Endocrine Abstracts

Introduction: Between 5-10% of patients with hypothyroidism treated with levothyroxine (T4) continue to experience profound symptoms, despite achieving free T4/thyroid stimulating hormone concentrations within reference range. Liothyronine is sometimes added to levothyroxine, but its use is controversial due to uncertainties in clinical/cost effectiveness.Methods: An economic model was developed to estimate the incremental cost per quality-adjusted life ...

This case highlights the lessons learnt from a patient who was diagnosed 37 years following presentation with abnormal Thyroid Function Tests (TFTs). Mrs ID had a subtotal thyroidectomy in 1983 for thyrotoxicosis and was started on levothyroxine. She was referred to endocrine services in 2003, and was noted to have a small goitre and abnormal TFTs. Follow up consultations concentrated on thyroxine dose adjustment and querying compliance. She had a background of COPD, CVA (2018...

Background: Recent evidence favours the use of TRAB in patients with hyperthyroidism (a) at presentation to identify the aetiology and predict outcomes (b) at the time of withdrawal of medical therapy to predict remission and (c) during pregnancy. However, If TRAB is not requested at an appropriate time, it may not help, may mislead or add to cost.Aim: To review the current process of requesting TRAB in line with available evidence and identify areas for...

A 37-year healthy man initially presented to primary care with weight loss and palpitations and diagnosed to have thyrotoxicosis based on thyroid function tests (TFT) – TSH (< 0.05; n = 0.27-4.20μIU/l), FT4 (59.8; n = 12-22 pmol/l), and FT3 (32; n = 3.1-6.8pmol/l) . CBZ was started and 4-weeks later was seen in the Endocrine clinic where Graves’ disease was confirmed based on a goitre and positive antiTSH receptor antibody. However...

Background: Euthyroid hyperthyroxinaemia can present a diagnostic challenge. Abnormalities in the binding proteins of thyroid hormones can cause this discordant picture of thyroid function tests, with thyroxine binding globulin being the protein most commonly affected. Familial dysalbuminaemic hyperthyroxinaemia is a rarer cause, and is an autosomal dominant condition which can present with euthyroid hyperthyroxinaemia. This condition is associated with a mutation in albumin w...

Background: The surgical technique and the extent of thyroidectomy are related to parathyroid injury and hypoparathyroidism.Methods and results: We retrospectively analyzed the files of 552 patients who underwent thyroidectomy in our surgery department between 2015-2017 with the aim to assess the incidence and impact of intraoperative features that may predispose to postoperative hypoparathyroidism (PoSH).Results: 171 (30.97%) pati...

Subacute thyroiditis (SAT) is a self-limited inflammatory condition of the thyroid characterised by a clinical course of hyperthyroidism, hypothyroidism, and then return to normal thyroid function. The inflammation is thought to be triggered by a viral infection and is usually treated with anti-inflammatory medications and steroids. Recurrences can uncommonly occur and could be difficult to manage. There are some promising reports of the role of Colchicine in managing recurren...

Presentation: A 32-year-old woman was brought to the Emergency Department following an out-of-hospital cardiac arrest. CPR was started by a neighbour and on arrival, she was found to be in ventricular fibrillation (VF). She received 4 DC-shocks and reverted to atrial fibrillation with fast ventricular rate and staged a full cognitive and haemodynamic recovery. She had a 10-year history of Graves’ thyrotoxicosis for which she was on Carbimazole but remained uncontrolled du...

Background: Graves’ disease and Hashimoto’s thyroiditis are the most common autoimmune thyroid conditions. Hyperthyroidism following hypothyroidism is a rare phenomenon. Hypothyroidism was once thought to be a permanent state requiring lifelong replacement therapy but we have noted that there are increasing numbers of cases which are against this postulation. We would like to report 3 cases initially diagnosed with hypothyroidism and referred to us following developm...

A 65-year-old lady who was known to hypothyroidism and was treated with Levothyroxine 100microgram once daily for more than 20 years presented to the endocrine clinic with symptoms and signs of thyrotoxicosis. Apart from Levothyroxine, she was taking over-the-counter multivitamins and Vitamin D. Visual fields were full to confrontation and there was no goitre. Thyrotoxicosis was confirmed biochemically and levothyroxine was stopped. Despite being off Levothyroxine for more tha...

Neonatal autoimmune hyperthyroidism is rare but potentially fatal condition. It occurs in 1-5% of infants born to pregnant mothers with Graves’ disease (GD). We present a case of transient neonatal thyrotoxicosis born to pregnant women with GD and high TSH Receptor antibodies. 42 years pregnant lady was referred to Antenatal Endocrine clinic at Walsall Manor Hospital in 15th week of pregnancy with symptoms of Thyrotoxicosis. She has GD and was taking Propylthio...

During the past year and a half during the Covid pandemic it has been noted that cases of abnormal thyroid functions post Covid infection rises and few case report published related to thyroiditis. For this we want to present one of our own patient who had Covid 19 infection in January 2020 with good recovery and after that she had symptoms of hyperthyroidism including palpitation weight loss and heat intolerance. It was confirmed with undetectable TSH and high T4 of 30. She w...

Aim: To evaluate the outcomes of radioactive iodine therapy (RAI) in benign thyroid disease following implementation of 2007 Royal College of Physicians (RCP) guidelines in a large NHS foundation trust.Method: The medical records of patients referred for RAI therapy at Sheffield Teaching Hospitals (UK) between 2013 and 2015 were retrospectively reviewed. Patient data was collected from patients’ notes and electronic documents system. The data record...

Background: Amiodarone-induced thyrotoxicosis is sometimes extremely difficult to treat necessitating emergency thyroidectomy with perioperative risks including possible thyroid storm. We obtained near normalization of free T3 (FT3) by pulse Methylprednisolone prior to thyroidectomy for drug-resistant Amiodarone-induced thyrotoxicosis.Case Description: A 56 year old man (BMI 29.7 kg/m2), with history atrial flutter/fibrillation, episodes of fa...

A 36-year-old lady presented at 26-weeks gestation with symptoms of palpitations, anxiety, tremors, and breathlessness. She had received the 1st dose of the mRNA vaccine (Pfizer) for Covid-19 a month prior and her symptoms started a couple of weeks after the vaccine. She was a gravida 4 para 2 with gestational diabetes diagnosed during previous pregnancies and also early on in the current pregnancy requiring insulin treatment maintaining excellent antenatal glycaemic control. ...

Background: Iodine deficiency is a well known cause of goitre and abnormal thyroid function but is rare in patients born in the UK. Iodine is primarily found in fish and dairy products and patients who avoid these foods may be at risk of iodine deficiency.Case: A 22 year old gentleman was referred to endocrine clinic with an unusual pattern of thyroid function tests (TFTs). He had a goitre on examination. He had a background of irritable bowel syndrome a...

Introduction: Risk of thyroid cancer is 17-32% in cold nodules and <1 % in hot nodules. Hot nodules are usually associated with Thyrotoxicosis. Patients with thyroid carcinoma are usually euthyroid but may be associated with hypothyroidism. We report 3 patients with hyperthyroidism and associated thyroid carcinoma.Case 1: A 17 years old lady presented with a lump in the neck and examination revealed prominent nodule on the right. TFTs were suggestive...

Pituitary hyperplasia is a relatively common condition that occurs in both physiological and pathological states. Pregnancy is the most common condition associated with physiological pituitary enlargement, associated primarily with lactotroph hyperplasia. Pathological hyperplasia has been shown to be associated with end organ insufficiency from primary gonadal insufficiency, primary adrenal insufficiency, and primary hypothyroidism. We present the case of a 33-year-old male wi...

Endometriosis is a common gynaecological condition caused by the abnormal growth of endometrial-like tissue outside the uterus. There are currently no biomarkers validated for non-invasive diagnosis and the exact aetiology is unknown; however, the association between endometriosis and thyroid dysfunction has recently been reported. We aimed to investigate the value of thyroid hormone testing in predicting the odds of an endometriosis diagnosis. Retrospective data was taken fro...

We present a case of a young female, who was diagnosed with Graves’ thyrotoxicosis in 2019 with very high TSH Receptor antibody. She had a goitre and mild thyroid ophthalmopathy and was commenced on carbimazole. She was followed up in the Endocrine Clinic and carbimazole was titrated according to the clinical and biochemical picture. Her past medical history included epilepsy, generalised anxiety, and emotionally unstable personality disorder. She had difficult social cir...

Introduction: Levothyroxine is the first choice treatment for patients with hypothyroidism However, some people would continue to have symptoms of thyroid disease despite biochemical control on levothyroxine. Others might be intolerant to levothyroxine.Aim: The aim of this audit is to evaluate UHL endocrinology practice against local and national guidelines with regards to prescribing and monitoring of liothyronine treatment in 2019.<p class="abstext...

32 year old female with no prior past medical problems presented to hospital with a two week history of rapid onset delusional psychosis with religious themes, paranoid ideas and rapidly developing into catatonia. There was no previous history of psychiatric disorders. On physical examination the Glasgow Coma Score (GCS) was 15 and she was responding to visual hallucinations; speaking to imaginary person and reported seeing objects. She was afebrile and bedside observations we...

A 36-year-old woman was admitted with newly diagnosed Grave’s disease due to significant symptoms. Blood results revealed fT4 83.2 (pmol/l) TSH <0.01 (mIU/l), and TSH Receptor Antibody 4.56 (0-0.4 U/l)). She was commenced on Propylthiouracil (PTU) thrice daily alongside Propranolol. She had a blood test in 4 months’ time, when she was 5 weeks pregnant. Blood results suggested profound hypothyroidism with fT4 4.7 (pmol/l) and TSH 82.02 (mIU/l), and she was commenc...