Endocrine Abstracts

The administration of 131I should strictly be avoided in pregnancy. Iodide concentrating capacity can be detected in the thyroid of the 10–11 week fetus. If administration is within the first 8 weeks, the major problem is fetal whole body dose due to gamma emission from 131I in the maternal bladder (about 50–100 μGy/ MBq of administered activity). This dose is reduced if the mother is well hydrated and voids frequently. Generally the lifeti...

A 30 year old gentleman was admitted to our department with symptoms of tiredness and weight loss over the past 3 weeks. He also gave a history of erectile dysfunction for several years. His only significant past history was asthma well controlled on inhalers. On examination he appeared tanned. There was no buccal or skin crease pigmentation. Smell sensation was normal and he had normal external genitalia and secondary sexual characteristics.Initial inve...

Presentation: A 20 year old student was brought to the Emergency Department with a 13 day history of heavy menstrual bleeding. On the day of her admission she had collapsed. On admission, she was noted to be pale with severe postural drop (70 mm Hg).Investigations: Haemogobin: 46 g/l. Blood film showed an iron-deficient picture. eGFR: 54ml/min/1.73m2. Creatinine: 124 μ mol/l. Free T4: <5.3 pmol/l. TSH: >500 mU/l. TPO antibodies positive (8.3...

Background: In 2014, Thy002 (the proportion of patients with hypothyroidism on the practice register with thyroid function tests recorded in the preceding 12 months) was removed as a Quality Outcome Framework (QOF) target.Aim: To audit the current management of hypothyroidism in primary care two years following the QOF changes.Method: Four local practices (total patient population: 37 200 (range 7300–1300 per Practice)) partic...

Introduction: The thyroxine absorption test (TAT) is well established to investigate persistently raised TSH in patients on L-thyroxine. We review our experience with this test.Method: Blood was taken for baseline FT4, FT3, TSH measurements and malabsorption screen. A week’s supply of L-thyroxine (1.6 mcg/kg×7) was administered orally under direct supervision and FT4 and TSH measured 2 h later. Patients continued o...

Aim: To investigate the relationship between baseline and stimulated cortisol responses in relation to the habitual time of rising and time of test.Method: The self-reported habitual rising time and time of cortisol testing were recorded in 63 consecutive patients (47F, 17M, age 18–94) undergoing standard stimulation testing with tetracosactide (SynActhen) 250 μg i.v. In total, 75 tests were analysed. A normal response was defined as a 30 min p...

Introduction: Symptoms of hypothyroidism are very variable and are frequently present in the healthy population. The diagnosis can easily be missed if considered only in patients with classical symptoms. Aim: To describe the range of presentations in patients diagnosed with hypothyroidism in primary care.Method: Patients were recruited via the British Thyroid Foundation and from a local GP surgery. Respondents were asked to complete a questionnaire for t...

Introduction: Hyponatraemia is not uncommon in primary care and its management can be complex. It is vital that initial assessment is carried out properly as mismanagement can have serious consequences.Aim: To investigate general practitioners’ views and perceptions on the management of hyponatraemia encountered in primary care.Method: Local general practitioners were surveyed with a questionnaire via email and at local postgr...

Introduction: Hyperthyroidism may mimic many conditions, and there is potential for under-diagnosis if testing is considered only in patients presenting with classical symptoms.Aim: To describe the range of presentations in patients found to have hyperthyroidism and referred from primary care.Method: Consecutive patients diagnosed with hyperthyroidism and referred to the endocrine clinic between Jan 2009 and Nov 2009 were studied. ...

Introduction: Hypocalcaemia is a rare presentation of thyrotoxicosis. We describe a patient with severe life-threatening hypocalcaemia and suggest pathogenic mechanisms.Case report: A 66-year old lady with long-standing insulin-treated type 2 diabetes presented acutely with generalised weakness and a collapse at home. Prior to admission, she had been treated for an infected neuro-ischaemic plantar ulcer with broad-spectrum antibiotics. She had developed ...