Endocrine Abstracts

Key discussion points• Make sure you know what it is that you are treating – is this Graves’ hyperthyroidism (with associated TSH receptor antibodies) or simply a brief, hyperthyroid phase of autoimmune thyroid disease (without TSH receptor antibodies) that will settle down spontaneously?• Ideally obtain the result of the thyroid receptor antibody titre pre intervention with carbimazole.&#...

Case presentation: A 40-year-old Caribbean woman presented with sudden onset palpitations. She described 3 months of progressive shortness of breath, non-productive cough and 7kg weight loss. She denied chest pain, fevers or night sweats, but reported increased stool frequency, gritty eyes, and occasional visual blurring. She appeared cachectic and had a fine tremor, left eye proptosis and a visible pulsatile goitre. She was afebrile, tachypnoeic, hypoxic, hypotensive with fas...

A 25-year-old primi 26 weeks pregnant was admitted with B/L flank pain & pleuritic sounding chest pain. She was septic on initial assessment by the Obstetric team and preliminary investigations revealed high inflammatory markers, raised CRP of 336 & deranged LFT’s. Her USS scan suggested possible hepatitis/cholangitis and blood cultures grew E. coli & she was started on IV Ceftriaxone & metronidazole for the same. At day 3 of her admission, she started det...

Radioactive iodine is used routinely and safely in the treatment of hyperthyroidism. We describe an unusual side effect after a single treatment in a patient with subclinical hyperthyroidism.A 64 year old woman was referred to our service with multinodular goitre. She was found to have subclinical hyperthyroidism with TSH 0.17 mU/L, fT3 5 pmol/L and fT4 14 pmol/L. She underwent radioactive iodine treatment with 530 MBq of Iodine -131 in Jan...

Radioactive iodine is used routinely and safely in the treatment of hyperthyroidism. We describe an unusual side effect after a single treatment in a patient with subclinical hyperthyroidism.A 64 year old woman was referred to our service with multinodular goitre. She was found to have subclinical hyperthyroidism with TSH 0.17 mU/L, fT3 5 pmol/L and fT4 14 pmol/L. She underwent radioactive iodine treatment with 530 MBq of Iodine -131 in Jan...

Case history: A 32 year old female was admitted for an elective gynaecological procedure LLETZ (large loop excision of the transformation zone) under general anaesthesia as per patient”s request. An uncomplicated LLETZ procedure was performed. Post operatively, patient was found to be tachycardiac and had severe palpitations with nausea. She then reported that she had recently lost a significant amount of weight, had been suffering with anxiety, palpitations, and tremors ...

Generally, after an initial active phase TED rarely reactivates. However, epidemiological evidence is scant. The following cases highlight the propensity for Graves’ orbitopathy to reactivate many years later.Case 1: A 69-year-old woman had Graves’ disease aged 29, and was reviewed in the TED clinic (ophthalmology, rheumatology and endocrinology), with reactivation of orbitopathy 40 years after initial disease. She was an ex-smoker, had hyperte...

Thyroid storm is rare and life threatening manifestation of thyroid hormone excess. It has high mortality rate with delayed treatment. As early intervention is associated with improved patient outcome, prompt diagnosis based on clinical grounds is of paramount importance. We present a case of thyroid storm which was different in terms of absence of fever on presentation, presence of thrombocytopenia and deranged cholestatic LFTs which resolved after treatment of thyroid storm....

Objective: Migraine is a common primary headache disorder that affects 12-15% of the general population. Also, vitamin D deficiency is a global health problem. A few studies have shown relationship between serum vitamin D levels and headache. The aim of this study was to investigate the difference in serum levels of 25-Hdroxy vitamin d [25(OH)D] between migraine patients and healthy controls and also to determine the relationship of vitamin D deficiency with frequency and seve...

L-T4 monotherapy remains the standard treatment of hypothyroidism, as RCTs comparing T4 and T4+T3 did not indicate superiority of the combination therapy. However, the issue is far from settled, as these RCTs can be criticized and 5–10% of patients on T4 have persistent complaints.i) Has T4+T3 therapy a true effect on serum thyroid hormones? Under T4 monotherapy serum FT4 is higher and serum FT3 is lower than in healthy subjects, giving ris...