Endocrine Abstracts

Introduction: There is no consensus about the management of thymic enlargement in Graves’ disease (GD). If imaging indicates ‘benign’ thymic appearances, and interval scans are stable, most authorities advocate no intervention until thyrotoxicosis is controlled. We present 3 patients with GD and incidentally found thymic enlargement.Case presentations: a. A 37-year-old female presented acutely with osmotic symptoms, a weight ...

A 46-year-old lady was referred to endocrinology with thyrotoxicosis. She was diagnosed with Graves’ disease by her GP in October 2016 when presenting with classical symptoms and investigations [TSH<0.01 mIU/L (NR 0.3–4.2), fT4=34.3 pmol/L (NR 9–23), TSHrAb>30 u/mL (NR<0.4), and increased iodine uptake]. She was therefore started on carbimazole 15 mg/day. She returned to her GP in December 2016 reporting resolved symptoms, however, she ...

We present a case of severe thyroid-associated orbitopathy in a 44-year-old man with metastatic follicular carcinoma of the thyroid. He presented with a neck lump, and following further investigations, underwent a hemithyroidectomy followed by a completion thyroidectomy. Histology of the thyroid confirmed widely invasive follicular carcinoma of Hurthle cell type with foci of vascular invasion (pT3 Nx Mx). He received radioactive iodine ablation therapy (3.7GBq), ...

Use of 18F-FDG-PET/CT (PET) staging for a variety of malignancies has increased in recent years. A rise in detection of incidental thyroid lesions creates a novel diagnostic challenge. We present four cases of Thyroid PET positivity.A 62-year-old lady with pulmonary adenocarcinoma on contrast CT-Thorax had diffuse thyroid PET uptake. Biochemistry revealed a self-limiting TSH rise. Thyroid ultrasound showed benign nodular goitre (U2). Findin...

We report a rare case of hyperthyroidism secondary to Graves’ disease which failed to respond to three consecutive therapeutic doses of radioactive iodine 131.This 62 year old gentleman with a history of ischaemic heart disease was first referred to endocrine services in September 2014 with classical symptomatic hyperthyroidism. He described fatigue, significant weight loss of 3.5 stones, sweating, palpitations and heat intolerance ove...

Case History: A 26 year old female patient was referred to her local endocrine clinic having presented to her GP complaining of ankle swelling. Routine biochemistry revealed a suppressed TSH (<0.05 U/l), and reduced serum levels of free T4 (2.0 pmol/l) and T3 (3.2 pmol/l). Random serum cortisol measurements were also elevated on 2 separate occasions (1266 nmol/l and 991 nmol/l). Clinical examination revealed her to be clinically euthyroid with no evidence of ...

Radioactive iodine is used routinely and safely in the treatment of hyperthyroidism. We describe an unusual side effect after a single treatment in a patient with subclinical hyperthyroidism.A 64 year old woman was referred to our service with multinodular goitre. She was found to have subclinical hyperthyroidism with TSH 0.17 mU/L, fT3 5 pmol/L and fT4 14 pmol/L. She underwent radioactive iodine treatment with 530 MBq of Iodine -131 in Jan...

A 73-year-old lady presented with symptoms of weight-loss, tiredness, sweating and thyroid gland enlargement. Biochemistry demonstrated a T4 of 65.7 pmol/L and TSH <0.02 mmol/l. TSH receptor antibodies were positive confirming Graves’ disease. Thyroid ultrasound demonstrated reduced echogenicity and increased vascularity with a 3.2 cm left lobe U3 nodule and FNA planned.The patient developed a severe reaction within 17 days of star...

Thymic hyperplasia is frequent in patients with Graves’ disease (GD) but it rarely is large enough to be detected radiologically as an anterior mediastinal mass. In the few cases operated, lymphoid hyperplasia (i.e. lymphoid follicle proliferation with expansion of both the cortical and the medullary component) has been documented histologically in 38% of cases, while true thymic hyperplasia, i.e. thymic enlargement with normal tissue architecture, was found...

Amiodarone-induced thyroiditis (AIT) can be a diagnostic and therapeutic challenge. It can be a diagnostic challenge in clinical cases, where response to therapy can be slow. It is important to achieve an early differentiation between various subtypes (i.e. AIT type 1 or AIT type 2) to guide therapy. We present a case of a 51-year-old man with a history of paroxysmal atrial fibrillation for which he was treated with a maintenance dose of Amiodarone. He presented ...

Background: Nivolumab is a programmed death receptor-1 blocking antibody and the first to gain regulatory approval for use in non-small cell lung cancer (NSCLC). Whilst well tolerated in clinical trials, 3% of patients in a phase Ib study displayed thyroid dysfunction. Diagnosis and referral to appropriate specialties is a challenge in complex cancer cases where symptoms are often multi-factorial. Improved knowledge of the potential complications of new and novel...

Clinical Case: A 51 year old woman of south Asian descent was referred by her GP to outpatient endocrine clinic for assistance with her mixed hyperlipidaemia (Cholesterol 9.5 mmol/L, HDL Cholesterol 1.03 mmol/L Triglycerides 6.7 mmol/L). Her past medical history included a previous hemithyroidectomy for removal of a thyroid nodule (histologically benign) and obesity.The patient’s symptoms were of weight gain (5 kg in 18 months...

Hyperthyroidism is associated with multiple gastrointestinal (GI) symptoms including vomiting, although this is not very common. We present a case of a 61-year-old female patient, who was admitted under surgeons with persistent and severe vomiting which was very difficult to manage. No acute surgical cause for vomiting was found and the patient was referred for a gastroscopy which was normal. Her past history was significant for Grave’s disease which was in ...

Background: Ischemic stroke is an unusual but important complication of Graves’ Thyrotoxicosis that is induced by the hypoercoaguable state of thyrotoxicosis.We present a 24-year old female patient admitted with a 3-day history of intermittent slurred speech associated with numbness of the right side of her mouth and face preceded by left sided headache.She had a history of uncontrolled Graves’ disease secon...