Endocrine Abstracts

A 40-year-old female was referred for further management of thyrotoxicosis to GSTT. She worked as a nanny and had Graves’ thyrotoxicosis since October 2019. Her presenting symptoms were weight gain, hair loss, insomnia, and increasing anxiety. She had a large palpable goitre on examination with no eye disease. Ultrasound of the thyroid showed a diffusely enlarged thyroid with a normal echotexture, reflectivity and vascular flow. Benign subcentimeter nodules were seen in each lobe, consistent with U2 nodules. No retrosternal extension was seen. ECG: Rate-controlled AF She was started on Carbimazole 60 mg OD in November 2019. This was tapered to 40 mg OD as the patient suffered from flu-like symptoms. However, due to ongoing thyrotoxicosis, it was subsequently increased to 60 mg OD. She became pregnant in April 2020 and was started on PTU 300 mg. The patient medically terminated the pregnancy in September 2020. She had to be restarted on Carbimazole 40 mg due to an isolated increase in alkaline phosphate. In September 2021, she developed coryzal symptoms and stopped carbimazole. Carbimazole was again restarted at the lower dose of 20 mg OD which continued till August 2022. She stopped her treatment in August 2022 because she disagreed with the management plan of her local endocrinology team and was referred to GSTT. At GSTT, she was started on PTU 50 mg BD after reporting an adverse reaction to Carbimazole. In February 2023, she developed severe neutropenia with PTU, so the anti-thyroid medications had to be discontinued. She also received three doses of G-CSF. She is now awaiting a thyroidectomy.