Thyroid

ea0094p127 | Thyroid | SFEBES2023

Effects of in utero thyroid hormone exposure on adolescent myelination: Quantitative magnetization transfer imaging in the controlled antenatal thyroid screening study

Scholz Anna , McNabb Carolyn , Bloomfield Laura , Bhargava Raghav , Taylor Peter , Lazarus John , Ludgate Marian , Jones Derek , Rees Aled

Introduction: The Controlled Antenatal Thyroid Screening II (CATS) study, a large randomised trial of thyroxine supplementation for suboptimal gestational thyroid function (SGTF), reported higher attention deficit hyperactivity disorder (ADHD) scores in 9 year-old children exposed to higher thyroid hormone (TH) in utero. We investigated if this was accompanied by altered myelination.Methods: Eighty-five children...

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ea0094p128 | Thyroid | SFEBES2023

Thyroid hormone profiles on non-standard thyroid hormone replacement

Taylor Peter , Arooj Aneela , Hanna Stephanie , Eligar Vinay , Muhammad Zubair , Stedman Mike , Premawardhana Lakdasa , Okosieme Onyebuchi , Heald Adrian , Dayan Colin

Context: Approximately 10% of patients on levothyroxine remain symptomatic despite restoration of biochemical euthyroidism. Some therefore utilise alternatives to levothyroxine monotherapy including combination thyroid hormone replacement, T3 monotherapy and desiccated thyroid extract (DTE). We examined thyroid hormone profiles in these patients.Methods: We examined 49 individuals 14 on combination thyroid hormone replac...

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ea0094p129 | Thyroid | SFEBES2023

A case for caution: Paediatric reference intervals for thyroid function tests

Chipchase Allison

Background: Thyroid stimulating hormone (TSH) and free T4 (fT4) were requested on a neonate, on Day 1 after birth. fT4 was flagged as below range, TSH was insufficient for analysis. Day 5-8 newborn bloodspot screening flagged a high TSH, hypothyroidism was confirmed, and thyroxine treatment commenced. Internal investigation into the incident, and the potential impact on the baby of delayed onset of treatment, raised the question of the relevance of our referen...

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ea0094p130 | Thyroid | SFEBES2023

Radioactive iodine treatment outcomes at imperial college healthcare NHS Trust

Gnanananthan Pairavi , Papadopoulou Deborah , Khan Sairah , Naik Mitesh , Meeran Karim

Background: Before radioiodine (RAI) therapy patients undergo a technetium 99m thyroid uptake scan and anti-thyroid medication is stopped prior to treatment following clinical review with the nuclear medicine team. Once treated, patients are followed up in the post-radioiodine telephone clinic. Thyroid function is checked at 3, 6, 9 and 12 weeks. Levothyroxine is started once the fT4 is <14 pmol/l.Purpose: To assess ...

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ea0094p131 | Thyroid | SFEBES2023

Can aetiology of hypothyroidism and prenatal dose help to predict need for dose increment of levothyroxine during pregnancy – Insights from a clinical audit

Assad Nabi Syed , Rajesh Shradha , Varadhan Lakshminarayanan

Introduction: The newly proposed RCOG guidelines suggests dose increment of thyroxine based on prenatal thyroxine doses. The aim of our retrospective audit was to assess if the aetiology of hypothyroidism (and dose of thyroxine) prenatally could help predict the need for dose increment during pregnancy.Methods: n=100. Local guidelines advised maintaining TSH <2.5 throughout pregnancy. Outcomes of thyroxine a...

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ea0094p132 | Thyroid | SFEBES2023

Hypothyroidism in elderly residents of karu village, abuja in North Central Nigeria

Shuaibu Ramatu , Reng Rifkatu , Anumah Felicia

Objective: To determine the prevalence of hypothyroidism among elderly subjects living in Karu village in the Federal Capital Territory.Methods: A community-based cross-sectional study involving 308 elderly subjects. A structured interview administered questionnaire was used for relevant data collection including biodata, clinical signs, and symptoms of hypothyroidism. Weight, height, waist circumference, presence and es...

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ea0094p133 | Thyroid | SFEBES2023

Radioactive iodine (I-131) in hyperthyroidism: Does weight gain remain a risk?

Green Kathryn , Connelly Paul , Tough Jillian , White Anna , Kelly Chris

Background: Radioactive iodine (RAI) is a safe and effective treatment for management of hyperthyroidism caused by Graves disease and multinodular goitres. However, patient engagement with this therapy is limited by concerns regarding significant weight gain following treatment. We therefore aimed to audit weight changes in individuals receiving RAI within our service and identify factors that may influence this outcome.Met...

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ea0094p134 | Thyroid | SFEBES2023

Identifying risk factors that predict medical treatment failure in Graves’ disease: a 4-year follow-up study in a single centre

Liarakos Alexandros , Foka Anna , Mohamed Ahmed , Kavvoura Foteini

Background: Graves disease (GD) is the commonest cause of primary hyperthyroidism. First-line treatment involves 12-18 months of anti-thyroid drugs (ATD). Subsequently, around 50% of patients will relapse, requiring definitive treatment. Identifying risk factors that predict relapse or treatment failure can guide management. We aimed to explore risk factors that identify patients at high risk of relapse or medical treatment failure, to allow prioritisati...

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ea0094p135 | Thyroid | SFEBES2023

Using nurse led clinics (including telephone and virtual reviews) in NHS Grampian to improve patient satisfaction following a diagnosis of hyperthyroidism

Stirling Claire , Paterson Rachel , Middleton Morag , Murray Lynne , Milne Alison , Alex Graveling Dr , Prakash Abraham Dr

Using nurse led clinics (including telephone and virtual reviews) in NHS Grampian to improve patient satisfaction following a diagnosis of hyperthyroidism.Aims: To reduce waiting times for patients with hyperthyroidism, nurse led clinics were introduced. Telephone and virtual follow up reviews are offered after commencement of thyroid treatment (e.g. anti-thyroid medication or radioactive iodine (RAI)). Nurse-led thyroid clinics aim to i...

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ea0094p136 | Thyroid | SFEBES2023

Thyroid hormone resistance: Diagnostic challenges and management

Abdulkareem Mustafa , Basavaraju Navya , Rangan Srinivasa , Moulik Probal , Singh Prashant

Introduction: Resistance to thyroid hormone (RTH) is an autosomal dominant condition with mutation of thyroid hormone receptor beta (THR-β) gene. We present 2 cases with unusual thyroid picture posing challenge to diagnosis.Case 1: 31-year-old lady presented with 6-month history of anxiety, tremors, insomnia and headache. She suffered from asthma and had a family history of hyperthyroidism. On examination, she was o...

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ea0094p137 | Thyroid | SFEBES2023

Combination Levothyroxine and Liothyronine therapy: Evaluation of a new local management pathway

Lin YeunYi , Hernandez Gillian , Leese Graham , Newey Paul , Malik Iqbal

Background: Combination treatment with Levothyroxine (LT4) and Liothyronine (LT3) in primary hypothyroidism has been debated recently due to restrictions placed by local health boards. National guidance suggests that a short-term trial of combination LT4/LT3 treatment may be considered for individuals who report persistent symptoms despite adequate LT4 replacement.Method: We created a prescribing protocol for combined LT...

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ea0094p138 | Thyroid | SFEBES2023

An unusual presentation of Grave’s disease with severe osteoporosis and pathological femoral fracture

W Butterly Elaine , Lynch Eilidh , A Sheridan Bethan , Banu Mohideen Shifaniya , Srivastava Rajeev , Mackin Sharon

Graves disease is an autoimmune condition commonly presenting with symptoms of hyperthyroidism including weight loss, palpations and tremor; rarely, it presents more atypically.A 35-year-old male (non-smoker, no significant history) presented with an atraumatic femur fracture. He was incidentally noted to have a large goitre, tachycardia and mild proptosis but no symptoms of hyperthyroidism. Further bloodwork revealed iron deficiency, unremarkable tumour markers includin...

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ea0094p139 | Thyroid | SFEBES2023

Iodine concentration and palatability of milk from cows fed the common red seaweed species Himanthalia elongata

Kayes Lucy , Mullan Karen , Barnes Kayley , Armaforte Emanuele , Chen Xianjiang , Yan Tianhai , Newton Eric , Stergiadis Sokratis , Hayes Maria , Huws Sharon , Woodside Jayne , Theodoridou Katerina

Cows milk remains a key source of iodine in the UK. However, there are concerns around the environmental impact of methane emissions from dairy cattle. Initial work suggests that adding certain seaweed species to the diet of cows can reduce enteric methane emissions and may increase the content of certain minerals such as iodine in milk. Little is known about the simultaneous effect of this feeding practice on milk organoleptic characteristics. This study investigates th...

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ea0094p140 | Thyroid | SFEBES2023

Levothyroxine allergy subsequently managed with desensitization – a highly challenging but definitely not sinister case

Lei Yin Win , Nawaz Asif , Ahmed Aftab , Hanna Stephanie , James Ponsford Mark , Stechman Michael , Gray Laurence , Taylor Peter

Levothyroxine, the standard therapy for hypothyroidism, is usually well tolerated and very few cases of true allergy to levothyroxine have been reported to date. In these cases mechanisms have not been conclusively identified but have been hypothesized to be allergies to excipients. Here we report a rare occurrence of levothyroxine allergy and the effectiveness of desensitization. A 56-year-old lady with no previous history of allergies required a total thyroidectomy for Grave...

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ea0094p141 | Thyroid | SFEBES2023

A rare but important side effect of anti-thyroid medication: Propylthiouracil-induced vasculitis

Fahad Khalid , Yousaf Saira , Pan Shwe

Background: We present a 47-year-old female, who is known to have recurrent Graves disease, developed vasculitic skin lesions upon treatment with propylthiouracil (PTU).Case details: She was diagnosed with Graves disease in 2020 and was started on propylthiouracil as she could not tolerate carbimazole. Propylthiouracil was stopped after 18 months. Her thyrotoxicosis recurred after 6 months. Two months after p...

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ea0094p142 | Thyroid | SFEBES2023

’Not just another Hashimoto’s!’

Mohamed Einas , Menon Ravi , Rayanagoudar Girish

Hashimotos thyroiditis is the most common cause of hypothyroidism in iodine-sufficient areas of the world, cause is thought to be a combination of genetic susceptibility and environmental factors. The pathology of the disease involves the formation of antithyroid antibodies that attack the thyroid tissue, causing progressive fibrosis. We present the case of a 38 year old male with history of hypertension, type 2 Diabetes and pre-existing hypothyroidism who presented with...

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ea0094p143 | Thyroid | SFEBES2023

A patient presenting with Carbimazole induced haemolytic anaemia- A case report

Ranathunga Ishara , Pambinezhut Fathima , Idampitiya Chandima

Background: Haematological side effects of Carbimazole including aplastic anaemia, thrombocytopenia and agranulocytosis are widely reported, but haemolytic anaemia is a rare occurrence. In such situations, the management options available for treating overactive thyroid disease will be limited, especially in frail elderly individuals. We report a case of Carbimazole induced haemolytic anaemia successfully treated with steroids and omitting the medication.<...

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ea0094p144 | Thyroid | SFEBES2023

Syndrome of inappropriate secretion of TSH, it’s complicated

Shaikh Sheeba , Glover Amy , Patil Aashutosh , Basu Ambar

Introduction: Deranged thyroid function tests are frequently referred to the endocrine team and are generally secondary to the assay interference.Case report: We Report a case of 33 years old lady referred with symptoms of dizziness, palpitations, cold intolerance and poor sleep with no associated tremors or weight changes. No goiter was observed on clinical examination. Thyroid function test showed abnormal hormone leve...

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ea0094p145 | Thyroid | SFEBES2023

Severe and protracted Type 2 Amiodarone Induced Thyrotoxicosis (AIT) presenting 6 months following discontinuation of Amiodarone

Idampitiya Chandima , Ranathunga Ishara , Pambinezhut Fathima

Background: Amiodarone induced thyroid dysfunction can be either thyrotoxicosis (AIT) or hypothyroidism (AIH). AIT is classified as Type 1 and Type 2. Type 1 occurs in patients with underlying thyroid pathology and Type 2 AIT is a destructive thyroiditis. We describe a patient with severe Type 2 AIT with a protracted course.>Case History: A 40 year old male with Atrial Fibrillation, Obesity and Obstructive Sleep Apnoea h...

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ea0094p146 | Thyroid | SFEBES2023

Unmasking the hidden link: Primary hypothyroidism unleashing severe pericardial effusion

Kapoor Ashutosh , Htut Zin , Uduku Chukwuma

Introduction: Primary Hypothyroidism is a commonly encountered endocrine disorder and can be associated with pericardial effusion and cardiac tamponade in severe cases. Early detection of Hypothyroidism is key since it is a potentially treatable and reversible cause of pericardial effusions.Case Presentation: A 53-year-old female was admitted following a fall. Clinical history was remarkable with symptoms of persistent t...

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ea0094p147 | Thyroid | SFEBES2023

A Challenge to treat Grave’s Disease

Hag Sara , Bahowairath Fatima , Meeran Karim

Although NICE guidelines recommend that radioiodine is the first-line treatment for Graves disease, carbimazole is often used initially to get control of the hyperthyroidism. This patient was exquisitely sensitive to carbimazole initially, and despite initial recurrence, he cannot be treated with radioiodine as he now has intermittent hypothyroidism.Case: A 42-year-old male was diagnosed with Graves disease and initially treated fo...

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ea0094p148 | Thyroid | SFEBES2023

Abstract withdrawn...

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ea0094p149 | Thyroid | SFEBES2023

Thyroid storm from Graves with AF, CHF, PE, proximal myopathy, lymphadenopathy, raised CA-125

Narayanan Mannath Sathia , Sudarshanan Aditya , Fernandez James Cornelius

Introduction: Thyroid storm presents as multiorgan dysfunction. Diagnosis is purely clinical, and early diagnosis improves the outcomes.Case Presentation: 45-year-old lady without significant illness presented with breathlessness, productive cough, anxiety, and weight loss. Chest x-ray showed right pleural effusion and left consolidation. She was in fast AF with NT-proBNP >27000. initially treated as chest sepsis wit...

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ea0094p278 | Thyroid | SFEBES2023

Effect of smoking status on TSH Receptor Antibody (TRAb) levels following treatment for Graves’ disease

Matthews Sarah , Razvi Salman

Background: Graves disease is an autoimmune condition leading to hyperthyroidism and characteristically elevated TSH receptor antibody (TRAb). TRAb levels typically fall post-treatment with anti-thyroid drugs (ATDs) and are used in identifying risk of relapse. Tobacco smoking is a risk factor for reduced treatment efficacy of ATDs. We intended to evaluate the effect of smoking on changes in TRAb levels in patients treated for Graves disease.<p ...

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ea0094p279 | Thyroid | SFEBES2023

Concurrent Myasthenia gravis (MG) and Graves’ ophthalmopathy (GO)

Naughton Aoife , Oustabassidis Eva , David Joel , Norris Jonathan , Turner Helen

Myasthenia gravis (MG) and Graves ophthalmopathy (GO) share many clinical characteristics but may also co-exist. Both are autoimmune disorders mediated by organ specific pathogenic autoantibodies to membrane surface receptors. Differential diagnosis and/or co-existence provides a potential management challenge, and there is a paucity of demographic information regarding precise prevalence rates and concurrence of disease.Method: Re...

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ea0094p280 | Thyroid | SFEBES2023

Molecular genetic testing in advanced thyroid cancer patients for the purposes of targeted systemic therapy

Jan Gajda Maciej , Wadsley Jonathan

Introduction: With the advent of specific gene targeted therapies for advanced thyroid cancers it has become important that molecular genetic testing is requested to identify patients suitable for these treatments, for example with BRAF, RET or NTRK inhibitors. We investigated the proportion of patients with advanced thyroid cancer in a specialist thyroid cancer clinic who had undergone appropriate testing.Participants and Method...

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ea0094p281 | Thyroid | SFEBES2023

A digital dashboard to manage graves’ disease

Butler Eve , O'Mahoney Samantha , A. R. McQuibban Nicholas , Morganstein Daniel

Introduction: Graves disease (GD) is the most common cause of thyrotoxicosis with antithyroid drugs (ATD) being first-line management. Consultations and monitoring required for ATD therapy are resource intensive. We evaluated the potential for a digital thyrotoxicosis monitoring pathway (DTP) on GD treatment outcomes and efficiency of care.Methods: We constructed a dashboard using Palantir Foundry to identify patie...

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ea0094p282 | Thyroid | SFEBES2023

Thyroid eye disease in pregnant women with Graves disease: Experience from a specialized thyroid eye clinic

Dissanayake Harsha , Oustabassidis Eva , Norris Jonathan , Turner Helen

Background: Thyroid eye disease (TED) affects 25% of patients with Graves disease (GD). GD affects nearly 1% of pregnancies. However, data on TED incidence, course, management and outcome in pregnancy are limited.Aims: To describe the prevalence, course and outcomes of TED in pregnant females.Methods: A retrospective analysis of electronic health records was conducted in a sp...

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ea0094p283 | Thyroid | SFEBES2023

Addressing unresolved controversies in thyroid hormone replacement for hypothyroidism: A systematic review

Nicolaou Marina , Druce Maralyn

Objective: Levothyroxine (LT4) is the gold standard of care for primary hypothyroidism. For most patients, it fully resolves the symptoms of hypothyroidism. However, a small proportion of treated individuals continue to experience symptoms even when euthyroid. The management of such patients has generated significant controversy and public attention throughout the years. This systematic review aims to analyse and evaluate the existing evidence for the benefits...

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ea0094p284 | Thyroid | SFEBES2023

Systematic review and meta-analysis (SRMA) of RAI monotherapy vs combination therapy for toxic nodular goiter (TMNG)

Huei-Sook Park Rachel , Tan Yi Rong Eugene , Pinto Diluka , Samuel Miny , Christine De Jong Mechteld , Parameswaran Rajeev

Background: Treatment options for patients with toxic multinodular goitre (TMNG) include antithyroid medications, thyroidectomy, and radioactive iodine (RAI) therapy. Our aim was to investigate the efficacy of RAI alone compared to combination therapy that includes RAI with medical therapy.Methods: Search was performed using MEDLINE, MEDLINE In-Process (PubMed platform), Embase (Elsevier platform), BIOSIS and Cochrane wa...

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ea0094p285 | Thyroid | SFEBES2023

Dietary and supplemental iodine intake in a cohort of pregnant women in Northern Ireland

Kayes Lucy , Mullan Karen , Woodside Jayne

Since the 1990s, eight survey studies have demonstrated iodine deficiency during pregnancy across the UK and Ireland. Both countries lack an iodine fortification programme, unlike many European countries. Therefore, women must rely on dietary adjustments and supplementation to achieve the iodine intake required in pregnancy. The World Health Organisation (WHO) recommends an increase from 150 to 250 µg/day during pregnancy. Pregnant women in Belfast were recruited to...

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ea0094p286 | Thyroid | SFEBES2023

Parameters impacting excessive weight gain in patients treated for hyperthyroidism

Vryza Paraskevi , Economides Panayiotis , Kyriacou Alexis , Picolos Michalis , Rizos Evangelos , Patrikios Ioannis , A Syed Akheel , Kyriacou Angelos

Background: Overshoot of weight regain following the treatment of hyperthyroidism is well described. Notwithstanding, there is a large interindividual variability in the observed weight changes. This study aims to identify parameters predicting excessive weight gain in hyperthyroidism patients.Methods: In a retrospective study of a prospectively completed database, we recruited consecutive patients with overt hyperthyroi...

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ea0094p287 | Thyroid | SFEBES2023

Using TRAb as a predictor of relapse in Graves’ disease

Lewin Michelle , Grounds Kerrie , Hamilton Amanda , Jones Karen , Panicker Janki

Background: Thyroid stimulating receptor hormone receptor antibodies (TRAb) markers are useful in confirming diagnosis of Graves disease, but also recognised as a predictor of relapse. Good practice dictates that a TRAb is measured at the commencement of treatment, to confirm a diagnosis of graves disease. Repeating the TRAb before discontinuation of treatment can assist in guiding treatment. If TRAb remains elevated, the chances of relapse are inc...

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ea0094p288 | Thyroid | SFEBES2023

Dual presentation of struma ovarii and autoimmune thyroiditis unmasked by salpingo-oophorectomy

Olaogun Idowu , Ronneberger Ruth , Baldeweg Stephanie

Introduction: Struma ovarii is often initially diagnosed as a suspected ovarian malignancy due to atypical characteristics on the imaging and hyperthyroidism is only seen in about 8% of presentation making thyroid function test (TFT) an unreliable test to suspect it pre-operatively. There are few case reports on its varied structural and functional characteristics in the literature. However, there are no reports of the influence of an intrinsic thyroid disease...

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ea0094p289 | Thyroid | SFEBES2023

Cure rates after a single dose of radioactive iodine to treat hyperthyroidism

M Madu Nneka , Skinner Catherine , O Oyibo Samson

Introduction: Radioactive iodine (RAI) has been used to treat hyperthyroidism for over 70 years. Some centres use a fixed dose regimen while others use a calculated dose regimen. Cure rates range between 80% and 100%, with some patients requiring two or more doses. We use the fixed-dose regimen at our centre. We therefore evaluated our cure rates after a single dose of RAI to treat hyperthyroidism.Methods: We reviewed th...

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ea0094p290 | Thyroid | SFEBES2023

Secondary hypothyroidism? a challenging diagnosis

Rajpar Hiba , Qureshi Sheharyar

Introduction: Secondary hypothyroidism can be a difficult diagnosis to make in patients presenting with fatigue. About 30% of females can develop hypopituitarism post-partum and report symptoms after losing any of the anterior pituitary hormone axis. Central hypopituitarism can occur secondary to various structural and vascular abnormalities but can present with pure hormonal abnormalities.Case: We present a case of a wo...

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ea0094p291 | Thyroid | SFEBES2023

Pembrolizumab Induced Hypothyroidism in a Patient with Pre-existing Thyrotoxicosis due To Grave’s Disease

Grounds Kerrie , Panicker Janki

Thyroid dysfunction by Immune Checkpoint Inhibitors (ICPI) is a common Immune-Related Adverse Event (IRAE). Thyroid dysfunction is prevalent in cancer patients receiving pembrolizumab treatment (ICPI). Most prevalent clinical manifestations are reversible destructive thyroiditis and overt hypothyroidism. Pembrolizumab-induced thyroid IRAEs have been reported to range from 3.2% to 10.1%.Case report: This case reports a 64-year-old l...

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ea0094p292 | Thyroid | SFEBES2023

Carbimazole patient information leaflet improves rate of educating patients on agranulocytosis

Jones Rhys , Bhagi Ridhi , Cozma Lawrence , Roy Chowdhury Sharmistha

Background: Carbimazole is a commonly used and effective treatment for hyperthyroidism. Although on the World Health Organisations list of essential medicines, it comes with the potentially significant side effect of agranulocytosis. We set out a Quality Improvement Project to improve communication with patients to ensure their understanding through creating a patient information leaflet.Methods: 30 patients receiv...

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ea0094p293 | Thyroid | SFEBES2023

Rebound worsening of amiodarone-induced thyrotoxicosis after discontinuation of pulse methylprednisolone despite treatment with oral steroids and thiamazole

Lewandowski Krzysztof , Kawalec Joanna , Lewinski Andrzej

Background: Amiodarone-induced thyrotoxicosis (AIT) is sometimes very difficult to treat. Pulse methylprednisolone in addition to oral steroids appears effective in treatment of AIT, but effects of such treatment may be transient.Presentation of The Case: A 65 year old man was admitted our Department because of drug-resistant AIT. He had a history of atrial fibrillation, treated with amiodarone since 2019, and NSTEMI myo...

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ea0094p294 | Thyroid | SFEBES2023

Development of a thyroid patient database in conjunction with the IT system development team at a DGH

Smurthwaite Hannah

In September 2021 the pathology department announced it would be going paperless, a change that resulted in endocrine monitoring being added to the trust risk register. To manage this risk several options were considered including the DAWN system used by rheumatology and systems used by other local hospitals. Unfortunately, none of these were viable options. Discussions were started with the IT systems development team about building a database for management of thyroid patien...

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ea0094p295 | Thyroid | SFEBES2023

Recurrent postpartum thyroiditis with negative test for anti-thyroid peroxidase antibodies

S Kazrooni Noor , NM Al-Aghbari Maram , Samyraju Manjula , O Oyibo Samson

Introduction: Postpartum thyroiditis (PPT) occurs during the first postpartum year with a prevalence between 1.1% and 16.7%. It presents either as transient hyperthyroidism, transient hypothyroidism, or transient hyperthyroidism followed by transient hypothyroidism. Anti-thyroid peroxidase antibodies (TPOAb) levels are high in 60-85% of cases, while the less measured anti-thyroglobulin antibodies (TgAb) can also be high. Risk factors for PPT include presence o...

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ea0094p296 | Thyroid | SFEBES2023

A case of intravenous immunoglobulin induced thyroiditis in pregnancy

Campbell Michael , Agha-Jaffar Rochan , Saad Muhammad , Yu Christina , Robinson Stephen

Intravenous Immunoglobin (IVIG) therapy is used in recurrent miscarriage, despite its efficacy being limited to specific sub-groups such as those with underlying immune conditions. The indications, efficacy and side effect profile of IVIG when used in pregnant women are not established. We present the case of a 41-year-old pregnant woman with one previous miscarriage, who had received IVIG as part of her fertility treatment and subsequently developed profound symptoms and bioc...

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ea0094p297 | Thyroid | SFEBES2023

Thioamide-resistant Graves’ Disease: Successful total thyroidectomy

Kerrie Thackray , Florence Burn , Mohamed Alfiky , Shyam Seshadri , Swe Myint

Background: Thioamide-resistant severe Graves’ thyrotoxicosis (SGT) is rare and often poor patient adherence to therapy is suspected. Management is truly challenging. Case report: 36-year-old female with SGT was referred for further management. The diagnosis was made 5 years ago following delivery of her first son. During her second pregnancy 2 years ago, she required emergency caesarean with the indication of foetal tac...

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ea0094p298 | Thyroid | SFEBES2023

A case report of Lithium induced autoimmune thyroiditis in a previously hypothyroid patient

Ali Syed , Elamin Aisha , Robinson Robert

Background: There is a well-documented relationship between lithium exposure and thyroid dysfunction via multiple mechanisms. Lithium is commonly associated with goitre, hypothyroidism, and subclinical hypothyroidism. Lithium-induced autoimmune hyperthyroidism is rare and poorly understood. We report a case of autoimmune thyroiditis, Graves disease (GD), in a patient with longstanding primary hypothyroidism believed to be induced by Lithium.<p class=...

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ea0094p299 | Thyroid | SFEBES2023

Amiodarone induced thyrotoxicosis type 1 (AIT1) without Graves’ disease or toxic nodular goitre

narayanan Mannath Sathia , Sudarshanan Aditya , Fernandez James Cornelius

Introduction: AIT1 usually occur on a background of Graves disease or toxic nodule goitre. The disease usually requires higher doses of carbimazole than Graves, might need rescue thyroidectomy, and can be treated with radioiodine with higher than standard radioiodine doses after iodine contamination has come down.Case Presentation: 57-year-old gentleman with history of HTN, T2DM, dyslipidemia, aortic stenosis...

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ea0094p300 | Thyroid | SFEBES2023

Elevated thyroid stimulating hormone (TSH) and Free T4 (FT4) – what could it be?

Soon Ooi Chia , DeSilva Akila

Mrs X (aged 79) had a history of longstanding hypothyroidism (levothyroxine 100 micrograms daily). Her Free T4 (FT4) had been slightly raised with normal TSH until in Dec 2019, where both became elevated (TSH 5.4 mU/l and FT4 29.4 pmol/l). Repeat TFT in January 2020 also showed the same. Mrs X felt well on Levothyroxine, with no thyrotoxic features. Endocrine clinic investigations (October 2020) showed no evidence of assay interference. Alternative diagnoses such as thyrotropi...

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ea0094p301 | Thyroid | SFEBES2023

Thyroid eye disease manifestation following radioactive iodine treatment in patients with Graves’ disease

Truong Vi , Slater Deborah , Dhage Shaishav , Adam Safwaan

Background: Thyroid eye disease (TED) is common among patients with Graves disease (GD), with an estimated prevalence of 25-58%. While radioactive iodine (RAI) therapy is effective in managing GD, there are concerns regarding the risk of TED after RAI. Therefore, studying the effects of RAI on TED is essential for improving clinical decision-making. Aim: To determine the incidence of the development or exacerbation...

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ea0094p382 | Thyroid | SFEBES2023

Inevitable succession: Give them one endocrinopathy and they’ll take three

Sharjeel Hassan , Gagandeep Kaur

We present the case of a 58-year-old Caucasian woman with a medical history of Hashimoto’s hypothyroidism who presented with several months of orthostasis, unintentional weight loss, nausea, and vomiting. Initial laboratory investigations revealed severe hyponatremia to 106 mmol/l, which prompted admission to the intensive care unit. TSH and free T4 were normal. She had orthostatic hypotension. Her outpatient medications were levothyroxine 50 mg daily and as-needed ondansetron...

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ea0094p383 | Thyroid | SFEBES2023

A case of thyroid hormone resistance with hyperthyroidism

Tzanninis Stamatios , Zarif Nadia

A 33-year-old woman was seen in the Endocrinology Clinic in May 2023 due to abnormal thyroid function tests with normal TSH and persistently elevated free T4 and free T3. She had been under investigation for tiredness, palpitations, and weight gain. The differential diagnosis was TSH-secreting tumour or thyroid hormone resistance. Her bloods were sent to Basingstoke Hospital and assay interference by heterophilic antibodies was excluded. She underwent a thyroid ultrasound whic...

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ea0094p384 | Thyroid | SFEBES2023

Thyroid peroxidase Antibodies (TPO), Does it change your management plan?

Guma Muna , Aggrawal Naveen

This audit investigated the utilization of thyroid peroxidase antibodies testing in our trust. TPOAb, which emerges as a response to thyroid injury, is found in up to 27% of the population and is associated with autoimmune thyroid disorders. However, it is not considered a disease-causing factor or transmitted from mother to fetus. TPOAb is commonly requested in the community. The retrospective audit reviewed 282 requests from the adult service to the laboratory. After excludi...

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ea0094p385 | Thyroid | SFEBES2023

Link between thyroidectomy and the development of osteoporosis in a south american population

Dulcey Luis , Theran Juan , Gomez Jaime , Blanco Edgar , Ciliberti Maria

Introduction: Patients undergoing thyroidectomy could be subject to osteoporosis, therefore, we evaluated the potential for fractures among 123 men and 134 controls from a South American hospital between 1999-2018.Materials and methods: The influence of thyroidectomy on the incidence of fractures was evaluated using basic methods of analysis. In the primary analysis, the frequency of fractures in the operated cases was d...

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ea0094p386 | Thyroid | SFEBES2023

Hypothyroidism and transient adrenal insufficiency after nivolumab treatment in a renal cell carcinoma woman

Lomidze Ketevan , Gordeladze Marine , Kikodze Nino

Introduction: Immune checkpoint inhibitors (ICIs) have gained popularity as a standard cancer treatment in recent years. IrAEs, or immune-related adverse events, are specific immunological side effects that are linked to ICIs. Thyroid dysfunction is a prevalent irAE, but the cause, severity, and clinical appearance might vary. The most frequent thyroid irAEs brought on by ICIs are destructive thyroiditis and hypothyroidism, whereas immune-related adrenal insuf...

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ea0094p387 | Thyroid | SFEBES2023

Rapid levothyroxine absorption test to diagnose ft4 pseudomalabsorption

Ali Mudassir , Abouglila Kamal

Young man with high BMI and known iatrogenic hypothyroidism, post radioactive iodine (RAI) treatment (2015) for Graves thyrotoxicosis (2011) was referred to endocrinology due to significantly raised TSH (at 50 mu/l) and low FT4 (5.0 pmol/l). He was actually admitted with progressive nausea, vomiting over last three weeks. He also complained of abnormal stool consistency (like semi-solid) intermittently. His past medical history also includes gastric bypass with gastro-je...

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ea0094p388 | Thyroid | SFEBES2023

Cost effectiveness of Inpatient thyroid function test- a snap shot from Great Western Hospital, SwindonTarek Abdellatif, Auditi Naziat

Abdellatif Tarek , Naziat Auditi

Background: In our Hospital, we have noticed a large number of thyroid profile are being requested without any clinical suspicion, which has led to difficulty in interpretation of the results, dilemmas in subsequent management and an increment of inpatient Endocrine referrals.Objective and Aim: To evaluate our local practice in ordering thyroid function tests and to identify strategies to reduce unnecessary testing and i...

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ea0094p389 | Thyroid | SFEBES2023

Thyroid associated ophthalmopathy due to radioactive iodine therapy in patient with right thyroid toxic adenoma

Abouglila Kamal

Thyroid-associated ophthalmopathy (TAO) is an inflammation of the extraocular muscles and periorbital connective tissue caused by autoantibodies against common antigens to both the thyroid and orbit. The release of antigens and induction of hypothyroidism caused by radioactive iodine (RAI) therapy may cause or exacerbate TAO. Radioactive iodine therapy has been associated with worsening TAO, particularly in smokers. A 57 years old female treated with radioactive iodine therapy...

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ea0094p390 | Thyroid | SFEBES2023

Radioiodine and Graves Orbitopathy (GO): lessons learned from an internal audit of 101 patients

Qin Xian Quah Nicole , Maenhout Annelies , Sobti Manvi , Scawn Richard , Kalogianni Eleni , Cleland James , Wren Alison

Graves orbitopathy (GO) development or reactivation is a well-recognised complication of radioactive iodine (RAI), with possible lower incidence in a recent series. We performed a retrospective audit of Graves disease patients treated with RAI at our centre over a 5-year period. We recorded the GO incidence after RAI treatment, risk factors present, and steroid prophylaxis use. Data collected: smoking status, thyroid-stimulating hormone receptor antibody (TRAb), GO...

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ea0094p391 | Thyroid | SFEBES2023

Alemtuzumab-induced Graves’ disease management in pregnancy

Calvo Latorre Julia , Kostoula Melina , Galliford Thomas , Mehta Anku , Sheikh Anum , Radia Florika , Ezenwa Chima

Alemtuzumab is a monoclonal antibody used in the treatment of relapsing-remitting multiple sclerosis (RRMS). Thyroid dysfunction is a common side effect. Alemtuzumab induced Graves disease (AIGD) is notable for its fluctuating and unpredictable course. We present the case of two women with RRMS who required total thyroidectomy to manage AIGD and were followed up in our antenatal endocrine clinic during their pregnancy. The first patient is a 31-year-old lady who develope...

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ea0094p392 | Thyroid | SFEBES2023

A rare but important side effect of anti-thyroid medication: propylthiouracil-induced vasculitis

Fahad Khalid , Yousaf Saira , Pan Shwe

Background: We present a 47-year-old female, who is known to have recurrent Graves disease, developed vasculitic skin lesions upon treatment with propylthiouracil (PTU).Case details: She was diagnosed with Graves disease in 2020 and was started on propylthiouracil as she could not tolerate carbimazole. Propylthiouracil was stopped after 18 months. Her thyrotoxicosis recurred after 6 months. Two months after p...

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ea0094p393 | Thyroid | SFEBES2023

Challenging graves disease (GD) case

Khalid Maha , Macklin Andrew

GD is a common thyroid disorder which in majority of cases respond to medical treatment with thionamides.A proportion of these patients will need definitive treatment with either radioiodine ablation or total thyroidectomy. We present a case of a 21 yr old woman with a year history of overt thyrotoxic symptoms. She lost 2 stones of weight, had palpitations, heat intolerance and noticed shaky hands. On examination:She had large symmetrical goitre with bruit, tachycardic and swe...

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ea0094p394 | Thyroid | SFEBES2023

Use of TRAB values to predict the need for second dose of Radio-iodine therapy (RAIT)

Dodiya Manoj , Weekes Joanne , Kalaria Tejas , N Buch Harit

Background and Aim: RAIT is successful in achieving cure of thyrotoxicosis. However, 10-15% patients require further doses, usually administered at 4-6 months after the initial dose. We assessed the role of TRAB values in predicting the need for redosing, which could have useful implications.Patients and Methods: We measured TRAB at diagnosis and at the time of 550MBq RAIT in 54 patients with Graves disease. We rec...

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ea0094p396 | Thyroid | SFEBES2023

Rhabdomyolysis associated with severe hypothyroidism

Marta Lubczynska Malgorzata , Macriyiannis Thrasos , Gohil Shailesh

Patients with clinical hypothyroidism often complain of muscular symptoms i.e., cramps, weakness and fatigue. However, rhabdomyolysis triggered by severe hypothyroidism is rarely reported. In most cases, external triggers (use of statins or excessive exercise) can be easily identified and modified. In absence of beforementioned triggers, it is prudent to look for other causes of rhabdomyolysis. On the forefront, it would be crucial to exclude myocardial ischaemia, followed by ...

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ea0094p397 | Thyroid | SFEBES2023

Is it euthyroid sick syndrome or central hypothyroidism?

Hla Myat Mon , Praveena Vankayalapati

73-year-old gentleman presented to AEC with 3-week history of shortness of breath, cough with sputum production, generalised weakness and loss of appetite. He was found to have iron deficiency anaemia and hyponatraemia (120mmol/l). He had history of type2 diabetes, and hypertension. On workup for hyponatremia, both free T3 and free T4 are reduced with suppressed TSH 0.01 uIU/ml. TSH receptor antibody was negative. He was started on levothyroxine 50mg on suspicion of secondary ...

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ea0094p398 | Thyroid | SFEBES2023

Unexpected testosterone results in a man complaining of low libido

Glyn Tessa , Hasan Faisal

A 50-year-old half Jamaican gentleman was referred urgently to the endocrinology clinic with thyrotoxicosis. He had lost 2 stone in weight over a 2 month period and was complaining of lethargy, low libido and loose stools. His bloods showed a fT4>100 pmol/l, fT3 32.7 pmol/l, and TSH <0.02mU/l. Subsequently his TSH-R Ab returned elevated at 5.5IU/l (<2.9IU/l), confirming a diagnosis of Graves disease. His GP also checked his testosterone level on the initial b...

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Society for Endocrinology BES 2023

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