Endocrine Abstracts

Thyroid dysfunction is common, and thyroid function tests (TFTs) are amongst the most frequently requested laboratory measurements, both in the adult and paediatric setting. Fortunately, most TFTs are straightforward to interpret and confirm a clinical diagnosis of eu-, hypo- or hyperthyroidism. In most cases, the underlying cause of thyroid dysfunction is readily apparent from clinical findings and standard investigations (e.g. antibody testing, radionuclide scan). In a subse...

Resistance to Thyroid hormone (RTH) encompasses various disorders of Thyroid Hormone (TH) Action, including defective signalling through TH Receptors (RTH alpha, RTH Beta), abnormal TH metabolism (Selenoprotein deficiency) and altered cellular entry of TH (MCT8 defects). In this talk, I will focus on RTH alpha and beta. RTH beta is usually associated with mutations in the THRB gene and is often readily identified, due to the associated typical biochemical pattern of r...

Thyroid storm is a rare medical emergency with high mortality and is difficult to diagnose and treat. The optimal treatment regimen is not clear, and options include combinations of beta blockade, high dose anti-thyroid drugs, potassium iodide, dexamethasone, iodinated contrast agents, plasmapheresis and dialysis. Patients with severe, uncontrolled thyrotoxicosis, unresponsive to anti-thyroid drug therapy, represent a group of patients in whom treatment can be particularly cha...

Biological therapies include interleukins, interferons, and MABs. Over the past few years, the use of MAB to treat cancer and other diseases such as multiple sclerosis (MS) have increased; some of these frequently cause endocrine side effects.Alemtuzumab, a MAB directed at CD52 on T and B lymphocytes, is very effective in reducing relapse rates and improving disability in relapsing remitting MS, however is frequently (16–35%) associated with the ons...

Background: Short synacthen tests (SSTs) are routinely performed for the investigation of adrenal insufficiency (AI), but are costly and time consuming. The frequency of SST testing could be reduced by prioritising testing for specific indications (based on likelihood of failure of the test), and also by identification of an assay-specific 9am cortisol level that obviates the need to proceed to SST.Methods: Retrospective review...

Background: Short synacthen tests (SSTs) are routinely performed for the investigation of adrenal insufficiency (AI), but are costly and time consuming. The frequency of SST testing could be reduced by prioritising testing for specific indications (based on likelihood of failure of the test), and also by identification of an assay-specific 9am cortisol level that obviates the need to proceed to SST.Methods: Retrospective review...

A 26 year old gentleman presented to his GP in July 2018 with a one month history of thyrotoxic symptoms, including palpitations and weight loss. His initial thyroid function tests (TFTs) showed a hyperthyroid picture, including a FT4 of >100pmol/l (RR 12-22). His TSH receptor antibody was 11.1 IU/l (RR <1.75). He had no evidence of thyroid eye disease, and no goitre or thyroid nodules on exam. His Graves” disease was initially managed medically with carbimazole. ...

In clinical practice, most thyroid disease is due to thyroid gland dysfunction and so can be detected by measurement of TSH alone. This is because the negative feedback of thyroid hormones on the hypothalamus and pituitary gland result in TSH levels that are closely, and inversely, correlated with circulating free thyroid hormone (FT4, FT3) levels. However, several conditions are exceptions to this rule and can be very hard to diagnose also due to a certa...

Background: Amiodarone induced thyrotoxicosis (AIT) is a potentially catastrophic situation for patients with cardiac disease who are at risk of life-threatening complications. We describe the protracted and challenging journey of a patient with Laminopathy and a significant cardiac history who developed AIT.Clinical Case: A 53-year-old man was referred with thyrotoxicosis (TSH <0.01mU/l, free T4 61 pmol/l, free T3 8.0 pmol/l) detected following comm...

An anonymised online survey was created to evaluate junior doctor’s competency and confidence with decision-making scenarios in managing patients with diabetes at the end-of-life. 26 doctors working at the Beacon Hospital completed the online survey. A structured education programme was then delivered to the junior doctors where the critical information pertaining to the management of diabetes at the end-of-life was discussed, based on the ABCD 2011 and Diabetes UK 2013 a...