannie

Alemtuzumab, a humanized anti-CD52 monoclonal antibody is effective in treating multiple sclerosis. However, it has been associated with thyroid disorder in up to 30–40% patients. While Graves’ disease is the most common disorder (70%), thyroiditis has been reported up to 4.9% cases.Case 1: 34 year old woman with the background of multiple sclerosis and autoimmune hypothyroidism (on levothyroxine 50 mcg OD) was given Alemtuzumab infusion in Jul...
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ea0062cb10 | Additional Cases | EU2019

Amiodarone induced thyroid dysfunction

Rafique Shemitha , Jacob Koshy

68 year old lady was on amiodarone for atrial fibrillation and poor left ventricular systolic function. She was feeling unwell, so she had some blood tests which showed elevated free T4 and suppressed TSH. She did not have a family history of thyroid disease. She did not have a goitre or eye signs. She did not have overt signs of thyrotoxicosis. She was admitted as her heart failure was not controlled and her diuretics were optimised. Her thyroid antibodieswere checked and was...
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ea0062cb11 | Additional Cases | EU2019

Pretibial Myxoedema (Thyroid Dermopathy) – a forgotten textbook sign!

Sim Sing Yang , Haider Najaf , Butt Nouman

A 46 years old gentleman was referred by his GP to cardiology with 3 weeks history of bilateral leg swelling and rash associated with breathlessness and palpitations. He has no other past medical history to note. He smokes 20 cigarettes a day and works as a manager in a window installation company. He was started on diuretics and further investigations were arranged by cardiology. His symptoms persisted with worsening of skin rash. He was reviewed by GP again 1 month later. He...
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ea0062cb12 | Additional Cases | EU2019

Acromegaly… challenges and treatment aspects

Hussein Ziad , Srirangalingam U

Case history: We report a 25-year-old man who presented to Neurology with two years history of a migrainous headache mainly at night. MRI head scan demonstrated large lobulated pituitary macroadenoma with significant suprasellar extension and anterior visual pathway compromise along with distortion of the basal forebrain, particularly on the right. Consequently, he was referred to the endocrinology team for further management. Upon initial assessment, he reported foot size enl...
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ea0062cb13 | Additional Cases | EU2019

Unusual thyroid case… Flying away from the herd…!

Hussein Ziad , Chung T

We report a 42-year-old female who was known to have autoimmune hypothyroidism for nearly 20 years with positive antiTPO antibodies. She was well controlled on levothyroxine including three antenatal periods when she required a slightly higher dose of 125 mcg daily. No significant past medical history and denies use of herbal/over the counter medications. In early 2017, the patient started to experience nonspecific symptoms of lethargy and tiredness. Her thyroid state was mana...
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ea0062cb14 | Additional Cases | EU2019

A case of amiodarone-induced hypothyroidism

Mifsud Simon , Imbroll Miriam Giordano , Gruppetta Mark

A sixty-four-year old lady with a past medical history of total thyroidectomy for Graves’ disease and atrial fibrillation on amiodarone was referred to the endocrine out-patients in view of hypothyroidism. Since starting amiodarone, the TSH was noted to be elevated at 75 mU/l and the free T4 was 18 pmol/l. The patient complained of non-specific lethargy and was administered levothyroxine 50 mcg daily. Despite this her TSH remained elevated at 147 mU/l with a free T4 of 17...
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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