Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology BES

ea0013p292 | Thyroid | SFEBES2007

The calcium-sensing receptor is a target of autoantibodies in patients with autoimmune polyendocrine syndrome type 1

Gavalas Nikos , Kemp Elizabeth , Krohn Kai , Brown Edward , Watson Philip , Weetman Anthony

Autoimmune polyendocrine syndrome type 1 (APS1) is a rare autosomal recessive disorder caused by mutations in the autoimmune regulator gene. Major disease components include mucocutaneous candidiasis, hypoparathyroidism and Addison’s disease. Acquired hypoparathyroidism (AH) occurs in 80% of APS1 patients and is associated with hypocalcaemia, hyperphosphataemia and low serum levels of parathyroid hormone (PTH). Reports suggest that these clinical symptoms are initiated by...

ea0013p293 | Thyroid | SFEBES2007

Persistent hypothyroidism despite optimal therapy: time to rethink

Varughese George , Tahrani Abd , Khan Tahir , Davis Julie , Clayton Richard , Hanna Fahmy

We report a 47-year old lady who was initially diagnosed to have primary hypothyroidism nearly four years ago; on treatment with levothyroxine sodium (LT4) 150 μcg daily. Despite reasonable doses of LT4, and being fully compliant with her therapy, at no stage her TSH was less than 20 mU/L (Table-1). Malabsorption was ruled out and there were no clinical features to suggest this. When she was reviewed...

ea0013p294 | Thyroid | SFEBES2007

Thyroid storm precipitated by trauma: a rare presentation with right heart failure and liver dysfunction

Mettayil Jeevan Joseph , Abouglila Kamal

Thyroid storm is a rarely seen complication of Thyrotoxicosis complicated by multiple organ dysfunctions. Early recognition is crucial in reducing morbidity and mortality. We present the case of a young lady admitted with traumatic fracture of Tibia and Fibula. She was noted to be in rapid AF and on examination manifested signs of Thyrotoxicosis with palpable goitre. She was noted to be hyperthermic and emotionally labile and confused with signs of right heart failure.Investig...

ea0013p295 | Thyroid | SFEBES2007

An audit of radioiodine treatment for thyrotoxicosis in a large district hospital

Mukhtar Mamoun , Aung Theinge , Hills Maggie , Elsheikh Mohgah

Objective: The aim of our audit was to determine the effectiveness of first dose Radioiodine (RAI) in curing thyrotoxicosis, comparing our results with published rates of success and hypothyroidism.Methods: All patients with thyrotoxicosis treated with RAI between 2002 – 2004 (n=71) were identified and casenotes reviewed. Patients were either given nominal doses of either 259 or 407 MBq. Data collected included: the cause of thyrotoxicosis, g...

ea0013p296 | Thyroid | SFEBES2007

Removal of tick box for TFT in pathology request forms reduces TFT performed during acute medical admission

Piya Milan , Belbase Biparna , Karki-Thapa Meenakshi , Baxter Susan , Myers M , Koppada A , Rajbhandari Satyan Man

Joint UK guideline (2006) recommends that routine testing of thyroid function (TFT) in patients admitted acutely to hospital is not warranted unless specific clinical indications exist. Despite this, TFT is frequently requested during acute medical admission. In our previous audit in 2002, during a 1 month period from 18th September, 458 subjects were admitted to medical assessment unit (MAU) and 183 (40%) were offered TFT. 39 (29%) results were beyond the laboratory reference...

ea0013p297 | Thyroid | SFEBES2007

Pendred syndrome;a comparison between new and old diagnostic approaches

Larijani Bagher , Sassan Sharghi , Vahid Haghpanah , Armaghan Fard , Masoud Motessadi , Ramin Heshmat , Homayoun Hadizadeh , Anahita Lashkari , Eghbal Taheri

Objective: Pendred syndrome, defined as the constellation of goiter, sensori-neural hearing loss and positive Perchlorate discharge test, is the most frequent cause of congenital deafness. Newly introduced diagnostic approaches to the disease are rather expensive and complicated, we evaluated the value of MRI as the sole, or adjunctive diagnostic approach, and compared it with the traditional ones.Methods: Presuming the classic triad as the gold standard...

ea0013p298 | Thyroid | SFEBES2007

Assessment and management of non-compliant hypothyroid patients: the role of weekly observed thyroxine therapy

Moisey Robert , Swinburne Julie , Orme Steve

There are a number of symptomatic patients with hypothyroidism who fail to normalise thyroid function (TFTs) despite large doses of thyroxine (LT4) replacement. Non-compliance is a common cause of treatment failure even in patients who strongly deny this. To avoid unnecessary and prolonged investigations for other causes we advocate a simple protocol to manage this problem. Patients are observed taking 1000 mcg of LT4 at 09.00 hrs, and have hourly Free T4 and TSH levels measur...

ea0013p299 | Thyroid | SFEBES2007

T3:TRAB ratio predicts patients with Graves’ thyrotoxicosis who cannot be controlled with antithyroid drug therapy and relapse at 2 years

Page Georgina , Chong JSW Li Voon

Aim: To determine whether the ratio of T3 to TRAB (TSH Receptor Antibody levels) could be used to identify those patients with Graves’ thyrotoxicosis who cannot be controlled with antithyroid drug (ATD) therapy and those who will relapse within 2 years of discontinuation of ATD therapy.Method: Retrospective analysis of 22 patients with Graves’ disease and their relapse at 2 years after discontinuation of ATD therapy. Patients were diagnosed wit...

ea0013p300 | Thyroid | SFEBES2007

Chronic leg rash in Graves disease, not always pretibial myxedema

Pusalkar Pawan , Tringham Jenny , Bingham Emma

We describe a case of 38 year old female of Indian origin who presented with symptoms of Graves disease to our clinic. She had a diffusely enlarged goitre and minimal eye signs. Her T4 was 62 pmol/L(9–24), T3 9 pmol/L(3.5–6.5), and TSH was <0.01 mu/L (0.3–5.0). Radioactive iodine uptake scan revealed the presence of increased uptake throughout the gland. She was treated with carbimazole for 18 months and is in remission at present.Abou...

ea0013p301 | Thyroid | SFEBES2007

The scope of cardiac complications of thyrotoxicosis in Lagos, Nigeria

Ogbera Anthonia , Isiba Abiodun

Thyrotoxicosis is the hypermetabolic clinical syndrome resulting from serum elevations in thyroid hormone levels and it is well known to be associated with cardiac morbidities. There is a dearth of reports from sub-saharan Africa on this all important complication of thyrotoxicosis hence this study sets out to bridge this gap.This was a prospective study carried out in the Endocrine Unit of the Lagos State University Teaching Hospital Ikeja for a period ...

ea0013p302 | Thyroid | SFEBES2007

The outcome of the management of subclinical hyperthyroidism: Use of fixed dose of radioiodine therapy

Rao Preethi , Pereira Olivia , Weaver Jola

Background: Following the advent of thyroid function screening and highly sensitive TSH assay subclinical hyperthyroidism (SCHT) is becoming increasingly common. No audit addressed the treatment outcome of this group of patients.Methods: Prospective analysis of management outcome of patients seen in endocrine clinic over 36 months was carried out. 46 patients who presented with SCHT were included, of whom 41 had confirmed SCHT on repeat testing.<p cl...

ea0013p303 | Thyroid | SFEBES2007

W546X mutation of the thyrotropin receptor, cause of subclinical hypothyroidism (SH) in various clinical settings

Locantore Pietro , Evans Carol , Zhang Lei , Warner Justin , Gregory John , John Rhys , Lazarus John , Ludgate Marian

Objectives: Pregnancy and early infancy are periods when increased demand for thyroid hormone can result in subclinical hypothyroidism (SH). SH is frequently a prodrome to autoimmunity, but may be a compensation mechanism for an underlying genetic defect. The W546X mutation of the thyrotropin receptor (TSHR) is present at a frequency of 1 in 180 in a Caucasian population. We aimed to investigate whether W546X was the cause of SH presenting in pregnancy and early infancy.<p...

ea0013p304 | Thyroid | SFEBES2007

Can neonatal TSH screening detect trends in population iodine intake?

Burns Robert , Mayne PD , Keating Garret , Smith DF , Byrne Elizabeth , Higgins Mary , Staines AJ , O’Herlihy C , Smyth PPA

Despite the relative absence of iodised salt (only ∼4% of table salt is iodised), Ireland has not been regarded as a region with a high prevalence of iodine deficiency disorders. However a recent and worrying decline in urinary iodine (UI) excretion, most marked in the summer months, was observed with median UI of 61–83 ug/L between 1988 and 1999; falling to 45.0 ug/L in 2004 and to 42.5 ug/L in 2005 with UI values <50 ug/L (64.5% and 73.9% respectively in summe...

ea0013p305 | Thyroid | SFEBES2007

Seaweed as a model for iodide accumulation and storage

Cloughley George , Emma Burbridge , Kraan Stefan , Keegan Noel , Smyth PPA

Seaweeds share properties with the mammalian thyroid and other iodide concentrating organs in that they take up iodide from surrounding seawater and internalise it within cells. The previously demonstrated high iodine concentration within seaweeds prompted a study of accumulation and retention of 125I and its location within the plants. Seaweed discs (1 cm3) cut from members of the red, green and brown phyla which were incubated at 4C in seawater spiked w...

ea0013p306 | Thyroid | SFEBES2007

Outcome of radio-active iodine treatment for thyrotoxicosis in Glan Clwyd Hospital 2003–2005

Swidan Ahmed , Platts Julia , Hassanein Mohammed

Background: There is controversy about the ideal outcome for radio-active iodine (RAI) treatment in thyrotoxicosis and the optimal dose to be given. Various centres use various doses ranging from 185 mBq to 550 mBq.Aim: Our aim was to determine the thyroid status post RAI treatment for thyrotoxicosis and in those who became hypothyroid, to assess the time of onset of hypothyroidism from the date of RAI treatment administration.Meth...

ea0013p307 | Thyroid | SFEBES2007

Can parathyroid hormone (PTH) levels be useful in predicting postoperative hypocalcaemia in patients undergoing total thyroidectomy?

Smart Neil , Morgan Justin

Introduction: Patients undergoing total thyroidectomy may stay in hospital for several days postoperatively because of the risk of hypocalcaemia, which necessitates frequent serum calcium level checks. A reliable test for predicting postoperative hypocalcaemia may enable many patients to have day case surgery. Recent studies suggest that perioperative PTH levels may be useful in identifying those at risk of hypocalcaemia.Objectives: The aim of the study ...

ea0013p308 | Thyroid | SFEBES2007

Stridor as the initial presentation of large retrosternal goitre

Abouglila Kamal , Madathil Asgar

We had a 67-year-old lady who presented with 2-week history of shortness of breath and dry cough. Her past medical history includes dense left sided hemiplegia from previous stroke, hemiarthroplasty for fracture neck of femur, hypertension and osteoporosis. She had a large goitre for many years without any recent change in size of the goitre and there was no history of dysphagia. She had a large goitre with engorged neck veins, but no palpable lymph nodes. Her Chest X-ray show...

ea0013p309 | Thyroid | SFEBES2007

An audit of radio active iodine treatment in the management of thyrotoxicosis at a district general hospital

Rangan S , Tahrani AA , Ghosh D , Pickett P , Macleod AF , Moulik PK

Aim: To audit radioactive iodine (RAI) treatment.Methods : A retrospective audit of thyrotoxic patients, who attended the one-stop RAI clinic, between April 2005 and February 2006.Results: We included 74 patients (60 females, 14 males) with a median age 54 (22–85) years.Before RAI: Smoking history was recorded in 19/74(26%) patients. 44/74(59%) patients received drug treatment for two years or mor...

ea0013p310 | Thyroid | SFEBES2007

Retrospective analysis of radioactive iodine (I131) treatment for hyperthyroidism

Parikh G , Carey P , Roper N , Carr D

To examine use of I131 therapy we conducted a retrospective analysis of patient case notes that received I131 between May 2002 and Dec 2003.46 patients received radioiodine therapy during 18 months. All had a prior thyroid uptake scan confirming their diagnosis and written informed consent obtained.Results: GD: 29 patients (18F:11M; aged 52.6±2.8 yrs). 11 had a FT3 of <10 pmol/L pre radioiodine...

ea0013p311 | Thyroid | SFEBES2007

A case of Burkitt’s lymphoma of the thyroid presenting as myxoedema coma

Ibrahim Ibrahim M , parr John , Pritchet Christopher , Wahid Shahid

Introduction: Myxoedmea coma is an extreme expression of hypothyroidism with a high mortality rate. It is rarely associated with thyroid lymphoma.Case report: A 66-year-old lady presented acutely unwell with a two week history of cough and shortness of breath. She was hypothermic, hypoxic with clinical and radiological signs of pneumonia. Her TSH was 99.8 mU/L and T4 less than 5 pmol/L with strongly positive thyroid microsomal antibodies, raised WBC and ...

ea0013p312 | Thyroid | SFEBES2007

Using an increased fixed dose of 131I (600MBq) leads to improved outcome in patients with hyperthyroidism

Boelaert Kristien , Manji Nilusha , Sheppard Michael , Gough Stephen , Franklyn Jayne

We have previously (Allehabadia et al., JCEM, 2001) reported better cure rates for patients treated with a single fixed dose of 370 MBq 131I compared with 185 MBq. We have since increased the standard dose of administered radioiodine to 600 MBq and re-audited our data in 1240 consecutive thyrotoxic patients. We aimed to compare the efficacy of the new dose regimen and to explore factors that might predict outcome. Patients were categorised in 3 diagnostic gro...

ea0013p313 | Thyroid | SFEBES2007

Effects of neurotensin and/or morphine on gene expression of mu and delta opioid receptor

White Helen , Hayden Katharine , MacFarlane Ian

Factitious thyrotoxicosis secondary to Levo-thyroxine accounts for approximately 0.3% of all cases of hyperthyroidism. Although recognised as a cause of thyrotoxicosis, there are no peer-reviewed published cases of thyrotoxicosis secondary to ingestion of Tri-iodothyronine.A 23-year old lady presented to endocrine clinic with a 6-month history of palpitations, heat intolerance and tremor. She had a history of PCOS and reported difficulties with weight co...

ea0013p314 | Thyroid | SFEBES2007

Only one in four patients with suspicious thyroid cytology (THY3) has a thyroid carcinoma

Mihai Radu , Chin Kenny , Parker Andrew , Roskell Derek , Sadler Greg

Background: Fine needle aspiration biopsy (FNA) is the cornerstone of assessment of thyroid nodules. Cytological criteria for benign (THY2) and malignant (THY5) nodules are well-established and reliable. In a minority of patients cytology raises the possibility of a neoplasm (THY3) and only formal histological assesment can differentiate between benign and malignant lesions.Method: Retrospective review of histological and clinical data in a cohort of pat...

ea0013p315 | Thyroid | SFEBES2007

Subclinical hyperthyroidism in cats

Wakeling Jennifer , Elliott Jonathan , Syme Harriet

Cats are the only species, other than humans, in which naturally occurring, non-malignant hyperthyroidism has been recorded. Feline hyperthyroidism has many similarities to toxic nodular goitre, including age at risk, presentation, histological features and similar ‘switch-on’ mutations of the TSH receptor and linked G-proteins. Subclinical hyperthyroidism is well recognised in humans but has only recently been described in cats. We present preliminary data from a pr...

ea0013p316 | Thyroid | SFEBES2007

Does synthetic thyroid extract work for everybody?

Das Gautam , Anand Shweta , De Parijat

Synthetic levothyroxine (L-Thyroxine) is the treatment of choice for hypothyroidism. It is safe, effective and generally well tolerated. Some patients, however, cannot tolerate L-Thyroxine. There is still some controversy about the effectiveness of combination T4 & T3 therapy. We describe 3 patients who were successfully treated with Armour thyroid (pork extract of T4 & T3) after being intolerant to L-Thyroxine.A 35 yr old lady initially presente...

ea0013p317 | Thyroid | SFEBES2007

Routine screening for thyroid disease in patients with diabetes mellitus: is it worthwhile?

Gonem Sherif , Wall Alan , De Parijat

Background: An increased prevalence of thyroid dysfunction is reported in both type 1 and type 2 diabetes mellitus compared to the normal population. However, the cost-effectiveness or otherwise of screening for thyroid dysfunction in this group of patients is an unresolved question.Aims: The aim of this study was to measure the effectiveness of screening for hypo- and hyperthyroidism, both sub-clinical and overt, in an ethnically diverse population of m...

ea0013p319 | Thyroid | SFEBES2007

Retrospective analysis of radioiodine therapy for thyrotoxicosis with a 550Mbq dose

Basu Ambar , Kaushal Kalpana , Hill Jonathan , Howell Simon J

Background: Radioiodine therapy using I131 is a well established, safe, cheap and effective treatment for thyrotoxicosis. Current recommendations support the administration of 400-550 Mbq. At this centre, we use a dose of 550 Mbq with the aim of minimising the chance of the patient remaining thyrotoxic following therapy.Aims: To determine (a) the thyroid status of patients following treatment with I131 at a dose of 550 Mbq, (b) the ...

ea0013p320 | Thyroid | SFEBES2007

Thyroid function testing in hypothyroid women during pregnancy

Jose Biju , Ashawesh Khaled , Ayres Chris , Redford David , Barton David

Background: Maintenance of euthyroidism is particularly important during pregnancy. In the early stages of gestation, maternal thyroid hormone is required for foetal neurological development. Some authors suggest presumptively increasing the thyroxine replacement at diagnosis of pregnancy. Recent United Kingdom guidelines recommended that thyroid stimulating hormone (TSH) and free T4 (fT4) should be measured in hypothyroid women before conception, at diagnosis of pregnancy, at...

ea0013p321 | Thyroid | SFEBES2007

Central arterial stiffness in resistance to thyroid hormone

Owen Penelope , John Rhys , Mitchell Catherine , Curran Suzanne , Chatterjee Krishna , Lazarus John

Resistance to thyroid hormone (RTH) is a rare, autosomal dominant disorder characterised by a reduced sensitivity of peripheral tissues to thyroid hormone. Thyroid function testing shows elevation of free T4 and T3 with non suppressed TSH levels.Vascular function in these patients has not been fully evaluated. We have studied central arterial stiffness in a cohort of RTH patients, comparing them with age and sex matched controls.Me...

ea0013p322 | Thyroid | SFEBES2007

Audit of follow-up after radio-iodine treatment for hyperthyroidism in East and North Hertfordshire NHS Trust

Nair Sunil , Hossain Sharif , Lumbers Tom , Walker Rebecca , Winocour Peter , Makepeace Alan , Ainsworth Ann

Objective: To assess adherence to RCP guidelines on radioiodine (RAI) treatment (1995) and management of thyroid eye disease, and also to look at patterns of thyroid function following RAI treatment.Method: Retrospective case notes review of 78 randomly selected patients from one acute trust. An audit performa was developed, based on the RCP guidelines.Results: The audit demonstrated significant deviations from standards. Communica...

ea0013p323 | Thyroid | SFEBES2007

The unrecognised use of alternative treatments for thyroid disorders

Hutchinson Maeve E , Shea Donal O’ , Cawood Tom J

Alternative treatments for thyroid disorders include animal thyroid extract and preparations containing iodine. These treatments can affect thyroid status and their use may be unrecognised by doctors treating patients with thyroid disorders. We aimed to determine the nature, availability and use of alternative treatments for thyroid disorders (ATTDs).Patient questionnaires were administered to all patients with a diagnosis of a thyroid disorder attending...

ea0013p324 | Thyroid | SFEBES2007

Management of thyroid nodules – Local experience at a district general hospital in UK

Rangan S , Tahrani AA , Grainger J , Macleod AF , Moulik PK

Aim: To evaluate local management of thyroid nodules in comparison with the British Thyroid Association guidelines.Methods: All patients who had fine needle aspiration cytology (FNAC) for a thyroid nodule in 2004 and 2005 were included. Data collected included: patients’ age, gender, thyroid status, FNA Cytology (including repeats) and THY classification, surgical intervention and histology (if applicable).Results: 97 patients...

ea0013p325 | Thyroid | SFEBES2007

Preliminary evidence for association of PTPN12 with Graves’ ophthalmopathy

Brand Oliver J , Syed Ateeq A , Franklyn Jayne A , Gough Stephen CL , Heward Joanne M , Simmonds Matthew J

Protein tyrosine phosphatases (PTPs) such as PTPN22, that encodes lymphoid tyrosine phosphatase (LYP), are important regulators of cell signalling. LYP, through interaction with various accessory molecules including Grb2 and Csk kinase, has been shown to be particularly important in regulating signal transduction from the T cell receptor. The identification of PTPN22 as a susceptibility locus for Graves’ disease (GD) led us to hypothesise that other PTPs may...

ea0013p326 | Thyroid | SFEBES2007

Thyrotoxicosis complicating a molar pregnancy

Hughes Katherine , Campbell Alastair , Cooper Sarah , Sandeep Thekkepat , Adamson Karen

A para 2+0 female, 11 weeks gestation presented with vaginal bleeding and hyper-emesis. An ultrasound scan showed a dichorionic pregnancy with one viable foetus and a hydatiform mole. β-human chorionic gonadotrophin (β-hCG) level was elevated at 159845 U/L and subsequent thyroid biochemistry revealed hyperthyroidism. Serum thyrotrophin (TSH) was suppressed at <0.05 mU/L (NR 0.2–4.5), with a FT4 37 pmol/L (NR 9–24), and Free T3 of 17.8 nmol/L (NR 2.6&#15...

ea0013p327 | Thyroid | SFEBES2007

RET proto-oncogene exon 11 germline mutations in patients with medullary thyroid carcinoma

Petakov Milan , Nikolic Jelena , Katarina Mirkovic , Jadranka Antic , Jovana Vignjevic , Bojana Beleslin-Cokic , Tatjana Isailovic , Sanja Ognjanovic , Djuro Macut , Svetozar Damjanovic

Several RET proto-oncogene germline mutations with dominant inheritance, predispose to hereditary medullary thyroid carcinoma (MTC), and whether the MTC is sporadic or hereditary should be determined by a direct analysis of the RET proto-oncogene. 85% of MEN IIA patients and 30% of patients with familial medullary thyroid carcinoma have mutations at codon 634 (exon 11). In 88 consecutive patients with MTC, the characterization of RET mutations in exon 11 had been done by PCR w...

ea0013p328 | Thyroid | SFEBES2007

T3 rather than TSH mediates the effects of altered thyroid status on bone turnover in man

Murphy Elaine , Williams Graham Richard

Recent controversial studies in mice imply that TSH inhibits bone remodelling, suggesting TSH-deficiency rather than thyroid hormone excess causes bone loss in thyrotoxicosis. Measurement of the TRH-stimulated rise in TSH following three days administration of graded doses of T3 is the gold-standard for determining resistance to thyroid hormone (RTH). During this test, T3 excess coupled with suppressed TSH should induce high bone turnover, whilst administration of TRH causes a...

ea0013p329 | Thyroid | SFEBES2007

Thyroid eye disease: adjusting to an altered sense of identity influences patients’ interactions with healthcare professionals

Estcourt Stephanie , Vaidya Bijay , Quinn Anthony , Shepherd Maggie

Introduction: Thyroid Eye Disease (TED) affects quality of life causing a negative impact on psychosocial life. Previous findings identifed the phenomenon of an altered sense of identity with associated lowered-self esteem, social withdrawal and isolation. How this ‘altered identity’ influences interactions with Healthcare Professionals (HCPs) has not been investigated.Study aim: To explore the nature of interactions between HCPs and patients w...

ea0013p330 | Thyroid | SFEBES2007

Plasminogen activators in human thyroid follicular cells

Susarla Radhika , Watkinson John C , Eggo Margaret C

Human thyroid follicular cells in culture synthesise plasminogen activators, both urokinase (uPA) and tissue-type (tPA). The PAs secreted into the culture medium were active (2.5–50 U/ml) and able to mediate the conversion of plasminogen to plasmin. Secreted PA activity (PAA) was markedly increased by epidermal growth factor (EGF) and protein kinase C (PKC) activation with TPA. There was a corresponding increase in uPA and tPA mRNA levels and in uPA and tPA protein secret...

ea0013p331 | Thyroid | SFEBES2007

Hypoxia inducible factor (HIF-1α) in thyroid carcinoma cell lines

Cowen Rachel , Williams Kaye , West Catherine , Resch Julia , Brabant Georg

Background: Tissue hypoxia is a hallmark of rapidly proliferating tumours which most frequently adapt and prosper under low oxygen tension. The transcription factor, HIF-1α, is mediating these effects and induces target genes involved in survival, invasion and resistance to drugs and radiation. No data are available on the functional regulation of HIF-1α in thyroid carcinoma cells.Methods: Using thyroid carcinoma cells derived from papillary (N...

ea0013p332 | Thyroid | SFEBES2007

Propylthiouracil induced foetal goitre: a food for thought

Patani Olomuza , Heald Adrian

Propylthiouracil (PTU) treatment for thyrotoxicosis in pregnancy is common clinical practice. However maternal ingestion of PTU has been recognised to be associated with the development of foetal hypothyroidism and in rare cases at high doses of PTU, overt foetal goitre. Foetal goitre can be potentially dangerous due to mechanical obstruction and needs to be carefully monitored in utero. We report a case of development of goitre in utero secondary to maternal ingestion of PTU ...

ea0013p333 | Thyroid | SFEBES2007

Neuropsychological abnormalities in overt and sub-clinical hypothyroidism improve but do not normalise following 3 months replacement with L-thyroxine

Correia Neuman , Mullally Sinead , Tun Tommy Kyaw , Phelan Niamh , Fitzgibbon Maria , O’Mara Shane , Boran Gerard , Gibney James

The neuropsychological mechanism underlying cognitive impairment in hypothyroidism is poorly understood. It is not known whether cognitive impairment resolves following L-Thyroxine (LT4) replacement. It is also unknown whether similar neuropsychological abnormalities occur in patients with sub-clinical hypothyroidism (SCH). To address these questions, we performed neuropsychological tests in 17 patients with hypothyroidism (age 45±3 years; mean±S.E.M.)...

ea0013p334 | Thyroid | SFEBES2007

Severe thyroid orbitopathy and ocular myasthenia gravis. A challenging case, and review of the literature

Bdiri Ashref , Heard Wendy , Hillier Charles , Parkin Ben , Taylor Martin

We describe an 80 year-old man with Graves’ thyrotoxicosis and thyroid orbitoapthy accompanied by ocular myasthenia gravis.He presented in 2004 with chemosis, exophthalmos, diplopia, ptosis, and restricted movements. He also gave history of weight loss (six kilograms). FT4 29, FT3 7.7 and TSH 0.04. MRI Orbits revealed swelling of the extra-ocular muscles.Ocular movement was markedly restricted but a curious feature of the pres...

ea0013p335 | Thyroid | SFEBES2007

Effect of methimazole on the immunoreactivity of recombinant thyroid peroxidase

McDonald David , Gora Monika , Lakey Jeremy , Pearce Simon

The mechanism by which the thionamide antithyroid drugs produce long-term remission of Graves’ hyperthyroidism is unknown. We wished to explore the hypothesis that methimazole (MMI) could induce a structural change in thyroid peroxidase (TPO), such that its major (immunodominant) epitope(s) was no longer recognised by circulating anti-TPO antibodies.An enzymatically active membrane preparation of a CHO cell-line stably transfected with human TPO was...

ea0013p336 | Thyroid | SFEBES2007

Role of Liothyronine in thyroid replacement therapy – a retrospective audit

Srinivasan BT , Levy MJ , Howlett TA

Introduction: A recent meta-analysis has suggested that combined replacement with Liothyronine (T3) and Levothyroxine (T4) confers no additional benefit to patients with hypothyroidism but patients still occasionally request this treatment approach.Aim: To analyse the indications and biochemical characteristics of patients on T4/T3 combination therapy for Hypothyroidism in our cohort of patients.Methodology: A retrospective search ...

ea0013p337 | Thyroid | SFEBES2007

Should long-term continuous anti-thyroid drug therapy be included in the therapeutic armamentarium for hyperthyroidism?

Savage Laura , Jones Rhian , Hayat Haleema , Murray Robert

A minority of patients with hyperthyroidism resulting from relapsed Grave’s disease or autonomous nodules refuse definitive treatment with surgery or radioiodine, and request long-term anti-thyroid medication. There are few data concerning the safety and efficacy of this therapeutic modality.We performed a retrospective analysis of 13 patients (8 relapsed Grave’s disease, 5 toxic MNG), 12F, median age 60 (31–76) yrs and duration of long-te...

ea0013p338 | Thyroid | SFEBES2007

The relative level and predictors of osteoporotic fracture in patients with treated thyroid dysfunction

Flynn Robert , Bonellie Sandra , Jung Roland , Morris Andrew , Macdonald Thomas , Leese Graham

Objectives: (1) to establish the relative level of osteoporotic fracture in the thyroid population compared to the general population, and (2) to establish whether osteoporotic fracture in patients receiving thyroxine was associated with plasma thyroid stimulating hormone (TSH) level or thyroxine dose.Method: A database of clinical information from subjects with treated thyroid disease was linked to morbidity records describing all in-patient episodes of...

ea0013p339 | Thyroid | SFEBES2007

Weekly thyroxine administration: a safe method to administer thyroxine when compliance issues arise

Walker Jonathan , Vincent Alex , Karvitaki Niki , Allahabadia Amit , Weetman Anthony , Wass John

We have studied 20 patients with autoimmune hypothyroidism on large doses of daily thyroxine that were referred to our departments with concerns regarding possible thyroxine malabsorption or compliance issues. Here we describe 3 patients seen in Oxford. One patient had coeliac disease. The other two patients had no history of malaborption and were coeliac antibody negative. None of the 3 patients were on medication which would interfere with thyroxine absorption. All were fema...

ea0013p340 | Thyroid | SFEBES2007

Pyogenic thyroiditis with hyperthyroxinaemia

Magee Glynis , McConnell Mae

A 14 year old girl presented with a two week history of painful throat and ears after having been previously treated with a course of antibiotics. She also complained of neck swelling and on further questioning admitted to increasing sweating and weight loss.On examination she had pyrexia of 38.9  °C and a tachycardia. A postural tremor was elicited and an enlarged, smooth, tender goitre. Initial laboratory investigations were fT4 56.2 and TSH ...

ea0013p341 | Thyroid | SFEBES2007

The relationship between serum TSH levels and blood pressure in a population sample with normal thyroid function

Razvi Salman , French Joyce , Weaver Jolanta , Vanderpump Mark , Pearce Simon

Background: There is evidence to suggest an association between hypothyroidism (overt and subclinical) and cardiovascular disease. It is unclear whether the set-point of the thyroid axis, within the normal range, may be related to vascular risk.Methods: We have reanalysed the data from the original Whickham study to assess BP in the entire cohort and its relationship to serum TSH within the reference range (0.3–6.0 mIU/L). Multivariate stepwise line...

ea0013p342 | Thyroid | SFEBES2007

Hyperemesis gravidarum and gestational hyperthyroidism

Maguire D , Whitelaw DC

Hyperemesis gravidarum is vomiting in pregnancy severe enough to cause weight loss and hospitalization. It occurs in up to 1% of pregnancies. It usually begins at 6–9 weeks gestation and resolves by 18–20 weeks. It can lead to dehydration and electrolyte imbalances. Treatment includes intravenous fluids and anti-emetics. The cause of vomiting is unknown. Hyperemesis gravidarum is often associated with transient gestational hyperthyroidism.The a...