Endocrine Abstracts

We present a 37-year-old gentleman (Mr. A) who self-referred to the endocrine clinic for review of his testosterone replacement therapy.He required testosterone replacement therapy aged 11 years old following surgical removal of underdeveloped testes of unknown aetiology. He was prescribed testosterone injections until the age of 22 years old when testosterone patches were trialled, which he did not tolerate. He commenced testosterone replacement gel (TE...

We present the case of a 51-year-old gentleman who had a giant parathyroid adenoma. He has a past medical history of deep vein thrombosis and hypertension. He is taking amlodipine 10 mg od. He is a non-smoker and drinks alcohol in moderation. He was admitted with right leg swelling found to be a new thrombosis. Incidental finding of extreme hypercalcaemia found on bloods with raised PTH (CorrCa 4.23 mmol/l, PTH 83.1 pmol/l.) Patient was completely asymptomatic. CT imaging of c...

A 37 year old woman was referred to the endocrinology clinic from the gynaecologists. She was awaiting an 8 cm left ovarian cyst removal and found to be hyperthyroid (fT3 7.8 pmol/l, fT4 of 19.0 pmol/l, TSH <0.01 mU/l). She described 4 months of palpitations, change in bowel habit and menstrual irregularity. She had no tremor or tachycardia. She had no palpable goitre or eye signs. She had a past medical history of asthma on inhalers. There was no family history of thyroid...

Introduction: Hypothyroidism can present in a variety of ways, from unexpected abnormal blood results in seemingly asymptomatic patients to those with a multitude of debilitating symptoms. Levothyroxine dose titration is a challenge often faced by physicians. We identified 8 difficult cases which following MDT discussion underwent the Thyroxine Absorption Test (TAT) to gain further clarification (Walker et al. 2013).Aim: To identify if the issue...

This is a case of a 48-year-old lady initially referred to respiratory clinic with symptoms of breathlessness. She had a high-resolution CT thorax where an incidental finding of a right para-oesophageal 2.4-cm soft tissue density at the level of the thyroid gland identified. A CT neck was performed for further evaluation again showed the soft tissue mass (26 mm×37 mm) situated to the right of the oesophagus and another mass (16 mm×26 mm) left of the oesophagus. Discu...

Current UK guidelines for thyroid nodules advise a thyroid ultrasound (ThyUSS) with U-Classification with or without Fine Needle Aspiration (FNA) with Thy-Classification to determine malignancy risk. We report four cases where thyroid carcinoma was diagnosed histologically following reassuring cytology and radiological examination. This is a case of 28-year-old female who presented with neck swelling. ThyUSS showed an enlarged left thyroid with cystic and solid components; FNA...

Introduction: Thyroid cancer is the most common malignant endocrine tumour and represents 1% of all malignancies. Cancer Research UK in 2015 reported 3528 new cases and 382 deaths with annual incidence of 5.1 and 1.9 per 100,000 women and men respectively. The incidence is increasing globally, mostly due to papillary thyroid cancer.Ultrasound is the preferred examination with recommended U1-U5 grading system +/- fine-needle aspiration cytology (FNAC)...

The British Thyroid Association executive committee advised in 2015 that there was insufficient evidence that levothyroxine(T4) and liothyronine(T3) combination therapy was superior to levothyroxine monotherapy, which remains the standard treatment of primary hypothyroidism. It was considered an experimental approach in symptomatic patients on T4 therapy with a TSH level within normal range.We present a 47-year-old lady who had been diagnosed with primar...

A previously fit and well 27 year old Ghanaian male was brought to hospital by his cousin due to new behavioural changes. The patient was described by his cousin as a normally reserved, self-sufficient man who had become a polar opposite ‘irritable’ personality that ‘spent extravagantly’. He repeatedly claimed to be ‘God’s protection’ and responded aggressively to visual hallucinations. This had resulted in social exclusion and loss of employ...

We report a case of a 43 year old lady who was referred by her general practitioner (GP) to the endocrine team with an 8 month history of extreme fatigue, difficulty losing weight, galactorrhoea and mild breast enlargement. She has two children aged 16 and 14, all well. Her background medical history included depression, asthma and hysterectomy for fibroids 3 years ago. Examination of all systems were unremarkable including visual fields to confrontation, fundoscopy and full n...