Endocrine Abstracts

Aim/introduction: The main purpose of this work was to describe a clinical case of thyrotoxicosis with concomitant HASHARON hemoglobinopathy scrutinizing whether the latter could hinder radioiodine therapy (RIT).

Materials and methods: Patient H., 53 years old, diagnosed with moderate toxic diffuse multinodular goiter. Clinical manifestation of the disease were in summer 2018 (TSH – 0 mIU/ml). Medication with thyrozole (20 mg) was initiated. Thyrotoxicosis recurrence in case of discontinuation antithyroid drug therapy proved. Instrumental methods of diagnostics was performed prior to RIT: ultrasound signs of nodular goiter (TIRADS 2) mixed with thyroiditis, thyroid volume – 8.6 ml; 99 mTc-pertechnetate scintigraphy shows increased thyroid uptake index – 2.7%. In 2000 patient was diagnosed with some unclear abnormal hemoglobin. Complete blood count was prescribed prior RIT: RBC 4.33 × 10 12/l, Hb 131 g/l, MCV 85 fl, RTC 1.04%; biochemical blood analysis: total bilirubin 24.2 µmol/l, bound 4.8 µmol/l, free 19.4 µmol/l, iron 10.2 µmol/l; according to ultrasound examination of the abdominal cavity and kidneys – no signs of pathology; hemoglobin electrophoresis revealed pathological HbS fraction of 17%. DNA diagnostics of the globin alpha chain genes showed the presence of the missense mutation (Asp47His) in the HBA2 gene, resulting in a heterozygous state, resulting in to the formation of abnormal hemoglobin Hb Hasharon. Thus, the diagnosis of hereditary hemoglobinopathy with the presence (17%) of unstable Hasharon hemoglobin in a heterozygous form was verified.

Results: 02.07.2019, RIT with 131I activity of 400 MBq. RIT follow up: monthly monitoring of the level of TSH, free T3, free T4 as well as the levels of red blood cells, hemoglobin, total, indirect and direct bilirubin; the level of TRAb and ultrasound of the thyroid gland – after 3 and 6 months. Hypothyroidism was established at the end of 2 months after RIT. Over the entire observation period (6 months), the patient’ condition remained satisfactory. There were no episodes of any anemia or significant increase in bilirubin level. Thus, no side effects after RIT were observed.

Conclusion: Clinical case illustrates the approach of patient’ preparation prior to RIT and follow up after RIT in the presence of unstable hemoglobin Hasharon. Taking everything into consideration there is no influence on safety of RIT thyrotoxicosis in patients with similar hemoglobinopathies, however, it individual approach in each case can not be excluded.