Endocrine Abstracts

Aims: In 2005 we defined a specific reference range for TSH in our pregnant population. We have assessed whether this has resulted in changed management of treated hypothyroidism in pregnant.Methods: The management of 73 mothers (Group 1) between January 2000 and July 2005 was compared to that of 67 mothers (Group 2) between August 2005 and December 2009. The upper limit of normal for TSH was 4.5 mU/l till July 2005; the specific TSH range defined for pr...

In 1999 Haddow et al (NEJM; 1999; 314:549) reported neuropsychological deficits in babies born to inadequately treated hypothyroid mothers. We have compared our management of treated hypothyroidism in 30 pregnancies in 24 mothers delivered before 2000 to 37 pregnancies in 33 mothers since.TSH levels were measured at booking in 22 (73%) in the pre-2000 group, 6 (27%) of which were raised; and 32 (86%) in the post-2000 group where 12 (38%) were raised. 7 m...

In October 2006 a 53-year-old, non-smoking woman presented with ectopic Cushings from a small cell, undifferentiated carcinoma (Grade 3 neuroendocrine) from a 10 mm tumour at the left lung hilum (Cortisol: 09:00 a.m. 720 nmol/l; 24.00 mm 742 nmol/l. ACTH 114 ng/l). Four years before she had sustained a myocardial infarction, with atrial fibrillation, and was found to have Graves’ disease, being treated initially with carbimazole then radioactive iodine, becoming hypothyro...

Context: Hyperthyroidism is a common endocrine condition that can be associated with significant morbidity. It is important to ascertain the underlying cause of hyperthyroidism as the natural history, potential complications and response to treatment can be very different.Objective: To investigate if measurement of TSH-receptor binding inhibitory immunoglobulin (TBII), a TSH-receptor antibody found in Graves disease, in the serum of newly diagnosed hyper...

Aims: Despite the plethora of testosterone therapies, Successful testosterone replacement remains a challenge. We assessed patient empowerment, treatment satisfaction and adherence to current testosterone replacement guidelines.Methods: Data were collected from case notes and a testosterone diary questionnaire in 16-patients with testosterone deficiency.Results: Median age was 46-years (range 21–69). All patients received an e...

The synacthen test is a commonly performed endocrine test; we have looked at whether we overuse this test. Of 150 synacthen tests performed in one year 52 were randomly selected for audit. 19 were undertaken for symptoms alone (Group 1); 16 for a low random cortisol (below 261 nmom/l – Group 2); 17 for electrolyte disturbances (either low sodium, high potassium or both – Group 3). 3 in Group 2 and 1 in Group 1 were abnormal but in no patient with a random cortisol ab...

Thyroid hormone and TSH levels change during pregnancy yet most laboratories use reference ranges derived from subjects who are not pregnant and male. Does this lead to an underestimation of thyroid disorders in pregnancy?We have derived our own reference range for Free T4 and TSH levels in pregnancy. The hormones were measured in 82 euthyroid mothers at booking and 68 at 28 weeks of pregnancy. Mean (95%CI: reference range of +2SD) FT4 levels were...

Introduction: Myxoedmea coma is an extreme expression of hypothyroidism with a high mortality rate. It is rarely associated with thyroid lymphoma.Case report: A 66-year-old lady presented acutely unwell with a two week history of cough and shortness of breath. She was hypothermic, hypoxic with clinical and radiological signs of pneumonia. Her TSH was 99.8 mU/L and T4 less than 5 pmol/L with strongly positive thyroid microsomal antibodies, raised WBC and ...