Endocrine Abstracts

A 25-year lady was referred to GSTT for further management of thyrotoxicosis as she had relocated to London. The patient developed thyrotoxicosis during her pregnancy at the age of 23. During her pregnancy, she had significant weight loss. Her thyroid function test in September 2020 showed TSH 0.04 mU/lwith FT4 of 24.1 pmo/land TSH receptor antibody of 1.35 U/l. Hence she was started on propylthiouracil (PTU) during pregnancy. PTU was titrated down based on biochemical response. However, she relapsed in the post-partum period in April 2021. Her TSH <0.01 mU/lwith FT4 of 41.5 pmol/l. Carbimazole was initiated at 40 mg per day. However, she developed swelling of her joints, thought to be carbimazole-related, and PTU was restarted. Nausea and vomiting were problematic, and therefore PTU was discontinued promptly. On review at GSTT in March 2022, she was found to have clinical features of thyrotoxicosis, with a body weight of 44 kg. There was a smooth goitre and no thyroid eye disease. Her thyroid function test showed TSH < 0.01 mU/l, FT4 of 77.0 pmol/l, FT3 of 28.2 pmol/lTSH receptor antibodies at 8.22IU/l, TPO antibodies at 175 U/ml US examination: Heterogeneous hypervascular thyroid gland. No suspicious discrete nodules are identified. As it was uncertain whether PTU had resulted in adverse effects, PTU 150 mg TDS was re-initiated. She complained of ongoing palpitation and was started on beta-blocker. However, she had an allergic reaction following the commencement of the beta-blocker. Hence her medications were stopped, and she was offered surgery as a definitive treatment option for her thyrotoxicosis. As she remained thyrotoxic before surgery, she was pre-operatively started on Lugol’s Iodine at a dose of ten drops TDS. This was commenced ten days before surgery to prevent thyroid storm. The patient had thyroid surgery on the 13th of June, 2022. The histopathological examination of the thyroid specimen demonstrated no evidence of malignancy. There were features consistent with treated Graves’ thyrotoxicosis.

Post-Surgery: June 2022 showed satisfactorily corrected calcium of 2.18 mmol/lwith PTH 9 nanograms/land TSH controlled at 0.5 mU/l.