Endocrine Abstracts

We have been seeing an 82 year old lady in endocrine clinic since 2017. She was initially admitted via ED in September 2017 with sudden onset confusion and left sided weakness. MRI confirmed ischaemic stroke with evidence of an acute right sided posterior cerebral artery infarct affecting right occipital and superior cerebellar regions. She was also noted to be in atrial fibrillation, and was also found to have significant thyrotoxicosis with a supressed TSH, FT4 60, FT3 30. There was no palpable goitre and no clinical evidence of thyroid eye disease. However she was strongly positive for both TSH receptor and anti-TPO antibodies, consistent with a diagnosis of Graves’ disease. Carotid dopplers normal. She had a sister with hypothyroidism, otherwise no known family history. Initially treated with aspirin, bisoprolol, atorvastatin and carbimazole 40 mg daily; aspirin was subsequently switched to warfarin and she was discharged after 2 weeks, having made good progress clinically. Subsequently carbimazole was gradually titrated down based on TFT and she was able to stop carbimazole in May 2019. Diagnosed with transitional cell carcinoma of the bladder in May 2020, but has otherwise remained well. She remained euthyroid off treatment until TFT in July 2020 showed evidence of relapse with a TSH of 0.03, FT4 19.4, FT3 6.7. She was then restarted on carbimazole, which she has tolerated well, and dose again adjusted based on TFT. She was well and euthyroid when last reviewed in December 2022 on carbimazole 5 mg alternate days. In summary this lady presented with ischaemic stroke, likely due to AF, in turn likely related to thyrotoxicosis.