bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT494 Impending Thyroid Storm during Pregnancy in a Patient with Gestational Trophoblastic Disease
Authors: Kulkarni Rohit , Sibai Zakaria 
Published: October 2023

Abstract
Disclosure: R. Kulkarni: None. Z. Sibai: None.
Background: Gestational trophoblastic disease (GTD) is a rare complication of pregnancy that arises due to abnormal proliferation of trophoblasts of the placenta. The incidence of GTD in the United States of America is about 110 to 120 per 100,000 pregnancies. Abnormal trophoblastic proliferation leads to higher than expected B-HCG levels compared to normal pregnancy. Since the beta subunit of β-hCG has similar structure to TSH, β-hCG stimulates TSH receptor and causes hyperthyroidism during pregnancy which can be asymptomatic, mild or it can lead to severe cases of thyroid storm. Clinical Case: A 19-year-old African American woman with no PMH, 8 weeks primigravida presented with complaints of nausea, abdominal pain and difficulty walking. Associated symptoms included blurry vision, excessive sweating, tremors and palpitations. Physical examination finding included sinus tachycardia and low BMIof 18.6kg/m2, bilateral hand tremors, weakness of bilateral lower extremities. Initial labs showed quantitative β-hCG level of 283,163(H) m(iU)/mL, TSH &lt;0.010 (L) m(iU)/L , FT4 2.54 (H) ng/dL, negativeTSI and TPO Abs. Burch-Wartofsky Point Scale score was 35 suggestive of impending thyroid storm. Pelvic ultrasound showed intrauterine pregnancy with estimated gestation age of 7 weeks 3 days with findings suggestive of fetal demise. Patient underwent Dilatation and Curettage for suspected molarpregnancy. Final histopathological report of aborted specimen verified the diagnosis of partial molar pregnancy. Based on clinical history, physical finding and lab results, patient was diagnosed with gestational trophoblastic disease induced impending thyroid storm. Endocrinology initiated management with Propranolol 40 mg TID and Methimazole 10 mg daily withimprovement in her clinical symptoms in two days. One week follow up as an outpatient showed resolution of symptoms, normalization of free T4 and down trending β-hCG titers to 166 m(iU)/mL. Propranolol and methimazole were stopped. Conclusion:Gestational trophoblastic disease although a rare clinical entity, it is potentially a life-threatening condition. β-hCG is a glycoprotein, and its beta subunit is structurally similar to TSH, allowing it to bind to the TSH receptor and causing hyperstimulation of the thyroid follicular cells leading to various degrees of hyperthyroidism. GTD associated with significant high level of β-HCG, in rare cases can cause severe consequences like thyroid storm. Therefore, GTD should be considered as a differential diagnosis in patient’s presenting with sever thyrotoxicosis during pregnancy. The mainstay of management is evacuation of the molar pregnancy. In severe cases of hyperthyroidism, Beta blocker and thioamides can be considered for symptoms relief and to speed the recovery. Follow-up with serial quantitative β-hCG measurements is crucial to evaluate for persistent molar tissue.
Presentation Date: Saturday, June 17, 2023
SAT517 Papillary Thyroid Cancer in Thyroglossal Duct Cyst.
Authors: Castellanos Paula Lorena , Meek Shon Edward , Chindris Ana Maria , Bernet Victor Joseph 
Published: October 2023

Abstract
Disclosure: P.L. castellanos: None. S.E. Meek: None. A.M. Chindris: None. V.J. Bernet: None.
Approximately 250 cases of papillary thyroid cancer (PTC) within a thyroglossal duct cyst (TGDC) have been reported worldwide. The presence of PTC within a TGDC is rare representing less than 1 % of all TGDC cases. This report describes the case of a young male with PTC in a TGDC suspicious nodules. We present this case along with a review of the literature related to this very uncommon finding. Papillary thyroid carcinoma is a very rare disease but always should be considered when speaking of a mass at the level of the central neck. There is a considerable controversy regarding the role of thyroidectomy to treat thyroglossal duct cyst carcinoma since the treatment of choice is Sistrunk procedure and the only indications to make a thyroidectomy will be aggressive disease and more than 45 years old according to some articles but without any consensus now. With a cure rate of 95 % and recurrence rate of 3 -10 % when this cancer is treated by Sistrunk operation, it doesn’t seem necessary to do an extent surgery if there is not enough thyroid compromised. Long term follow up is necessary to exclude the development of thyroid cancer.
Presentation Date: Saturday, June 17, 2023
SAT527 The Management Of Thyroid Cancer: Where We Started And Where We Are Heading? A Five-decades Text Mining Analysis
Authors: Tessler Idit , Gecel Nir Abraham , Avior Galit , Klang Eyal , Alon Eran , Kolitz Tamara 
Published: October 2023

Abstract
Disclosure: I. Tessler: None. N.A. Gecel: None. G. Avior: None. E. Klang: None. E. Alon: None. T. Kolitz: None.
Aim: Thyroid cancer prevalence rate continues to increase, being the most common endocrine cancer. During the years, significant progress in methods for diagnosis, risk-stratification and management were developed, with the recent advance of molecular testing. Here we explore the evolution of thyroid cancer management over the past five decades through a text-mining analysis. Materials and methods: We have queried PubMed for all available 'thyroid cancer' related entries published during 1970-2022. The following data were extracted for each entry: year of publication, publishing journal, title, keywords, and abstract text. Search terms belonged to demographics, histology, diagnosis methods, treatment, and follow-up. Annual trends of publications were plotted. The slopes of publication trends were calculated by fitting regression lines to the yearly number of publications. We also retrieved the number of citations per publication and analyzed the most impactful papers on each topic.Results: Our search yielded 95,931 papers published during the study period. Publications regarding diagnosis (39,490) outnumbered all other topics, in which molecular testing has significantly sharpest raise (slope p=34.1±3.3). Most publication focused on females (n=56,198) and differentiated thyroid cancer (n=45,953). Surgery remains the most studied treatment method during the whole study period, with recent raise in studies regarding active-surveillance (slope 14.2±1.3). Studies concerning shared decision-making and patient experience emerged in 2000, with a sharp increase in recent years (slope 3.8±0.3, p &lt; .001).Conclusions: Our study provides an overview of the trends in thyroid cancer research over the past five decades. Publications regarding molecular testing outnumbered all other diagnosis methods, identified as the primary trend of the current era. Publications on active surveillance have rapidly risen in recent years, highlighting this method's role in thyroid cancer. Keywords: Machine learning; artificial intelligence; Thyroid cancer; Molecular-tests
Presentation Date: Saturday, June 17, 2023
SAT545 Erythropoietic Thyroid Nodule in the Setting of Myelofibrosis
Authors: Vasquez Libia M , Bruder Jan M , Koops Maureen , Trejo Jonathan 
Published: October 2023

Abstract
Disclosure: L.M. Vasquez: None. J.M. Bruder: None. M. Koops: None. J. Trejo: None.
Background: Extramedullary hematopoiesis is frequently seen in non-osseous locations but not endocrine organs, this is a case of hematopoesis in a thyroid nodule. Clinical Case: A 79-year-old man with myelofibrosis diagnosed at age 66, CAD post CABG, atrial fibrillation on anticoagulation and HFrEF was referred to the endocrinology clinic due to enlarging left lobe thyroid nodule. He was diagnosed with a goiter at age 72 but denied compressive symptoms. He had no history of radiation to his neck or family history of thyroid cancer. On physical exam, the left thyroid lobe was visibly enlarged with slight right tracheal deviation without lymphadenopathy. TSH level was normal. Thyroid ultrasound demonstrated a 6.4 x 4.0 x 4.8 cm, complex cystic-solid, taller than wide nodule in the left lobe and a sub-centimeter cystic nodule in the right lobe. FNA showed hematopoietic elements, including maturing cells in three lineages of hematopoiesis. On repeat ultrasound 5 years later. The left nodule increased in size to 7.3 x 5.4 x 4.4 cm and highly suspicious (TR4 and TR3) by Ti-RADS criteria. Repeat FNA of the nodule showed many red blood cells with few hematopoietic cells, flow cytometry did not show any abnormal populations. No thyroid follicular cells were reported. Myelofibrosis was diagnosed by bone marrow biopsy many years prior. He had maintained a stable CBC without palpable spleen or hepatomegaly. Given this history without thyroid dysfunction or reported symptoms, surgery was not pursued. External beam radiation was a treatment option should the nodule cause symptoms. He continued to have mild anemia not requiring blood transfusions. He passed away 2 years later in hospice care after hospitalization for severe heart failure decompensation. Conclusion: Extramedullary hematopoiesis involving the thyroid is rare but has been reported(1). This type of extramedullary hematopoiesis. can be treated with surgery or low-dose radiation because of the radiosensitivity of hematopoietic tissue (2). This was a potential treatment modality if compressive symptoms arose, but they did not. This case illustrates a situation in which surgical intervention on highly suspicious nodules would not have been the optimal treatment choice.
Reference: 1. Jan I., Weng M., Wang C., et al. Extramedullary hematopoiesis involving the thyroid: A rare cytologic finding in otherwise healthy patients and review of literature. Journal of the Formosan Medical Association. (2018) 117, 1108-1114.
2. Taher A, Vichinsky E, Musallam K et al., authors; Weatherall D, editor. Guidelines for the Management of Non-Transfusion Dependent Thalassaemia (NTDT) [Internet]. Nicosia (Cyprus): Thalassaemia International Federation; 2013. Chapter 11, EXTRAMEDULLARY HEMATOPOIESIS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK190455/
Presentation Date: Saturday, June 17, 2023
OR26-06 Cardiovascular Morbidity And Mortality In Patients With Resistance to THYROID Hormone (RTH): A Linked Record Study
Authors: Okosieme Onyebuchi , Usman Danyal , Taylor Peter , Dayan Colin , Lyons Greta , Moran Carla M , Chatterjee V Krishna K , Rees Aled 
Published: October 2023

Abstract
Disclosure: O. Okosieme: None. D. Usman: None. P. Taylor: None. C. Dayan: None. G. Lyons: None. C.M. Moran: None. V.K. Chatterjee: None. A. Rees: None.
Introduction: Individuals with Resistance to Thyroid Hormone β (RTH-β) may develop cardiac disease, including cardiomyopathy or arrhythmia. Long-term survival outcomes in this group of patients have not been systematically evaluated. Objectives: We investigated all-cause mortality and cardiovascular event risk in a cohort of patients with RTH-β in endocrine clinics in Wales. Methods: In a retrospective cohort study using linked datasets within the Welsh Secure Anonymised Information Linkage (SAIL) Databank, Welsh patients with genetically-proven RTH-β were identified from laboratory records (n=55), matched to population controls by age and sex (n=2750), and linked to outcomes in SAIL. We used Kaplan-Meier and Cox regression models to analyse the association of RTH-β with all-cause mortality, acute myocardial infarction, atrial fibrillation, heart failure, strokes and major adverse cardiovascular events (MACE; a composite of cardiovascular death, acute myocardial infarction, heart failure, and strokes). We also investigated any association between baseline thyroid hormone concentrations and outcomes using restricted cubic splines. Results: Compared to controls, patients had an increased risk of all-cause mortality (Hazard ratio [HR] 2.84, 95% Confidence Interval [95%CI] 1.59-5.08), MACE (HR 3.49, 95%CI 2.04-5.99), atrial fibrillation (HR 10.56, 95%CI 4.72-23.63), and heart failure (HR 6.35, 95%CI 2.26-17.86). Positive associations between FT4 concentration at diagnosis and subsequent cardiovascular morbidity or death were observed, with a 7% increased risk of death per pmol/L increase in FT4. The relationship between FT4 and outcomes was non-linear, with increased risk associated with FT4 concentration exceeding 30 pmol/L. When compared to no intervention, treatment with antithyroid drugs, radioiodine/surgical ablation or levothyroxine, alone or in combination, did not effectively control thyroid hormone excess in the long-term. Conclusion: Patients with RTH-β have increased mortality and cardiovascular outcomes that correlates with high, circulating thyroid hormone levels. Ideal future therapies would target both thyroid hormone excess and tissue resistance and could potentially reduce cardiovascular risk in this disorder.
Presentation: Saturday, June 17, 2023
SAT393 Resilience And Resistance In The Face Of Stigma And Trauma: A Qualitative Study Of Transgender People’s Reactions To Interactions With The Healthcare System
Authors: Stroumsa Daphna , Maksutova Mariam , Indig Gnendy , Ballard Jesse Y , Trammell Racquelle , Popoff Elliot E , Wu Justine P , Gamarel Kristi 
Published: October 2023

Abstract
Disclosure: D. Stroumsa: None. M. Maksutova: None. G. Indig: None. J.Y. Ballard: None. R. Trammell: None. E.E. Popoff: None. J.P. Wu: None. K. Gamarel: None.
IntroductionFor many transgender people, interactions with healthcare, including for initiating gender affirming hormones, can be stigmatizing and traumatic. This study sought to explore how trans people navigate interactions with the healthcare system when accessing gender-affirming hormones.
MethodsWe conducted semi-structured interviews with trans adults ages 21 to 54 (mean=31.7) who had initiated gender-affirming hormone therapy (n=21) using purposive and snowball sampling methods. Interviews were transcribed verbatim and de-identified. Interviews were analyzed using a reflective thematic analysis approach in which codes were deductive and inductive in nature. The study was designed in collaboration with a community advisory board. ResultsParticipants included 9 (42.9%) who identified as men or trans men, 9 (42.9)% who identified as women trans women, and 3 (14.3%) who identified as nonbinary; 8 (38%) identified as a person of color, and 8 (38.1%) participants resided in an urban area. Four overarching themes were identified: (1) multi-level minority stress barriers to care; (2) resilience and resistance in response to minority stress; (3) the cost of stigma and discrimination; and (4) recommendations for change. Multilevel minority stressors included internalized, anticipated, and enacted/interpersonal stigma, as well as vicarious trauma in healthcare systems when initiating gender-affirming hormones. In response to stigmatizing and traumatic experiences, participants engaged in a number of resilience and resistance strategies including selective-disclosure, self-advocacy, relying on community support, as well as innovative “workarounds” to overcome the bureaucratic and traumatic hurdles to accessing gender-affirming hormones. These strategies were however not unassailable, and the stigma and discrimination did have negative consequences. Participants described areas for change, which included provider training and addressing the political environment.
ConclusionTransgender people encounter stigma when accessing gender-affirming hormones; however, they also engage in a range of resilience strategies. Ensuring access to gender-affirming care necessitates addressing stigma in healthcare systems. Structural interventions addressing root causes of stigma and trauma transgender people experience are needed to complement provider-level interventions.
Presentation: Saturday, June 17, 2023
SAT419 Characteristics Of Trans Male Children And Adolescents Care Followed Up In A Children Hospital
Authors: Esposito Mariela , Gonzalez Veronica G , Pasqualotto Julio , Morin Analia 
Published: October 2023

Abstract
Disclosure: M. Esposito: None. V.G. Gonzalez: None. J. Pasqualotto: None. A. Morin: None.
Introduction Transgender and gender diverse (TGD) people are those whose gender identity do not correspond with their sex assigned at birth. Gender identity law was approved in 2012, guarantees access to health care including hormones and surgical procedures reassignment without any requirement except "informed consent by the individual concerned". Last years the number of youth with TGD seeking gender affirming care has increased, resulting in the formation of multidisciplinary care teams to respond to the growing demand. Objective To characterize the population of transgender male(TM) attended in a Pediatric Endocrinology Service. Method Medical records of the Pediatric Endocrine Service were reviewed for youth with TGD seen from December 2017 to November 2022. Results We received 92 TGD individuals in our care team, of which 64 (69.6%) consulted in Endocrinology Service, 52 trans-male (TM) (81.3%) and 12 trans-female (TF) (18.7%). We describe TM group. Median age was calculated for first medical advice: 14 (9-16) years; self-perception TGD: 9 (3-14) years; and gender affirmation: 13 (6-16) years. Obesity and overweight was present in 22 (42.3%), normoweight in 25 (48%) and underweight in 5 (9.7%). Vitamin D levels (N: 35) were insufficient in 30 children (85.7%). At first visit 45 (86%) were in Tanner stage 5. Gonadotropin releasing hormone agonists (Gnrh) were used in 27 TM (51.9 %) to prevent the progression of biological puberty, median age at start of treatment was 14 (11-15) years. Testosterone (T) was used in 18 (34.6%) to develop sex characteristics of the self-identified gender, median age of beginning was 16 (14-17) years of which 12 have previously used GnRH. In 4 adolescents (7.7%) thoracic masculinization surgery was performed at a median age of 16 years. Conclusion Most of the TGD children and adolescents were TM with a median age at first visit of 14 years and tanner stage 5. Overweight and obesity rates were higher than international norms and are a common problem among TGD youth. They should be considered a high-risk group and targeted in obesity prevention and treatment efforts. The majority of transgender youth had vitamin D insufficiency, so we recommend sun exposure and physical activity. Although they consulted in the Pediatric Endocrinology Service, only 63.5% started some hormonal therapy. Gender affirmation require multidisciplinary approach in which endocrinologists play an important role.
Presentation: Saturday, June 17, 2023
SAT644 Gender Affirming Hormone Therapy (GHAT) In Adult Male-to-female Mice Increases Cortical And Trabecular Bone, Resulting In An Increase In Bone Strength
Authors: Zajac Jeffrey D , Nie Tian , Venkatesh Varun , Golub Suzanne , Stok Kathryn , Desai Reena , Handelsman David J , Grossmann Mathis , Davey Rachel A 
Published: October 2023

Abstract
Disclosure: J.D. Zajac: None. T. Nie: None. V. Venkatesh: None. S. Golub: None. K. Stok: None. R. Desai: None. D.J. Handelsman: None. R.A. Davey: None.
There are conflicting reports of the effects of GAHT on bone health and fracture risk in adult transgender women, and the underlying changes are poorly understood. We aimed to determine the effects of GAHT administered during adulthood on bone microarchitecture and strength in a mouse model of male-to-female transition. To model male-to-female transition in adults, C57BL/6 male mice aged 16 weeks that had reached peak bone mass were administered an estradiol-filled silastic implant (∼1.3mg) intraperitoneally for 12 weeks. Controls included vehicle treated intact males and females, n=9-10/group. At study end, serum sex steroids were determined by LCMS/MS, femoral bone microarchitecture by μ-CT, and strength by 3-point bending. Mean serum estradiol was 4.7-fold higher in males treated with estradiol (91.8±10.4 pg/mL) than the peak estradiol levels observed during the proestrus stage of the estrus cycle in adult female mice (19.4±13.5 pg/mL, Handelsman, 2020). Estradiol treatment in males increased the endocortical deposition of bone evidenced by an increase in cortical thickness (mm)(P&lt;0.05) and a decrease in medullary volume (mm3)(P&lt;0.05) compared to male and female controls. Periosteal circumference was not effected by estradiol treatment in males compared to controls. Trabecular bone volume/tissue volume (%) was 4-fold higher in estradiol treated males compared to male controls and 12-fold higher than female controls due to an increase in trabecular number (μm)(P&lt;0.0001). The increase in both cortical and trabecular bone contributed to increased bone strength, as the maximum force (N) the bone could withstand prior to fracture was 2-fold higher in males treated with estradiol compared to both male and female controls (P&lt;0.0001). Measurement of the material properties of the femur showed an increase in ultimate stress (MPa)(P&lt;0.001) and elastic modulus (MPa)(P&lt;0.01) in males following estradiol treatment compared to male controls, indicative of increased rigidity. In this model of adult male-to-female transition, supraphysiological levels of estradiol in male mice increases cortical and trabecular bone mass leading to increased bone strength. The increased rigidity of the femur following estradiol treatment suggests increased bone mineral content. It may be possible therefore, to preserve bone health and prevent fractures in trans women treated with GAHT, however a dose of estradiol that protects the bone without adverse side effects needs to be identified.
Presentation: Saturday, June 17, 2023