Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology BES 2008

ea0015p333 | Thyroid | SFEBES2008

Differences in maternal and fetal serum thyroid hormone concentrations between non-pregnant, normal and pre-eclamptic pregnancy

Mistry Hiten , Ramsay Margaret , Pipkin Fiona Broughton , Symonds Michael

Background: The pregnancy-specific condition pre-eclampsia (PE) affects ~2% of women contributing to neonatal and maternal morbidity and has been linked with a deficiency in selenium. The iodothyronine deiodinases all contain selenium and play crucial roles in determining the circulating and intracellular levels of the active thyroid hormone. It is hypothesised that due to the role of deiodinases in extrathyroidal production of T3, thyroid-stimulating hormone (TSH) will be inc...

ea0015p334 | Thyroid | SFEBES2008

The value of the anti-thyroid peroxidase antibodies measurement in the diagnosis of Graves’ disease

Borge Virginia Martin , Capatina Cristina , Fazal-Sanderson Violet , Wass John AH , Karavitaki Niki

Background: Anti-thyroid peroxidase (TPO) antibodies are the serological hallmark of autoimmune thyroid disease and are often used for the establishment of the diagnosis of Graves’ disease (GD).Aim: To investigate the diagnostic value of the anti-TPO antibodies in a series of patients with GD.Patients and methods: All patients presenting to our Department with GD between 1/2004-6/2007 were studied. The diagnosis was based on t...

ea0015p335 | Thyroid | SFEBES2008

Cholestasis induced by carbimazole: a case report

Vithian Karunakaran , Vithian Sivamala , Skelly Robert

An 85-year-old lady presented to hospital with fast atrial fibrillation and had some signs of pulmonary congestion. Her admission blood tests were normal apart from a raised urea. Her liver function tests on admission were normal (AST 26 ALP 99). Thyroid function tests showed that she was thyrotoxic with fT4 42 and TSH<0.03. Her TPO antibodies were negative. She was started on carbimazole 20 mg od.Repeat liver function tests showed that her GGT and a...

ea0015p336 | Thyroid | SFEBES2008

Effects of dietary soy phytoestrogens on thyroid function and insulin resistance in patients with subclinical hypothyroidism: a double blind crossover study

Sathyapalan Thozhukat , Manuchehri Alireza M , Thatcher Natalie J , Clarke Don B , Rigby Alan S , Kilpatrick Eric S , Chapman Tom , Lloyd Anthony S , Atkin Stephen L

Soy phytoestrogens (PE) have been shown to improve insulin resistance and lipids but may adversely affect thyroid function.Objective: To determine the effects of soy PE on thyroid function, insulin resistance and lipid parameters in patients with subclinical hypothyroidism.Design: A randomised, double-blind, crossover study was undertaken involving 60 patients with subclinical hypothyroidism. Patients were randomly assigned to eith...

ea0015p337 | Thyroid | SFEBES2008

Thyroid function tests: rarely justified in the acutely ill

Hall Suzanne , Begley Joe , Wong Mo Lee , Masding Mike

Objective: The British Thyroid Association (BTA) published guidelines for thyroid function testing (TFTs) in June 2006, recommending that TFTs should not be requested for acute medical patients in the absence of specific clinical indications. This audit assesses the proportion of thyroid function tests performed on acute medical inpatients that are indicated.Design: Retrospective data collection on 205 sequential thyroid function tests performed over 3 m...

ea0015p338 | Thyroid | SFEBES2008

Primary triiodonaemic hypothyroidism: a case report

Tevaarwerk Gerald

Objective: To report a patient with clinical hypothyroidism due to primary hypotriiodonaemia.Design: Case report.Main outcome: A 26-year-old woman presented with weight gain, cold intolerance, fatigue, mental lethargy, depression, long periods of amenorrhea and delayed ankle reflex relaxation. She was not on any medications. The (mean of two) thyroid stimulating hormone (TSH) concentrations was 2.5 (N: 3.8–5.5 mU/l), th...

ea0015p339 | Thyroid | SFEBES2008

Prevalence of diabetes following intravenous methylprednisolone therapy for Graves’ ophthalmopathy

Mettayil Jeevan , Matthews Lucy , Neoh C , Dickinson A , Perros Petros , Pearce Simon

Thyroid eye disease is the most frequent extrathyroidal manifestation of Graves’ disease. Severe and active disease is frequently treated with immunosuppressive therapy. IV methylprednisolone (500 mg daily for 3 days) is the treatment of choice with efficacy rates of up to 77%. New onset glucose intolerance/diabetes is the most relevant side effect of this treatment. We investigated the risk of steroid induced diabetes and the risk factors for its development.<p class...

ea0015p340 | Thyroid | SFEBES2008

How useful is post-operative PTH at predicting hypocalcaemia following thyroidectomy?

Sharma Nidhi , Meeran Karim , Palazzo Fausto

Background: Post-operative hypocalcaemia affects up to 30% of patients. It may be delayed to the second or third post-operative day and is therefore the key determinant of post-operative stay. Various strategies have been used to overcome this problem including the blanket administration of calcium and discharge followed by daily blood tests.Objectives: To evaluate the use of using a parathyroid hormone (PTH) assay 4 h following surgery as a predictor of...

ea0015p341 | Thyroid | SFEBES2008

Specialist endocrine care for all hyperthyroid patients?

Evans Kate , Coupe Aileen , Mascas Ramona , Pilianidis George , Foote John , Browne Duncan , Pinkney Jon

Objectives: To establish the proportion of patients locally with potentially significant thyroid pathology not receiving specialist endocrine input. To look at the management of hyperthyroid patients within the Endocrinology service.Patients and methods: Utilising the laboratory database, 121 patients identified (97 female, 24 male; age range 17–93 years, average 55 years) with TFTs suggesting hyperthyroidism (raised fT4/fT3, and/or suppressed TSH) ...

ea0015p342 | Thyroid | SFEBES2008

Triumvirate contribution of ultrasound characteristics, clinical risk and TSH in predicting neoplasia in thyroid nodules

Hatton Rebecca , Bravis Vassiliki , Lingam Ravi , Qarib Mohammad , Devendra Devasenan

The prevalence of thyroid nodules is extraordinarily common. An increase in the use of head and neck imaging, including ultrasound, computed tomography (CT) and carotid Dopplers, has increased the number of non-palpable thyroid nodules identified. For most patients, their thyroid disease is non-neoplastic and asymptomatic. The challenge in the management of thyroid nodules is identifying patients with clinically significant disease, most notably thyroid neoplasia, without exce...

ea0015p343 | Thyroid | SFEBES2008

Successful discontinuation of treatment after 16 years of replacement therapy with thyroxine in congenital hypothyroidism

Talapatra Indrajit , Scott Ian , Tymms David James

We describe below a 16-year-old male referred with neonatal hypothyroidism. He was commenced on levothyroxine at the age of 3 weeks. The TSH was >100 IU/l (normal: 0.27–4.7) and Total T4 was <10 nmol/l (normal: 60–150) and there was no uptake on thyroid isotope scanning. He was diagnosed as having congenital absence of thyroid tissue and given levothyroxine and the dose adjusted to maintain normal thyroid function. His mother was diagnosed with hypothyroidism...

ea0015p344 | Thyroid | SFEBES2008

Gynaecomastia as a sole manifestation of asymptomatic hyperthyroidism

Rana Subhash C , Mousa A , Bangar V

Objective: We present a 62-year-old male who had manifested with gynaecomastia to a surgeon. He was able to avoid mastectomy when it was found that his gynaecomastia was being caused by asymptomatic hyperthyroidism.Case report: A 62 years male presented to a surgeon with 6 months history of gradual enlargement of both of his breasts primarily for cosmetic reasons. The surgeon had planned bilateral mastectomies pending funding from the primary care trust....

ea0015p345 | Thyroid | SFEBES2008

Fixed and calculated doses of radioiodine achieve similar cure rate for hyperthyroidism

George Jyothis , Matthews David , McIntyre Elizabeth

Background: Radioiodine ablation is an effective curative treatment for hyperthyroidism in virtually all patients with single or multiple doses. The dosage of radioiodine used in the treatment of thyrotoxicosis has varied widely according to local experience and practice. Administration of low doses could lead to inadequate or delayed response, while using larger doses is associated with the risk of increased incidence of hypothyroidism.Introduction: In ...

ea0015p346 | Thyroid | SFEBES2008

Can placental iodine accumulation and storage compensate for inadequate iodine intake?

Burns Robert , Higgins Mary , Smyth Derek F , Kelehan Peter , O'Herlihy Colm , Smyth Peter P A

The production of iodine containing thyroid hormones necessary for brain development in the fetus depends not only on maternal dietary intake but also on placental iodine transport.Previously, studies focused on finding the optimum level of iodine nutrition for expectant mothers. However, little knowledge exists on the ability of the placenta to either accumulate or even store iodine. This study aims to investigate iodine uptake and tissue iodine content...

ea0015p347 | Thyroid | SFEBES2008

Use of thyroglobulin antibody measurement in detecting recurrence in differentiated thyroid carcinoma

Muldowney Maeve , Smith Derek , Burns Robert , Moriarty Michael J , Smyth Peter P A

Serum thyroglobulin (Tg) is a tumour marker used to manage patients with differentiated thyroid carcinoma (DTC). However, its diagnostic accuracy can be questioned when thyroglobulin antibodies (TgAb) are simultaneously present. Changes in serum TgAb can also serve as an index of disease progression in DTC. The objective of this study was to identify the relationship between TgAb titre and disease progression, defined as radiological or histological evidence of recurrence. Eig...

ea0015p348 | Thyroid | SFEBES2008

Expression of thyroid hormone transporters in human placenta and changes with intrauterine growth restriction (IUGR)

Chan Shiao , Loubiere Laurence , Vasilopoulou Elisavet , McCabe Christopher , Franklyn Jayne , Kilby Mark

Thyroid hormones (TH) are important for the development of the fetus and placenta. We have previously reported increased placental expression of the potent TH transporter, MCT8, with advancing gestation. The amino acid plasma membrane transporters, MCT10, LAT1, LAT2, and the organic anion transporters, OATP1A2 and OATP4A1, are also known to transport TH.Objective: To describe the ontogeny of these TH transporters and the obligate heterodimer of the LATs,...

ea0015p349 | Thyroid | SFEBES2008

Use of rectal anti-thyroid medications as an alternative to oral route

Letham C , Khan A S A , Kawafi K R , Kouta S , Norris A J

Objective: We report two cases of thyrotoxicosis with use of anti-thyroid medications via rectum in elderly patients where oral or naso-gastric route was unavailable.Discussion: Case 1: An 86-year-old woman was admitted in July 2007 with confusion associated with agitation and tachycardia. She had a known history of thyrotoxicosis. At the time of this admission, the TFTs were once again found to be abnormal (Table 1) and she was started on PTU. During ad...

ea0015p350 | Thyroid | SFEBES2008

Does cord blood selenium correlate with maternal anti-TPO-titers?

Pflanz Benita , Peters Norbert , Bohnet Heinz G

Selenium (Se) has been shown to capture radicals, one of which is oxygen originating from thyroxin-peroxidase (TPO) activity. Se supplementation to patients with Hashimoto’s resulted in a decrease of anti-TPO-titers and Se concentrations of ≥1.4 μmol/l have been proven to prevent deterioration of post partum thyreoiditis. Our group previously showed that in nonpregnant women with Hashimoto’s Se concentrations were decreased, and pregnant women have decreas...

ea0015p351 | Thyroid | SFEBES2008

Discrepancy between free thyroid hormones and thyrotropin values in patient with Hashimotos thyroiditis

Abouglila Kamal , Ullah Arif , Cooper Helen , Thirugnanasothy Logan , Day Julie

Background: Measurements of thyrotropin (TSH), free thyroxine (FT4) and triiodothyronine (FT3) are widely used diagnostic methods for thyroid function evaluation. However, some serum samples will demonstrate a nonspecific binding with assay reagents that can interfere with the measurement of these hormones. Few case reports of TSH interfering antibodies have described the presence of such interferences resulting in reported abnormal concentrations of thyroid hormones. Unusual ...

ea0015p352 | Thyroid | SFEBES2008

Hippocampal memory deficits in hypothyroidism

Correia Neuman , Mullaly Sinead , Cooke Gillian , Tun Tommy Kyaw , Phelan Niamh , Feeney Joanne , Fitzgibbon Maria , O'Mara Shane , Boran Gerard , Gibney James

Memory formation largely depends on normal function of the temporal lobes (particularly the hippocampal complex) and prefrontal cortex. Evidence from animal studies suggests abnormal hippocampal function in hypothyroidism1. We hypothesized that specific defects in hippocampal-dependent memory would be observed in hypothyroid patients. Patients with overt (n=17) and subclinical (n=17) hypothyroidism underwent neuropsychological testing at baseline, 3 an...

ea0015p353 | Thyroid | SFEBES2008

Hashi toxicosis presenting with severe active thyroid eye disease

Cooper Helen , Abouglila Kamal , Ullah Arif , Ibrahim I Mohammed , Thirugnanasothy Logan

Background: Autoimmune thyroid disease is a common cause of thyroid dysfunction, either Graves’ disease causing hyperthyroidism or Hashimoto’s thyroiditis causing hypothyroidism. It has been noted that patients suffering from autoimmune hypothyroidism can transform to hyperthyroidism and vice versa. We report the case of a patient with long standing autoimmune hypothyroidism presenting with active thyroid eye disease and subsequently diagnosed with Graves’ disea...

ea0015p354 | Thyroid | SFEBES2008

Hypo-osmolar hyponatremia and orthostatic hypotension as the chief symptom in primary hypothyroidism

Ullah Arif , Abouglila Kamal , Thirugnanasothy Logan , Cooper Helen

Background: Postural hypotension has been commonly described in elderly. Common causes include medication, fluid loss, adrenal insufficiency and autonomic dysfunction. Hyponatremia is not a disease in itself, but a manifestation of a variety of disorders and side-effects of diuretics; alternatively, it may be the only manifestation of certain disorders. We present a case of primary hypothyroidism presenting as collapse with postural hypotension and severe hyponatremia.<p c...

ea0015p355 | Thyroid | SFEBES2008

Sunitinib induced hypothyroidism in gastrointestinal stromal tumours

Cooper Helen , Abouglila Kamal , Ullah Arif , Thirugnanasothy Logan

Background: Sunitinib is a tyrosine kinase inhibitor used in the treatment of metastatic GIST and renal cell carcinoma. Tyrosine kinase receptors are involved in tumour growth, angiogenesis and metastatic invasion. It can cause hypothyroidism but few cases have actually been reported. Mechanisms suggested for the incidence of hypothyroidism include antithyroperoxidase activity,1 and blocking uptake of iodine in the thyroid gland,2 or it may induce destruc...

ea0015p356 | Thyroid | SFEBES2008

The follow up of radioiodine treated hyperthyroid patients: the Bradford experience

Satish Kumar Sampath , King Rhodric , Wright Diane , Peacey Steve

There is a relative lack of data regarding the timing and in particular the severity of hypothyroidism post Radioiodine (RI). We retrospectively examined the timing and severity of hypothyroidism following RI in 213 patients, in relation to ‘target’ and actual follow up appointments, and the introduction of a nurse-led follow-up clinic. Hypothyroidism was defined as persistent elevation of TSH – mild (TSH 6.1–10 mU/l), moderate (TSH 10.1–50 mU/l) and s...

ea0015p357 | Thyroid | SFEBES2008

Thyroid disorders in pregnancy

Saraf Sanjay , Saraf Sanchita , Jones Sharon

After diabetes, thyroid disorder is the second most common endocrine disorder in women of reproductive age. Thyroid disorders in pregnancy have been proven to have adverse maternal and foetal outcome if not treated adequately and timely.Aim: The aim of this audit was to assess management and therapeutic interventions and outcomes of pregnancies complicated by thyroid disorders.Method: A retrospective case notes analysis of 35 pregn...

ea0015p358 | Thyroid | SFEBES2008

Familial dysalbuminaemic hyperthyroxinaemia: a persistent diagnostic problem

Cartwright David , O'Shea Paula , Rajanayagam Odelia , Moran Carla , John Rhys , Agha Amar , Chatterjee Krishna , Halsall David

The differential diagnosis of raised circulating thyroid hormones with normal TSH includes familial dysalbuminaemic hyperthyroxinaemia (FDH), a benign, inherited disorder caused by a variant albumin with increased affinity for thyroxine (T4) or triiodothyronine (T3). Three different albumin gene mutations, generating mutant proteins with increased affinity for either T4 (R218H,R218P) or T3 (L66P) have been commonly described. Typically, serum total T4 is raised and free T4 mea...

ea0015p359 | Thyroid | SFEBES2008

Improvements in quality of life in hypothyroid patients taking Armour thyroid

Lewis DH , Kumar J , Goulden P , Barnes DJ

Armour thyroid (Armour) is unlicensed in the UK for the treatment of hypothyroidism. It is natural porcine-derived thyroid replacement with 1 grain containing 38 mcg levothyroxine (T4) and 9 mcg L-triiodothyronine (T3), and unspecified amounts of T1, T2 and calcitonin. We have used Armour as a third line agent in selected patients who have not responded adequately to T4 monotherapy, and combination T4/T3 therapy since 2003.Aim: To assess c...

ea0015p360 | Thyroid | SFEBES2008

The one-stop thyroid clinic: what’s the rush?

Lewis DH , Goulden P , Kumar J , Barnes DJ

A 64-year-old man presented with mild biochemical hyperthyroidism – TSH <0.01 mU/l (NR 0.35–4.90), FT4 19.4 pmol/l (NR 9–19) in 2005. He was treated by his general practitioner with a 9 months course of carbimazole. Six months later, TSH became suppressed (0.05 mU/l) but with a normal fT4 (17 pmol/l). He was referred to a ‘One-Stop’ Thyroid Clinic and was seen there 3 months later. Thyroid isotope scan showed a toxic multinodular goitre. He was tre...

ea0015p361 | Thyroid | SFEBES2008

Carbimazole induced agranulocytosis: an unusual manifestation

Zalin Ben , Wren Alison

We present here the case of a 33-year-old woman, previously fit and well who presented initially with thyrotoxic symptoms. TFTs showed TSH <0.05, fT3 40. Thyroid uptake scan showed homogenous uptake of 8%. She was prescribed carbimazole 40 mg od and propanolol 40 mg bd with improvement.One month later, she presented to A+E with abdominal pain associated with diarrhoea and vomiting. She was found to be unwell, tachycardic and febrile. She had a global...

ea0015p362 | Thyroid | SFEBES2008

Failure of TSH suppression in patients with thyroid cancer

Paschalidis E , Mallick UK , Morris M , Perros P

Introduction: Part of the long-term management of patients with differentiated thyroid cancer (DTC) is TSH suppression with supraphysiological doses of levothyroxine. Anecdotal experience suggests that GPs often are not aware of the differences in objectives between treating patients with DTC with suppressive doses of thyroxine and treating patients with primary hypothyroidism, thus leading to inappropriate adjustments of the dose of levothyroxine.Object...

ea0015p363 | Thyroid | SFEBES2008

Abstract unavailable...

ea0015p364 | Thyroid | SFEBES2008

Hypothyroidism and hyponatraemia: diagnostic relevance of ADH measurement

Khan Azhar , Nair Sunil , Waldron Julian , Davies Marten , Heald Adrian

Background: Hyponatraemia is one of most common electrolyte abnormalities in acutely ill elderly patients. Severe hypothyroidism is often associated with hyponatraemia. The mechanism of hyponatraemia in hypothyroidism is not fully understood. It is suggested that hypothyroidism induces hyponatraemia either by inappropriate release of ADH or by decrease in GFR. Regardless of the mechanism, the net effect is impairment of water excretion. We report a case of severe hypothyroidis...

ea0015p365 | Thyroid | SFEBES2008

A different relationship between thyroid function and mood in people on thyroxine compared to the general population: results from the HUNT study

Panicker Vijay , Evans Jonathan , Bjoro Trine , Asvold Bjorn , Dayan Colin , Bjerkeset Ottar

Introduction: It is standard teaching that thyroid function is associated with mood, in particular hypothyroidism with depression. Recent studies however have provided conflicting data, with community based studies suggesting no relationship, but a study in patients on thyroxine showing an association. There may be biases involved in these studies as in communities with good health care, symptomatic people with mildly abnormal thyroid function are often put on thyroxine and ex...

ea0015p366 | Thyroid | SFEBES2008

Radioactive iodine (I131) treatment in thyrotoxicosis- audit of local experience

Lambert Kimberley , Al-Mrayat Maen

We reviewed the outcomes of 40 patients (30F, 10M; mean age 56 years) with thyrotoxicosis who were referred for radioactive iodine treatment (RAI) via our department (catchment area of 130 000 people) over a period of 3 years (February 2004–March 2007). Twenty-three patients had Graves (GD); 6 had single toxic adenoma (STA); 11 had toxic multinodular goitre (MNG). Thirty-six patients (90%) had a preceding isotope scan, and 2 patients (5%) had previous partial thyroidectom...

ea0015p367 | Thyroid | SFEBES2008

My brother and I–differential tissue sensitivity to thyroid hormones in thyroid hormone resistance

Lockett Helen , Stride Amanda , MacLeod Kenneth

A 62-year-old man with insulin treated type 2 diabetes presented with atrial fibrillation. Despite anticoagulation he suffered an embolic cerebellar infarct ten days later. He was found to have abnormal thyroid function tests (TSH 7.75 mu/l, free T4 49.3 pmol/l, free T3 12.0 pmol/l). Thyroid function test analysis was repeated in a second laboratory confirming the results above. TSH was stimulated by thyrotrophin releasing hormone, confirming thyroid hormone resistance. Magnet...

ea0015p368 | Thyroid | SFEBES2008

Patient perception of aetiology of Graves’ orbitopathy

Vamvini Maria , Morris Margaret , Dickinson A Jane , Perros Petros

Introduction: The aetiology of Graves’ orbitopathy (GO) is complex and includes genetic and environmental influences. Among potentially controllable risk factors smoking ranks highest. There is strong evidence that smoking cessation benefits patients with GO. The success of secondary prevention strategies depends largely on how the intervention is perceived by patients, especially when it involves lifestyle changes.Objectives: To determine patient p...

ea0015p369 | Thyroid | SFEBES2008

Raised serum FT4 and inappropriately detectable serum TSH: evaluation of recommendations from the UK TFT guidelines

Han T S , Woolman E , Marshall K , Thomas M , Vanderpump M

Objectives: The UK TFT Guidelines (2006) recommend screening for heterophilic antibodies (HA), thyroid hormone resistance (THR) and TSHoma in samples with raised FT4 and detectable or raised TSH levels. The aim was to determine the frequency and aetiology of such ‘abnormal’ thyroid function tests (TFTs) and to evaluate the use of further analyses for this common biochemical abnormality.Design: Six-month retrospective study (1/08/06&#...

ea0015p370 | Thyroid | SFEBES2008

A trial of radioiodine with and without adjuvant lithium therapy in the treatment of hyperthyroidism

Mitchinson S , Nijher GMK , Meeran K , Martin N

Background: Radioiodine (RAI) is highly effective in the treatment of hyperthyroidism. Lithium reduces thyroidal release of organic iodide and thyroid hormones, thus increasing thyroid retention of RAI and subsequently, the delivered dose of radiation. Controversy surrounds whether lithium increases the efficacy of RAI.Aims: To assess whether lithium improved outcome after radioiodine treatment and analyse fT4 and eye disease changes in lithium treatment...

ea0015p371 | Thyroid | SFEBES2008

Use of a telephone clinic to follow up patients post-radioiodine treatment

Mitchinson S , Nijher GMK , Meeran K , Martin N

Background: Close follow up of patients treated with radioiodine (RAI) for hyperthyroidism is imperative to ensure that resultant hypothyroidism or ensuing hyperthyroidism is detected promptly and treated. Protocols of follow up vary between hospitals. In our centre, a telephone clinic is used and patients are called after thyroid function tests at 1, 3, 6, 9 and 12 weeks post radioiodine.Aims: To audit patient follow up in the telephone clinic, comparin...

ea0015p372 | Thyroid | SFEBES2008

Thyriod surgery for patients 70 years old and over

Tulwin Dorota , Zeitoun Hisham , Hassanein Mohamed

The aim of this study was to examine the indications, the surgical result and the complications rate after thyroidectomy for patients aged 70 and over.Material and methods: Retrospective analysis of 46 patients underwent thyroid surgery at District General Hospital.Results: Micronodular goitre/20 patients/toxic thyroid/7 patients, and suspected malignancy/19 patients/was indication for surgery.Twenty-four pat...

ea0015p373 | Thyroid | SFEBES2008

An unusual cause of a thyroid mass

Thomas Julia , Norton Andrew , Calaminici Maria , Plowman P Nicholas , Richards Polly , Alusi Ghassan , Montoto Silvia , Akker Scott

A 24-year-old woman presented with stridor resulting from a large, firm, anterior neck mass. At age six she had been treated for acute lymphoblastic leukaemia (ALL) with vincristine, prednisolone, daunorubicin, asparaginase, prophylactic cranial radiotherapy and intrathecal methotrexate. She also had primary hypothyroidism with strongly positive thyroid peroxidase antibodies.The mass had been gradually enlarging for 6 months, causing exertional breathles...

ea0015p374 | Thyroid | SFEBES2008

A retrospective audit of radioiodine treatment for thyrotoxicosis

Madathil Asgar , Kakarla Ram , Abouglila Kamal

Background: The aim of radioiodine treatment is to ameliorate hyperthyroidism, with minimal risk of hypothyroidism. The Royal College of Physicians recommends the administration of 400–550 Mbq for Grave’s disease and 550–600 Mbq for toxic multinodular goitre.Aim: Our audit aimed to analyze the results of our current practice of radioiodine treatment, and also to compare it with the published results of success rate and hypothyroidism.<...

ea0015p375 | Thyroid | SFEBES2008

Thyrotoxic psychosis associated with fluctuation in thyroid status

Rathi Manjusha , Ward Emma

Background: Thyrotoxicosis can be associated with various psychiatric symptoms, such as emotional lability, anxiety, restlessness and rarely frank psychosis. We report such a case.Case report: Forty-seven year old female presented with palpitations, agitation, irritability, itching of her eyes in March 2007. She denied history of tremor or insomnia. No history of drug or alcohol abuse. No personal or family history of depression or any other psychiatric ...

ea0015p376 | Thyroid | SFEBES2008

Management of hypothyroidism in joint antenatal endocrine clinic

Rathi Manjusha , Thein Angela , Ward Emma

Hypothyroidism (including subclinical hypothyroidism) occurs in about 2.5% of pregnancies. During pregnancy, maternal thyroid hormone requirements increase. It is known that the pregnant woman is the sole source of the fetal supply of thyroid hormones from conception to approximately 13 weeks of gestation when fetal thyroid function has developed. Organogenesis particularly of the nervous system is dependent on adequate thyroxine levels in fetal circulation. An elevated thyrot...

ea0015p377 | Thyroid | SFEBES2008

TSH-secreting pituitary adenoma (TSH-oma) with coexistent autoimmune hypothyroidism

Rangan Srinivasa , Karamat Muhammad , Mitchell Rosalind , Gittoes Neil , Franklyn Jayne

A 69-year-old man with no family history of thyroid disease presented with weight gain and constipation. He was clinically euthyroid with no goitre. Investigations confirmed autoimmune hypothyroidism with FT4 16.9 pmol/l (N: 10–22), TSH 29.14 mIU/l (N: 0.4–4.5), elevated thyroid peroxidase (TPO) antibodies 3311 IU/ml (N: 0–34) and he was commenced on thyroxine with serial dose adjustments to 250 mcg OD over 2 years. His TSH however remained ...

ea0015p378 | Thyroid | SFEBES2008

Specificity of first-line tests for the diagnosis of Graves’ disease: assessment in a large series of hyperthyroid patients

Razvi Salman , Perros Petros , Parr John , Wahid Shahid

Context: Hyperthyroidism is a common endocrine condition that can be associated with significant morbidity. It is important to ascertain the underlying cause of hyperthyroidism as the natural history, potential complications and response to treatment can be very different.Objective: To investigate if measurement of TSH-receptor binding inhibitory immunoglobulin (TBII), a TSH-receptor antibody found in Graves disease, in the serum of newly diagnosed hyper...

ea0015p379 | Thyroid | SFEBES2008

Does the PTPN2 gene exhibit disease specific associations for Graves’ disease?

Storrar Joshua , Newby Paul , Heward Joanne , Franklyn Jayne , Gough Stephen , Simmonds Matthew

Recent genome wide screens performed by the Wellcome Trust Case Control Consortium using 500k single nucleotide polymorphisms (SNP) genotyping arrays have detected several novel susceptibility loci for the common autoimmune diseases (AIDs): Crohn’s disease (CD), type 1 diabetes (T1D) and rheumatoid arthritis (RA). PTPN2, which encodes TCPTP an important negative regulator of inflammation, is one such locus. The rs2542151 SNP in PTPN2 was shown to be highly a...

ea0015p380 | Thyroid | SFEBES2008

A role for 3-iodothyronamine in regulation of adipocyte lipolysis

Mitchell Fiona , Scanlan Thomas , Taylor Peter

Iodothyronamines are endogenous trace amines which are putative products of thyroid hormone decarboxylation by Aromatic Amino acid Decarboxylase (AADC). 3-Iodothyronamine (T1AM) has been shown to have profound effects on rodents in vivo, including reductions in body temperature, blood pressure and cardiac output, alongside a switch from carbohydrate to fat utilisation. It is possible that T1AM induces some of these effec...

ea0015p381 | Thyroid | SFEBES2008

Case report: type 3 amiodarone induced thyrotoxicosis

Helmy Ahmed , Nugent Ailish

A 48-year-old gentleman was referred to the endocrine team with abnormal thyroid function tests (TFTs). His background history included cardiomyopathy complicated by atrial fibrillation (AF). He had been treated with amiodarone for a year. TFTs were monitored regularly during treatment and were normal. Four months after stopping amiodarone, he complained of weight loss, sweating and tremor. He had no family history of thyroid disease. He had a resting heart rate of 120/min (AF...

ea0015p382 | Thyroid | SFEBES2008

Propylthiouracil (PTU) induced agranulocytosis in pregnancy

Syed Ateeq , Rangan Srinivasa , Franklyn Jayne

Hyperthyroidism complicates ~1 in 1000–2000 pregnancies, with majority of cases due to Grave’s disease (GD). PTU remains the preferred ATD of choice in pregnancy with carbimazole a reasonable second-line alternative in patients allergic or intolerant to PTU. We present the case of a lady with PTU induced agranulocytosis in pregnancy.A 29-year-old lady was seen in thyroid clinic in May 2006 having had symptoms suggestive of thyrotoxicosis since ...

ea0015p383 | Thyroid | SFEBES2008

Audit on thyroid function tests in acutely unwell patients

Thirumurugan Ethirajan , Kaur Tejinder , Jordaan Marieke , White Colin

Isolated change in serum TSH concentration occurs in 15% of hospitalised patients in response to non-thyroidal illness or various drugs, which interfere with thyroidal synthesis and secretion, thyroid hormone metabolism and absorption. Significant change in concentration of either suppressed (<0.1 mU/l) or elevated (>10 mU/l) TSH level is seen in 1–2% of them but only less than half have underlying thyroid disorder.UK Guideline for use of TF...

ea0015p384 | Thyroid | SFEBES2008

Rhabdomyolysis and acute renal failure due to hypothyroidism

Macleod Andrew , Siddique Haroon , Bashir Ahmed , Moulik Probal , Beshr Ahmed

Introduction: Hypothyroid myopathy with moderate elevation of muscle enzymes is not uncommon. However rhabdomyolysis and acute renal failure due hypothyroidism is rare and only few cases have reported. We describe a patient with rhabdomyolysis due to primary hypothyroidism.Case report: A 45-year-old male was admitted with 6 weeks history of generalised muscle weakness. He described his gait as ‘walking like a drunk’ in the absence of alcohol. H...

ea0015p385 | Thyroid | SFEBES2008

Risk of co-existing autoimmune diseases in 3309 index cases with auto-immune thyroid disease and their relatives

Boelaert Kristien , Newby Paul , Simmonds Matthew , Carr-Smith Jackie , Heward Joanne , Gough Stephen , Franklyn Jayne

Autoimmune thyroid diseases (AITD), Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) are common, but there is limited information on the prevalence of co-existing auto-immune diseases (AID). We prospectively collected 3309 patients with AITD and determined prevalences of other autoimmune diseases in index cases and relatives. Overall, 10.3% of 2806 GD patients and 18.1% of 503 HT subjects reported a co-existing AID. Rheumatoid arthritis was the commonest AID in ...

ea0015p386 | Thyroid | SFEBES2008

Characteristics of subclinical hyperthyroidism in secondary care

Eaton Gemma , Rebora Cayetano , Chapman A John

Background/objective: The prevalence of low serum TSH in the general population is in the order of 2.5–3.9%, and increases with age. True subclinical hyperthyroidism (SH) (low/suppressed serum TSH, normal serum fT4 and fT3) is less common. In one population based study of 1193 subjects, 66 (5.5%) were found to fit the criteria for SH. Of these, 75% had serum TSH 0.05–0.5 mIU/l, of whom 76% normalised within 12 months. At 12 months 87.5% subjects with serum TSH <0...

ea0015p387 | Thyroid | SFEBES2008

Treatment of hyperthyroidism with 400 MBq I-131

Britton Edward , Turner Esther , Hall Rebecca , Nayar Rahul , Carey Peter

Background: Iodine-131 (I-131) has been used to treat hyperthyroidism for half a century. Recent recommendations from the RCP London and British Thyroid Association suggest 400 MBq in most cases, but 500–600 MBq for toxic multinodular goitre (MNG). We have reviewed our clinic data with particular reference to response to a standard dose, 400 MBq, given to treat hyperthyroidism.Method: Casenotes of 88 patients who received 400 MBq I-131 for hyperthyr...

ea0015p388 | Thyroid | SFEBES2008

Fine needle aspiration biopsy (FNA) of the thyroid gland: a district general hospital experience

Elmalti Akrem , Nagi Dinesh , d'Costa Ryan , Andrews Julia , Ajjan Ramzi , Moisey Rob , Jenkins Richard

FNA of the thyroid is used for fast and early assessment of thyroid nodules, however it is sensitivity as a useful diagnostic test depends largely on the technique, experience of the aspirator and expertise of the cytologist. We undertook a retrospective audit of FNA to evaluate our results and compliance with the national guidelines.We examined 121 patients had FNAs at Pinderfields Hospital from October 2000 to June 2007. The cohort was comprised of 106...

ea0015p389 | Thyroid | SFEBES2008

Regulation of VEGF and PlGF production by human thyroid follicular cells

Susarla Radhika , Watkinson John , Eggo Margaret

Vascular endothelial growth factors (VEGFs) support angiogenesis and thus tissue growth. They are synthesised and secreted by several cell types but their actions are normally limited to endothelial cells which express VEGF receptors (VEGFRs). Using qRT-PCR and Western blotting we found that normal human thyroid follicular cells also express VEGFRs (VEGFR1-3, neuropilin1 and 2). We have examined the regulation of the expression of VEGFs and PlGFs in the cells. Cells were fully...

ea0015p390 | Thyroid | SFEBES2008

Expression and subcellular localisation of VEGFRs in human thyroid follicular cells

Susarla Radhika , Gonzalez Ana-Maria , Watkinson John , Eggo Margaret

Using qRT-PCR, we found that normal human thyroid follicular cells in culture express the mRNAs for the receptors for vascular endothelial growth factors (VEGFRs). qRT-PCR revealed that the relative production of mRNAs for VEGFRs was neuropilin1=neuropilin2=VEGFR2>VEGFR1 >VEGFR3. Western blotting for phosphoVEGFR2 showed labelling of a 235 kDa protein with few degradation products. VEGFR2 is likely in its active, phosphorylated form, because thyroid cells secrete large...

ea0015p391 | Thyroid | SFEBES2008

Mechanisms regulating plasminogen activator production from human thyroid follicular cells

Susarla Radhika , Watkinson John , Eggo Margaret

We have recently shown that human thyroid follicular cells in culture secrete large amounts of active plasminogen activators (PAs). Thyroid cells also secrete large amounts of vascular endothelial growth factors (VEGFs) and express their receptors, the VEGFRs. PAs, as serine proteases, are known to process growth factors, particularly VEGFs into active forms. In endothelial cells, VEGFs stimulate PA production. We examined the effect of inhibiting VEGF signalling on thyroid fo...

ea0015p392 | Thyroid | SFEBES2008

Audit of outcomes of radioiodine treatment for benign thyroid disease

Bejinariu Emanuela , Crasto Winston , Elrishi Mohamed A , Levy Miles J , Peat I , Howlett Trevor A

Objective: To assess the effect of antithyroid drug pretreatment on radioiodine (I-131) treatment outcomes for benign thyroid disease.Method: Retrospective analysis of all patient records on the clinical database that underwent I-131 treatment for benign thyroid disease between 1989 and 2007.Results: About 544 patients were identified, 98 males (18%) and 446 females (82%). The mean age was 54 years (11-88). 464 patients (85.3%) we...

ea0015p393 | Thyroid | SFEBES2008

Severe sight-threatening thyroid eye disease presenting de novo in an euthyroid pregnant woman

Germain Sarah , Saha Shouvik , Nelson-Piercy Cathy , Stanford Miles , Carroll Paul

Introduction: Graves’ disease is a common cause of hyperthyroidism in pregnant woman, but usually improves during pregnancy.Case: A 23-year-old Pakistani woman in her first pregnancy had no personal or family history of thyroid disease. At 30 weeks gestation she developed a swollen, red left eye, which progressed to involve the right eye. Orbital MRI demonstrated left-sided proptosis, bulky superior and inferior rectus muscles, but no extra-orbital ...

ea0015p394 | Thyroid | SFEBES2008

Recurrent Riedel’s thyroiditis as a part of multifocal fibrosclerosis

Mohamed A Elrishi , Hopkins Rebecca , Levy Miles , Woltmann Gareth , Howlett Trevor

Introduction: Riedel’s thyroiditis is a rare disorder of unknown aetiology and may be seen isolated or as a part of multifocal fibrosclerosis. Multifocal fibrosclerosis involves two or more fibrotic disorders including Riedel’s thyroiditis, retroperitoneal fibrosis, sclerosing mediastinitis, retro-orbital pseudotumour and sclerosing cholangitis. We report a case of recurrent Riedel’s thyroiditis as part of multifocal fibrosclerosis presenting with a woody neck s...

ea0015p395 | Thyroid | SFEBES2008

An uncommon cause of thyrotoxicosis and thyroid eye disease

Hopkins Rebecca , Rishi Mohammed El , Levy Miles , Howlett Trevor

Introduction: It is well known that struma ovarii, choriocarcinoma and follicular thyroid carcinoma can cause thyrotoxicosis. We report a rare case of a man with carcinomatosis presenting with acute thyrotoxicosis, unilateral proptosis and neck swelling.Case report: A 48-year-old man presented with a 2 weeks history of neck swelling, profuse sweating, heat intolerance, agitation, weight loss and mild unilateral proptosis. He was a smoker with a 20 years ...

ea0015p396 | Thyroid | SFEBES2008

Subclinical thyroid disorders in ischaemic heart disease: audit of clinical practice within rapid access chest pain clinic

Shakoor Abdul , Blount Emily , Low Melanie , Howe Rachel , Razvi Salman , Barker John , Weaver Jolanta

Introduction: Subclinical hypothyroidism (SCH, higher serum thyroid stimulating hormone (TSH) with normal thyroid hormone) is associated with an increased risk of ischaemic heart disease (IHD). Subclinical thyrotoxicosis (SCT, lower serum TSH with normal thyroid hormone) is also associated with an increased risk of atrial fibrillation, cardiovascular morbidity and mortality.Aim and methods: To examine the relationship between IHD and thyroid disorders in...

ea0015p397 | Thyroid | SFEBES2008

Reversible thyrotoxic cardiomyopathy

Hamda Arif , Hurel Steve , Rizig Mie

A middle age barrister admitted via accident and emergency department with the history of dyspnoea on exersion, orthopnoea,palpitation, weight loss and significantly reduced exercise tolerance to an extent he was not able to walk more than few metres. He had been investigated for tuberculosis and treated for chronic alcohol excess in the past, there was no history of ischaemic heart disease. He was not on any regular medication.Clinical examination revea...

ea0015p398 | Thyroid | SFEBES2008

High versus low dose of 131I and the impact of carbimazole on subsequent radioiodine therapy outcome in thyrotoxicosis

Yousseif Ahmed , Shah Nimish , Skelly Robert

Controversy about the optimal dose of 131I in thyrotoxicosis is ongoing. High doses result in higher cure rates, but are associated with elevated risk of hypothyroidism and irradiation exposure. There is no consensus as to the optimum period of thionamide discontinuation prior to treatment, nor to its impact on the success of RAI.We retrospectively analysed 151 clinical records of patients with thyrotoxicosis due to Grave’s disease or tox...

ea0015p399 | Thyroid | SFEBES2008

Thyroxine replacement in patients on peritoneal dialysis

Rao-Balakrishna Prasanna , Negali Padmanna , Wu Frederick CW

A 44-year-old gentleman known to have adult polycystic kidney disease with chronic renal failure was found to be profoundly hypothyroid in predialysis assessments in the renal clinic. He was symptomatic feeling tired and generally unwell with multiple problems, which were initially all attributed to his renal failure. Investigations of his thyroid by ultrasound revealed two nodules in the left lobe and one nodule in the right lobe of the thyroid. FNAC failed to differentiate b...

ea0015p400 | Thyroid | SFEBES2008

Predictors of recurrence in Graves’ disease in Oxford

Lafferty Jessica , Walker Neil , Wass John

In order to assess the frequency and timing of recurrence in a group of patients with Graves’ disease and the predictors of recurrence, 197 patients were sampled, who were first seen in the OCDEM clinic in either 2001 or 2002 and put on anti-thyroid medication. Graves’ disease was diagnosed by the presence of low TSH levels ± symmetrical goitre ± uniform radioactive iodine uptake ± eye disease ± high levels of thyroid hormones. Patients with <...