Endocrine Abstracts

Introduction: Patient with co existing oncological disease can easily be misunderstood by endocrinological pathology as hypothyroid, both representing similar appearances. The aim of this case report is to stress the importance of multidisciplinary teamwork, meaning of follow up, and increase knowledge about side effects of hormonal therapy which could affect endocrine system.

Case report: A patient 55 years old female complaining about weakness, dry skin, hair loss, constipation and headaches was referred to general practitioner and by examining autoimmune thyroiditis with elevated TSH-11 mU/l and anti TPO – 900 IU/ml, low fT4–7 pmol/l were found and Levothyroxine 25 mg OD was started. Few months after euthyroid state was reached, patient was diagnosed with infiltrative (Grade 2) ductal carcinoma (HER2 – positive) and left mammary gland sectoral resection with sentinel node biopsy was performed shortly afterwards. After the surgery surgeon and immunologist relying to a year-old lab results cancelled therapy of Levothyroxine, calling it useless. Chemotherapy by EC-T scheme, including Epirubicin 140 mg, Cyclophosphamide 1000 mg and Paclitaxel 300 mg was started with continuous hormonal therapy including Trastuzumab 600 mg by scheme and Tamoxifen 20 mg OD. Nine months after cancellation of thyroid hormone therapy patient with recurrent complaints about weakness was examined and high TSH – 25 mU/l, low normal fT4–12.4 pmol/l and clinically significant dyslipidemia (total cholesterol 6.45 mmol/l (< 5.0); LDL 3.88 mmol/l (< 3.0); Non HDL – 4.95 mmol/l (< 3.4); triglycerides – 3.37 mmol/l (< 2.0)) was found. Head MRI revealed multiple vascular lesions with hemosiderin deposition in basal ganglia. Initiation of Levothyroxine 25 mg OD followed, as well as continuation with Trastuzumab 600 mg by scheme and Tamoxifen 20 mg OD. Patient is now followed up by multidisciplinary team including endocrinologist and oncologist.

Conclusions: This case report reveals lack of multidisciplinary teamwork in patients with oncological disease receiving hormonal therapy, as well as treatment options in patients with subclinical thyroiditis causing severe dyslipidemia and importance of consideration of screening imaging of the brain for patients with HER2-positive subtypes.