Endocrine Abstracts

36F from Hungary with a h/o Graves disease in the past which was in remission since 2017 presented to ED at UCLH with a fast heart rate and acute weight loss. Feb 2020 presented with fast heart rate and FT4 84.9, TSH < 0.01. TPO Negative, TRAB raised at 6.5. Patient was commenced on 20 mg carbimazole and 20 mg TDS propranolol, referred to endocrine clinic. Patient missed her appointment in the endocrine clinic as she was in Hungary during the pandemic. June 2020: 15 weeks pregnant and Carbimazole changed by her GP to Propyle thiouracil 50 mg BD. Reviewed in the antenatal clinic by Endocrinology who advised for her to continue PTU 50 mg and repeat TFT, TRAB and FU in Aug 2020. Nov 2020: 34 weeks missed ANC endo appointment in August returned to report stopped PTU Sept 2020. Repeat TFT in Nov 2020: TSH 0.71, FT4 9.7 TRAB neg, TPO Negative. Graves’ disease in Biochemical remission repeat TFT’s 6 weeks post-partum. C section 12/1/21. Nov 2021: Contracted COVID and was admitted to hospital with hypoxia. March 2022: Recovering from COVID 19 infection developed tachycardia and weight loss. TSH 0.010, FT4 21.7 FT3 6.1: commenced on antithyroid medication in Hungary as she went back to have an endocrine consultation 11/6/2022: Presented to ED follicular tonsillitis unable to eat and drink. Admitted under ENT for IV antibiotics, observation and found to be neutropenic. TSH 0.01 Free T4 48.5 WBCs 0.67 Lymphocytes 0.61 Neutrophils 0.02. Patient treated with Clarithromycin for her tonsillitis. Patient discussed. Screening tests for neutropenia sent (Hepatitis, HIV, EBV, CMV). 14/6/2022: Patient started complaining of abdominal pain, mild diarrhoea, and menstruating. D/W microbiology and Haematology for persistent neutropenia. Commenced on Neutropenic sepsis antibiotics: Ceftzidime, Teicoplanin 6 mg/kg and stat dose of Amikacin (Patient is penicillin allergic). TSH <0.01 and FT4 42.0 Neut 0.10. 15/6/2022: US abo: ureterinc calculus, CT KUB: Ureteric calculus / diverticulum. Gen surgery review: possible appendicitis to continue antibiotics. To conservatively manage. Thyroid surgeon met the patient and consented for emergency thyroidectomy. Patient keen to go home to her infant. Commenced Lugols iodine 0.3 ml TDS and Daily TFT’s. 20/6/22: Discharged with Lugols Iodine to return 22//6/22 for repeat TFT’s. 22/6/22: TSH <0.01 FT4 16.3, Neut 7.15, WCC 13. 05/07/22: Total thyroidectomy under GA with no complications. 08/08/2022: Tingling both hands and feet. The story goes on.