Endocrine Abstracts

Background: Thyroid disorders are among the common endocrine problems in pregnant women. Overt and subclinical hypothyroidism has been shown to be associated with an adverse outcome for both the mother and offspring.Objective: Are to find out the prevalence and complications of overt and subclinical hypothyroidism among pregnant Saudi women living at ALMadinah region.Materials and methods: A hospital-based prospective study perform...

A 58-year old female with long standing type 1 diabetes and treated hypothyroidism presented to casualty with a 1-day history of vomiting and breathlessness. Clinically she was dehydrated with a depressed conscious level (GCS=12). Initial investigations confirmed diabetic ketoacidosis (pH=6.8, bicarbonate=4.7 mmol/l, urinary ketones=4+, blood glucose=54.6 mmol/l) and acute renal failure, likely to be secondary to pneumonia as there was consolidation on her CXR and a raised WCC...

Background: Maternal thyrotoxicosis affects 0.2% of pregnancies. Pharmacological treatments include carbimazole, methimazole and propylthiouracil. The Endocrine Society recommends the use of propylthiouracil as first line during pregnancy, because of possible associations between carbimazole and congenital anomalies. However, recent reports link propylthiouracil to liver injury in adults, children, pregnant women and fetuses, raising questions over its safety.<p class="abs...

Aim: Retrospective survey on outcomes of 131I therapy in subjects with hyperthyroidism.Methods: We analysed the outcomes at 1 year, of 55 episodes of 131I therapy in 52 patients (36 males, 15 females) who were treated between January 2007 and January 2009.Results: At 1 year post 131I therapy, 31 (56.3%) subjects were hypothyroid (median age 54 years), 14 (25.5%) were euthyroid (median age 69 years) ...

We report an unusual case of struma ovarii diagnosed after thyroidectomy for Graves’ disease and papillary thyroid cancer.A 46-year-old woman presented with a 3-month history of weight loss, palpitations and irregular periods. Physical examination revealed tachycardia, fine tremor and a diffuse goitre. TSH <0.1 (0.5–4.2 mU/l), FreeT4 26 (10.8–19.3 pmol/l) confirmed thyrotoxicosis.Thyroid ultrasound scan showed a ...

Anaplastic carcinoma accounts for <5% of thyroid cancer. The simultaneous occurrence of anaplastic carcinoma (ATC) and Graves’s thyrotoxicosis is extremely uncommon with only six cases described in the literature.A 73-year-old female presented with weight loss and atrial fibrillation. Investigations showed TSH-0.02 mU with T4-40 pmol/l and T3-16 pmol/l suggesting thyrotoxicosis.There was no thyromegaly or orbitopathy. TBII was elevated at 10.3 U...

Background: Temporary hypocalcaemia occurs in up to 40% of patients following a total thyroidectomy. Serum calcium and parathyroid hormone (PTH) measurements are currently used to predict post-thyroidectomy hypocalcaemia. However, immediate access to PTH measurement is expensive and not widely available. Serum phosphate responds rapidly to changes in circulating PTH levels and its measurement is readily available in all hospitals. We evaluated the use of serum phosphate to pre...

Background: National osteoporosis guideline group recommend routine measurement of thyroid function tests. However it is well recognised that abnormal thyroid function tests done during acute hospital stays is not always suggestive of thyroid dysfunction and that they need to be repeated to determine the need for further management.Aim: To identify and assess the follow up of thyroid function tests (TFTs) done between June 2009 and Feb 2010 in the orthop...

Background: Thyroid hormone deficiency is associated with increased cardiovascular morbidity, which cannot be fully explained by the atherogenic changes in lipid profile observed in these patients. Hyperhomocysteinemia could help to explain the increased risk for arteriosclerotic coronary artery disease in hypothyroidism because is an important and independent risk factor for cardiovascular disease. Hypothyroidism decreases hepatic levels of enzymes involved in the remethylati...

Previously we showed that thyroid-targeted overexpression of the PTTG binding factor (PBF) induced significant goitrogenesis in transgenic mice (PBF-Tg). In 10 week old PBF-Tg mice thyroid weight was increased by 1.8±0.3-fold compared to wild-type (WT) controls (n=20, P<0.0001). We have now examined the long-term effects of PBF overexpression on thyroid gland weight and histology in aged PBF-Tg mice. Our study shows that the penetrance of increased thyro...

Aims: In 2005 we defined a specific reference range for TSH in our pregnant population. We have assessed whether this has resulted in changed management of treated hypothyroidism in pregnant.Methods: The management of 73 mothers (Group 1) between January 2000 and July 2005 was compared to that of 67 mothers (Group 2) between August 2005 and December 2009. The upper limit of normal for TSH was 4.5 mU/l till July 2005; the specific TSH range defined for pr...

The reported incidence of thyroid dysfunction associated with interferon-α (IFNα) treatment for hepatitis C infection varies widely between countries.1 To our knowledge the spectrum of thyroid dysfunction in IFNα-treated Irish patients has not been described outside of an anti-D-related, hepatitis C-infected cohort.We reviewed thyroid function tests (TFTs) from all Hepatitis C positive patients undergoing IFNα treatment ove...

Background: Thyroid function within the normal range has been shown to influence body weight in a population. Even slightly elevated serum TSH levels are associated with an increase in the occurrence of obesity. It is unclear whether significant weight loss has the reverse effect on thyroid function, and studies to date have yielded inconsistent results.Aims: Our aim was to describe changes in TSH and fT4 in relation to durable and significant...

Over recent years, the numbers of commercially available slimming aids have increased dramatically. Whilst the majority of these aids are harmless, their interaction with normal physiology is either not understood or not brought to the attention of the customer. We report the case of a 45-year-old woman who presented with clinical and biochemical thyrotoxicosis (fT4 31.5 pmol/l, fT3 14.3 pmol/l, TSH <0.02 mIU/l). She had elevated TPO antibodies (51 IU...

Introduction: With increased biochemical screening primary hyperparathyroidism (pHPT) is discovered incidentally while patients are still asymptomatic.Objective: To assess the impact of surgery on neuropsychological symptoms in people with apparent asymptomatic pHPT.Methods: Twenty-four patients with asymptomatic pHPT requiring parathyroidectomy, in accordance with NIH recommendations, were recruited prospectively between May 2005 ...

A 70-year-old female with known schizophrenia presented in hyperthyroid crisis. Examination revealed muscle wasting, tremor, sweating, low-grade fever, and sinus tachycardia. Biochemistry confirmed the diagnosis (TSH <0.1 mlU/l, thyroxine 41 pmol/l (9–25), tri-iodothyronine 25 pmol/l (3.5–6.5)). The patient was commenced on i.v. esmolol and carbimazole (40 mg) crushed into warm milk.However, lacking mental capacity, and refusing to take all...

Thyroid storm or thyrotoxic crisis is a manifestation of an extreme state of thyrotoxicosis. It is both rare and potentially fatal. Its presentation can be clouded by the precipitating illness and the involvement of one or more organ systems underlining the importance of clinical suspicion, early recognition and prompt intervention.We present a case of a 37-year-old man presenting to hospital with a community acquired chest infection that had not settled...

Introduction: Adrenaleukodystrophy is an X linked disorder associated with functional defect of very long fatty acid (VLFCA) oxidation leading to accumulation of VLFCA in the white matter of brain and adrenal cortex. It usually presents with adrenal insufficiency and neurological problems and has association with other autoimmune conditions reported so far including vitiligo, ulcerative colitis. We report a case of adrenaleukodystrophy, vitiligo and hypothyroidism.<p class...

Introduction: British Thyroid Association Guidelines state that the diagnosis of thyroid malignancy cannot be based on the results of an aspiration’s cytology alone and will usually require surgical removal for confirmation. There has been much debate about the management of indeterminate fine needle aspirations (Thy 3). Recent publications have reported that the prevalence of thyroid carcinoma following a Thy 3 result to be as high has 28%, emphasising the importance of ...

Objective: To define the rates of progression to frank hyperthyroidism and to normal thyroid function for subclinical hyperthyroid patients (SH).Design: Record-linkage technology was used retrospectively to identify patients with SH in the general population from 1st January 1993 to 31st December 2009.Patients: All residents over 18 years old with at least two measurements of TSH below the reference range for at least 4 months from...

Introduction: Amiodarone is a class III antiarrhythmic agent widely used in the treatment of atrial and ventricular arrhythmias.Amiodarone is known to cause thyroid dysfunction in three ways; amiodarone induced hypothyroidism, amiodarone induced thyrotoxicosis (AIT) type I and type II.We present a case of a patient with AIT type II who subsequently developed hypothyroidism.Case presentation: A 43-year-old man...

Objective: Amiodarone is an iodine rich, potent antiarrhythmic drug that is highly lipid soluble and total body iodine stores remain increased for up to 9 months. Abnormal thyroid functions, either thyrotoxicosis or hypothyroidism occur in upto 14–18% of patients receiving long-term amiodarone therapy. Hence regular thyroid function tests are required in patients on long-term amiodarone treatment. The BNF clearly states that thyroid function tests should be done at a mini...

Expansion of the orbital contents, by adipogenesis and hyaluronan (HA) overproduction, causes Graves orbitopathy (GO). Orbital HA is generated predominantly by hyaluronan synthase 2 (HAS2) whose transcription is positively regulated by pAkt in cell lines. GO is most frequently associated with Graves’ disease (GD) in which thyroid stimulating antibodies bind the TSH receptor (TSHR) increasing cAMP. Previous studies highlight a role for TSAB and ‘neutral’ TSHR ant...

PBF is a proto-oncogene implicated in the aetiology of thyroid cancer. PBF binds to several proteins, including PTTG and NIS, but its full function is unknown. Understanding the range of interactions PBF has within thyroid cells is therefore vital; these were explored by tandem mass spectrometry (MS/MS), which relies on the predictable fragmentation pattern of an amino acid chain to identify the exact proteins present in a sample.K1 and TPC1 papillary th...

Graves’ disease (GD) and Hashimotos’ thyroiditis (HT), two of the most common autoimmune thyroid diseases (AITD), are caused by both shared and disease specific genetic determinants. In females one copy of the X chromosome is randomly inactivated, and although inactivation should occur with a parent of origin ratio of 50:50, skewed X chromosome inactivation (XCI) can occur, whereby >80% of a specific copy of the X chromosome is inactivated. Increased skewed XCI i...

Background: Environmental factors play a role in the pathogenesis of autoimmune conditions. The incidence of type 1 diabetes is higher in winter. It is unclear whether autoimmune thyroid disease is similarly affected by seasonal variation. We aimed to study the variation in anti thyroid peroxidase (TPO) antibodies in relation to calendar month of sampling.Methods: We obtained TPO-antibody results for the 12 months (October 2009 till September 2010). Indi...

A 25-year lady was referred by her GP with a six-month history of symptoms suggestive of thyrotoxicosis; weight loss, palpitations, heat intolerance and lethargy. She also complained of thirst, polyuria and nocturia. Examination findings included tachycardia, tremor and a moderately enlarged goitre.In clinic, blood tests performed confirmed thyrotoxicosis: TSH<0.05 mU/l (NR 0.3–4.2 mU/l), free T3 >46.1 pmol/l (NR 2.5–5.7 pmol...

Thyrotoxicosis is characterised by increased osteoclast activity. Thyroid hormone receptor alpha (TRα) is the predominant TR-isoform in bone and mice lacking TRα have skeletal hypothyroidism with impaired osteoclastic bone resorption. By contrast, mice lacking TRβ have skeletal hyperthyroidism and increased bone resorption. Thus, we hypothesized that T3 acts via TRα to stimulate osteoclastogenesis. Osteoclasts were differentiated in vitro ...

The human pituitary tumor transforming gene (hPTTG) plays important roles in tumourigenesis through its function as a securin and by interaction with the tumour suppressor gene p53. We have previously indentified hPTTG expression as a prognostic indicator for differentiated thyroid cancer. We recently generated a transgenic mouse model overexpressing hPTTG targeted to the thyroid gland via a thyroglobulin promoter to delineate PTTG effects on thyroid tumourigenesis in vivo<...

Anecdotal reports suggest that management of Graves’ disease (GD) is more challenging in patients with concomitant autoimmune disease, however there are few studies evaluating this premise and thus no satisfactory evidence base to guide clinicians. We aimed to identify the impact of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) on treatment outcomes of GD.We identified all GD patients (n=265) who attended endocrinology clin...

A 48-year-old female received radioiodine ablation therapy for thyrotoxicosis secondary to a solitary toxic nodule. The subsequent unexpected requirement for replacement thyroxine was explained by Hashimoto’s thyroiditis with an anti-thyroid peroxidase antibody level of 692.3 IU/ml. Thirty months later she presented with debilitating left facial pain and painful sensory symptoms of her left arm and leg. She was euthyroid taking thyroxine 75 μg daily with a fT4</...

Background: A variety of thyroid antibody assays are used in the diagnosis of auto-immune thyroid disease (AITD). Commonly both thyroid peroxidase (TPOab) and thyroglobulin antibodies (TGab) are measured but the added value of testing two markers has not been established.Method: We retrospectively collected clinical and laboratory data on 500 consecutive patients who had thyroid autoantibodies requested from a specialist endocrine department of a tertiar...

Objective: Acclimatization to high-altitude is a dynamic process affecting the neuro-endocrine and physiological systems. Psychological well-being is also influenced by hypobaric-hypoxia. Psychic stress is known to influence the hypothalamo–pituitary–adrenal/thyroid axis. However, the involvement/contribution of ‘psychological-performance’ on hormone changes at high-altitude is not known. The objective of this study was to examine: i) the effect of ethnicit...

Background: Adipocytokines are biologically active substances produced by adipocyte with different physiological functions. Adiponectin, an adipocyte derived protein has multiple effects on homeostatic mechanism that regulate body weight and metabolism. Leptin, a signal of satiety to the brain, is considered as a proinflammatory adipocytokine. Thyroid hormones act on several aspects of metabolic and energy homeostasis influencing body weight, thermogenesis, and lipolysis in ad...

Hyperthyroid cats have elevated parathyroid hormone (PTH) concentrations and suppressed fibroblast growth factor-23 (FGF-23) concentrations, both of which normalise following treatment of hyperthyroidism. PTH, FGF-23, and thyroid hormone can influence the renal reabsorption of calcium and phosphate. The aim of the present study was to assess the influence of hyperthyroidism on renal tubular function in cats indirectly, by comparing the FE of electrolytes in hyperthyroid cats w...

Aim: In this study we have compared the adequacy rates of FNA samples between more experienced and less experienced operators in thyroid FNA.Introduction: The prevalence of thyroid nodules is estimated to be about 4–7%, increasing up to 50% in the adult population. US guided FNA has become the preliminary investigation of choice for thyroid nodules, as it is widely available and has been proven to increase diagnostic efficacy....

Obesity is a global heath concern and the proportion of overweight and obese people in the UK is rapidly increasing. Patients undergoing treatment for hyperthyroidism frequently express concerns regarding excessive weight gain especially when offered treatment with 131I. We followed 1159 patients with overt hyperthyroidism to determine the extent of weight changes and to identify risk factors for weight gain following treatment. Overall, BMI remained unchanged in 13...

A 31-year-old engineer presented with a 6-week history of tremor, weight loss, mild goitre and palpitations. At the onset of these symptoms, he also presented to a specialist eye hospital for difficulty with focussing his vision. He had no past medical history and was taking no medications. He did not have any family history of ocular or autoimmune conditions and was a non-smoker. On examination his BMI was 20, he had very mild proptosis, no diplopia and a diffuse symmetrical ...

A 47-year-old afrocaribbean lady was referred to endocrinology clinic with a 1-month history of weight loss, heat intolerance, palpitations, fatigue and hair loss. She reported symptoms consistent with proximal myopathy including myalgia and difficulty rising from chairs. Interestingly she noted a 1-month history of hypersalivation, which had caused her significant distress in her social and work life. The hypersalivation had resulted in a change in her voice and had also inte...

Aims and objective: Pegylated interferon is widely used in the treatment of hepatitis C. Thyroid dysfunction (TD) is a well recognised side effect of interferon treatment. As the use of interferon therapy in hepatitis C is on the rise, we conducted an audit to determine its prevalence and to formulate local guidelines for the monitoring and management of thyroid dysfunction in these patients.Methods: A case note based retrospective audit of all patients ...

Objective: The hypothalamus–pituitary–thyroid axis profoundly influences skeletal development. Whilst the adverse effects of thyroid dysfunction on bone are well established; the effects of variation within the normal range is less clear.Design: In a subset of the Avon Longitudinal Study of Parents and Children we performed full thyroid function tests from stored samples taken at age 7. 668 children had thyroid hormone parameters within the ref...

Langerhans cell histiocytosis (histiocytosis X) is a rare, proliferative monoclonal histiocytic disease of unknown cause that can involve many systems. Intermediate forms of the disease are characterized by a chronic course of a multi-organ involvement, including skin, bone lesions, interstitial lung disease, diabetes insipidus and rarely can involve primarily the thyroid gland.A 23-year-old gentleman presented with weight gain, lethargy and headaches. I...

A 38-year-old woman presented with tremor and anxiety 3 weeks into her pregnancy and was diagnosed with thyrotoxicosis. One year postpartum, the thyroid appeared multinodular with a dominant nodule that showed deficient uptake on the technetium scan. Her thyroid function was normal and thyroid peroxidase antibodies were negative. She developed an enlarging goitre and underwent total thyroidectomy following which she developed persistent hypocalcaemia and hypomagnesaemia.<p...