Endocrine Abstracts

Patient a 30 year old female was referred to Endocrinology from ED. Patient had presented to ED with palpitations and anxiety. Was having these symptoms for last month and had no other medical illness, not on any regular medications. In ED had ECG done which showed sinus tachycardia, had Bloods done which showed picture of Hyperthyroidism so was referred to Endocrinology. She was started on oral propranolol for symptomatic relief and the TRAB antibodies, TPO antibodies were requested. On examination she had no evidence of Thyroid eye disease and goiter. She was seen later in Clinic after repeating her TFTs in week time to exclude thyroiditis. The TFT showed similar picture as on presentation to ED, The TRAB antibodies were positive and diagnosis of Auto immune thyroid disease was made. She was treated with ATD (Carbimazole) and during counselling was warned about the side effects of ATD as agranulocytosis. The dose of ATD was titrated and the patient was on ATD for 2 years. After the period of 2 years she was given a trial off ATD after explaining the risk of relapse around 50%. Unfortunately she had a relapse of her condition and she was considered for definitive management. In her case she was referred for RAI therapy. She was warned about the precautions to be taken and the risks involved. She decided to proceed with RAI. She was warned about pregnancy and was advised to be on contraceptives for 6 months post RAI. She went ahead with RAI after confirming negative pregnancy test. She was restarted on ATD after the RAI as per guidelines and the dose of ATD was titrated and stopped after 3 months. During the surveillance of her TFTs after stopping the ATD there was a relapse of her condition which was managed with restarting the ATD. She is currently being counselled for the second trial of treatment with RAI or lifelong ATD treatment.

Discussion points: -Etiology of Hyperthyroidism as Autoiimune / Thyroiditis -various etiologies/ Multi nodular goiter.-Importance of counselling about pregnancy and precautions before and after RAI for treatment of Autoimmune thyroid disease.