Endocrine Abstracts

38 year old lady with history of thyrotoxicosis managed since 2012. She works as a bus driver and is a single mother. She had no evidence of thyroid eye disease and her clinical activity score was 0. She has a smooth goitre which is non compressive. She was previously treated with propylthiouracil and she went into remission but then she relapsed in 2018. She has been on treatment but due to being a single mother and also her work schedules, she struggles with her medications leading to her missing many of her doses. She has been admitted on a few occasions to hospital but never fulfilled criteria for thyroid storm. Clinically she still has symptoms consistent with thyrotoxicosis and is now being worked up for Thyroidectomy. She was given a choice for Radioiodine therapy but refused due to having young children and being a single mother thereby being unable to stay away from them for a prolonged period as advised by the Nuclear medicine department. Coincidentally, she has also had multiple episodes where her medications were temporarily ceased due to suspected lymphopenia but has never had formal agranulocytosis. Her lymphocytes were low but her neutrophils have never reached below the defined neutropenic range. We have discussed in detail with the General practice surgery to ensure she does not end up having her medications stopped. She is not keen on Propylthiouracil as well due to the shift working pattern as this was tried previously but while she was pregnant. We are currently awaiting a date for her surgery and until this happens, we will continue to manage her medically as best as possible.