Endocrine Abstracts

Graves’ orbitopathy (GO) affects 20-40% of patients with Graves’ disease. Some patients require several treatment modalities with outcomes that are often far from ideal. The quest for disrupting the autoimmune process with targeted therapies began with the emergence of biologics developed for rheumatoid arthritis. In the meantime basic research revealed an important potential role for cross-talk between the TSH and IGF-1 receptors on orbital fibroblasts. This attract...

Graves’ orbitopathy (GO) is a relatively rare condition, but can cause significant morbidity, poor quality of life, socioeconomic cost and occasionally impaired vision. Some studies indicate that nearly all patients with Graves’ hyperthyroidism, even those without overt GO, have subclinical eye disease. It is becoming increasingly evident that early recognition of GO and early interventions can affect the long-term outcome favourably. Predicting which patients will d...

Over the past two decades, the developed world has witnessed an epidemic of incidental thyroid nodules diagnosed through imaging of the neck for other indications. This has created new challenges for patients and clinicians. Several guidelines have been published in the past 2 years on this topic, which are broadly concordant and only differ in detail. Optimal management is based on the following principles: 1. Avoidance of imaging unless there is a clea...

Evidence is emerging from the UK and elsewhere that: (a) endocrine clinics are reservoirs of undiagnosed thyroid eye disease (TED); (b) the interval from onset of symptoms of TED to diagnosis and treatment often exceeds 1 year; (c) simple interventions that can be initiated in the endocrine clinic can reverse mild TED and prevent progression; (d) immunosuppressive treatments work best in the first 9 months. Early detection of TED is a fundamental part of management and can be ...

Previous UK guidelines (2002, 2007) focused on reducing regional variations in practice, concentrating expertise (especially surgical), and eliminating clinical, radiological and biochemical evidence of persistent disease. The 2014 guidelines aim to improve the overall survival while enhancing the health-related quality of life of patients. This presentation will discuss areas of the guidelines that are significantly different from the previous edition of the guidelines and ar...

The introduction of fine needle aspiration biopsy revolutionised the investigation of thyroid nodules. Several decades on, diagnosis relies largely on the same technique. Meanwhile clinicians are faced with an epidemic of incidentally discovered thyroid nodules and an increasingly ‘informed’ public frequently misled by unreliable sources. Molecular diagnostics and new imaging techniques are in the horizon, but unlikely to influence clinical practice in the next few y...

Thyroid associated orbitopathy affects approximately a third of patients with Graves’ disease. It is responsible for significant symptoms, poor quality of life, and if neglected can cause blindness. Early diagnosis of Graves’ ophthalmopathy is paramount as is early detection of sight-threatening disease. All but the mildest cases are best referred to centres who provide multidisciplinary care and have the experience and expertise on managing this condition. Treatment...

Thyroid cancer is generally associated with a good prognosis, yet mortality in the UK was reported to be higher than other developed countries, and published audits have highlighted deficiencies in management of this condition in Scotland and England. The British Thyroid Association (BTA) responded by publishing national guidelines for the management of differentiated thyroid cancer in 2002. Since then, other guidelines and consensus statements have been published from Europe ...

The majority of patients with thyroid eye disease (TED) improve spontaneously without any specific intervention. Some have acute sight-threatening complications and most are left with significant disfigurement. Numerous medical treatments have been tried and most do not work. Steroids and orbital irradiation are helpful in some cases, but neither has a major impact on appearance. All patients with TED deserve consideration for rehabilitative reconstructive surgery. The role of...

Permanent hypoparathyroidism is rare after total thyroidectomy. However, our experience is that often patients remain on alfacalcidol and calcium supplements long-term after thyroidectomy.A study was initiated in our centre in 2004, whereby all patients on alfacalcidol or calcium supplements post thyroidectomy underwent a gradual alfacalcidol and calcium reduction programme. Of 57 patients thus enrolled, we report on 22 who were initially on alfacalcidol...