bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT496 Tobacco Smoking May Mimic Subclinical Hyperthyroidism
Authors: Alshantti Raeda , Rafat Ummara , Alkhaurri Bashar , Barsano Charles P , Siddiqui Mahwash 
Published: October 2023

Abstract
Disclosure: R. Alshantti: None. U. Rafat: None. B. Alkhaurri: None. C.P. Barsano: None. M. Siddiqui: None.
Introduction: Studies have shown lower levels of TSH in smokers and a positive association of smoking with hyperthyroidism. The urinary nicotine level is reported to be negatively correlated with TSH. Moreover, smoking cessation have shown reversible effects on thyroid functions and risk of having overt hypothyroidism increased more than 6-fold in the first 2 years after cessation of smoking. Whether transient smoking cessation, prior to blood work would alter thyroid functions is unknown. We report the case of an elderly woman who had normalization of suppressed TSH after smoking abstinence prior to her blood work, suggestive of smoking-induced alteration of the TSH level. Clinical Case: A 77- year-old woman was referred to endocrinology clinic for an abnormal TSH level. She had a suppressed TSH &lt;0.01 uIU/mL [Ref range: 0.45-5.33], with normal free T4 0.78 ng/dl [Ref range: 0.70-2.70], and free T3 3.66 pg/ml [Ref range: 2.5-3.9], consistent with subclinical hyperthyroidism. Thyroid auto-antibodies were negative. She had a long-standing history of multinodular goiter with mild tracheal deviation for which she had declined surgical management. She was an active smoker with 40 pack years smoking history. There was no preceding viral illness. She was not taking any biotin-containing supplements or medications that would interfere with thyroid hormones. The patient denied symptoms of overt hyperthyroidism. On physical examination she had a large multinodular goiter with negative Pemberton’s sign. There was no exophthalmos, lid lag, tachycardia, tremors or hyperreflexia. Her subsequent blood tests, 2 and 4 months apart, were also consistent with subclinical hyperthyroidism with TSH levels of 0.115 to 0.144 uIU/mL with normal free T4 0.72 ng/dl and total T3 136.3 to 153 ng/dl [Ref range 80-187]. Based on her age, she met the treatment threshold. However, as the patient continued to smoke 10 cigarettes daily, even on the days when thyroid labs were drawn, treatment was deferred considering the possibility of smoking-induced altered thyroid function. Blood work re-drawn after a smoking abstinence of 10-12 hours showed normalization of TSH 0.58 uIU/mL consistent with a euthyroid state. Conclusion: When evaluating patients with abnormal thyroid functions, it is important to address smoking status. Cigarette smoking may alter thyroid function tests in a pattern consistent with subclinical or overt hyperthyroidism and its effect on thyroid functions may be transient and reversible. Therefore, the possibility of smoking-induced alteration of thyroid functions should be considered in active, clinically euthyroid smokers. It may be judicious to hold treatment with thionamides in such patients and to re-evaluate thyroid functions after smoking abstinence.
Presentation Date: Saturday, June 17, 2023
SAT497 Radiofrequency Ablation of Thyroid Cancer in A Patient With Steinert’s Disease
Authors: Solis Pazmiño Andrea Paola , Carvajal Mishel Arboleda , Godoy Richard , Garcia Cristhian 
Published: October 2023

Abstract
Disclosure: A.P. Solis Pazmiño: None. M. Arboleda Carvajal: None. R. Godoy: None. C. Garcia: None.
Background: Radiofrequency Ablation (RFA) is a non-surgical, minimally invasive technique for benign or microcarcinoma thyroid nodule (TN); and it has emerged as an alternative option for patients deemed at high risk for surgery. Steinert’s Disease or Myotonic dystrophy type 1 (DM1) is a genetic multisystem disease that affects almost all organs and tissues, including the thyroid. In these patients the prevalence of TN is increased, regardless they are benign or malignant. Patients with DM1 commonly have post-anesthetic complications such as cardiorespiratory arrest. Clinical Case: A young man diagnosed with DM1 and no other comorbidities came to the office for a TN. The patient was asymptomatic and had normal thyroid function. Nothing relevant was found on physical examination, and no cervical lymph nodules were found. The thyroid ultrasonography (US) showed a 12x11x13 mm solid isoechoic left lobe nodule, with microcalcifications, irregular borders and the color-flow Doppler US detected increased perfusion, classifying it as a TI-RADS 5 nodule, elastography score of 2.2, and Bethesda VI. Due to DM1 high risk of surgery, the patient underwent RFA with no complications and successful recovery. Results: At the first month follow-up after RFA, the thyroid nodule was fibrosed with a size of 10x14x15 mm and with a volume of 1,11 cc. The thyroid function was normal without late complications. Conclusions: RFA is a non-invasive and effective technique for the treatment of benign and malignant TN. It is safe and very useful in cases where surgery is contraindicated or in patients with a high probability of post-surgical or post-anesthetic complications. Data on a longer follow-up are needed to confirm long-term efficacy.
Presentation Date: Saturday, June 17, 2023
SAT500 Thyroglossal Duct Cyst Cancer: Diagnosis And Management
Authors: Solis Pazmiño Andrea Paola , Rocha Carla , Figueroa Luis , Garcia Cristhian 
Published: October 2023

Abstract
Disclosure: A.P. Solis Pazmiño: None. C. Rocha: None. L. Figueroa: None. C. Garcia: None.
Background: Thyroglossal duct remnants form during the embryologic development of the thyroid gland. In rare cases, with an incidence of about 1%, carcinoma is present within these cysts, most commonly papillary thyroid carcinoma. Sistrunk procedure (SP) is the main treatment and optimal patient management includes multidisciplinary consultation in order to improve survival. However, there is a debate about whether SP is enough if there is a malignancy in the thyroid or if total thyroidectomy should be done on patients 45 years of age and individuals with aggressive disease [1]. TGDCC harbors an excellent prognosis and low recurrence rate. Clinical Case: We present a case of an elderly woman with a large submental mass that had been gradually enlarging for about 2 years. She had symptoms of dysphagia but denied odynophagia, hoarseness, or shortness of breath. Our patient had high blood pressure and a penicillin allergy but was otherwise healthy without a family history of carcinoma. Physical examination revealed a large submental mass (4.5x4x3.5 cm) that was hard and with smooth edges and did not move with deglutition. There was no extension into the oral cavity on bimanual palpation or palpable masses/nodules in the cervical region. There was a thyroid gland enlargement (right lobe 5x3x1.5, left lobe 4.5x2x1.2 cm). The ultrasound showed enlarged cervical lymph nodes. Fine needle aspiration (PAAF) suggested metastasis of thyroid cancer. Clinical lesson: Although Sistrunk surgery is accepted, performing a total thyroidectomy for TGDCC is controversial. Evidence suggests that it should be reserved for patients older than 45 years, like the patient described in this case. Total thyroidectomy is preferably performed based on the FNAB result (high-risk malignant) or if both thyroid lobes do not consist of healthy tissue anymore, regarding postoperative complication. Since TGDCC is a rare malignancy, a broad differential diagnosis should be considered: metastasis from an unknown primary, paraganglioma, hyalinizing trabecular tumor, and thyroglossal duct cyst, among others. The clinicopathological correlation, as well as the use of the FNA and the immunohistochemical markers, improve the diagnosis accuracy and help to decide the best treatment for the patient.
Presentation Date: Saturday, June 17, 2023
SAT506 A Unique Case of Large Pericardial Effusion In Hypothyroidism
Authors: Ahmad Malik Waseem , Arshad Bushra , Tarabichi Ula , Calimag Angela Pauline 
Published: October 2023

Abstract
Disclosure: M. Ahmad: None. B. Arshad: None. U. Tarabichi: None. A.P. Calimag: None.
Introduction: Hypothyroidism if left untreated can have devastating consequences both short and long term. We present you a case in which patient developed large pericardial effusion within a few months of stopping levothyroxine. Pericardial effusion is a relatively infrequent finding in hypothyroidism. This case is unique as large pericardial effusion is typically associated with severe thyroid hormone insufficiency such as myxedema, which wasn’t the case in our patient. Case: Patient is a 46-year-old female with PMHx of papillary thyroid cancer, s/p total thyroidectomy 2008, , HTN, obesity, Vit D Deficiency, iron deficiency anemia, sickle cell trait who presented to the ED with complaints of shortness of breath. Her symptoms started about a week ago and were associated with progressive dyspnea on exertion and fatigue. Patient mentioned that she stopped taking her levothyroxine 188 mcg daily and tried to treat herself with supplements. Workup was relevant for TSH 94.7 (0.350-5.0 mcU/ml), WBC 5.2 (4.2-11.0 k/mcl), Hgb 9.2 (12.0-15.5 g/dl),​ Na 141 (135-145 mmol/L), Cr 1.71 (0.51-0.95 mg/dl), ​negative Troponins,​ NT pro BNP 2590 (less then125 pg/ml)​ D Dimer 1.06. Vitals on presentation to the ED were Bp 194/135, HR 97, RR 18, T 98.4, Spo2 99% on room air.​ Chest x ray revealed new cardiomegaly, mild right sided pleural effusion. CTA chest was negative for pulmonary embolism but showed massive pericardial effusion. This was followed with transthoracic echo which demonstrated the pericardial effusion on the posterior surface of heart without tamponade. Cardiothoracic surgery was consulted but it was decided to treat the patient with IV levothyroxine rather than pericardial drainage as there was no hemodynamic compromise. Patient received 2 doses of IV levothyroxine and followed by PO levothyroxine per home dose. Shortness of breath improved by day 4 and patient was discharge in stable condition. Discussion: Complications related to hypothyroidism are preventable. There is a lot of misleading information about alternative medicine, which in turn can lead to life-threatening complications. Fortunately, pericardial effusion associated with severe hypothyroidism can rarely lead to cardiac tamponade and cardiovascular compromise. More emphasis and counselling about the importance of compliance with levothyroxine can prove vital to prevent thyroid hormone deficiency related complications.
Presentation Date: Saturday, June 17, 2023
SAT509 The Clinical Significance of Cribriform Morular Thyroid Carcinoma
Authors: Soh Gilbert , Sek Kathleen , Yang Samantha Peiling , Nga Min En , Mok Shao Feng 
Published: October 2023

Abstract
Disclosure: G. Soh: None. K. Sek: None. S. Yang: None. M. Nga: None. S. Mok: None.
We present two young (aged below 30) female patients who were diagnosed with the rare cribriform morular thyroid carcinoma. Both patients presented with neck swellings and underwent total thyroidectomy for the thyroid malignancies. The histological diagnosis prompted subsequent genetic evaluation. Both patients demonstrated genotypic and phenotypic evidence of familial adenomatosis polyposis (FAP) syndrome. One of the patients had a mutation which resulted in a premature translational stop signal in the adenomatous polyposis coli (APC) gene. She was eventually diagnosed with adenocarcinoma in 2 colonic polyps and underwent a curative pan-proctocolectomy. The other patient was diagnosed clinically with FAP as she had multiple (30-40) colonic polyps which were tubular adenomas. She had a variant of unknown significance in the APC gene. She declined surgery and remained on colonoscopic surveillance. Both patients’ thyroid cancers are in clinical remission. While uncommon, diagnosing cribriform-morular thyroid carcinoma is significant as 25 to 30% of patients harbour genetic mutations in the APC gene on chromosome 5q21. This is associated with FAP syndrome, an autosomal dominant genetic syndrome characterized by young-onset colonic polyposis, usually of malignant potential. Additionally, these patients may exhibit features of Gardner’s syndrome, a subset of FAP syndrome in which patients can develop extra-colonic manifestations such as osteomas of the mandible and supernumerary teeth. Histologically, cribriform morular thyroid carcinoma are well circumscribed and show a variable combination of follicular, cribriform, papillary, trabecular, solid and morular patterns. There is nuclear and cytoplasmic staining for beta catenin, as the inactivating APC mutation causes a loss of beta catenin destruction complex, impeding beta catenin degradation and increasing its nuclear translocation. This is a key event in thyroid tumorigenesis. The diagnosis of cribriform morular thyroid carcinoma should alert the clinician about the possibility of FAP with consideration for further clinical and genetic evaluation to confirm the diagnosis. References1)Cameselle-Teijeiro, J. M., Peteiro-González, D., Caneiro-Gómez, J., Sánchez-Ares, M., Abdulkader, I., Eloy, C., Melo, M., Amendoeira, I., Soares, P., & Sobrinho-Simões, M. (2018). Cribriform-morular variant of thyroid carcinoma: A neoplasm with distinctive phenotype associated with the activation of the Wnt/β-catenin pathway. Modern Pathology, 31(8), 1168–1179. https://doi.org/10.1038/s41379-018-0070-2 2)Peiling Yang, S., & Ngeow, J. (2016). Familial non-medullary thyroid cancer: Unraveling the Genetic Maze. Endocrine-Related Cancer, 23(12). https://doi.org/10.1530/erc-16-0067
Presentation Date: Saturday, June 17, 2023
SAT526 Limited Utility of Routine Neck Ultrasound Follow-up in Advanced Stage Differentiated Thyroid Cancer
Authors: Munro Vicki , Mustafa Syed , Siddiqi Ferhan S , Rajaraman Murali , Imran Syed Ali 
Published: October 2023

Abstract
Disclosure: V. Munro: None. S. Mustafa: None. F.S. Siddiqi: None. M. Rajaraman: None. S.A. Imran: None.
Background: Most guidelines recommend periodic cervical ultrasound (US) for ongoing surveillance of differentiated thyroid cancer (DTC). While recent studies do not support routine US surveillance in low-risk DTC, to date, no study has assessed the clinical utility of cervical US in advanced DTC. Methods: We conducted a retrospective study of our hospital DTC registry using the following criteria: a) AJCC stage III and IV, b) minimum follow-up of &gt;4 years since total thyroidectomy +/-I-131 ablation, and c) at least one US per 3 years of follow-up. Patients with hemithyroidectomy only or positive anti-thyroglobulin antibody at the initial visit were excluded. Two years after initial treatment, patients were categorized by Dynamic Risk Stratification (DRS) as excellent, indeterminate, biochemically incomplete, or structurally incomplete response. Data obtained at each visit included: treatment response, thyroglobulin (TG) level, and US findings. Results: A total of 114 patients (85 AJCC stage III and 29 stage IV patients) met the inclusion criteria. Mean age (yrs) at diagnosis was 59, and 67% were female. Mean duration of follow-up was 8.5 years. Based on DRS, 73 patients had excellent response, 28 indeterminate, 8 biochemically incomplete, and 5 structurally incomplete. Recurrence or progression was detected in 20 patients (17.5%): 5 excellent response, 6 indeterminate, 5 biochemically incomplete, and 4 structurally incomplete. Recurrence sites included cervical region (14), distant metastases (5) and both (1). The TG rose from a mean of 4.76 ng/mL at baseline to 40.37 ng/mL at time of recurrence/progression. In those with structurally incomplete disease, US demonstrated progression in all 4 patients. However in other DRS categories, only 5/10 had definite US abnormalities. Of those without recurrence, 4 patients (4.3%) had false positive TG (mean baseline TG 0.08 rose to 11.8 ng/ml) without clinical/radiologic recurrence whereas the rate of false positive US abnormalities was 32% (37/114). The sensitivity and specificity of US vs. TG in diagnosing recurrence was 45% and 60% vs 100% and 95.7%, respectively. Conclusion: Our study suggests that routine cervical US surveillance after initial DRS does not improve the detection of recurrence in patients with excellent, indeterminate, or biochemically incomplete disease, and has a high false positive rate. Therefore, we suggest TG should be considered the mainstay of surveillance and any further imaging guided by DRS status and change in TG.
Presentation Date: Saturday, June 17, 2023
SAT538 Thyrotoxicosis in the Setting of Metastatic Poorly Differentiated Thyroid Carcinoma, a Marker of Disease Progression?
Authors: Chang Bolin L , Fernandez Mayumi A , Shikuma Lee Kelsey M 
Published: October 2023

Abstract
Disclosure: B.L. Chang: None. M.A. Fernandez: None. K.M. Shikuma Lee: None.
Background: Thyrotoxicosis is a rare manifestation of thyroid cancer, and poorly differentiated thyroid carcinoma (PDTC) causing thyrotoxicosis has even more rarely been reported. Here, we report a case of PDTC with thyrotoxicosis developing in a previously euthyroid individual with longstanding untreated follicular neoplasm. Clinical Case: A 79-year-old veteran presented to routine endocrine follow up with new symptoms of thyrotoxicosis. Although previously euthyroid, the evaluation revealed new findings of low serum thyrotropin (TSH) (&lt;0.01 uIU/mL, n=0.34 – 5.60 uIU/mL), elevated free thyroxine (FT4) (2.6 ng/dL, n=0.58 – 1.64 ng/dL), and high total T3 (TT3) levels (223 ng/dL, n=76 – 181 ng/dL). Thyroid stimulating immunoglobulin antibodies (TSI) were positive (214, n&lt;140). Patient has a nine-year history of a fine needle aspiration (FNA) of a large right-sided thyroid nodule with cytology suspicious for follicular neoplasm but declined surgical removal. Thyroid uptake and scan showed heterogeneous uptake throughout the right lobe with a relative photopenic region centrally and spots of more increased activity in areas within the right lobe. The left thyroid lobe showed uniformly low uptake. PET-CT evaluation confirmed spotty FDG-avid areas within the right thyroid mass but did not show other areas of hyperactivity. Methimazole was started with clinical and biochemical improvement. Patient underwent total thyroidectomy, and histopathologic examination showed PDTC with extensive angioinvasion involving the majority of the right thyroid lobe with the left lobe containing a mix of benign thyroid tissue and PDTC fragments. Areas of hyperintensity on the uptake scan correlated to pathological PDTC locations within the right lobe. Within three weeks of thyroidectomy, patient developed recurrent hyperthyroidism. Laboratory studies showed low TSH (0.04 uIU/mL) and elevated FT4 (2 ng/dL). In contrast to pre-operative studies, repeat TSI was below the reference range. Levothyroxine (LT4) was held in anticipation of radioactive iodine therapy, but four weeks later the TSH remained suppressed. 131I was administered which showed accumulation within small thyroid remnants and a single left level three 131I-avid lymph node without other metastases. Following 131I treatment, patient returned to a euthyroid state on standard LT4. Conclusion: Hyperthyroidism has rarely been associated with PDTC, although previous reports have linked more aggressive, multifocal, and locally invasive thyroid cancers to concurrent Graves’ disease or productive bulky metastatic disease. Even without bulky metastatic disease, clinicians should be aware that hyperproductivity may indicate development of autoimmune thyrotoxicosis within PDTC.
Presentation Date: Saturday, June 17, 2023
OR26-02 VRDN-001, A Full Antagonist Antibody To IGF-1 Receptor In Development For Thyroid Eye Disease (TED), Binds To A Distinct Epitope From Teprotumumab
Authors: Bedian Vahe , Tsai Jordan C , Newell Rachel N , Zhao Yang 
Published: October 2023

Abstract
Disclosure: V. Bedian: Employee; Self; Viridian Therapeutics Inc. J.C. Tsai: Employee; Self; Viridian Therapeutics Inc. R.N. Newell: Employee; Self; Viridian Therapeutics Inc. Y. Zhao: Employee; Self; Viridian Therapeutics Inc.
Introduction: VRDN-001, a full antagonist antibody to IGF-1 receptor (IGF-1R), is under development for the treatment of thyroid eye disease (TED). Clinical and preclinical evidence confirm IGF-1R antagonism reduces the inflammation and proptosis that occur in TED. As different anti-IGF-1R antibodies may have distinct characteristics, we compared the binding epitope and in vitro antagonist properties of VRDN-001 with teprotumumab. Methods: We generated a panel of IGF-1R extracellular domain point mutants of 40 potential IGF-1 interacting residues and 3 N-terminal truncations and assessed the binding pattern of the 2 antibodies to these variants by bio-layer interferometry (Octet). Antagonist characteristics were determined by dose-responses of inhibition of biotinylated IGF-1 binding to IGF-1R expressing FreeStyle™ 293-F cells by flow cytometry and inhibition of IGF-1 mediated signaling in primary human ocular choroidal fibroblasts. Results: VRDN-001 binding was affected by the same domain deletions/truncations as teprotumumab but was not affected by the same point mutations; while teprotumumab binding was reduced or abolished by 2 of the mutations, VRDN-001 binding was not affected by any of the 40-point mutations. These results are consistent with overlapping binding sites but distinct receptor interactions. In antagonism studies, at ≥50 nM, VRDN-001 nearly completely inhibited IGF-1 binding, while teprotumumab only partially inhibited IGF-1 binding through 300 nM. Similarly, VRDN-001 more completely antagonized IGF-1 mediated signaling (phosphorylation of IGF-1R and AKT) than teprotumumab. Conclusion: Despite having overlapping epitopes, VRDN-001 is distinct from teprotumumab in both its mutational signature and its more complete antagonism of IGF-1 mediated signaling. VRDN-001’s unique binding and functional antagonism characteristics may contribute to the robust pharmacodynamic responses observed in healthy volunteers and favorable efficacy signals observed in early clinical trials of TED patients.
Presentation: Saturday, June 17, 2023