Endocrine Abstracts

Background: The BTA guidelines for the use of thyroid function tests recommend the measurement of TSH receptor antibodies (TRAb) when investigating hyperthyroidism of uncertain aetiology, in suspected Graves’ ophthalmopathy and in pregnant women with Graves’ disease. An in-house TSH receptor autoantibody ELISA assay (TRAb) was introduced in 2008. This study has audited the assay performance and evaluated its clinical usefulness in a tertiary centre.<p class="abst...

Destructive thyroiditis is characterised by hyperthyroidism due to release of pre-formed hormones. The increased concentration of thyroid hormone suppresses serum TSH. Radioactive iodine uptake is close to nil in all cases when hyperthyroidism is present. The duration of hyperthyroidism is generally 2–3 months and limited by the amount of thyroid hormone present. The ratio of serum T3:T4 is lower in destructive thyroiditis than in Graves’ disease. Hypothyroidism is c...

Iodine is an essential component of the thyroid hormones thyroxine (T4) and triiodothyronine (T3) which play a crucial role in brain and neurological development. The ideal dietary allowance of iodine recommended by World Health Organisation (WHO) is 150 μg of iodine per day which increases to 200–250 μg/day in pregnancy. Severe iodine deficiency may be associated with impairment in the psycho-neurological outcome in the progeny because bot...

Amiodarone has been used widely for treating resistant tachyarrhythmias in the past three decades. It is an iodinated benzofuran derivative with a structural formula that closely resembles that of thyroid hormones and contains about 37% of organic iodine by weight, from which 10% is deiodinated to yield free iodide. Given the daily maintenance dose of amiodarone between 100–600 mg daily, about 3.5–21 mg of iodide are released into the systemic circulation, equivalent...

The aetiology of thyroid nodules is due to the interaction between genetic and environmental factors. Thyroid nodules are common. Epidemiological studies suggest that 1% of men and 5% of women have thyroid nodules detected clinically and that the frequency increases with age and in iodine-deficient populations. With the increasing use of sensitive imaging techniques, an increasing proportion of thyroid nodules are detected incidentally. Up to 50% of nodules >1 cm detected ...

Subclinical thyrotoxicosis, defined as a low serum thyrotrophin (TSH) and normal serum free T4 and T3 concentrations, has been found in up to 3.2% of adults in cross-sectional surveys of thyroid function, of whom 75% have serum TSH concentrations of 0.1 to 0.4 mU/L. If the diagnosis is limited to only those with a serum TSH lower than 0.1 mU/L, the prevalence decreases to 0.7%, with 20% being treated with thyroxine.Thyrotoxicosis is considered overt only...

Recent advances in immunology have resulted in the development of new classes of immune-modulatory therapy in the management of cancers and an increased overall survival for various cancers. Immune checkpoint direct antibodies block intrinsic down-regulators of immunity, such as cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death 1 (PD-1) or its ligand, programmed cell death ligand 1 (PD-L1). As an inevitable consequence of increasing the activity of the immune...

Tolvaptan is an ADH antagonist licensed for the treatment of the syndrome of inappropriate ADH secretion (SIADH). We describe the case of a patient with severe symptoms due to refractory SIADH who was successfully treated with tolvaptan. A 35-year old patient developed a chordoma involving the pituitary gland and optic chiasm and was treated with surgery, radiotherapy and gamma knife therapy. After several years, she developed recurrent, severe, symptomatic hyponatraemia due t...

Objective: A review of the efficacy and safety of radioiodine treatment for Graves’ disease.Methodology: Patients were identified following a search of the nuclear medicine departmental database. Consecutive patients who had radioiodine in 3-year period from January 2009 to December 2011 were included in the audit. Information was obtained from medical notes, blood results and nuclear medicine database. Data was analysed using Microsoft Excel.<p...

Introduction: The association between fatigue, functional status and subclinical hypothyroidism (SCH) remains unclear. The available data is not consistent, and this is likely to be due to selection bias in studies recruiting patients from clinic rather than unselected community populations. Only population surveys looking at prevalence of fatigue and functional status in SCH are likely to provide the answer.Objective and Methodology: We compared the pre...