Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology BES 2017

Harrogate, UK
06 Nov 2017 - 08 Nov 2017

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SfE BES 2017 will be on the 6-8 November 2016 in Harrogate, UK.

ea0050p381 | Thyroid | SFEBES2017

Genetic variants modify susceptibility to AF in patients on thyroid hormone replacement therapy

Soto-Pedre Enrique , Siddiqui Moneeza , Doney Alex , Palmer Colin , Pearson Ewan , Leese Graham

Purpose: Hypothyroidism has been associated with atrial fibrillation (AF) in some studies. This study aimed to characterize thyroid related genetic variants that may change susceptibility to AF in patients on thyroid hormone replacement therapy (levothyroxine).Methods: A case-control study was done among patients of European Caucasian ethnicity from the Genetics of Diabetes Audit and Research Tayside (GoDARTS) recruited in Tayside (Scotland...

ea0050p382 | Thyroid | SFEBES2017

A population-based study of the Epidemiology of Chronic Hypoparathyroidism

Vadiveloo Thenmalar , Donnan Peter , Leese Graham

Aim: We aimed to undertake a population-based approach to describing the prevalence and incidence of chronic hypoparathyroidism. There are very few reports on the epidemiology of this condition.Methods: Data linkage of all biochemistry, hospital admissions, prescribing and death records was undertaken in Tayside Scotland (population 400,000) from 1988 to 2015. Patients with at least 3 serum calcium concentrations below the reference range f...

ea0050p383 | Thyroid | SFEBES2017

Novel driver mutations in thyroid cancer recurrence

Nieto Hannah , Fletcher Alice , Thompson Rebecca , Baker Kate , Alshahrani Mohammed , de Menezes Albert Nobre , Read Martin , Boelaert Kristien , Smith Vicki , Cazier Jean-Baptiste , Mehanna Hisham , McCabe Chris

Worldwide, ˜300,000 new cases of differentiated thyroid cancer are reported per annum and thyroid cancer now represents the most rapidly increasing cancer in the US and in the UK. In general terms, outcome is good (10-year survival >90%). However, up to 25% of patients develop local or regional recurrences, and have a significantly reduced life expectancy. We hypothesise those thyroid tumours which subsequently recur display a distinct pattern of driver ...

ea0050p384 | Thyroid | SFEBES2017

Urinary Iodine to Creatinine ratio (UI/C) during pregnancy is not associated with adverse obstetric outcomes

Torlinska Barbara , Bah Sarah , Janjua Aisha , Boelaert Kristien , Chan Shiao-Yng

Background: Maternal severe iodine deficiency has been associated with pregnancy and neonatal loss but the impact of mild-moderate iodine deficiency on pregnancy is not well-documented. Mild-moderate iodine deficiency during pregnancy is common even in iodine replete countries. In the UK women of reproductive age have been found to be mildly-to-moderately iodine deficient. UI/C is an optimal indicator for iodine status in pregnancy.Aims: We...

ea0050p385 | Thyroid | SFEBES2017

Marked increases in levothyroxine prescribing and laboratory testing following a reduction in the upper end of the TSH reference range

Symonds Christopher , Gjata I Nelda , Rose M Sarah , Cooke Lara , Naugler Christopher

Context: Subclinical hypothyroidism is a common clinical problem defined as an elevation in serum thyrotrophin (TSH) with normal circulating free thyroid hormone levels. Empiric treatment of mild subclinical hypothyroidism (mSCH) is controversial.Objective: To evaluate the change in the levothyroxine prescribing rate and TSH testing following a decrease in the TSH reference range from 6 to 4 mU/L in a large urban center.<p class="abstex...

ea0050p386 | Thyroid | SFEBES2017

Prevalence of and factors predicting thyroid dysfunction at the time of ST- and non-ST- elevation myocardial infarction – the ThyrAMI 1 study

Jabbar Avais , Ingoe Lorna , Zaman Azfar , Razvi Salman

Introduction: Thyroid dysfunction is common affecting 5–10% of the adult population. Cardiovascular disease, including acute myocardial infarction (AMI), has been suggested as one of the adverse outcomes of thyroid disease. Furthermore, individuals with thyroid dysfunction at the time of AMI have worse outcomes. Despite this, there is scarce data on the prevalence of thyroid dysfunction in patients with AMI. We conducted a prospective observational multi-cen...

ea0050p387 | Thyroid | SFEBES2017

The Oxford Multidisciplinary Thyroid Eye Disease Clinic: Can short waiting times and use of Steroid Sparing Agents reduce total glucocorticoid dose and requirement for surgery/radiotherapy?

Turner Helen , David Joel , Norris Jonathan

Introduction: The Oxford multidisciplinary thyroid eye disease (TED) clinic comprising an oculoplastic surgeon, rheumatologist and endocrinologist with access to orthoptics, neuroradiology and radiotherapy was established in 2013. The aim of the service is to facilitate rapid referral and treatment in a specialist centre in keeping with the Amsterdam Declaration. Early use of steroid sparing agents (SSA) and recently rituximab form part of the treatment regimen.<...

ea0050p388 | Thyroid | SFEBES2017

An electronic protocol replicating QOF thyroid alerts improves monitoring but does not help optimise levothyroxine replacement in hypothyroidism in primary care

Tran Anh , Hyer Steve , Johri Nikhil , Rodin Andrew , Hickey Janis , Dayan Colin , Okosieme Onyebuchi

Introduction: Thyroid quality indicators were removed from the Quality Outcome Framework (QOF) targets in 2014, resulting in discontinuation of statutory system alerts to remind GPs to check annual thyroid function in patients with primary hypothyroidism treated with levothyroxine.Aim: To investigate the impact of the discontinuation and reinstitution of the QOF thyroid e-alerts on the management of hypothyroidism in primary care.<p cla...

ea0050p389 | Thyroid | SFEBES2017

Morbidity and Mortality in patients with Chronic Hypoparathyroidism

Vadiveloo Thenmalar , Donnan Peter , Leese Graham

Aim: We aimed to investigate mortality and morbidity in patients who were identified with primary hypoparathyroidism, post-surgical and non-surgical hypoparathyroidism.Methods: The patients who were previously identified with hypoparathyroidism, were linked to hospital admission dataset, renal registry, biochemistry dataset and prescribing dataset. In this study, death and 6 morbidities; cataract, circulatory system, infection, fracture, me...

ea0050p390 | Thyroid | SFEBES2017

Thyrotrophin receptor antibodies (TRAb) and other autoantibodies after treatment of Graves’ disease

Nalla Preethi , Young Stuart , Sanders Jane , Adlan Mohamed , Furmaniak Judwiga , Chen Shue , Rees Smith Bernard , Premawardhana Lakadasa

Introduction: Following treatment of Graves’ disease (GD), levels of thyrotropin receptor autoantibodies (TRAb) tend to decrease depending on treatment modality and length of follow up. We have assessed TRAb biological activity at follow up, years after GD treatment.Subjects and methods: TRAb concentration and biological activity were measured in 69 GD patients (59 females; 10 males; median age 59 years; TRAb positive at diagnosis), with follow up r...

ea0050p391 | Thyroid | SFEBES2017

Iodine status on the Island of Ireland

Mullan Karen , McKeever Edward , Hamill Lesley , Doolan Katie , Young Ian , Smyth Peter , Flynn Albert , Patterson Chris , Walton Janette , Meharg Andy , Graham Una , McMullan Paul , McCance David , Bell Marcia , McHugh Cathy , McQuaid Siobhan , Tuthill Antoinette , Black Neil , O'Loughlin Aonghus , Woodside Jayne

Iodine is a trace element required for thyroid hormone production. Requirements increase in pregnancy, when even mild deficiency may affect offspring neurocognitive development.The gold standard for assessing iodine status is population surveys of urinary iodine concentration (UIC). The WHO also suggests a population prevalence of >3% of TSH values > 5 mIU/L indicates deficiency. A recent UK survey of 700 teenage girls demonstrated ...

ea0050p392 | Thyroid | SFEBES2017

The relationship between free T4 and thyrotropin receptor antibodies is log-linear and negatively influenced by age and smoking in patients with Graves’ disease

Gan Earn H , Tsatlidis Vasileios , Kennedy David , Razvi Salman

Background: The third generation thyrotropin receptor antibodies (TRAb) assay has high sensitivity and specificity in diagnosing Graves’ disease (GD). Circulating levels of TRAbs predict the disease course of Graves’ orbitopathy (GO) and remission rates in GD. However, the relationship between TRAb and thyroxine (FT4) and the factors affecting their interaction are unclear.Method: A prospective cohort study was conducted to evalua...

ea0050p393 | Thyroid | SFEBES2017

Long-term relapse rates following thionamide withdrawal in Graves’ thyrotoxicosis and the predictive role of TRAbs

Tun Nyo Nyo , Gibb Frase , Strachan Mark , Zammitt Nicola

Background: Thionamides are a safe and effective treatment for Graves’ thyrotoxicosis and tend to be favoured over radioiodine in the UK. Risk of recurrence following cessation of thionamides is high although most studies tend to have short duration of follow up. We have previously published follow-up data to 4 years in this cohort and now present follow-up out to 7 years.Methods: Retrospective review of first presentation Graves’...

ea0050p394 | Thyroid | SFEBES2017

Investigating the utility of diffusion weighted magnetic resonance Imaging as an adjunct to clinical assessment in Graves’ Orbitopathy (GO)

Feeney Claire , Rahman Farzana , Lingam Ravi , Lee Vickie

Purpose: Early diagnosis and treatment of Graves’ orbitopathy (GO) are essential to prevent physical and psychological burdens of advanced disease. MRI diffusion weighted imaging (DWI) is an emerging modality to assist with timely diagnosis. We investigated the value of DWI in early diagnosis and monitoring and its relationship with the clinical activity score (CAS) and quality of life (QoL) scores in a joint endocrine/ophthalmology clinic.<p class="abst...

ea0050p395 | Thyroid | SFEBES2017

Recent liothyronine price increases have changed primary care prescription practice, with increased referrals to specialist care

Terry Isabelle , Perros Petros , Moran Carla

Background: The cost of liothyronine (T3) has significantly increased, possibly affecting prescription practices.Methods: An online questionnaire was designed to assess current T3 use by UK endocrinologists and to determine whether the price increase resulted in a change in primary care prescription practices. Consultant grade members of the Society for Endocrinology Thyroid Network were invited to partake.Results: Re...

ea0050p396 | Thyroid | SFEBES2017

Association of a promoter BAFF polymorphism in Graves’ disease

Lane Laura C , Allinson Kathleen , Cordell Heather J , Mitchell Anna L , Pearce Simon

Introduction: B lymphocyte activating factor (BAFF), a member of the tumour necrosis factor family, is essential for B cell activation, differentiation and survival. It promotes autoantibody production and as Graves’ disease is caused by thyroid stimulating autoantibodies, it is an excellent functional candidate gene. Indeed, elevated serum BAFF levels have been found in patients with several autoimmune diseases, including Graves’ disease (GD). The T al...

ea0050p397 | Thyroid | SFEBES2017

Primary versus tertiary care follow-up of low risk well differentiated thyroid cancer

Imran Syed , Rajaraman Mal , Chu Karen , VanUum Stan , Kaiser Stephanie

The optimum approach to long-term follow-up of well differentiated thyroid cancer (DTC) remains unclear. We assessed the outcome of DTC patients followed in primary care (PrC) from Edmonton, AB with tertiary care (TrC) settings from Halifax, NS and London, ON. Patients who met the following criteria were identified: a) Initial diagnosis between January 1, 2006 to December 31, 2011, b) primary tumourA total of 317 patients, (PrC=93 and TrC=2...

ea0050p398 | Thyroid | SFEBES2017

Predictors of thyroid autoimmunity in Maltese individuals

Attard Carol Cardona , Sze WC Candy , Vella Sandro

Introduction: Autoimmune thyroid disease is a multifactorial disorder, which has been linked to the exposure of certain environmental factors.Aims and Objectives: To investigate whether thyroid autoimmunity (TAI) is significantly associated with identifiable and potentially modifiable environmental factors in Maltese individuals.Materials and Methods: A case-control observational study was conducted among 324 Maltese ...

ea0050p399 | Thyroid | SFEBES2017

Autoantibodies to the thyrotropin receptor in Alemtuzumab-induced thyroid autoimmunity: determination of their biological activity, and possible role as predictive marker of disease

Muller Ilaria , Willis Mark , Healy Sarah , Nasser Taha , Zhang Lei , Draman Mohd Shazli , Taylor Peter , Robertson Neil , Ludgate Marian , Dayan Colin

Background: Alemtuzumab (ALTZ) is a humanised monoclonal anti-CD52 antibody used as effective treatment for relapsing/remitting multiple sclerosis (MS), causing panlymphopenia with subsequent lymphocyte repopulation. Unfortunately, around 40% of patients develop secondary humoral autoimmunity, mainly affecting the thyroid gland. Anti-thyrotropin-receptor (TSHR) autoantibodies (TRAb) can stimulate (TSAb), block (TBAb) or not affect (‘neutral’) TSHR function, with TSAb...

ea0050p400 | Thyroid | SFEBES2017

Activating germline TSHR mutations are rare in adult hyperthyroid patients without autoimmunity and showing diffuse uptake on radionuclide thyroid scintigraphy

Patel Kashyap , Knight Bridget , Aziz Aftab , Avades Tamar , Ward Rebecca , Babiker Taz , Tysoe Carolyn , Dimitropoulos Ioannis , Panicker Vijay , Vaidya Bijay

Background: Sporadic and familial autosomal dominant non-autoimmune hyperthyroidism (S/FANH) is caused by activating germline mutations in the TSH Receptor (TSHR) gene. These patients lack TSHR-Ab, show diffuse uptake on radionuclide thyroid scan and often lack positive family history due to variable penetrance. Because of these overlapping features, S/FANH is difficult to distinguished from Graves’ disease without autoimmune features. Ther...

ea0050p401 | Thyroid | SFEBES2017

Does presence of ‘Coexisting Thyroiditis’ affect Radioiodine Uptake in Thyroid Cancer Ablation Doses?

Shah Shanty George , Waterhouse Mona , Akker Scott , Drake William , Plowman Nick , Berney Daniel M , Richards Polly , Adams Ashok , Nowosinska Ewa , Brennan Carmel , Druce Maralyn

Background: Patients being treated for differentiated thyroid cancer (DTC) receive a dose of Radioiodine for remnant ablation. Occasional patients appear to have little or no iodine uptake at all in the thyroid bed or else where even shortly after thyroidectomy.Objective: To evaluate the influence of ‘Coexisting Thyroiditis’ on radioiodine uptake in thyroid cancer ablation doses.Methods and Design: Retrospec...

ea0050p402 | Thyroid | SFEBES2017

Evaluation of normal reference range for thyroid uptake of technetium-99 m in a single centre UK population

Macauley Mavin , Shagwi Mohamed , Howe Kim , Curry Andrew , Howell Elizabeth , James Andy , Petrides George , Perros Petros

Objectives: The aim of the study was to evaluate the normal reference values for thyroid uptake using Technetium-99 m (Tc-99 m) pertechnetate.Methods: Sixty-seven euthyroid patients with primary hyperparathydism who underwent parathyroid imaging with Tc-99 m pertechnetate between January 2012 to April 2014 at the Nuclear Medicine department, Newcastle upon Tyne Hospitals was studied. Electronic medical records and biochemical thyroid functi...

ea0050p403 | Thyroid | SFEBES2017

Use of glucocorticoids in subacute thyroiditis

Kyriacou Angelos , Syed Akheel

Background: Subacute thyroiditis is a self-limited inflammatory thyroid disorder with a triphasic clinical course of thyrotoxicosis, hypothyroidism, and return to euthyroidism. Whilst glucocorticoid (GC) treatment is advocated for managing moderate-to-severe symptoms, the ideal initiating dose and titration regime is unclear. Traditionally, doses of up to 40 mg of prednisolone have been used. More recently, to minimize adverse effects, a 15 mg initiation dose of ...

ea0050p404 | Thyroid | SFEBES2017

The impact of a profoma introduction on the accuracy and appropriateness of Synacthen testing

Jarvis Peter , Partridge Helen , Holt Helen , Richardson Tristan , Page Georgina

Background: We previously reported that a high number of synacthen tests are carried inaccurately within our trust with a significant delay in sample collection after tetracosactide injection. We also reported a high number of patients having Synacthen tests unnecessarily. In light of this we introduced a Synacthen proforma and re-audited our results.Method: A retrospective study was carried out on 36 patients undergoing Synacthen tests bet...

ea0050p405 | Thyroid | SFEBES2017

Metoprolol succinate is associated with better quality of life in treatment of grave’s disease

Ghazi Hossam

Background: Grave’s Disease (GD) is the most common cause of hyperthyroidism and its effect of health status is well known. Beta blockers (BB) are routinely used to control thyrotoxic symptoms in initial phase of treatment of GD.Objective: To study the effect of BB on quality of life (QOL) in patients with GD using different BB; propranolol, nebivolol and metoprolol succinate.Method: A cohort prospective study was conducted on...

ea0050p406 | Thyroid | SFEBES2017

Radioiodine treatment for thyrotoxicosis in a district hospital: a re-audit

Ukpabi Oyidiya , Rahman Jubeka , Ding Uzhe , Nwoseh Oby T. , Oyibo Samson O

Introduction: Radioiodine is used for the treatment of Thyrotoxicosis when medical treatment (anti-thyroid drugs) has failed or cannot be tolerated and surgical treatment is not an option. Our previous audit in 2011 demonstrated substantial adherence to the Royal College of Physicians (RCP) guidelines for Radioiodine treatment, but one patient was lost to follow-up. It was recommended that we improve our re-call system. We aimed to re-audit our service.<p ...

ea0050p407 | Thyroid | SFEBES2017

Clinical outcomes following radioiodine therapy in Graves’ thyrotoxicosis

Gibb Fraser , Aung Ei Thu , Chaudhri Zahra

Introduction: Radioiodine (RAI) is safe and effective but further information to predict outcomes, specifically treatment failure and residual symptoms following treatment of hypothyroidism, may help improve outcomes.Methods: Retrospective, observational, single-centre study. Electronic medical record review (n= 664) and patient questionnaire (n= 174).Results: Complete cohort: Analysis of outcomes li...

ea0050p408 | Thyroid | SFEBES2017

Thyroid Nodules (n=400): Correlation of TI-RADS’ score with cytological results

Boudiaf Dia eddine , Bekaouassa Adel , Abdellali M , Chentli Farida , Fedala Nora soumeya

Introduction: Nowadays, thyroid Ultrasound (US) is a reference exam and the best way for detection, diagnosis and monitoring of thyroid nodules suspect of malignancy. It allows selection of suspicious thyroid nodules for malignancy.Our aim was to assess contribution of this exam using the TI-RADS score in order to establish the correlation with cytological results.Materials and methods: A prospective study of 395 pati...

ea0050p409 | Thyroid | SFEBES2017

Orbital decompression surgery for graves’ ophthalmopathy

Halsey Jordan , Rossi Kristie , Patel Tushar R

Introduction: Graves’ disease is an autoimmune disorder of the thyroid gland causing over-production of thyroid hormone. Although this disorder can lead to systemic changes throughout the body, the most common extrathyroid manifestation of Graves’ disease is ophthalmopathy. Patients can have significant ocular prominence from the increase in intraconal and extraconal fat and muscular hypertrophy. This can lead to vision changes, decreased ocular motilit...

ea0050p410 | Thyroid | SFEBES2017

Adoption of the British Thyroid Association guidelines for the investigation of thyroid nodules: a district general hospital experience

Grecian Sheila , Herlihy Olive , Ferrando Luis , Strachan Mark , Patel Dilip , Williamson Rachel

Background: The British Thyroid Association’s thyroid cancer guidelines (2014) advocate the U1-5 nodule grading system as a primary diagnostic and classification tool.Aims: We assessed whether practice reflected guidelines, and examined patient outcomes.Methods: Patients with a thyroid ultrasound, undertaken by radiographers or general radiologists, in January-June 2015 were identified. Investigation and outcomes...

ea0050p412 | Thyroid | SFEBES2017

A rare case of Moyamoya disease in association with Graves Disease in a Caucasian female

Hasan Faisal , Ahmad Shaza , Chau Fong , Parfitt Vernon

Moyamoya disease is a progressive chronic neurological disease due to multiple narrowing of the carotid arteries. It can be seen in association with atherosclerosis, vasculitis, haematological conditions, connective tissue disease, neurocutaneous syndromes and certain autoimmune diseases. Very few cases have been reported in association with Graves disease and the majority being in the East Asian population. We present a rare case of this association in a young C...

ea0050p413 | Thyroid | SFEBES2017

Radioiodine treatment phone clinic for benign thyroid disease: A service audit and quality improvement project in a large tertiary hospital

Khan Sidrah , Manova Yuliya , Bomanji2 Jamshed , Chung Teng-Teng

Background: Radioiodine treatment (RIT) for benign functioning thyroid disease is an effective treatment for patients with hyperthyroidism. The safety, preparation, administration and follow-up of treatment demands time and organisation. The planning of this elective treatment is affected by the patient’s availability which makes adequate and timely treatment of the subsequent hypothyroidism challenging. A quality improvement project was therefore set up to mitigate this....

ea0050p414 | Thyroid | SFEBES2017

Pitfalls in the diagnosis of TSHoma vs Resistant Thyroid Hormone Syndrome.

Lenkalapally A , Quader M , Koshy R , Jacob K

65 yr female presented with headaches, heat intolerance and loose stools. She had cerebrovascular accident, osteoporosis and vitiligo. A 24 hr ECG revealed atrial flutter with heart rate upto 117 beats /minute. Her medications include warfarin and bisoprolol.A Thyroid function test (TFT) revealed Free T4 (Ft4): 32 pmol/L (9-19) Free T3: 7.97 pmol/L (3.6–6.5), TSH: 5.7 mU/L (0.35–4.94). Other anterior pituitary function tests were ...

ea0050p415 | Thyroid | SFEBES2017

A rare case of carbimazole-induced acute liver failure

Khan Shaila , Galliford Thomas

Antithyroid drugs can cause hepatic dysfunction, from mild derangement to severe, fulminant failure. It is well known that propylthiouracil may cause fulminant liver failure yet we present an exceptionally rare case of this type of adverse drug reaction with carbimazole.A 75 year old woman presented to hospital with a fall and a two day history of jaundice. Six weeks earlier, she had been diagnosed with both congestive cardiac failure and G...

ea0050p416 | Thyroid | SFEBES2017

Myopathy and dyshagia cause by Severe Hyperthyroidism

Rizvi Fareeha

Severe hyperthyroidism, along with several other endocrinopathies, is well recognised as a cause of myopathy. This myopathic clinical picture varies from mild myasthenia to profound muscular weakness. We present the case of a 61 year old female (Ms SM), with learning difficulties, who presented with a short history of reduced mobility and anorexia. She was noted to have hypernatraemia and acute kidney injury on admission, secondary to poor oral intake and new ons...

ea0050p417 | Thyroid | SFEBES2017

Results of the Liothyronine audit looking at the improvements seen in over all physical well being, mental concentration & somatic symptoms in patients before & after starting T3+T4 combination

Malhotra Gaurav , Simon Godwin , Khan Rehman

Many patients continue complaining of subjective symptoms of hypothyroidism despite being on adequate doses of levothyroxine. There are about 14 studies involving T3+T4 combination including 7 which were rigorously conducted. Majority of them (11 studies) did not show any benefit of combination therapy. But our local experience has been a little different. We looked at small cohort of 15 patients who were on combination T3+T4 for more than 6 months and were asked...