Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology BES 2013

ea0031p352 | Thyroid | SFEBES2013

Local regulation of T3 availability in susceptibility to osteoarthritis

Waung J A , Sandison A , Bassett J H D , Williams G R

Local regulation of T3 action in bone and cartilage is a novel mechanism underlying the pathogenesis of osteoarthritis (OA). Accelerated chondrocyte differentiation is a hallmark of OA and T3 regulates this process. The type 1 and 2 deiodinases (D1, D2) convert the pro-hormone T4 to the active hormone T3 whilst D3 inactivates both T3 and T4. D1 contributes to circulating T3 levels and local T3</s...

ea0031p353 | Thyroid | SFEBES2013

Low frequency of pendrin autoantibodies detected using a radioligand binding assay in patients with autoimmune thyroid disease

Kemp Elizabeth , Sandhu Harpreet , Weetman Anthony

Context: Pendrin is a transmembrane protein located at the apical end of the thyrocyte where it mediates the efflux of iodide through the thyroid follicular cell. Recently, pendrin was described as a significant antibody target in Japanese patients with Graves’ disease or autoimmune hypothyroidism using an immunoblotting assay. However, a subsequent study failed to verify this in autoimmune thyroid disease patients of Tunisian origin.Objective: The ...

ea0031p354 | Thyroid | SFEBES2013

Interferon induced thyrotoxicosis

Salazar Veneranda Lorelei , Whomersley Sarah , Imtiaz Komal

A 44-year-old gentleman with history of intravenous drug abuse, was referred for new onset hyperthyroidism. He was diagnosed with hepatitis C a year prior to presentation. Treatment included pegylated-interferon (IFN-α) 100 μg weekly and Ribavirin 1 g daily. He had early viral response at week 4 of treatment with viral load of <30 IU/ml from 24 089 IU/ml. At week 8, patient complained of lethargy. He was tachycardic, but had no goitre or thyroid eye disease. Thyr...

ea0031p355 | Thyroid | SFEBES2013

Levothyroxine therapy affects cerebral blood flow and fatigue in subclinical hypothyroidism

Aslam Nasar , He Jiabao , Madathil Asgar , Razvi Salman , Blamire Andrew , Weaver Jolanta

Background: Overt and subclinical hypothyroidisms are associated with altered cerebral blood flow (CBF) which may be reversed with levothyroxine treatment (T4T). Subclinical hypothyroidism (SCH) is associated with fatigue but it is unclear whether fatigue is related to abnormal CBF and whether T4T has a beneficial impact. We therefore studied fatigued SCH patients before and after T4T and euthyroid non-fatigued healthy controls (HC).Methods: CBF was meas...

ea0031p356 | Thyroid | SFEBES2013

Thyroid incidentaloma incidence and malignant prevalence in F-18-FDG-PET/CT imaging

Gorrigan Rebecca , Goddard Ian , Druce Maralyn

Background: Thyroid incidentaloma (TI) is an unsuspected, asymptomatic thyroid lesion discovered on an imaging study performed for unrelated purposes. Reported incidence during 2-(18)(F) fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET/CT) varies from 0.2 to 8.9%, with a quoted thyroid malignancy prevalence of 8-64%.Method: We reviewed all 18F-FDG-PET/CT scans performed in our institution over 52 mon...

ea0031p357 | Thyroid | SFEBES2013

Vitamin D status in autoimmune hypothyroidism

Kota Sunil Kumar , Meher Lalit Kumar , Jammula Sruti , Modi Kirtikumar D

Objective: To investigate vitamin D status in patients with autoimmune hypothyroidism.Methods: The study group consisted of 100 patients with newly diagnosed Hashimato’s thyroiditis and 100 subjects as the control group. Parameters of calcium metabolism, thyroid function tests and 25(OH) vitamin D levels were measured.Results or Case Presentation: Mean age of the study study groups was 33.4±4.8 years with female:male=72:2...

ea0031p358 | Thyroid | SFEBES2013

Prevalence of anti-thyroglobulin antibodies, their prognostic significance and impact on patient care in a cohort of patients with differentiated thyroid cancer

O'Toole Sam , Pittaway James , Raja Omair , Buckland Matthew , Plowman Nick , Brennan Carmel , Waterhouse Mona , Akker Scott , Drake Will , Druce Maralyn

Background: The measurement of thyroglobulin (Tg) is important in the follow-up of patients with differentiated thyroid cancer (DTC), but interpretation is subject to interference by anti-thyroglobulin antibodies (TgAb). National guidelines recommend measurement of TgAb status but no consensus exists on how surveillance should be adapted in cases of TgAb positivity.Aims: To evaluate the impact of TgAbs on clinical management, in a single-centre cohort of...

ea0031p359 | Thyroid | SFEBES2013

Factors prompting thyroid function testing in hospitalised patients with thyroid dysfunction: analysis of a large hospital database

Torlinska Barbara , Coleman Jamie , Afzal Mariam , Franklyn Jayne , Boelaert Kristien

Thyroid dysfunction is common and the clinical presentation of subjects with abnormal thyroid hormone concentrations varies widely. Whilst acute illness may affect the interpretation of thyroid function tests, delaying diagnosis and treatment of thyroid dysfunction may have significant consequences. We set out to determine the likelihood of thyroid function testing and the factors influencing the probability of serum TSH measurement in hospitalised patients with a recorded dia...

ea0031p360 | Thyroid | SFEBES2013

Homozygous resistance to thyroid hormone: can cardiac complications be prevented?

Moran Carla , Al-Johani Amal , Rajanayagam Odelia , Halsall David , Habeb Abdelhadi , Chatterjee V K K

Resistance to thyroid hormone (RTH) is usually due to heterozygous mutations in THRB gene with rare cases being homozygous for receptor defects. We describe an RTH case due to a homozygous TRβ mutation (R243Q).The Proband (male, 8.4 years), was born at term with low birth weight (1.9 kg) to consanguineous parents. He has a prominent nasal bridge, goitre, low body weight (10th centile), recurrent tonsillitis, hyperactivity and has mild hearing impair...

ea0031p361 | Thyroid | SFEBES2013

Factors predicting the development of hypothyroidism after radioactive iodine treatment

Varghese Jeanny , Aye Mo , Wright Graham , Rigby A , England James , Sathyapalan Thozhukat , Atkin Stephen

Background: The use of radioactive iodine treatment (RAI) for the definitive treatment of benign hyperthyroid disorders has been well established. This study was conducted to determine the factors predicting the development of hypothyroidism following RAI therapy.Methods: All patients (n=104, 25 men, 79 women) who had RAI for hyperthyroidism between January 2008 and December 2009 were included. In 82.6% of patients antithyroid medications were u...

ea0031p362 | Thyroid | SFEBES2013

Does closer monitoring of thyroid function post radioiodine reduce the severity of hypothyroidism when first detected?

Thida Myat , Ellis N R , Wright D , Peacey S R

We have previously shown that the current guidelines for monitoring thyroid function post radioiodine (RI), may not detect hypothyroidism until it has become severe, in a significant proportion of cases (J Endocrinol Invest 2012 35 82–86). An alternative more intense follow-up strategy was used whereby patients had TSH and FT4 measured at 4-week intervals post RI for 6 months. Endocrine specialist nurse-led telephone and nurse-led out-...

ea0031p363 | Thyroid | SFEBES2013

Interferon-induced thyroid dysfunction: a case series

Sennik Devesh , Forton Daniel , Seal Leighton

Interferon use for the treatment of chronic hepatitis infection, is associated with the side effect of thyroid dysfunction. This is frequent and can be severe, particularly if not recognised. We performed a retrospective analysis of cases of interferon related thyroid dysfunction referred to our tertiary endocrinology centre. Fourteen cases were identified over the last 8 years. An analysis was carried out of demographic features, presentation, treatment and outcomes.<p cl...

ea0031p364 | Thyroid | SFEBES2013

Clinical performance of fine-needle aspiration biopsy of thyroid nodules in a tertiary referral centre

Glynn Nigel , Hannon Mark , Lewis Sarah , Hillary Patrick , Hill Arnold D K , Keeling Frank , Morrin Martina , McHenry Claire , Smith Diarmuid , Thompson Chris , Leader Mary , Agha Amar

Fine-needle aspiration biopsy (FNAB) is the tool of choice for evaluating thyroid nodules but there is a significant percentage of insufficient or indeterminate aspirates and falsely reassuring results have been reported in up to 6% of cases.We aimed to examine our experience with FNAB among a large cohort of unselected patients with thyroid nodules.239 consecutive patients (211 women) underwent FNA of a thyroid nodule between July...

ea0031p365 | Thyroid | SFEBES2013

The challenge of managing refractory amiodarone-induced Graves' disease in resistance to thyroid hormone

Moran Carla , Chatterjee V K K , Page M D , Owen Penny

A 42-year-old man with resistance to thyroid hormone (RTH) and a recognised thyroid hormone receptorβ mutation (R383C) mutation, presented with atrial fibrillation (AF) which was resistant to DC cardioversion until initiation of amiodarone therapy.As expected in RTH, his baseline TFTs were abnormal (FT4 34.6 pmol/l, TSH 2.27 mU/l), but rose further (FT4 45 pmol/l, TSH 0.93 mU/l) following commencement of amiodarone. However, sh...

ea0031p366 | Thyroid | SFEBES2013

A rapidly enlarging neck lump and Horner's sign: lessons from a novel case

Donaldson James Fergus , Booth Frank , Parameswaran Rajeev , Rodriguez Gomez Iria Adriana

Background: Anaplastic carcinoma and primary lymphoma (TL) each constitute <2% of thyroid malignancies and are difficult to distinguish clinically. Both typically present with rapidly enlarging anterior neck masses in the elderly. Both may cause pressure symptoms (e.g. dysphagia, stridor and hoarseness). Differentiation is imperative as their treatment and prognoses differ.Case report: A 68-year-old man presented with a rapidly enlarging thyroid mass...

ea0031p367 | Thyroid | SFEBES2013

The presence of thyroid peroxidase antibodies in Graves' disease is predictive of disease duration and relapse rates

Wahab Furat , Kearney Edward , Joseph Stonny

TSH receptor antibodies (TRAB) are now routinely measured in patients with Graves’ disease (GD) to aid diagnosis. Thyroid peroxidase antibodies (TPO) sometimes co-exist in these patients but not always. Some studies have suggested a functional and prognostic role for these antibodies. However, the phenotypic characteristics of the patient with positive TPO (with or without TRAB) and the influence of TPO on the clinical course of GD are not known.A r...

ea0031p368 | Thyroid | SFEBES2013

Managing Graves' disease: management involving endocrine nurse led service: experience from DGH

Aziz Aftab , Cox Sue , Dyer Rob G.

Graves’ disease is an autoimmune condition predominantly affecting middle aged women. It can be difficult to manage and consumes a lot of medical time and resources.In Torbay Hospital, we introduced endocrine nurse specialist (ENS) follow up service to reduce medical burden. This has shifted the work-load of patient care but on the other hand, has resulted in identification of great need for support and increased nurse time.We...

ea0031p369 | Thyroid | SFEBES2013

Thyroid nodules, FNA cytology and thyroid cancer in Malta

Gruppetta Mark , Abela Alexia-Giovanna , Cachia Mario J , Fava Stephen , Vassallo Josanne

Introduction: Thyroid nodules are very common and elucidating the nature of these thyroid nodules is an important task.Methodology: Patients who had an ultrasound guided fine needle aspiration (FNA) of a thyroid nodule between January 2008 and June 2012 were retrospectively audited and their ultrasonographic and biochemical characteristics where analysed. For those patients who were operated nodule characteristics were correlated with thyroid histology.<...

ea0031p370 | Thyroid | SFEBES2013

False positive pentagastrin stimulation test in a family with medullary thyroid cancer

Fulford Laurence , Skene Anthony , Begley Joe , Richardson Tristan

We report a case of a false positive pentagastrin stimulation test in a patient with a positive family history for medullary thyroid cancer (MTC), but normal histology following total thyroidectomy.An asymptomatic 50-year-old man was referred urgently with an elevated calcitonin level of 19.9 ng/l (reference range<11.8), taken following the diagnosis of his brother with MTC which had been discovered on a routine private medical examination. There was...

ea0031p371 | Thyroid | SFEBES2013

Factors affecting choice of definitive therapy in patients with relapsed thyrotoxicosis

Moussa Hend , Macias-Fernandez Elena , Joseph Stonny

The use of anti-thyroid medication is favoured first line therapy in Graves’ disease (GD). However, relapse rates are high (up to 50%) and definitive therapies of either surgery or radioactive Iodine therapy (RAI) are often considered following an informed decision. The definitive choice taken depends on several factors considered during the patient-doctor interaction. The aim of this study was thus to determine the influence of such factors.A cross...

ea0031p372 | Thyroid | SFEBES2013

Levothyroxine absorption testing: a 5-day (usual dose) test as an alternative to the 1-day (1000 μg) test

Elmahi E , Vas P , Oyibo S

Introduction: Despite being on adequate amounts of levothyroxine (>1.6 μg/kg) some patients still exhibit biochemical evidence of inadequate replacement (serum TSH >4.2 mIU/l±free-thyroxine (FT4) <12 pmol/l). We report the use of a 5-day absorption test for assessing levothyroxine absorption in such a patient.Case: A 35-year-old female with hypothyroidism since 2007 had a serum TSH ranging from 4.48 to 54.9 mIU/l and FT<s...

ea0031p373 | Thyroid | SFEBES2013

Four cases of thyroid carcinoma presenting in childhood: 15 years experience in a National Tertiary Referral Centre

Ervine Evelyn , Wallace Ian , Taghavi Kiarash , Morreau Philip

Thyroid cancer has an annual incidence of 0.2–5 per million children representing 3% of all childhood tumours. We describe the presentation, histopathology and treatment of four patients in a regional paediatric surgical and endocrine unit over the past 15 years.Three of four cases are female with 1 male. Age of diagnosis ranged from 6 to 15 years. All had an elevated thyroglobulin at presentation with normal thyroid function tests. Three underwent ...

ea0031p374 | Thyroid | SFEBES2013

Acute transient thyrotoxicosis following intensity-modulated radiotherapy to the neck

Menon Ravi , Ahlquist James

Radiation to the neck is known to be associated with the later development of hypothyroidism. The possibility of acute radiation-induced thyrotoxicosis is not generally recognised. We report here a case of acute hyperthyroidism shortly after radiotherapy.A 57-year-old man with poorly differentiated adenocarcinoma of the left parotid underwent parotidectomy with radical neck dissection followed by radiotherapy. He received 65 Gy by intensity modulated rad...

ea0031p375 | Thyroid | SFEBES2013

Evaluation of fine needle aspiration and ultrasound in diagnostic assessment of thyroid nodules

Sagi SV , Berman L , Chatterjee VKK , Simpson HL

Objective: To evaluate the outcome of fine needle aspiration biopsy (FNAB) of solid thyroid nodules, and the utility of thyroid ultrasound in determining the nature of solid nodules in our practice.Methods: We reviewed the diagnostic outcome of FNAB of solid thyroid nodules in 93 patients from our dedicated thyroid biopsy clinic. In addition we compared the predictive value of sonographic assessment with FNAB in a subset of patients who had undergone bot...

ea0031p376 | Thyroid | SFEBES2013

Thyroid dermopathy: an extreme variant

Majumdar Kalpita , Barry Natalia , Hollington Sophie

Introduction: Thyroid dermopathy usually takes the form of pre-tibial myxedema, which may rarely be caused by Hashimoto’s thyroiditis. We present an extreme variant of pre-tibial myxedema, called Elephantiasis nostras verruca (ENV), in a hypothyroid patient.Case: A 51-year-old woman presented with a progressively worsening growth on her left leg and reduced mobility, constipation, cold intolerance and severe self-neglect. She was slow to respond to ...

ea0031p377 | Thyroid | SFEBES2013

Too low, too high: is it the Roux-en-Y? Fluctuating thyroid function post obesity surgery

Crane James , Scobie Ian

Hypothyroidism is common condition with a strong female preponderance and a UK prevalence of ~2%. It is normally treated with replacement oral levothyroxine.Morbid obesity is a costly public health issue with a prevalence in England of ~3% with two-thirds of sufferers being female. Weight loss surgery is increasingly employed as a successful and cost effective intervention for super-morbidly obese patients (BMI >40 kg/m2) in accordance wit...

ea0031p378 | Thyroid | SFEBES2013

Not all raised T4 needed treatment!

Raja U Y , Kapadi Tauseef , Basu Ansu

Introduction: Thyrotoxicosis is a common condition referred to endocrine clinics. However, not all of them needed treatment with antithyroid medications. We report a case of thyroid hormone resistance due to a novel TSHRβ mutation who has been treated with subtotal thyroidectomy and antithyroid medications due to raised T4 levels.Case report: A 38-year-old south Asian woman was seen in orthopaedic clinic for elective right foot scarf oste...

ea0031p379 | Thyroid | SFEBES2013

A case of metastatic papillary thyroid carcinoma presenting with pleural, pulmonary and bone metastases

Parthasarathy Sathish Babu , Alshahwan Sarah , Srinath Aswathiah , Schulte Klaus-Martin , Terry Mark , Vivian Gill , Gilbert Jackie

Background: Differentiated thyroid cancers are reported to present with synchronous distant metastases in 1–9% of cases. The most common single sites of synchronous metastases are lung (45%) and bone (39%) with dual site involvement (12%). Other single sites of metastases are rare (4%). Pleural metastases are very unusual, accounting for < 0.6% of cases.Case: A 55-year-old male smoker presented with cough, weight loss and thoracic back pain. Exa...

ea0031p380 | Thyroid | SFEBES2013

Raised TSH: a diagnostic conundrum!

Mohammad Misbah , Thida Myat , Holmes Simon , Srinivasan Bala T

Background: Elevated TSH with raised free T4 (fT4) presents a diagnostic challenge. Symptomatically they vary across the spectrum of thyroid status. We report cases with these dilemmas.Case 1: Seventy four year old was referred with 5 years of TSH ranging between 4.9–7.9 mIU/l (0.2–4.0), fT4 18.5–27 pmol/l (9.0–19) and free T3 (fT3) 4.5–12 pmol/l (2.5–5.7). Thyroid perox...

ea0031p381 | Thyroid | SFEBES2013

Bilateral thyroid cysts: an important association not to forget?

Wong Mo Lee , Skene Anthony , Richardson Tristan

A 64-year-old man was referred with an incidental finding of multiple bilateral thyroid cysts following CT scanning for abdominal pain. He had originally presented with an acute episode of left upper quadrant pain. CT scan of the abdomen demonstrated multiple lesions in the liver compatible with simple cysts. There were also multiple bilateral renal cysts, of which the largest was 10 cm. A small amount of retroperitoneal fluid was seen, probably as a result of a ruptured cyst....

ea0031p382 | Thyroid | SFEBES2013

An unusual association with autoimmune hypothyroidism

Overend Louise , Furlong Niall , McNulty Steven

Background: Untreated hypothyroidism may be associated with cutaneous signs including coarse, dry skin and hair loss. Myxoedema (also known as thyroid dermopathy) is usually associated with Graves’ thyrotoxicosis but has been reported in patients with hypothyroidism. We describe an unusual skin disorder in a patient with autoimmune hypothyroidism, initially misdiagnosed as myxoedema.Case: A 41-year-old female with an extensive medical history includ...

ea0031p383 | Thyroid | SFEBES2013

Case report: when measured free T4 and free T3 may be misleading. Interference with free thyroid hormones measurements on Roche and Siemens platforms

Lewandowski Krzysztof , Dabrowska Katarzyna , Lewinski Andrzej

A 59-year-old female presented with apathy and 6 kg weight gain. Investigations revealed primary hypothyroidism (TSH >100 μIU/ml). Thyroxine (L-T4) was started and titrated up to 75 μg, o.d., with clinical improvement. Other investigations revealed high titres of anti-thyroid peroxidase and anti-thyroglobulin antibodies. After three months, there was a fall in TSH to 12.74 μIU/ml, however, with unexpectedly high free T4 (...

ea0031p384 | Thyroid | SFEBES2013

Management of thyrotoxic crisis in a brittle asthmatic

Barrett George , Kankara Chenchi , Squires Phillipa , Malik Tass

A 35-year lady with Grave’s disease and brittle asthma presented to the Endocrinology team with symptoms and signs of thyrotoxic crisis. She was not on any anti-thyroid medication as she had previous suffered a severe rash in response to carbimazole, and profound gastrointestinal disturbance with propylthiouracil. It was suggested that she consider radioiodine to control her condition, but as a single parent with young children she was not prepared to undergo the isolatio...

ea0031p385 | Thyroid | SFEBES2013

Audit of use of radioactive iodine in the treatment of thyrotoxicosis at the Bristol royal infirmary (2008–2009)

Jitan John , Triay Jessica , Bradley Karin

Audit was performed to identify outcomes of patients from our department referred for RAI for thyrotoxicosis over 14 month period. Follow-up data of atleast 6 months was required for inclusion. Forty-eight patients were identified; four were excluded due to insufficient follow-up. Diagnoses were: Graves’ disease (n=35; 79.5%), multinodular disease (MND) (n=8; 18.2%) and Amiodarone induced thyrotoxicosis (AIT) (n=1; 0.02%)....

ea0031p386 | Thyroid | SFEBES2013

Successful pregnancy outcomes with thyroxine treatment in euthyroid women with positive thyroid autoantibodies and recurrent miscarriage

Shonibare Tolulope , Waheed Najeeb , Butt Muhammad

We present two thyroid antibody positive euthyroid women with history of recurrent miscarriage who had successful pregnancy outcome when treated with levothyroxine.A 31-year-old Caucasian lady was referred to our endocrine services with a history of three previous miscarriages. She had strongly positive thyroid peroxidise antibodies (TPO) with normal thyroid function tests.We commenced her on 25 μg of levothyroxine. Within two...

ea0031p387 | Thyroid | SFEBES2013

Carbimazole induced cholestatic hepatitis

Khan Hamza , Tarigopula Giridhar , Partha Praveen , Peter Paul

Thyrotoxicosis is a common disorder especially in women. Most of the patients tolerate antithyroid medications very well with very few developing life threatening side effects. We describe a 64 years old gentleman who was diagnosed with hyperthyroidism secondary to Grave’s disease (autoimmune). He was treated with Carbimazole 20 mg daily. With in a month, he presented with malaise and reduced oral intake. Laboratory investigations showed acute cholestatic hepatitis with r...

ea0031p388 | Thyroid | SFEBES2013

Myxedema Coma: an uncommon presentation of a common thyroid problem

Munir Atif , Hutchison Caroline , Kumar Balakrishna , Anthony Sony

Myxedema coma has very high mortality and should be suspected in an acutely unwell patient presenting with depressed mental status who is hypothermic, bradycardic and or hypotensive. Myxedema coma may be the first presentation of people with undiagnosed hypothyroidism. Definitive management is with thyroid hormone but supportive measures, identification and treatment of precipitating factors in an appropriately safe environment are vital. There is no consensus about preferred ...