Endocrine Abstracts

Thyroid diseases are common with thyroid dysfunction affecting up to 10% of the population and thyroid nodules occurring in more than 50% of people. I currently lead an internationally unique and wide-ranging programme of translational thyroid research, which integrates clinical and laboratory research with rigorously conducted clinical trials. My research findings are incorporated in national and international clinical management guidelines and drive professional training in ...

The NICE guidelines on the assessment and management of benign thyroid disorders were published in November 2019. They provide evidence based guidance on how to investigate thyroid dysfunction and thyroid enlargement as well as on the management and follow-up of these conditions. In addition, they include a chapter on important information to be provided to patients with thyroid diseases. The guidelines propose a cascading approach to measurement of thyroid funct...

Changes in thyroid hormone concentrations that are characteristic of hyperthyroidism must be distinguished from physiological changes in thyroid hormone economy that occur in pregnancy, especially in the first trimester. Gestational transient thyrotoxicosis, caused by very high serum hCG concentrations, is typically seen in women with hyperemesis gravidarum and occurs in one to two per 1000 pregnancies. This is generally a self-limiting condition which does not require antithy...

Changes in thyroid hormone concentrations that are characteristic of hyperthyroidism must be distinguished from physiological changes in thyroid hormone economy that occur in pregnancy, especially in the first trimester. Gestational transient thyrotoxicosis, caused by very high serum hCG concentrations, is typically seen in women with hyperemesis gravidarum and occurs in one to two per 1000 pregnancies. This is generally a self-limiting condition which does not require antithy...

Thyroid hormones play crucial roles in foetal growth and neurodevelopment which are dependent on adequate supply of maternal thyroid hormones from early gestation onwards. During pregnancy there are important physiological changes resulting in altered reference ranges and complicating the interpretation of thyroid function tests. Thyroid dysfunction is common in pregnancy and the prevention of adverse obstetric and foetal outcomes relies upon careful monitoring and treatment b...

Hypothyroidism before and during pregnancy has been linked with adverse pregnancy outcomes. Observational studies have demonstrated that thyroid autoimmunity, characterised by the presence of thyroid peroxidase (TPO) antibodies, is associated with increased risks of miscarriage and pre-term birth. Small trials indicated that levothyroxine therapy could reduce such adverse outcomes, but the evidence was inconclusive. The TABLET trial is a multicentre, double-blind, placebo-cont...

Thyrotoxicosis is a common disorder affecting up to 3% of the UK population and Graves’ disease is the most common aetiology. Clinically relevant thyroid eye disease is present in 25–50% of patients with Graves’ disease causing significant disfigurement and morbidity in 5–10% of patients. At the onset of ophthalmopathy, 80–90% of patients have hyperthyroidism, with the rest having euthyroidism or hypothyroidism. Risk factors for development of eye comp...

The thyroid gland undergoes several anatomical changes with age and both overt and subclinical thyroid dysfunction a more prevalent in elderly patients. Recent reports have convincingly shown a physiological rise in serum TSH concentrations in the elderly and studies on autoimmunity have indicated an age-related prevalence of antithyroid antibodies. Interpreting thyroid function tests in elderly patients may be complicated by an increased prevalence of co-existing chronic dise...

Weight loss is a common symptom observed in the majority of patients presenting with autoimmune Graves’ hyperthyroidism. The three main treatment modalities used for treatment of Graves’ disease are associated with excess weight gain, reportedly over and above regain of lost weight. Hyperthyroidism is associated with alterations in satiety signals and there are conflicting data relating to whether lean or fat mass are increased following successful treatment. Risk fa...

A 25 year old lady initially presented with symptoms of palpitation, irregular menses and unintentional weight loss. She was a non-smoker with no current pregnancy plans or family history of thyroid disease. On examination, she was tachycardic and had a moderate diffuse goitre but no signs of thyroid ophthalmopathy. She was biochemically hyperthyroid (TSH <0.01 mIU/l, fT4 30.0 pmol/l, fT3 >30.7 pmol/l). Carbimazole 30 mg daily was started for likely Graves’ diseas...