Primary Hyperthyroidism Research Articles

Prevalence of thyroid dysfunction in namakkal district -A hospital based study

Thyroid disorders are most common endocrine disorder in India but the prevalence studies on these dysfunction is limited. All subjects who visited the hospital for a period of four months to have thyroid function tests (TFTs) on their first outpatient visit were included in the study. Thyroid disordrs were present in 22.11 % of the total 2510 subjects . The prevalence rate was higher in females (64.8%) than males (35.2%) with (p=0.0003).The prevalence of hypothyroidism in the study population was 64.32 % (n = 357). In our study those with primary hypothyroidism were predominant (55.18 %, 197 out of 357) and 43.1 % (154 out of 357) were having sub clinical hypothyroidism and 6 of 357 were having secondary hypothyroidism. The prevalence rate of hyperthyroidism was 52.6 % (n-188) . The majority were subclinical hyperthyroidism (65.90 % , 124 out of 188) ,30.8 % (58 out of 188) had primary hyperthyroidism and3% ( 6 out of 188) had secondary hyperthyroidism. In our study thyroid function abnormalities were noted in 15.73 % of all subjects. Thyroid disorders were common in age of >20 years than 20-40 ,40-60 and and >60 year categories. The prevalence of primary hypothyroidism was found to be higher than subclinical hypothyroidism, while in hyperthyroidism subclinical condition was predominant compared to primary hyperthyroidism.

6441 Hyperthyroidism in a patient with Lyme disease

Abstract Disclosure: J. Epstein: None. C. Berman: None. Background: Lyme disease is known to cause inflammation in many organs. There are few case reports in the literature that discuss the association between Lyme disease and thyroiditis. This case underscores the need to further research the association between Lyme disease and thyroid physiology. Clinical Case: A 15-year-old female with a history of polycystic kidney disease is referred to a pediatric endocrinologist for primary amenorrhea and hyperthyroidism. Initial thyroid function tests demonstrated suppressed TSH of 0.03 mIU/L with an elevated free T4 level of 4.0 ng/dL and total T3 of 437 ng/dL. The patient was asymptomatic with normal vital signs, and physical exam was normal without goiter, tremor, tongue fasciculations, or exophthalmos. Thyroid ultrasound demonstrated a mildly heterogenous appearance without nodules. Incidentally, Lyme disease was concurrently diagnosed based on a positive screen confirmed with immunoblot. There was no known tick exposure or rash, but the patient had recently spent time outdoors in upstate New York. Doxycycline was started for the treatment of Lyme disease and repeat thyroid tests one week later showed a decrease in free T4 and total T3 levels, although still elevated. Thyroid antibodies including thyroid peroxidase (TPO), thyroglobulin and thyroid-stimulating immunoglobulin (TSI) were negative. After finishing doxycycline treatment, she developed a hypothyroid state with a TSH of 6.39 mIU/L, free T4 of 0.6 ng/dL, and a normal total T3 of 148 ng/dL. Free T4 has since normalized however TSH remains elevated. The patient continues to be monitored closely without pharmacologic treatment. The evolution of this patient’s thyroid function is consistent with thyroiditis and appears similar to the course of Hashitoxicosis, however antibodies remain negative. There is literature that suggests molecular mimicry between Borrelia proteins and thyroid autoantigens due to amino acid sequence homology. Some Borrelial proteins are found to share antigenic properties with multiple thyroid related proteins, specifically the TSH receptor, TPO, thyroglobulin and sodium iodine symporter, potentially leading to thyroiditis. Three case reports describe adults with hyperthyroidism in the setting of Lyme disease, however in these cases thyroid antibodies (TPO +/- thyroglobulin) were positive. Two of these patients were asymptomatic, similar to our patient. This phenomenon has never been described in a pediatric patient and illustrates the need to consider Lyme disease as a potential cause of destructive, transient, thyroiditis. Presentation: 6/1/2024

Clinical Significance of Thyroid Autoantibodies in Differential Diagnosis and Predicting the Course of Programmed Cell Death Protein-1 Inhibitor-Induced Thyroid Dysfunction

ObjectiveThyroid immune-related thyrotoxicosis is one of the most common adverse effects in patients treated with programmed cell death protein-1 (PD-1) inhibitors. We investigated the significance of levels of serum anti-thyroglobulin antibodies (TgAbs), anti-thyroid peroxidase antibodies (TPOAbs), and thyroid-stimulating hormone receptor antibodies (TRAbs) in the identification of anti-PD-1-induced thyroid thyrotoxicosis. MethodsWe divided 161 patients with thyroid dysfunction who received PD-1 inhibitors at our hospital between January 2022 and June 2024 into 3 groups: primary hypothyroidism group, primary hyperthyroidism group, and destructive thyroiditis group. The characteristics of the 3 groups were determined, and the positivity rates of serum TgAbs, TPOAbs, and TRAbs were assessed. An additional 42 patients diagnosed with Hashimoto’s thyroiditis were selected as the control group for PD-1 inhibition-induced destructive thyroiditis. Age, sex, and time of transition from thyrotoxicosis to hypothyroidism in the 2 groups were compared. ResultsIn the primary hypothyroidism group, only 1 case was TPOAbs-positive (1/1%). In the destructive thyroiditis group, the positivity rate for TPOAbs or TgAbs was 92.9%, and TPOAbs and TgAbs were negative in the primary hyperthyroidism group. TRAbs were undetectable in all 3 groups. There were statistically significant differences in age, sex, and time from thyrotoxicosis to hypothyroidism in the PD-1 induced destructive thyroiditis and Hashimoto’s thyroiditis groups. ConclusionsIn patients with thyrotoxicosis caused by PD-1 inhibitors, serum TgAb, and TPOAb levels can be used to distinguish between primary hyperthyroidism and destructive thyroiditis. This study provides insights into novel treatment targets and effective management strategies for PD-1-induced thyrotoxicosis.

Biochemical pattern and prevalence of thyroid disorders among adults in a tertiary hospital in North-East Nigeria

Thyroid disorders are a relatively common group of endocrine disorders globally. Thyroid function tests are critical for diagnosing, screening, and prognosticating thyroidal and non-thyroidal diseases, and their accurate interpretation is required for effective and accurate patient management. A retrospective analysis of thyroid function tests - Thyroid Stimulating Hormone (TSH), Free Thyroxine (fT4), and Free Triiodothyronine (fT3) - was carried out at a Nigerian tertiary hospital between January 2017 and January 2024. The tests were conducted using an enzyme-linked fluorescent immunoassay system and interpreted following standard protocols. A preponderance of female patients was investigated for thyroid diseases, with a male-female ratio of 2.2:1. The majority (80.8%) of the analyzed requests showed a euthyroid pattern; primary hyperthyroidism was the most common biochemical pattern of thyroid dysfunction observed, accounting for 10.8% of all the analyzed requests. Secondary hyperthyroidism and hypothyroidism were generally rare. Occasional cases (0.3%) of T3 toxicosis were also observed. Goiters remain a common presentation of thyroid diseases in our environment. Primary hyperthyroidism and primary hypothyroidism are the most common forms of thyroid dysfunction observed.

Hemolytic Anemia and Thrombocytopenia with Hyperthyroidism : A Case Report

Hemolytic Anemia and Thrombocytopenia with Hyperthyroidism : A Case Report

Exploring Post-treatment Weight Changes in Overweight and Obese Patients With Graves' Disease: A Retrospective Analysis.

Graves' disease (GD) is associated with primary hyperthyroidism, leading to weight loss before treatment. During the treatment, weight gain is frequently observed, often surpassing the initial weight loss. This study aimed to analyze weight fluctuations in GD patients, focusing on the subset of overweight and obese (OAO) individuals, considering the significant metabolic implications and heightened cardiovascular risk of these weight changes. A retrospective cohort study included 122 GD patients with biochemical primary hyperthyroidism and at least 12 months of clinical follow-up after treatment for analysis. The OAO cohort comprised individuals with a body mass index (BMI) ≥25 kg/m². Data on laboratory, demographic, and weight variables were collected longitudinally. During the hyperthyroidism state, 34.4% (n=42) of patients presented with weight loss, a phenomenon linked to lower serum thyroid-stimulating hormone levels at diagnosis (p=0.010) and an extended need for anti-thyroid drug treatment (p<0.001). Following treatment, around 60% (n=73) of individuals encountered weight gain, exhibiting a higher prevalence among women (p<0.001) and those undergoing definitive treatment modalities (p=0.024). Notably, 26.2% (n=32) experienced excessive weight gain, which was correlated with higher premorbid BMI and diminished weight loss induced by hyperthyroidism (p<0.001). Within the OAO cohort, 66.7% (n=26) observed an increase in weight post-treatment, and in 28.2% (n=11), excessive weight gain was reported. Weight gain and excessive weight gain were noted in patients with higher initial BMIs. This study highlights that post-treatment weight gain is common, emphasizing the need for careful weight management in GD. In OAO GD patients, the association between initial BMI and increased weight underscores potential cardiovascular risks, warranting vigilant monitoring and early intervention.

Explainable Classification of Patients with Primary Hyperparathyroidism Using Highly Imbalanced Clinical Data Derived from Imaging and Biochemical Procedures

Primary hyperthyroidism (PHPT) is a common endocrine disorder characterized by hypercalcemia and elevated parathyroid hormone (PTH) levels. The most common cause is a single parathyroid adenoma, though the rest of the cases are due to multiglandular disease [double adenoma/hyperplasia]. The main focus driving this work is to develop a computer-aided classification model relying on clinical data to classify PHPT instances and, at the same time, offer explainability for the classification process. A highly imbalanced dataset was created using biometric and clinical data from 134 patients (six total features, 20.2% multiglandular instances). The features used by the current study are age, sex, max diameter index, number of deficiencies, Wisconsin index, and the reference variable indicating the type of PHPT. State-of-the-art machine learning (ML) classification algorithms were used in order to create trained prediction models and give predicted classifications based on all features/indexes. Of the ML models considered (Support Vector Machines, CatBoost, LightGBM, and AdaBoost), LightGBM was able to procure the best performing prediction model. Given the highly imbalanced nature of the particular dataset, oversampling was opted for, so as to increase prediction robustness for both classes. The ML model’s performance was then evaluated using common metrics and stratified ten-fold validation. The significance of this work is rooted in two axes: firstly, in the incorporation of oversampling to smooth out the highly imbalanced dataset and offer good prediction accuracy for both classes, and secondly, in offering an explainability aspect to an otherwise black-box ML prediction model. The maximum achievable accuracy for adenoma is 86.9% and for multigland disease 81.5%. Summarizing the above, this study demonstrates the potential for an ML approach to improve the diagnosis of PHPT and also highlights the importance of explainable artificial intelligence (AI).

Fetuin-A level in patients with untreated thyroid dysfunction

Fetuin-A, a plasma glycoprotein, has been demonstrated to play an essential role in the pathogene­sis of several metabolic disorders. This study aimed to estimate fetuin-A serum level in patients with newly diagnosed primary hyperthyroidism (PHT) and subclinical hypothyroidism (SCH) and to examine its correlation with thyroid hormones level, age and sex of patients. The study involved 90 patients with untreated thyroid dysfunction verified with thyroid function test (45 with PHT and 45 with SCH) and 90 control subjects. Triiodo­thyronin (T3), tetraiodothyronin (T4), and thyroid stimulating hormone (TSH) serum concentrations were measured with enzyme-linked fluorescent assay (ELFA), fetuin-A concentration was measured with enzyme-linked immunosorbent assay (ELISA). It was demonstrated that the level of fetuin-A was significantly higher in the PHT group as compared with the control group and showed a significant positive correlation with the T3 level. In the SCH group, the level of fetuin-A was significantly lower and showed a negative correlation with TSH level. Fetuin-A level rose with age in the PHT group and was unaffected by sex in all studied groups. The perfect AUC value obtained for fetuin-A in the comparison between PHT and SCH groups suggests its potential use as a reliable diagnostic marker to differentiate between these two thyroid conditions.

Thyroid dysfunction among patients assessed by thyroid function tests at a tertiary care hospital: a retrospective study.

previous studies in African populations have not extensively described the spectrum of thyroid dysfunction using the profile of thyroid hormones. Although iodine deficiency is a common thyroid disorder in Africa, it does not represent the entire spectrum of thyroid dysfunction seen in patients. This retrospective study aimed to describe the spectrum of thyroid dysfunction among patients seen at the Korle-Bu Teaching Hospital (KBTH), a tertiary care hospital in Accra, Ghana. a retrospective analysis of medical records of all consultations on thyroid disorders seen at the Internal Medicine Department of KBTH between January 2019 and December 2021 was conducted. Information on patient demographics, and thyroid hormone profiles (triiodothyronine - FT3, thyroxine - FT4, and thyroid stimulating hormone - TSH) were extracted and subjected to descriptive statistics. The thyroid hormone profiles of the subjects were analyzed and classified into thyroid dysfunction categories using guidelines from the American Thyroid Association (ATA). out of the 215 patients with thyroid disorders enrolled, 85.1% (n=183) were females and 14.9% (n=32), were males. The mean age of patients was 45±14 years, with most of the patients within the age range of 31-50 years (49.3%; n=106). The most reported thyroid function dysfunction was primary hyperthyroidism (57.7%), followed by primary hypothyroidism (22.3%), subclinical hyperthyroidism (9.3%), euthyroid sick syndrome (6.5%), and subclinical hypothyroidism (4.6%) respectively. primary hyperthyroidism was the most commonly diagnosed thyroid dysfunction. Hyperthyroidism has been associated with cardiac morbidity and mortality. Timely interventions are required to reduce the morbidity risks and burden associated with the hyperthyroid state.

Перелом шейки бедра у молодой пациентки как манифестация первичного гиперпаратиреоза

Aim. To demonstrate the development of severe bone and visceral manifestations of primary hyperparathyroidism in a patient with a parathyroid adenoma, without complaints until the occurrence of a low-traumatic femoral neck fracture. Key points. Fibrocystic osteitis is a severe disabling manifestation of primary hyperparathyroidism. Early diagnosis has certain difficulties due to the variability of clinical manifestations, the lack of calcium screening at the outpatient stage and the low alertness among doctors in related specialties regarding primary hyperparathyroidism. Conclusion. Delayed diagnosis of primary hyperparathyroidism can lead to disability and a significant decrease in the quality of patients’ lives. Thus, it is extremely important to be alert to this disease, especially in young patients with signs of bilateral nephrocalcinosis, low-traumatic fractures. It is also vital to raise awareness about the primary hyperthyroidism among doctors specializing in adjacent fields. Keywords: primary hyperparathyroidism, fibrocystic osteitis, parathyroid adenoma, low-traumatic fracture.

Homoeopathic management of primary hyperthyroidism: An evidence based case report

Homoeopathic management of primary hyperthyroidism: An evidence based case report

Can Pathological Conditions of the Thyroid Gland During Pregnancy Affect the Course and Outcome of Pregnancy and The Parameters of the Newborn?

Background: To determine the influence of hypothyroidism and hyperthyroidism on the course, outcome of pregnancy and parameters of the newborn.Methods: The cross-sectional epidemiological study was conducted. The study included 319 pregnant women of which 257 had hypothyroidism, and 62 pregnant women had hyperthyroidism. The main parameter was the pathological conditions of the mother’s thyroid gland. Data were collected from the protocol, medical history and discharge letters. The results of the statistical analysis are expressed in absolute and relative frequencies. The significance of the differences was tested with the χ2 test.Main findings: In 2020 and 2021, a total of 3,627 children were born. 318 mothers were included in research, of which 257 (80.82%) had hypothyroidism, and 61 (19.18%) had hyperthyroidism. 91 newborns (35.4%) of mothers suffering from hypothyroidism and 20 newborns (32.79%) of mothers suffering from hyperthyroidism were transferred to the NICU. No statistically significant difference was found in the influence of hypothyroidism and hypothyroidism on newborn parameters. Statistically significant difference was observed in the incidence of pathological conditions during pregnancy. In subjects with hypothyroidism, there was significantly more gestational diabetes (15%) and preeclampsia (3.5%).Principal conclusion:Thyroid dysfunction in pregnant women didn't significantly affect the course and outcome of pregnancy, as well as parameters of the newborn including gestational age or anthropometric measurements.Key words: TSH Deficiency, Primary Hyperthyroidism, Neonate, Perinatal Care, Complications, Pregnancy

Clinicopathologic Features in a TSH Secreting Pituitary Tumor : a Case Report

Thyrotropin-stimulating hormone-producing adenoma (TSHoma) is a rare cause of hyperthyroidism. Patients with this condition are often diagnosed when the tumor has already grown significantly, as the diagnosis of TSHoma is frequently delayed and confused with primary hyperthyroidism. Our case describes a 60-year-old woman with a goiter who was referred to our center from the otolaryngology department. Her thyroid panel in endocrinology showed elevated free hormone levels (fT3: 4.6 mg/ml and fT4: 1.93 mg/ml) and an unsuppressed TSH: 12.85 μ mIU/l, suggesting central hyperthyroidism. A thyroid gland sample obtained by a fine needle aspiration biopsy did not show malignant cells. An MRI scan of the pituitary gland revealed a macroadenoma with KNOSP grade 1. She underwent transsphenoidal surgery for the tumor. Histopathology revealed an acidophilic adenoma with the expression of TSH and prolactin by immunostaining. The proliferation rate, as indicated by MIB-1 staining, was only 0.6%. The decrease in thyroid hormones after the operation confirmed the effectiveness of the surgery. In conclusion, TSHoma, a rare tumor associated with hyperthyroidism, requires a careful diagnosis for effective management. Our article serves as reference material for understanding cases of pituitary-secreting tumors in Indonesia.

The calcium-clot connection: investigating the association between primary hyperparathyroidism and acute venous thromboembolism.

Primary hyperthyroidism (PHPT) is a relatively uncommon disease and leads to increased calcium levels. Ionized calcium, known as clotting Factor IV, may lead to overt coagulation cascade activation, increasing the risk of venous thromboembolism (VTE). National Inpatient Sample Database was used to sample individuals with primary hyperparathyroidism, and baseline demographics and comorbidities were collected using ICD-10 codes. Patients with missing data and age less than 18 were excluded. Moreover, patients with other types of hyperparathyroidism and risk factors for VTE, such as malignancy, thrombophilia, chronic kidney and liver disease, fractures, trauma, oral contraceptive/steroid use, and organ transplant, were excluded. Greedy propensity matching using R was performed to match patients with and without primary hyperparathyroidism on age, race, gender, and 10 other comorbidities, including chronic deep venous thromboembolism. Univariate analysis pre- and post-match were performed. Binary logistic regression was performed after matching to assess whether primary hyperparathyroidism was an independent risk factor for acute VTE. A p-value of < 0.05 was considered statistically significant. Out of 460,529 patients included in the study, 1114 (6.5%) had PHPT. Baseline comorbidities were more common in the PHPT group. On univariate analysis, patients with PHPT were more likely to have acute VTE (2.5% vs. 1.4%; p < 0.001). After 1:1 matching, PHPT patients were twice as likely to have Acute VTE. (OR: 2.1 [1.08-4.1]; p < 0.025). These findings suggest an association between PHPT and VTE, which should be further investigated to prevent the increasing incidence of VTE and its recurrence.

THU423 Recognizing Secondary Contributors Of Osteoporosis In A Hip Fracture Cohort In Singapore

Abstract Disclosure: W. Tay: None. T.Y. Donovan: None. Osteoporotic fractures pose a considerable burden on a country’s healthcare system. Identifying and managing secondary contributors is essential in optimizing the response to osteoporosis treatment. The reported prevalence of secondary osteoporosis is heterogeneous and maybe country-specific and recommendations on screening for these contributors in guidelines are variable. Knowing the frequency of underlying disorders can facilitate development of suitable and cost-effective recommendations specific to a population. We aimed to examine the prevalence of secondary contributors of osteoporosis in a multi-ethnic cohort of Singaporean women and men presenting with hip fracture and to also identify the extent of treatment gap. A retrospective cohort study of 493 consecutive adult patients admitted to a regional hospital in Singapore for a hip fracture were evaluated for secondary contributors. All patients were enrolled in a standard electronic hip fracture clinical pathway. Laboratory investigations were standardised. Deidentified data was extracted from the electronic health intelligence system (eHINTS) using the Oracle Business Intelligence and Enterprise Edition (OBIEE) software. The eHINTS is a data repository that consolidates healthcare, operational and finance data from multiple healthcare system uploaded on the web-based business intelligence software. Demographics, clinical data and laboratory investigations, bone mineral density and current medication were extracted. Approval was obtained from the centralized institutional board of our institution. The mean age of the cohort was 78 ±11 years. The majority (67.3%) of the cohort were female. Mean BMI was 22.3± 9.2 kg/m2. The mean T score at the lumbar spine was -1.87± 1.55; total hip -2.32±1.42; femoral neck -2.50 ± 1.28. 45.2% of the cohort had at least a secondary contributor of osteoporosis. 30.6% had vitamin deficiency (25OHD &amp;lt;20µg/L). 12.2% were on at least 1 medication implicated in the pathogenesis of osteoporosis such as aromatase inhibitors, glucocorticoids, anti-epileptics, levothyroxine, anti-depressants, warfarin, gonadotropin-releasing hormone (GnRH) therapy. 6.9% had primary hyperparathyroidism. 2.6% had primary hyperthyroidism. In male patients, 2.5% had hypogonadism. 1 patient had hypercalciuria. 13.6% had a BMD done prior to the hip fracture admission and only 11.8% of patients were on osteoporosis treatment prior to admission. Secondary contributors to osteoporosis are common and this should be considered in the evaluation of patients presenting with hip fractures. A significant treatment gap still exists and future studies should address the reasons behind the treatment inertia. Presentation: Thursday, June 15, 2023

FRI472 Thyroid Hormone Resistance β (RTH- β) Syndrome In Patient With Multiple-system Atrophy Parkinsonian Type (MSA-P)

Abstract Disclosure: S. Lio: None. M. Albin: None. I. Campi: None. L. Persani: None. Background: Resistance to thyroid hormone β (RTHβ) is a rare dominantly inherited condition of impaired tissue responsiveness to thyroid hormones (TH) due to variants in the THRB gene encoding the TH receptor β (TRβ). RTHβ patients display a distinctive biochemical feature of central hyperthyroidism with elevated serum levels of FT3 and FT4 and unsuppressed TSH. Unfortunately, this syndrome is sometimes misdiagnosed as primary hyperthyroidism, with a delayed diagnosis or inappropriate treatments. Clinical Case: A 72-year-old lady was diagnosed elsewhere in 2010 with atrial fibrillation (AF) and parkinsonian multisystem atrophy (MSA-P), an orphan disease causing progressive autonomic and motor impairment. The patient reported an unspecified dysthyroidism discovered during the diagnostic work-up of AF, but no further investigations were performed. Bisoprolol, Edoxaban and Levodopa/Benserazide were started. In 2020 she had multiple hospitalization due to fall-related injuries, and multiple rib fractures. A neurological and cardiological reassessment did not highlight new problems, nor MSA-P progression, while discrepant thyroid function tests (TFTs) were found (TSH 2.4 mU/L, fT4 3.5 ng/dl, fT3 7.9 pg/ml; normal ranges: 0.4-4.5; 0.8-1.7 and 2.-5, respectively). Anterior pituitary function and a gadolinium-enhanced pituitary MRI were normal. Thyroid ultrasound revealed a modest goiter, with a normal vascularization and multiple hypo-anechoic and spongiform nodules ≤1 cm. Propylthiouracil has been started At referral in our Center, discrepant TFTs were confirmed (TSH 6.6 mU/L, fT4 2.5 ng/dL, fT3 5.1 pg/ml). TPOAb, TgAb and TRAb were absent. We also excluded assay interferences due to heterophiles antibodies. Being T3 administration contraindicated due to AF, a TRH-test, after suspension of PTU, was performed showing an intense and prolonged response of the TSH (36.7 and 19.2 mU/L at 30 and 120 minutes, respectively), consistent with RTHβ. Consistently, molecular analysis by a targeted NGS panel revealed a heterozygous known pathogenic variant in the exon 9 of the TRHB gene (c.1033G&amp;gt;A, p.Gly345Ser). Conclusion: In the differential diagnosis of central hyperthyroidism RTHβ should be considered even in older patients, as late diagnosis may occur. The association of RTHβ with MSA-P has never been reported before, although a causal relationship is improbable. Nevertheless, central hyperthyroidism could worsen underlying neurological diseases, given the critical role of TH in CNS and muscle. A greater awareness of both neurologists and endocrinologists on rare thyroid diseases is warranted, to improve the care of patients with neurological orphan diseases. Presentation: Friday, June 16, 2023

FRI691 Intrathyroidal Parathyroid Adenoma With Congenitally Absent Contralateral Thyroid Lobe Treated With Thermal Ablation

Abstract Disclosure: L. Bilandzic: None. L. Bilandzic: None. H. Korkusuz: None. We present a rare case of primary hyperthyroidism with ectopic adenoma located in the right thyroid lobe with congenitally absent left thyroid lobe which was treated with thermal ablation. A 60-year-old woman was referred to endocrinology clinic for further evaluation of her elevated total serum calcium of 11.4 mg/dL (reference range 8.5-10.5), elevated parathyroid hormone (PTH) level of 106 (10-60 pg/mL). Bone mineral densitometry showed a total T score of -2.9 in L1-L4. Other results were vitamin D 25-OH 30 ng/mL (ref. range 30 - 100), TSH 3.36 µIU/mL (ref range 0.4-5.0), eGFR 83 (normal &amp;gt; 59 mL/min/ 1.73 m²). She was asymptomatic and had no history of kidney stones. Other causes of hypercalcemia were refuted. Given the osteoporosis in her lumbar spine, parathyroid localization and surgery were suggested. Thyroid and parathyroid sonography demonstrated a solid hypoechoic nodule in the right thyroid lobe, 12x10x11mm, with smooth margins, no calcifications, classified as ACR TI-RADS T4. Left thyroid lobe was not appreciated and was considered to be congenitally absent since the patient did not have a history of a previous thyroid resection. Further localization studies (99mTc Sestamibi parathyroid scintigraphy and 4D-CT of the neck) did not reveal any other possible candidates for parathyroid adenomas. Eventually, a fine needle aspiration of the nodule in the right thyroid lobe was performed. PTH needle wash showed a PTH value of 633 pg/mL whereas the PTH value ≥ 100 pg/mL is suggestive of the presence of PTH secreting tissue. Given the thyroid anatomy found with this patient, a right lobe hemithyroidectomy would result with a permanent substitution dependent hypothyroidism. As an alternative, thermal ablation was presented as a treatment option for which the patient opted. She underwent the procedure in local anesthesia. Sonographic imaging of the adenoma was followed by the percutaneous insertion of the coagulation electrode. The utilized high frequency ablator was used with an output of 9 to 40 W and a frequency of 470 ± 10 kHz. There were no complications developed during or after the procedure. Two weeks after the thermal ablation, PTH level was measured at 55 pg/mL, total serum calcium at 9.5 mg/dL, TSH 1.01 µIU/mL. Sonography showed a hyperechoic nodule at the former location of the parathyroid adenoma, which was evaluated as a scar tissue. Three months after the procedure total calcium was at 9.3 mg/dL, PTH at 58 pg/mL, hence no biochemical evidence of pHPT. This is a rare case of ectopic parathyroid adenoma located in the thyroid gland with hemi agenesis of the contralateral lobe. A minimally invasive thermal ablation was performed with the goal of inactivation of the adenoma and preserving the euthyroid function. Presentation: Friday, June 16, 2023

Can artificial intelligence replace biochemists? A study comparing interpretation of thyroid function test results by ChatGPT and Google Bard to practising biochemists.

Public awareness of artificial intelligence (AI) is increasing and this novel technology is being used for a range of everyday tasks and more specialist clinical applications. On a background of increasing waits for GP appointments alongside patient access to laboratory test results through the NHS app, this study aimed to assess the accuracy and safety of two AI tools, ChatGPT and Google Bard, in providing interpretation of thyroid function test results as if posed by laboratory scientists or patients. Fifteen fictional cases were presented to a team of clinicians and clinical scientists to produce a consensus opinion. The cases were then presented to ChatGPT and Google Bard as though from healthcare providers and from patients. The responses were categorized as correct, partially correct or incorrect compared to consensus opinion and the advice assessed for safety to patients. Of the 15 cases presented, ChatGPT and Google Bard correctly interpreted only 33.3% and 20.0% of cases, respectively. When queries were posed as a patient, 66.7% of ChatGPT responses were safe compared to 60.0% of Google Bard responses. Both AI tools were able to identify primary hypothyroidism and hyperthyroidism but failed to identify subclinical presentations, non-thyroidal illness or secondary hypothyroidism. This study has demonstrated that AI tools do not currently have the capacity to generate consistently correct interpretation and safe advice to patients and should not be used as an alternative to a consultation with a qualified medical professional. Available AI in its current form cannot replace human clinical knowledge in this scenario.

Thoracoscopic removal of a retrosternal parathyroid adenoma

Primary hyperthyroidism is a common endocrine pathology, with parathyroid adenoma being the most frequent cause of this condition. A number of patients have deep-seated mediastinal adenomas which poses certain challenges in diagnostics and impose serious limitations for performing a surgery using a traditional transcervical approach. Nonetheless, the combination of modern tools of topical diagnostic investigations along with mini-invasive surgical methods allow to perform a radical operation in this group of patients with reduced injury rate. In this article we present a clinical case of surgical treatment of a 65-Year-Old female patient with primary hyperthyroidism caused by retrosternal parathyroid adenoma located in the aortic-pulmonal window. Preliminary diagnosis was based on Chest Computed Tomography (CCT scan) and technetium-99mTC scintigraphy. Considering complex anatomical and topographical location of the tumour it was decided to perform a thoracoscopic parathyroidectomy. The postoperative period was uneventful, with the laboratory values of parathormone being within reference range after the surgery. On the third day after the operation the patient was discharged. Further follow-up has not shown any signs of relapse.

Thyroid Disorders in Pediatric Long Term Survivors after Hematopoietic Stem Cell Transplantation

Background Thyroid dysfunction is one of the major long term endocrinopathies shown after hematopoietic stem cell transplantation (HSCT), it is usually described after total body irradiation, thyroid dysfunction after the use of chemotherapy only in conditioning regimen was evaluated in our study. Aim of the Study To assess the frequency of thyroid dysfunction after HSCT in children using chemotherapy only in conditioning and to relate the thyroid dysfunction after HSCT to the underlying disease and transplant related factors. Subjects and methods This cross sectional observational study was conducted over 12 months duration, from 1st of September 2020 to 1st of September 2021, at Pediatric Transplant Unit, Children,s hospital, Ain Shams University, on pediatric long term survivors who received HSCT in the duration between 2011 to 2019. They were investigated for thyroid dysfunction by measuring Thyroid-stimulating hormone (TSH), free thyroxine (Free T4) and free triiodothyronine (Free T3), Antithyroglobulin antibody (Anti-TG) and by thyroid US. Results The frequency of thyroid dysfunction among the long term survivors was 30% (6/20) including: subclinical hypothyroidism 50%, subclinical hyperthyroidism 16.7%, primary hyperthyroidism 16.7% and graves’ disease 16.7%. The most common thyroid disorder was subclinical hypothyroidism. No significant correlation was observed between the frequency of thyroid disorders and type of conditioning regimen used (p = 0.16), underlying disease (p = 0.5), age at transplantation(p = 0.35). Also, no significant correlation was observed between the thyroid disorders and graft versus host disease (GVHD) (p = 0.92) or Anti-TG (p = 0.26). Conclusion HSCT recipients had a high frequencyyof thyroid gland disorders, therefore, the thyroid status of each HSCT recipient should be screened before and after transplant. These findings also emphasize the need for long-term monitoring of thyroid function following HSCT.