Endocrine Abstracts

38 year female presented to the endocrine clinic with palpitations. On further questioning she reported weight loss, diarrhoea but normal menstrual cycles. She was diagnosed in September 2022 with thyrotoxicosis in a country outside UK and was commenced on carbimazole 20 mg once daily. Blood investigations in September 2022- TSH 0.02 serum FT4 31.0 FT3 8.17). Bloods repeated by GP 4 months later after arrival in UK, showed the following: Serum TSH 23.45, serum T4 1.20, serum T3 1.82. GP stopped Carbimazole after viewing the bloods results. Two months after stopping Carbimazole, she represented with palpitations. She never smoked. Blood tests in January 2023 showed TSH <0.01 FT4 43 FT3 >30.7 TSH receptor antibodies 28.90. On examination, she had tremor and there was a large goitre with no palpable nodules nor bruit. Proptosis with lid swelling was evident on eye examination. She was restarted on carbimazole 30 mg od and propranolol 40 mg bd. Referral was made to thyroid eye clinic. Radio iodine treatment couldn’t be offered due to thyroid eye disease. Surgery was discussed given the large goitre and significantly elevated TSH receptor antibodies. This reiterates the need to monitor thyroid function after initiating treatment for Graves disease. In this case, abruptly stopping the treatment before completion of the recommended course has resulted in re-presentation with Graves. Another important aspect is discussion about use of contraception, pregnancy and warning regarding the side effects of thionamides. This lady was not aware of the teratogenic effects (treatment commenced outside UK) or has not been advised to get pregnant whilst on thionamides (the patient was actively trying to get pregnant). This case illustrates the importance of not just diagnosing a condition, but providing appropriate advise and monitoring to guide the therapy in order to achieve effective control of the disease.