Endocrine Abstracts

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...

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: Thyroid quality indicators were removed from the Quality Outcome Framework (QOF) targets in 2014, resulting in discontinuation of statutory system alerts to remind GPs to check annual thyroid function in patients with primary hypothyroidism treated with levothyroxine.Aim: To investigate the impact of the discontinuation and reinstitution of the QOF thyroid e-alerts on the management of hypothyroidism in primary care.<p cla...

Introduction: Thyroid quality indicators were removed from the Quality Outcome Framework (QOF) targets in 2014, resulting in discontinuation of statutory system alerts to remind GPs to check annual thyroid function in patients with primary hypothyroidism treated with levothyroxine.Aim: To investigate the impact of the discontinuation and reinstitution of the QOF thyroid e-alerts on the management of hypothyroidism in primary care.<p cla...

Case History: Hyperandrogenism is a relatively common clinical problem. However, severe hyperandrogenism causing virilisation is rare. A 22-year-old lady with no significant past medical history, presented with oligomenorrhoea, hirsutism and male pattern hair loss over last 3 years duration. She has no acne or change in voice or clitoromegaly. She was also noted to be having high BP on clinic visit and grade 1 acanthosis nigricans.Investigations: Her tot...

Case History: An 81-year-old gentleman was brought to A&E by ambulance after being found to be hypoglycaemic at home by paramedics. His wife reported that he experienced unsteadiness and slurred speech after waking up in the morning and she called the emergency number. On arrival of paramedics, his capillary blood glucose was found to be 1.2 mmol/l and he was administered intravenous dextrose. He also had a couple of similar episodes which were resolved with food. He is no...

Introduction: Thyroid hormone replacement is frequently suboptimal but interventions that are proven to optimise therapy are lacking. In 2017, we developed in EMIS an electronic Protocol for Monitoring Patients on Thyroxine in General Practice (‘e-Prompt GP’), to offer automated alerts to prompt GP's to test and address out of range thyroid function tests in patients with hypothyroidism.Aim: To investigate the long-term impact of an electronic ...

Introduction: Following the introduction of the Quality Outcome Framework (QOF), 98–100% patients with hypothyroidism received annual TSH checks during the period 2009–2014. However, there was no evidence this resulted in improved care. We have developed an electronic protocol in EMIS web to both emulate the former QOF thyroid e-alerts in prompting GP’s to check annual thyroid function in patients with treated primary hypothyroidism, and also to alert if TSH is ...