Endocrine Abstracts

A 68 year old gentleman referred to endocrinology clinic with a few years history of erectile dysfunction (ED), which manifested as reduced libido and partial erections. Investigations revealed primary hypogonadism with a low morning serum Testosterone of 4.8 (Ref: 7.9-31 nmol/l), raised FSH at 47 (Ref:1.5-12.4 iu/l) LH at 36.8 (Ref: 1.7-8.6iu/l) and normal thyroid function tests (TFTs). The patient declined testosterone replacement therapy following a discussion of pros and cons of the risk vs benefit. Clinical examination revealed a deep seated right thyroid lobe and also a possible right thyroid nodule. Ultrasound (US) thyroid showed a right U3 nodule of 6.3x4.1mm. Subsequent cytology following US guided Fine Needle Aspiration (FNA) of the right U3 nodule revealed Thy3f. According to the Royal College of Pathologists ^[1] Thy3f suggest follicular neoplasms whose characteristics are difficult to distinguish between benign or malignant nature. The Royal college of pathologists also states that the malignant potential of Thy3f nodules to be approximately 15-30% ^[1]. The options of surgery vs monitoring by means of US guided FNA of the thyroid nodule were discussed. Patient opted for the latter option, repeat Cytology showed Thy1 (non-diagnostic). In view of all of the above and the recommendation from the British Thyroid Association guidelines, patient elected for right hemithyroidectomy ^[2]. The histology revealed the presence of variable size thyroid follicles containing colloid material and no evidence of malignancy. Patient had an uneventful post-operative recovery, and subsequent examination showed a well healed post thyroidectomy scar.

Conclusion: While modern clinical practice tends to lean towards investigations and imaging to guide clinical management, a good history, thorough examination and patient engagement should always be at the cornerstone of every consultation. This in turn can lead to improved patient care and outcome. References 1. The Royal College of Pathologists: Guidance on the reporting of thyroid cytology specimens. (2016). Accessed: February 02, 2022: https://www.rcpath.org/uploads/assets/7d693ce4-0091-4621-97f79e2a0d1034d6/g089_guidance_on_reporting_of_thyroid_cytology_specimens.pdf Perros, P. et al (2014) British Thyroid Association Guidelines for the Management of Thyroid Cancer. Clinical Endocrinology, 81 (Suppl. 1), 1-122