Endocrine Abstracts

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 1.96, T4 11.1 and T3 2.7. Later in May 2014, she presented to her GP with weight fain and her repeat TFTs showed TSH 6.72, FT4 was 14.8 and FT3 4.7, consistent with transient sub clinical hypothyroidism. By October 2014 her TFTs normalized again with TSH 1.5 and FT4 14.7 without any thyroid replacement. In October 2015, she had features of over active thyroid with TSH 1.5 and normalize by itself. She was prescribed propranolol during that period. Her TPO antibody was 216. In Feb 2016, her TFTs were normal with TSH 5.78 and FT4 12.1 and she was discharged from clinic. In Feb 2018, she started to feeling tired and weight loss and fatigued. Repeat TFTs showed TSH was 0.30, FT4 14.6. No treatment given. She has another TFTs in march 2018, showed TSH of 15.7 and TPO antibody was significantly raised to 1209 iu/l. Based on these result, she was started levothyroxine 25 mcg. There was no neck tenderness and goiter. Her TRAB was checked in May 2018 and it was <0.3 and TSH was 6.0. The last TFTs in September checked with TSH well within the normal limits of 2.3 and was on LT4 25 mcg once a day. The two main disorders that comprise autoimmune thyroid disease are Hashimoto thyroiditis and Graves’ disease. The Hashimoto is the most common cause of hypothyroditis, whereas the Graves’ is major cause of hyperthyroidism. Occasionally, a patient may present with features of one of these disorders at one time and features of other at another time. The usual sequence is hyperthyroidism followed by hypothyroidism, however, vice versa can be seen in these type of patients.