Endocrine Abstracts

Hypothyroidism is one of the commonest endocrine disorders, affecting about 3% of the adult population. Levothyroxine (T4) is the standard treatment for hypothyroidism and is one of the most commonly prescribed drugs in the UK. Whilst most patients with hypothyroidism are satisfied with this treatment, a small subgroup of patients do not feel well on T4 monotherapy. Whether such patients would benefit from Liothyronine (T3), taken either in combination with T4, as a monotherap...

Autoimmune thyroid diseases, including Graves’ disease and autoimmune thyroiditis, are common in women of childbearing age. Poorly controlled Graves’ disease is associated with an increased risk of fetal loss, premature birth, pre-eclampsia, intra-uterine growth retardation, and thyroid storm. Antithyroid drugs, propylthiouracil and carbimazole (or its metabolite methimazole), cross placenta and may cause hypothyroidism and goitre in the fetus. Carbimazole is associa...

We describe a 35 year old man who was referred back to the endocrinology service with a chronically raised amylase. He had previously been seen for early onset type 2 diabetes and for primary hyperparathyroidism. He had undergone a single gland parathyroidectomy, aged 32, for primary hyperparathyroidism in 2013 after which his calcium had remained normal. In clinic he was found to be overweight but otherwise well, with normal blood pressure and an HbA1c 49 mmol/mol. The most s...

Introduction: A short-synacthen test (SST) is routinely used to diagnose hypoadrenalism, however, some authors suggest using morning serum cortisol as an initial screening test to rule out hypoadrenalism. We assessed the utility of a morning cortisol as a screening test when compared with the outcome of SST.Methods: We retrospectively analysed SSTs carried out in our endocrine outpatient clinic in the last 3 years (649 results). Of these, 113 were identi...

Introduction: Mutations in the RET gene cause multiple endocrine neoplasia type 2A (MEN2A), MEN2B, and familial medullary thyroid carcinoma (FMTC). The identification of a germline RET mutation aids clinical management, enables the identification and predictive testing of at risk family members and provides reassurance for mutation-negative family members. In the research setting, mutations in exons 5, 8, 10, 11, 13–16 of the RET gene have been ...

We present the case of a 70 year-old man who presented with several months history of tiredness and lethargy. He had a past medical history of ischaemic heart disease. Examination identified a bitemporal hemianopia. Initial investigations demonstrated hyponatraemia, sodium 117 mmol/L (Reference range 132–145) with normokalaemia. Further investigations confirmed hypopituitarism: Short Synacthen Test Cortisol at T=0 min, 125 mmol/L, Cortisol at T=30 mins, 277 mmol/L, free T...

A 75-year-old lady presented with hypertension, weight gain, ankle oedema and proximal myopathy. She had clinical features of Cushing’s syndrome. Blood pressure was 180/99 mmHg. Her visual fields were normal. Investigations confirmed Cushing’s syndrome with high 24-hour free urinary cortisol levels (2264 nmol/l and 3295 nmol/l; normal range 40–305) and a high serum cortisol level following overnight dexamethasone suppression test (serum cortisol 1,550 nmol/l). F...

Background: Accurate diagnosis of an underlying cause of thyrotoxicosis is critical for targeted therapy. Thyroid radionuclide uptake scan is a useful second line investigation in patients who lack TSH receptor antibody. The uptake scan patterns identify patients who can be preferentially treated with anti-thyroid drugs (diffuse pattern - Graves’ disease) or radio-iodine treatment (patchy uptake - multinodular or localised uptake – toxic adenoma) or simple monitoring...

Introduction: A breech presentation occurs in 3–5% of all full-term pregnancies and is associated with increased risk of maternal and foetal morbidity. Factors known to increase the risk of breech presentation include prematurity, low birth weight and multiple pregnancies. Recent studies suggest maternal thyroid hormone deficiency in late pregnancy may also be a risk factor. Our study aims to assess if a breech presentation at 36 weeks gestation in a healthy singleton coh...

Background: Subclinical hypothyroidism is common in pregnancy affecting about 5% of all pregnant women, and is associated with adverse pregnancy outcomes. There is a general consensus that subclinical hypothyroidism detected during pregnancy should be treated with L-thyroxine (Stagnaro-green et al. 2011, DeGroot et al. 2012). However, it is unclear whether the treatment should be limited only during the pregnancy or continued long-term. Therefo...