Endocrine Abstracts

Objectives: Graves’ ophthalmopathy is an immunological manifestation of the orbit associated with autoimmune thyroid disease. The immunopathology, although not completely understood, is driven by B lymphocytes and plasma cells with the production of autoantibodies that have a high affinity for the thyroid stimulating hormone receptor. Understanding the pathogenic architecture of Grave’s ophthalmopathy is important, particularly the role of T-lymphocytes. Two case rep...

Introduction: Acquired primary hypothyroidism is the most common autoimmune endocrine disorder associated with Type 1 Diabetes (T1D). It is associated with presence of antibodies called Thyroid peroxidase (TPO) and requires lifelong supplementation with Levothyroxine. NICE guidelines (NG145) 1 recommends regular surveillance of thyroid levels for primary hypothyroidism every 4-6 months until puberty and then annually. Children and young people (CYP) with diabetes an...

Background: Some forms of thyroid disease (TD) pose significant diagnostic difficulties. The quarterly complex thyroid clinic (CTC) at SVUH facilitates diagnosis and management of less common forms of TD.Methodology: We reviewed the clinical notes of patients attending the CTC from January 2021 to March 2024.Results: 59 patients attended the clinic. The average age was 41.7 years, the majority were female (73%). Referrals were from...

Despite that the standard treatment for hypothyroidism is Levothyroxine, it is now recognised that a certain group of patients would benefit from treatment with Liothyronine either alone or in combination with Levothyroxine. Compared to Levothyroxine, Liothyronine has shorter-half life and can be associated with less predictable biochemical outcomes. In 2021, we published the outcome of the 1 st cycle of audit of use of Liothyronine at the University Hospital of Lei...

Introduction: Polyglandular autoimmune syndrome-type 2 is defined by the presence of autoimmune primary adrenal insufficiency, autoimmune thyroid disease and/or type 1 diabetes.Case report: A 35 year old female was referred to our endocrinology department with lethargy, poor sleep, palpitations, dyspnoea and 1 stone weight loss, menses were regular. Past medical history included iron deficiency anaemia, irritable bowel syndrome, and gastro-oesophageal re...

Selenium (Se) supplementation is recommended by the European Group (EUGOGO) for mildly active TED (200 mg/day for six-months) based on a seminal RCT which reported slowing of disease progression vs placebo. Treatment in Se deficient geographical areas may be particularly important. We recently reported Se deficiency in a cohort of 240 pregnant women in NI. The TEAMeD-NI group was set up in 2019 as part of the UK-wide quality improvement program to take a proactive approach to ...

Ropeginterferon alfa-2b is a mono-pegylated type I interferon (P-I) used in myeloproliferative neoplasm (MPN). Thyroid dysfunction (TD) is a well recognised side-effect of P-I (1). We conducted a review determining TD prevalence and current practice on thyroid function (TF)/antibody (TAB) monitoring during P-I treatment. Retrospective data was collected, from electronic and physical medical records from July 2019-March 2024, on 37 adult MPN patients in the South-West of Irelan...

Graves’ disease (GD) poses significant challenges in management, particularly due to its higher prevalence in women and the diverse treatment modalities available. Antithyroid drugs (ATD), radioactive iodine (RAI) therapy, and thyroidectomy each offer distinct advantages and risks. While ATD is initially favoured for its safety profile, it carries a notable relapse rate and considerable costs. In contrast, RAI boasts a lower relapse rate but elevates the risk of hypothyro...

We report the development of de novo thyroid eye disease (TED) following COVID-19 vaccination, that occurred several years after administration of radioiodine (RAI) therapy for Grave’s disease, rendering the patient hypothyroid and requiring levothyroxine replacement therapy. A 52-year-old lady, who had previously been treated with RAI for an overactive thyroid gland, presented 5 years later with symptoms of dryness and protrusion of her left eye, that was initially notic...

Introduction: Papillary thyroid microcarcinomas (PTMC) are defined as thyroid cancers with a maximum tumour diameter of 10 mm. These neoplasms have become a topic of significant interest, particularly concerning their active surveillance and conservative management. Incidental papillary microcarcinomas (I-PTMCs) discovered post-operatively on histology are less studied compared to lesions identified pre-operatively via FNA, especially regarding demographics, histopathological ...

Introduction: Radioactive iodine treatment (RAI) of thyroid pathologies contributes to endocrine and metabolic complications. Cardiovascular disease (CVD) is a leading cause of mortality and morbidity worldwide. Identification of the subpopulations with a higher risk of developing CVD and lipid metabolic disorders is crucial, particularly in Graves patients.Aim: This study aimed to investigate the usefulness of new anthropometric indices such as BAI, VAI...

With widespread use of sensitive imaging techniques, an increasing number of thyroid nodules are being detected. Thyroid nodules are common and reported to occur in 60% of adults. Most are benign, asymptomatic and do not warrant further intervention. Once detected, however, most patients are referred to endocrinology and/or otorhinolaryngology services for further assessment, adding to the already lengthy waiting lists and contributing to patient stress. An audit was undertake...

Introduction: We aimed to characterise clinical and biochemical features, management and outcome in subjects with thyrotoxicosis who presented for definitive treatment with radioactive iodine (RAI) therapy to our unit.Methods: This retrospective analysis examined patients with Graves’ disease (GD) and nodular thyroid disease (NTD) who were treated with RAI as definitive treatment for thyrotoxicosis between 2008 – 2012. A standard activity of RA...

University Hospital Limerick (UHL) is a large model 4 hospital in Ireland’s Midwest serving a population of ~413,000 people. The radiology department performs an average of 220 thyroid fine needle aspiration biopsies (FNABs) per year. The aim of this study was to determine how many non-diagnostic or unsatisfactory results are returned, necessitating repeat FNAB. Data was collected on the previous 502 thyroid FNAB results using the hospital laboratory information system. O...

Introduction: The connection between rheumatoid arthritis (RA) and thyroid disorders (TD) is primarily driven by overlapping immunological mechanisms, shared genetic factors, and similar inflammatory processes. We aimed to discuss some possible causes and triggers that interplay in both conditions based on data from the literature.Material and methods: Data analysis was done using the systematic search performed in PubMed, MEDLINE, Scopus, Web of Science...

A 15 year old male presented to paediatric endocrinology with a large goitre and a thyroid function test confirming fT4 4.4 pmol/l and TSH 3.0 mU/l. Previous medical history included lifelong atopic eczema and multiple food allergies which had led to the exclusion of nuts, dairy products, eggs and fish from his diet. Autism spectrum disorder had been diagnosed at 4½ years of age. Two subsequent thyroid function tests were unchanged and thyroid auto-antibodies were negativ...

Thyroid Orbitopathy is rarely associated with de novo Primary Hypothyroidism; this phenomenon is incompletely understood. Here we present the case of a 51-year-old female presenting with Primary Hypothyroidism, Thyroid Orbitopathy, and high titres of Anti-TSH Receptor Antibodies (TRAb), and discuss the potential underlying pathogenesis. Our patient first presented to Regional Hospital Mullingar with an unrelated, and ultimately self-limiting, complaint. The Endocrinol...

We present the case of a patient with a diagnosis of thyroid cancer who has developed multiple, sequential autoimmune conditions. Our patient, a now 41 year-old female, was initially diagnosed with Follicular Thyroid Cancer in the context of pre-existing autoimmune hypothyroidism evidenced by serum Anti-Thyroid Microsomal antibodies as well as lymphocytic thyroiditis on post-operative histopathology. The association between autoimmune thyroid disease and Thyroid Cancer has bee...

The NHS is an evolving organisation facing huge challenges (bed pressures, lack of workforce/specialists, outpatient waiting lists etc.) while still striving to provide best possible patient care. Our Endocrine Specialist Nurses (ESNs) are an integral part of endocrine services in creating an individualised, smooth patient pathway. They are a link between endocrinologist, patients and community services to ensure high quality care for all. A dedicated ESN clinic with direct ac...

Background: Thyroid nodules incidentally picked up on imaging studies are extremely common with a prevalence of around 50% in the general population. Ultrasound characterization using the British Thyroid Association (BTA) U classification system is commonly employed in the United Kingdom and Ireland. Most reported nodules are classified as U3 which indicates an indeterminate suspicion of malignancy. There are limited data on the malignancy rates in U3 nodules.<p class="abs...

Cerebral venous sinus thrombosis (CVST) represents approximately 0.5-1% of all patients with strokes. It is associated with conditions resulting in a hypercoagulable state, typically occurring in young women during pregnancy and taking the combined oral contraceptive pill (COCP). Thyrotoxicosis is a predisposing factor in 1.7% of patients with CVST. A 26-year-old female presented with acalculus cholecystitis. Doppler ultrasound of liver demonstrated turbulent flow through hepa...