Endocrine Abstracts

A 25 year-old female was referred to endocrinology outpatients from her general practitioner (GP) in view of abnormal thyroid function tests (TFTs). She gave a 2 week history of increasing lethargy limiting her daily activities, loose stools and palpitations. She denied changes in appetite or weight and no neck pain or swelling. No recent history of illness. She has no past medical history and was not on any regular medications. She gave birth to her first child 6 weeks ago. P...

Amiodarone is commonly prescribed anti-arrhythmic drug which can lead to thyroid dysfunction manifesting as either hypothyroidism or hyperthyroidism. This clinical case of amiodarone induced thyrotoxicosis is being reported to highlight the challenges faced during its management. A 72-year-old gentleman was admitted with history of recurrent falls. He had past medical history of non-ischemic cardiomyopathy, CRT, atrial fibrillation, vascular dementia, osteoporosis, primary hyp...

Lithium is commonly used for management of Bipolar disorders. Li-induced thyroid dysfunction, including hypothyroidism and goitre are the most prevalent while hyperthyroidism is very infrequent, mainly characterised by transient painless thyroiditis but it increases the propensity to thyroid autoimmunity in susceptible individuals. Thyroid profile, thyroid auto-antibodies, assessment of thyroid size should be performed among patients initiating lithium, at baseline and later a...

Introduction: Graves thyrotoxicosis can be life-threatening if uncontrolled. Resistant thyrotoxicosis is not uncommon and may require urgent intervention. We present a case with severe refractory thyrotoxicosis which required urgent total thyroidectomy following bridging plasma exchange.Case History: A 35-year-old male with Grave’s disease presented with persistent thyrotoxic symptoms despite medical management for 10 months. Clinically he was hyper...

Introduction: Thyroid dysfunction in pregnancy is not uncommon (1). Early recognition and intervention are essential to avoid any adverse pregnancy outcomes however caution must be exercised while interpreting the thyroid functions during pregnancy to avoid any unnecessary treatment.Case report: 32-year female with was referred to the combined antenatal clinic for review following an abnormal thyroid function tests during pregnancy. She had no known medi...

55-year-old man referred to the medical assessment unit by GP with weight loss and tachycardia. His past medical history was significant for myocarditis, long-QT syndrome, out of hospital cardiac arrest and an in-situ ICD. On examination the patient was tremulous, sweaty and tachycardic but otherwise well. An ECG demonstrated sinus tachycardia and routine blood tests were unremarkable. A clinical diagnosis of thyrotoxicosis was made and confirmed biochemically with TSH<0.0...

History: 72 yr. Female, Initially presented to A&E with new confusion and speech disturbance. NEWS of 7- RR 22, sats- 98% on RA, BP 162/107, HR-124, and T- 37. AMTS- 7/10. PMH: depression, previous dysphasia, Medication: Amitriptyline, Omeprazole.Investigations: FBC, UE, LFT, CRP, Cholesterol levels, urine dip Normal and CT head – normal. ECG – Sinus tachycardia. Observations improved and no obvious cause found for confusion patient was dis...

A 39-year-old female was referred to the emergency department with a sore throat, fever, myalgia and odynophagia. She had presented to her GP three months previously with palpitations, erratic mood and fatigue and had been diagnosed with hyperthyroidism. She had been started on carbimazole 20 mg od and was awaiting review in endocrinology OPD. She had no other past medical history and was a non-smoker. On examination she was tachycardic with a heart rate of 113. She had cervic...

A 31 year old female patient initially presented with a two month history of unintentional weight loss. Past medical history included multiple sclerosis, for which she had last received alemtuzumab immunotherapy five months previously. Thyroid function tests (TFTs) demonstrated hyperthyroidism, with Thyroid Stimulating Immunoglobulins (TSI) 5.71 iu/l(NR: <0.56). She was diagnosed with Graves’ disease, possibly induced by alemtuzumab, and commenced on carbimazole. She ...

A 41 year old female, followed up closely by cardiology in view of grown up congenital heart disease secondary to tricuspid atresia, pulmonary stenosis and atrial septal defect in infacy, and brittle paroxysmal atrial fibrillation (AF) was noted to be progressively lethargic and anorexic. She also developed bilateral lower limb oedema and was admitted for further investigation of decompensated congestive heart failure (CHF). Overt thyrotoxicosis was found on investigation. Sin...

A 25 year old lady initially presented with symptoms of palpitation, irregular menses and unintentional weight loss. She was a non-smoker with no current pregnancy plans or family history of thyroid disease. On examination, she was tachycardic and had a moderate diffuse goitre but no signs of thyroid ophthalmopathy. She was biochemically hyperthyroid (TSH <0.01 mIU/l, fT4 30.0 pmol/l, fT3 >30.7 pmol/l). Carbimazole 30 mg daily was started for likely Graves’ diseas...

36F from Hungary with a h/o Graves disease in the past which was in remission since 2017 presented to ED at UCLH with a fast heart rate and acute weight loss. Feb 2020 presented with fast heart rate and FT4 84.9, TSH < 0.01. TPO Negative, TRAB raised at 6.5. Patient was commenced on 20 mg carbimazole and 20 mg TDS propranolol, referred to endocrine clinic. Patient missed her appointment in the endocrine clinic as she was in Hungary during the pandemic. June 2020: 15 weeks ...

Case history: A 30-year-old Afrocaribbean lady with a history of Graves’ thyrotoxicosis (2012) and subsequent thyroidectomy (2013) presented to the antenatal clinic in January 2020 at 9+6w gestation. Medication included levothyroxine 125 mg daily. She had a history of neonatal thyrotoxicosis in her first pregnancy in 2017 which required carbimazole therapy due to fetal tachycardia.Investigations: At booking, thyroid function tests (TFTs) showed a TS...

A 56 year old man came to the attention of the endocrine service during an admission with COVID 19. Due to persistent tachycardia he had thyroid function tests (TFTs) which showed TSH <0.01mU/land free T4 of 58 pmol/l. He had reported weight loss over the past couple of months and occasional palpitations but no other features of thyrotoxicosis. He had no personal or family history of thyroid or autoimmune disease. On examination his pulse was 90 beats per minute, had no go...

Background: Conventional management for thyrotoxicosis includes anti-thyroid medications, radioactive iodine and/or surgery. However, in some cases patients are resistant to first line drugs and need second line treatment to normalize thyroid function tests (TFTs) before considering definitive therapy. We present a case of Grave’s disease where patient didn’t respond to first line anti-thyroid medications and required Lithium and Cholestyramine to achieve euthyroid s...

A 35 year old Asian man presented to the emergency department on several occasions with episodes of severe muscle weakness, affecting his arms and legs, to the point he was unable to walk or stand. He was found to be hypokalaemic on both occasions, at 2.3mmol/l and 3.0mmol/l respectively, and his weakness gradually improved with potassium replacement. He gave a history of two years of intermittent weakness and stiffness of the limbs which typically occurred at night or after l...