bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT528 Evaluation of Fine Needle Aspiration Biopsy Results in Patients with History of Thyroid Surgery for Benign Thyroid Disease
Authors: Can Ahmet Selçuk , Naran Jaya 
Published: October 2023

Abstract
Disclosure: A.S. Can: None. J. Naran: None.
Objective: We aimed to compare our thyroid fine needle aspiration (FNA) biopsy results in patients with history of thyroid surgery for benign thyroid disease and in patients without history of thyroid surgery. Material and Method: FNAs were performed between January 2016 and December 2020. The demographic data and outcomes were reviewed retrospectively. The results were presented per nodule, not per patient. FNA was performed on two groups: Group 1: nodules with history of thyroid surgery for benign thyroid disease, and Group 2: nodules without history of thyroid surgery. FNA results were categorized as malignant, benign, indeterminate, and unsatisfactory. FNAs were performed under ultrasound guidance. Results: 711 thyroid nodules underwent ultrasound guided FNA. 18 FNAs were performed on nodules diagnosed in patients who had history of thyroid surgery for benign thyroid disease (Group 1). Average age and standard deviation (SD) of Group 1 were 63±10 years. Average maximum size of nodules in Group 1 was 20±12 mm and average volume was 5.4±13.0 mL. Group 1 nodules had surgery on average 18±10 years ago. Thirteen nodules had hemithyroidectomy, three subtotal thyroidectomy and two nodule removal only. 693 FNAs were performed on nodules diagnosed in patients without history of thyroid surgery (Group 2). Average age and SD of Group 2 patients were 58±14 years. Average maximum size of nodules in Group 2 was 21±11 mm and average volume was 4.7±9.7 mL. FNA results in Group 1 versus Group 2 nodules were as follows: malignant 0% versus 3% (n=0 versus n=22), benign 72% versus 68% (n=13 versus n=470), indeterminate 6% versus 10% (n=1 versus n=70), unsatisfactory 22% versus 19 % (n=4 versus n=131), Chi-Square= 1.08, degrees of freedom= 3, p= 0.78. There was no statistical difference between groups in biopsy results. The chi-square statistic may not be reliable because two of the expected frequencies were less than 5. Conclusions: We did not observe any malignancy in patients with thyroid nodules who had history of thyroid surgery for benign thyroid disease. FNA performed similarly well whether there was history of thyroid surgery for benign thyroid disease or not. Further studies on larger group of patients with history of thyroid surgery for benign disease can be considered to confirm our findings.
Presentation Date: Saturday, June 17, 2023
SAT530 Use of Tamoxifen and Cabergoline to Suppress Breast Tissue Uptake of Radioactive Iodine Among Differentiated Thyroid Cancer Patients
Authors: Mohamed Abubakr H B , Basina Marina 
Published: October 2023

Abstract
Disclosure: A.H. Mohamed: None. M. Basina: None.
Background: Radioactive iodine (RAI) has been used in thyroid cancer treatment. Physiologic breast tissue uptake and accumulation of RAI are not desirable due to increased carcinogenesis risk. Case1:31 years old non lactating female diagnosed with stage IVB papillary thyroid cancer and underwent total thyroidectomy and bilateral neck dissection. She had high initial risk with stage of T3N1bM1 and underwent 118 mCi of I-131 treatment with pulmonary foci. One year later, she had biochemical and structural incomplete response and underwent I-123 RAI uptake scan demonstrating residual disease in the right neck and diffuse breast uptake, thus, I-131 treatment was deferred. The patient was started on cabergoline 0.5 mg daily for 2 months. Repeated I-123 uptake scan during day 2 of Cabergoline remained with diffuse breast uptake. Four months later, another repeated RAI uptake scan after 4 months showed minimal breast uptake and RAI I-131 treatment was given. She had normal mammogram screening. Case2: 41 years old non lactating female diagnosed with stage II papillary thyroid cancer and underwent total thyroidectomy with right neck dissection. She had moderate initial risk with stage of T3 N1aM0 and underwent 159 mCI of I-131 treatment. Two years later, she had structural incomplete response and repeated I-123 uptake scan showed thyroid bed foci of avid uptake and diffuse bilateral breast uptake, thus, I-131 therapy was deferred. The patient was started on cabergoline 0.25 mg daily for 4 weeks and Tamoxifen 10 mg twice daily for 10 days prior to repeated I-123 RAI scan that redemonstrated thyroid bed foci without breast tissue uptake. She had normal mammogram screening. DiscussionPotential malignancy risk secondary to non-thyroidal RAI accumulation in tissues was reported. The mechanism of breast RAI uptake involves Na/iodide symporter channel regulated by prolactin and estrogen. Blocking the effect of these hormones prior to I-131 administration are believed to prevent breast uptake. We describe two papillary thyroid cancer cases with breast RAI uptake that was suppressed partially with Cabergoline (prolactin lowering agent) and fully with combination of Cabergoline and Tamoxifen (estrogen receptor blocker). Further studies are needed to evaluate the efficacy of Tamoxifen and cabergoline in suppressing physiologic breast RAI uptake.
Presentation Date: Saturday, June 17, 2023
SAT536 A Case of Papillary Thyroid Cancer in Multiple Cervical Lymph Nodes, But Not Found in Thyroid Tissue on Pathology
Authors: Green Maria A , Kim Grace Y 
Published: October 2023

Abstract
Disclosure: M.A. Green: None. G.Y. Kim: None.
Introduction:As technology advances, imaging becomes increasingly frequent and within the thyroid gland nodules can often be detected. After detection comes evaluation and lymph nodes within the neck are an integral part of this step. For that reason, fine needle aspiration (FNA) of cervical lymph nodes is known to lend a hand toward diagnosis. Here we present a patient who was diagnosed with Papillary Thyroid Cancer (PTC) from FNA pathology of a lymph node, but PTC was not noted within pathology of the thyroid tissue after total thyroidectomy. Case Presentation: This patient is a 34 year-old female with a history of ovarian cancer who presented to the clinic for a thyroid nodule and Hashimoto’s disease. A bed side ultrasound noted a right upper pole 1.6 x 0.6 x 0.6 cm thyroid nodule and a solid 1.8 x 1.5 x 0.8 cm nodule superior to the isthmus likely representing a delphian lymph node. As well, significant cervical lymphadenopathy was seen. A biopsy of the right upper pole nodule was nondiagnostic on FNA, but the delphian lymph node superior to the isthmus was positive for PTC. The patient then underwent total thyroidectomy and right and central neck lymph node dissections. Interestingly, PTC was noted in 3 of 27 lymph nodes in the central compartment, 5 of 18 lymph nodes excised with the thyroid tissue with extranodal extension, and 5 of 24 lymph nodes in the right neck compartment, but not noted in the thyroid tissue itself. The largest metastatic dimension of PTC within the cervical lymph nodes was noted to be 3 cm. The pathology noted a 1.0 cm tumor in the right lobe “approaching skeletal muscle” and psammoma bodies within the left lobe. After the patient’s surgery her stimulated thyroglobulin reported as 0.21 NG/mL and thyroglobulin antibody 2 IU/mL. She was then able to receive 30 mCi of I 131 sodium iodide. TSH maintained at goal on levothyroxine 200 mcg daily. Discussion: Diagnosis of PTC within multiple cervical lymph nodes, but not noted on thyroid pathology is very uncommon. It is highly unlikely in our patient that a cancer within the thyroid does not exist and there are theories to postulate this unique finding. These include missed pathology on the dissection, tumor regression prior to removal, or possibly ectopic tissue as the source of PTC. Although in our patient, given the significant amount of positive cervical lymph nodes, it is hard to believe that ectopic tissue away from the neck was the source or that tumor regression occurred. The pathological findings of psammoma bodies suggest the presence of PTC that spread to the lymphatic system. As well, the nature of thyroid removal leads to some destruction of tissue prior to evaluation. This case highlights the importance of thorough lymph node evaluation as a complete part of preoperative PTC assessment.
Presentation Date: Saturday, June 17, 2023
FRI206 A Rare Case Of Coexisting Acromegaly And Adrenal Cushing’s Syndrome
Authors: Chamakkala Tess , Gallagher Thomas 
Published: October 2023

Abstract
Disclosure: T. Chamakkala: None. T. Gallagher: None.
Introduction: Acromegaly has been associated with higher risk of cancer morbidity and mortality. Acromegaly coexisting with adrenal Cushing’s disease has been rarely described in literature. We present a patient who was found to have acromegaly during evaluation for Cushing’s syndrome. Clinical Case: A 50-year-old woman presented to the office for endocrinology evaluation at the referral of PCP for elevated 24h urine cortisol level 176ug/24h. She had noticed facial plethora over several years, fatigue, and easy bruising. She had recently been diagnosed with hypertension, poorly controlled on two medications at the time of evaluation. Repeat 24h urine cortisol and midnight salivary cortisol levels were elevated; dexamethasone suppression test was positive. ACTH was &lt;1.5pg/mL, consistent with ACTH independent hypercortisolemia. Adrenal CT showed 2.6x3cm left adrenal adenoma. She underwent left adrenalectomy and pathology showed adrenal cortical adenoma. During evaluation for Cushing’s disease and new onset hypertension, IGF1 was evaluated and found to be elevated at 354ng/mL. She additionally endorsed symptoms of worsening carpal tunnel syndrome and increasing ring size. After adrenalectomy, IGF1 was repeated and remained elevated at 429ng/mL. Growth hormone suppression test showed nadir of 0.56ng/mL which is higher than &lt;0.3ng/mL expected of high sensitivity GH assays. Pituitary MRI showed three suspected pituitary microadenomas, 4mm and 5mm in left gland, 7mm in right gland. Given difficulty with surgical approach and higher risk of hypopituitarism, she was started on lanreotide for treatment without surgery. She underwent genetic counseling and was offered genetic testing. Conclusion: This case highlights the rare coexistence of acromegaly and adrenal Cushing’s disease in a 50 year old woman. Though the relationship between acromegaly and cancer has been historically controversial, more recent studies have shown an increased risk of both benign and malignant tumors with acromegaly. Untreated Cushing’s Disease has been associated with mildly elevated IGF1 which then decreases after remission; it is unclear if the same pathological process is involved in other etiologies of hypercortisolemia like adrenal Cushing’s syndrome, but re-evaluation of IGF1 after treatment of Cushing’s should be considered. As Cushing’s and acromegaly share similar consequences such as worsening HTN, changing facial appearance, and worsening diabetes, it is prudent to consider each as differential diagnoses when signs do not remit after treatment. Acromegaly has additionally been associated with other endocrinopathies in syndromes including MEN1 syndrome, McCune Albright Syndrome, and Carney Complex. Evaluation for these syndromes and consideration for genetic testing should be considered in the evaluation of a patient with acromegaly and additional associated endocrinopathies.
Presentation: Friday, June 16, 2023
SAT391 Supratherapeutic Estrogen Levels in Transgender Women Likely From Sublingual Estradiol
Authors: Jalal Erica , Baldwin Chelsey 
Published: October 2023

Abstract
Disclosure: E. Jalal: None. C. Baldwin: None.
Transgender medicine is typically managed in the outpatient setting. We report a case where the patient’s hospitalization provided unique insight into hormone management to achieve cis-female range estrogen and testosterone levels in a monitored environment.A 38-year-old transgender woman with HIV (on antiretroviral therapy) complicated by neurocognitive disorder, polysubstance use, mood disorder with previous suicidal ideation, and polytrauma (currently wheelchair bound) was admitted for respiratory failure from MRSA pneumonia. She completed 14 days of antibiotics with resolution of acute medical problems, but ability to secure a safe discharge plan prolonged her hospitalization. Endocrinology was consulted to aid in oral estradiol (E2) management.Prior to admission, patient reported taking 10mg of oral E2 daily. While hospitalized, she was given 6mg E2 daily, but requested resumption of her home dose. Initial total estrogen and testosterone levels were 913 pg/mL (56-213 pg/mL) and 105 ng/dL (264-916 ng/dL), respectively. She denied estrogen pellets, implants, or consumption of additional E2 beyond 6mg daily, nor did she have visitors who provided supplemental hormone; however, she admitted that she does not swallow the E2 pills immediately.Endocrinology initiated intramuscular leuprolide to suppress her total testosterone production to the female range of 0-50 ng/dL, allow for decreased dosing of E2 to maintain female range estrogen levels, and minimize venous thromboembolism (VTE) risk given reduced patient mobility. Her E2 was held for 5 days, with a subsequent total estrogen level of 398 pg/mL (56-213 pg/mL). She was restarted on oral E2 2mg, with total estrogen levels of 238 pg/mL and 517 pg/mL (56-213 pg/mL) at three and six days respectively. Oral E2 was again held for an additional four days, leading to total estrogen level of 119 pg/mL (56-213 pg/mL) and total testosterone of 18 ng/dL (264-916 ng/dL). Her final regimen is now oral E2 1mg daily. She did not develop VTE while hospitalized.Research into the pharmacokinetics of oral versus sublingual E2 is scarce. Differences in absorption explain this patient’s supratherapeutic estrogen level of 913 pg/mL and insufficiently suppressed total testosterone of 105 ng/dL. Sublingual E2 achieves higher peak levels but multi-daily dosing is required to fully suppress testosterone production when compared to its oral counterpart, which corresponds to this patient’s initial laboratory findings. Sublingual E2 also has a lower risk of VTE since it avoids first-pass metabolism. Future research should target alternative routes of estrogen therapy that may potentially be safer than current modalities.
Presentation: Saturday, June 17, 2023
SAT398 Pubertal Status And Trends In Gender Affirming Treatment Of Transgender And Gender Diverse Youth
Authors: Lin Cathy , Oransky Matthew , Fader Ralph , Malhotra Neha R , Baldiserroto Eva M , Romero Christopher Joseph , Safer Joshua D , Yau Mabel 
Published: October 2023

Abstract
Disclosure: C. Lin: None. M. Oransky: None. R. Fader: None. N.R. Malhotra: None. E.M. Baldiserroto: None. C.J. Romero: None. J.D. Safer: None. M. Yau: None.
Background: Transgender and gender diverse (TGD) youth seek care to affirm their gender identities and improve quality of life and mental health. Gender affirming care of youth includes pubertal assessment, pubertal suppression with gonadotropin-releasing hormone agonist (GnRHa) and gender-affirming hormone therapy (GAHT). Management choices are made collaboratively among the patient, the patient’s family, and the multidisciplinary treatment team.
Objective: We sought to characterize the pubertal status of the TGD youth to consider medical intervention.
Method: The medical records of 58 TGD youth referred to pediatric endocrinology from 2020-2022 were retrospectively analyzed. Pubertal assessments were made by visualization of pubic hair and breast development according to the Tanner scale and determination of testicular volume with an orchidometer. We labeled Tanner stage 1 as prepuberty; stages 2-3 as early puberty; and stages 4-5 as late puberty.
Results: The median age was 15 years (range 8-18 years). 46.6% were trans girls (n=27), 44.8% were trans boys (n=26), and 8.6% were non-binary (n=1 natal male and n=4 natal female). Of the trans girls, 7.4% were prepubertal (n=2), 51.9% were in early puberty (n =14), and 40.7% were in late puberty (n=11). Of the trans boys, none were prepubertal, 3.6% were in early puberty (n=1), and 96.4% were in late puberty (n=25). Of the non-binary youth, 20% were in early puberty (n=1) and 80% were in late puberty (n=4).For the prepubertal patients, monitoring for onset of puberty without treatment was recommended. Of the 15 patients in early puberty, 73.3% started GnRHa (10 trans girls, 1 trans boy) and 26.7% started GAHT (4 trans girls). Of the 36 patients in late puberty, 2.8% received no treatment (1 trans boy), 25.0% started GnRHa (7 trans girls, 2 trans boys) and 72.2% started GAHT (4 trans girl, 22 trans boy). Of the 5 non-binary patients, 1 patient in early puberty (1 natal female) was treated with GnRHa, and 4 were in late puberty and initiated on GAHT (1 natal male, 3 natal female).
Conclusion: In our multidisciplinary practice, trans feminine patients are evenly divided between those who present in early and late puberty. This presents possible implications for fertility preservation strategies. Trans masculine patients overwhelmingly present in late puberty, perhaps owing in part to earlier timing for typical “female” puberty. This means that even prompt initiation of GnRHa therapy cannot entirely prevent the potential future need for chest masculinization surgery.
Presentation: Saturday, June 17, 2023
SAT408 Assessment Of Family Planning Readiness In Transgender Youth
Authors: Conard Ryan Steven , Folsom Lisal J 
Published: October 2023

Abstract
Disclosure: R.S. Conard: None. L.J. Folsom: None.
Background: Transgender individuals identify with a gender incongruent with the sex assigned at birth. Some seek medical care in the form of gender affirming hormone therapy (GAHT) or gender affirming surgery (GAS). GAHT initiated in adolescence may include GnRH analogues and cross-sex hormones. Barriers to family planning in this population include low utilization of cryopreservation and decisional regret. There is a paucity of data on the risk of infertility with GAHT, and on to what degree transgender adolescents feel informed about fertility and family planning options.
Objective: To assess knowledge regarding options for family planning and fertility preservation in transgender adolescents treated with GAHT in a pediatric endocrinology gender clinic. The goal is to enhance patient education about potential effects of GAHT on fertility and options for family planning.
Methods: 41 adolescent patients aged 10 years and older treated with GAHT in an urban outpatient pediatric endocrinology clinic were surveyed from January to June 2022. Survey questions were multiple choice, Likert scale, and open-ended. To be included participants were at least 10 years of age, actively followed in the clinic, and receiving GAHT at time of enrollment.
Results: 41 participants completed the survey. Four (10%) expressed interest in discussing family planning with their provider at the time of survey completion. 18 (45%) were open to discussion in the future; 16 (39%) were not interested at all. 13 (32.5%) participants were planning for future parenthood, and 16 (40%) participants were undecided. Of those interested in parenthood 7 (53.8%) planned to adopt or foster. Barriers to family planning expressed included financial concerns, potential need to pause GAHT, and social stigma of transgender parenthood. 20 (50%) participants reported prior family planning discussion with their endocrinologist.
Conclusion: Despite routine family planning discussions documented during visits, these may not be optimally impactful given that 50% of participants did not recall the conversations. Family planning appears to be of lower priority in this population as most desired to postpone discussions with their provider despite undergoing treatment that could influence fertility. Our findings indicate it is essential to actively identify methods to engage transgender youth in discussions related to family planning during GAHT.
Presentation: Saturday, June 17, 2023
SAT646 Cutaneous Manifestations In Adults With Gender Dysphoria Under Treatment Hormonal In External Consultation Of The Hospital De San José , Bogotá Colombia
Authors: Cortes Henry Tovar 
Published: October 2023

Abstract
Disclosure: H. Tovar Cortes: None.
I. Title Cutaneous manifestations in adults with gender dysphoria under treatment hormonal in external consultation of the Hospital de san José , Bogotá .Colombia II. Authors Dr. Manuel Fernando Ortiz Castañeda1, Dr. Henry Tovar Cortes2 , Dra. Nicolle Guiot Isaac3, Dra. Carolina Morales Cardenas3, Dr. Carlos Jimenez4 1. Dermatologist and Instructor or Professor (Assistant, Associate) of the Department of Dermatology Fundación Universitaria de Ciencias de Salud - Hospital de San José de Bogotá 2. Endocrinologist and Instructor or Professor (Assistant, Associate) from the Department of Endocrinology Fundación Universitaria de Ciencias de la Salud - Hospital de San José de Bogotá 3. Third-year residents of Dermatology Fundación Universitaria de Ciencias de la Salud - Hospital de San José de Bogotá 4. Fellow of Endocrinology Foundation University of Health Sciences - Hospital de San José de Bogotá III. Introduction : Comprehensive health care for patients with gender dysphoria includes Access to gender affirmation hormone therapy. It can have skin and annex side effects, which often affect quality of life, are underdiagnosed and not treated promptly. Literature on the subject is scarce. Objective: To determine skin manifestations secondary to hormonal treatment in adults with gender dysphoria. IV. Methodology: Cross-sectional descriptive observational study. A search was carried out in the database of patients with gender dysphoria over 18 years of age, treated in dermatology and/or endocrinology clinic of the San José Hospital of Bogotá in the period 2015-2021. The clinical records of patients who were in hormonal therapy with skin manifestations were selected, patients who used other drugs as possible triggers were excluded. Sociodemographic data, skin manifestations, evaluation by specialists and treatment received were analyzed. V. Results : 85 patients were included, predominantly young transgender men in whom the main manifestation was acne (90%), followed by androgenetic alopecia and acanthosis nigricans. Transgender women presented more acne, androgenetic alopecia, seborrheic dermatitis and melasma. More than half of the patients were seen by endocrinology and dermatology, receiving mainly topical treatment. VI. Discussion and conclusion: Skin manifestations in patients with gender dysphoria in hormonal therapy are frequent, so they should be known and taken into account in the multidisciplinary approach of these patients, including the participation of a dermatologist. VII.
KEYWORDS: Gender dysphoria, Gender identity, Gonadal steroid hormones, Testosterone, Estrogens, Estradiol, Antiandrogens, Androgens VIII. ADDRESS - CONTACT Dr. Henry Tovar Cortés Mail: htovar@fucsalud.edu.co Contact number: 3158849232 Correspondence address: Carrera 18 9-18 , office 103
Presentation: Saturday, June 17, 2023