bluuebunny/crossref_metadata_2025_split huggingface dataset:
FRI487 Oral Liquid L- Thyroxine (L-T4) Is More Effective In Controlling Hypothyroidism, Than L-T4 Tablet, In Patients Submitted To Total Thyroidectomy
Authors: Fallahi Poupak , Martina Ferrari Silvia , Ragusa Francesca , Elia Giusy , Materazzi Gabriele , Rosaria Paparo Sabrina , Patrizio Armando , Mazzi Valeria , Miccoli Paolo , Antonelli Alessandro 
Published: October 2023

Abstract
Disclosure: P. Fallahi: None. S. Ferrari: None. F. Ragusa: None. G. Elia: None. G. Materazzi: None. S. Paparo: None. A. Patrizio: None. V. Mazzi: None. P. Miccoli: None. A. Antonelli: None.
Objectives: Our aim is to investigate the efficacy of levothyroxine (L-T4) in liquid formulation in patients recently subjected to total thyroidectomy (without malabsorption or drug interference), with respect to L-T4 tablets. Methods: We enrolled two hundred and twenty-five patients of whom 75 received L-T4 in tablets, and 150 were treated with liquid L-T4 at the same dosage (1.5 mcg/kg/day). The therapy started the day after thyroidectomy, and the drugs were assumed every day 30 min before breakfast. The thyroid profile was assessed by evaluating serum thyrotropic hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) in a first control after 6 weeks, then in a second control after 12 weeks. Results: Our results showed that the prevalence of patients in the hypothyroid range (TSH&gt;3.6 mcU/ml) was significantly higher in the L-T4 tablet group. Moreover, TSH values were significantly lower in the liquid L-T4 group, than in the tablet L-T4 group both at the first (P &lt; 0.05), and at the second control (P &lt; 0.01), while FT4 and FT3 levels were not significantly different. Conclusions: Our data showes that thyroidectomized patients, not reporting issues of malabsorption, gastric disorders, or drug interference, have a better control of TSH levels under a liquid L-T4 therapy.
Presentation: Friday, June 16, 2023
FRI490 Association Between TSH Levels And Early Development Of Secondary Sexual Characteristics Among Children With Congenital Hypothyroidism
Authors: Nunez Stosic Mariana Mercedes , Seeherunvong Tossaporn 
Published: October 2023

Abstract
Disclosure: M.M. Nunez Stosic: None. T. Seeherunvong: None.
Although hypothyroidism typically delays puberty, early pubertal development in patients with hypothyroidism and markedly elevated TSH levels has been reported. Recent studies investigated the association between thyroid function and timing of puberty among normal children. Jung et al. reported an association between serum TSH and LH levels in girls with central precocious puberty. By contrast Wilken et al. found an association between serum T4 level and onset of pubarche but not thelarche among female subjects. We investigated the association between serum TSH levels and onset of secondary sexual characteristics among patients with congenital hypothyroidism. A retrospective study was conducted including girls and boys aged ≥6 years and ≤ 18 years with confirmed primary congenital hypothyroidism who were seen in our pediatric endocrinology clinic at University of Miami, between May 2012 and May 2022. Age of onset of secondary sexual characteristics (SSC) such as body odor, acne, axillary hair, pubic hair, breast/testicular development was recorded. Early onset of SSC was defined by its presence in girls younger than 8 years and in boys younger than 9 years. Onset of SSC was considered early normal if it occurred between 8-9.5 years in girls and between 9-10.5 years in boys. A third group of patients were those with onset of SSC after 9.5 years in girls and after 10.5 years in boys. We recorded the serum TSH levels from age 6-8 years in girls and from 7-9 years in boys. We determined the average TSH levels and the proportion of the serum TSH level above normal range. IBM SPSS Statistics software version 28.0.0.0(190) was used for data analysis. Fifty-seven subjects with a history of congenital hypothyroidism, 36 girls (63.2%) and 21 boys (36.8%) were included in the study. Seventeen patients (29.8%) had early or early normal onset of SSC. The prevalence was more frequent among girls than boys, 14% and 3% respectively (p value= 0.046). Among all 57 subjects, only 9 had normal serum TSH. The mean proportion of TSH levels above normal limit was 62.4% in patients with early or normal early onset of SSC. By contrast, the mean proportion of serum TSH level above normal limit was 53.7% in those patients who had neither early nor early normal onset of SSC (p value=0.044). In summary, early and early normal onset of SSC was associated with higher TSH levels in children with congenital hypothyroidism. Further studies with a larger number of subjects will be needed to define further the specific SSC most associated with an abnormally elevated TSH.
Presentation: Friday, June 16, 2023
FRI536 Association Between Thyroid Cancer And Thyroid Autoimmunity: A Systematic Review
Authors: Pessoa Bruna , Loch Batista Rafael 
Published: October 2023

Abstract
Disclosure: B. Pessoa: None. R.L. Batista: None.
Thyroid cancer (TC) is the most frequent endocrine neoplasm with growing incidence worldwide. Autoimmune thyroid disorders, especially Hashimoto's thyroiditis (HT), are also highly prevalent worldwide. The association between thyroid cancer and thyroid autoimmunity has long been suggested. However, several studies that have assessed the relationship between thyroid cancer and thyroid autoimmunity had inconsistent findings. While some studies did not show a significant relationship between these topics, others confirmed this association. Objective: The present study aims to summarize and update the data on literature about the association between thyroid cancer and thyroid autoimmunity. Materials and methods: A systematic literature search was conducted in the Medline database (PubMed) in November 2022, including all published scientific papers from 2016 to 2022. The association was analyzed in two ways: the prevalence of thyroid cancer in patients with thyroid autoimmunity versus those without and the progression of thyroid cancer according to autoimmunity status. Results: A total of 137 papers were first identified. After the screening for eligibility, only 10 matched all inclusion criteria and were included in this study. Collectively, these studies included 7,873 patients. Half of the studies showed a higher prevalence of TC in patients with thyroid autoimmunity and an associated risk for TC development. An estimate OR for TC in these studies ranged from 1.45 to 3.14. There is also evidence showing that TC in cases of thyroid autoimmunity are smaller (≤ 10 mm in diameter) than those without thyroid autoimmunity, which may suggest thyroid cancers are diagnosed at an early stage. Regarding the progression of thyroid cancer according to autoimmunity status, the results are inconsistent. While some studies reported findings to support thyroid autoimmunity as a protective factor against TC based on less tumor size, capsule invasion, extra-thyroidal extension, lymph node metastasis, and distant metastasis, others showed that 50% of patients with detectable TgAb had more lymph node metastasis than those with undetectable TgAb. On the other hand, no significant association between TPOAb and lymph node metastasis was shown. Conclusion: the association between thyroid cancer and thyroid autoimmunity appears to be a relevant mechanism to elucidate. However, no definitive data justify a clear connection between thyroid autoimmunity and thyroid cancer. Furthermore, there is insufficient data to determine if thyroid autoimmunity leads to different progression and prognoses of thyroid cancer.
Presentation: Friday, June 16, 2023
FRI555 A Misdiagnosis Of TSH-secreting Adenoma With Thyrotoxicosis In A Patient With Graves’ Disease
Authors: Huynh James , Makawi Alladdin , Elshimy Ghada 
Published: October 2023

Abstract
Disclosure: J. Huynh: None. A. Makawi: None. G. Elshimy: None.
Introduction: Modern healthcare relies on laboratory and imaging results for accurate diagnosis and medical decision-making. However, the collection and distillation of laboratory results is a multi-step process with the potential for error at each stage. This may result in diagnostic errors. A review of salient cases is one avenue to improving awareness of the risk for failure in the laboratory assessment process. We present one such case of a patient initially referred to neurosurgery for management of a thyroid stimulating hormone (TSH) secreting microadenoma, which is a rare disease and accounts for less than 1% of all pituitary adenomas, with incongruent laboratory presentation including elevation in TSH and free T4. Endocrinology consultation prompted further investigations which led to the diagnosis of Graves’ disease with a concomitant nonfunctional pituitary microadenoma. Case Presentation: This is a case of a 61-year-old white male who presented with 30-lb weight loss, insomnia, palpitations, and diaphoresis. Initial thyroid stimulating hormone (TSH) from outside facility was &gt; 90 mcIU/mL with elevated free T4 of 23.4 pg/mL. MRI of the brain shows a 3x3 mm pituitary microadenoma raising concern for an atypical case of TSH-secreting adenoma. The patient referred to Neurosurgery for evaluation by primary care. Endocrinology was consulted for evaluation prior to any surgical intervention. A large goiter was noted on exam. Clinical presentation was highly concern for Graves’ disease. Repeated labs included undetectable TSH with FT4 of 4.4 pg/mL and free T3 12.9 pg/ml. TPO-ab was elevated at 17.1 IU/mL. TSIg index was low. Ultrasound of the thyroid gland revealed a normal thyroid without nodules. He was diagnosed with Graves’ disease and was initiated on methimazole and propranolol with symptomatic improvement. His pituitary panels continued to show suppressed TSH pre and post treatment with no other significant pituitary abnormalities hence the diagnosis of a concomitant nonfunctional pituitary microadenoma was made. Discussion: Ultimately, the initial TSH-secreting microadenoma has deemed a misdiagnosis and he was subsequently treated appropriately for Graves’ disease with normalization of thyroid functions. Standard of care for any laboratory abnormalities is to assess for reproducibility of the result. In our patient, subsequent in-house and outside assays were unable to demonstrate elevation of both TSH and FT4. Instead, the patient had suppressed TSH with elevated FT4, without evidence of nodules consistent with Graves’ disease. Treatment of Graves’ disease differs greatly from the treatment of TSH-secreting pituitary adenoma, which includes surgical resection, radiotherapy, and/or, a somatostatin analog based on the clinical picture. Correct diagnosis prevented our patients from unnecessary surgical complications and lifelong morbidity.
Presentation: Friday, June 16, 2023
FRI571 Maternal Graves’ Disease With Foetal Thyrotoxicosis And Goitre
Authors: Fennell David , Walsh Jennifer , Hatunic Mensud 
Published: October 2023

Abstract
Disclosure: D. Fennell: None. J. Walsh: None. M. Hatunic: None.
Background: Graves’ disease (GD) is an uncommon condition affecting 0.2% of pregnancies. Foetal and neonatal thyrotoxicosis occurs in between 1-5% of pregnant patients with a history of GD, typically beyond 20 weeks gestation. Given its potential for serious morbidity and mortality, prompt recognition and treatment of the condition is essential. Clinical case: A 34-year-old female was referred at 21+2 weeks’ gestation from another hospital due to concerning cardiac findings noted on routine prenatal ultrasound (US). Her medical history was significant for GD (TRAb positive) with moderate ophthalmopathy and total thyroidectomy ten months prior, on L-thyroxine 150 mcg daily. Foetal tachycardia 170-180bpm was noted, with US showing with right ventricular hypertrophy, small pericardial effusion and a 1.9 x 2.7 x 2.8cm neck mass, suspicious for foetal goitre. Maternal laboratory studies showed TSH 2.38mIU/L (0.27-4.2), FT4 16.0pmol/L (12-22), TPO antibody negative &lt;3.0IU/ml and TRAb markedly elevated &gt;30IU/L (0-1.8). A diagnosis of foetal thyrotoxicosis secondary to placental passage of maternal TRAb was made. She was commenced on carbimazole 20mg twice daily at 21+6 weeks’ gestation as treatment, with the goal of normalising foetal heart rate. Careful, weekly follow-up with US scanning noted gradual improvement in the foetus’ condition, with resolution of pericardial effusion and foetal heart rate normalisation. Maternal TFTs were monitored weekly and she remained euthyroid on increased dose L-thyroxine (200 mcg daily). Multidisciplinary team consensus was to proceed with elective Caesarean section at 34 weeks’ gestation, to avoid risk of airway obstruction from foetal goitre. A healthy male infant was born with spontaneous breathing and normal heart rate at delivery. Apgar scores were 9 and 9 at 1 and 5 minutes. Maternal carbimazole was immediately discontinued post-delivery and L-thyroxine reduced to 150 mcg daily. She had an uncomplicated recovery post-Caesarean section. The infant was closely monitored in the neonatal ICU. On day five of life, he became unwell, developing a supraventricular tachycardia. Thyrotoxicosis was confirmed on laboratory studies (FT4 &gt;100pmol/L). Carbimazole, propranolol and Lugol’s iodine were all used as treatment. Thyroid hormone levels normalised within days, with gradual clinical improvement. He was discharged home well four weeks after birth, remaining on propranolol 0.3mg four times daily and carbimazole 0.5mg twice daily, with close paediatric outpatient follow-up planned. Conclusion: Foetal thyrotoxicosis is a rare condition, but can cause serious morbidity, as demonstrated here. First trimester maternal thyroid antibody testing is recommended for all patients with a history of GD, to identify those at risk. Management of the condition is complex, requiring multidisciplinary specialist input for favourable outcome.
Presentation: Friday, June 16, 2023
SAT468 Assessment of Peak Systolic Velocity of Various Thyroid Arteries
Authors: Raju Karishma , Ibrahim Katherine , Morkos Michael 
Published: October 2023

Abstract
Disclosure: K. Raju: None. K. Ibrahim: None. M. Morkos: None.
Objective: Peak systolic velocity (PSV) assessment is a useful bedside tool in the evaluation of patients presenting with thyrotoxicosis. Graves’ disease is characterized by increased PSV values, and it was previously reported that inferior arteries had higher PSV as compared to the superior arteries. We aimed to assess the peak systolic velocity (PSV) in the superior and inferior thyroid arteries bilaterally in patients with Graves’ disease and determine the arteries with the highest values. Research and Design Methods: This is a retrospective cross-sectional study of patients diagnosed with Graves’ disease at an academic outpatient endocrinology clinic from August 2019 to November 2022. The peak systolic velocities were measured using spectral Doppler ultrasound at the superior and inferior thyroid arteries bilaterally. Descriptive statistics, Chi square, and t-test were utilized to describe and compare data. Results: We identified 58 patients who presented for initial assessment of Graves’ disease, 48 (82.8%) were newly diagnosed and presented for initial assessment, 45 (77.6%) were female, 36 (62.1%) Caucasian, and 18 (31.0%) African American. Mean age (± standard deviation) 44.6 ± 13.9 years, TSH 0.27 ± 0.85 (reference range [ref] 0.4 - 4.2), free T4 2.2 ± 1.6 (ref 0.6 - 1.5), and total T3 242.9 ± 169.9 (ref 80 - 179). The mean PSV at the right inferior artery (RIA; n=43) 40.2 ± 18.3 cm/sec, right superior artery (RSA; n=37) 40.0 ± 24.5 cm/sec, left inferior artery (LIA; n=45) 38.2 ± 15.1 cm/sec, and left superior artery (LSA: n=33) 35.1 ± 17.2 cm/sec (P=0.16). The highest PSV was in the LIA in 32.8% of patients, followed by RSA (22.4%), RIA (20.7%), and LSA (15.5%). There was no statistically significant difference between right versus left or superior versus inferior arteries (P=0.17). Seven patients (12.1%) had elevated PSV in superior thyroid arteries while having normal values in the inferior thyroid arteries. Conclusion: PSV assessment of the four thyroid arteries in patients with Graves’ disease did not reveal a consistent pattern. Assessment of the superior and inferior thyroid arteries bilaterally is recommended to avoid missing the artery with the highest PSV.
Presentation Date: Saturday, June 17, 2023
SAT480 Diagnosing Dysphagia Due to Thyroid Nodules by Thyroid Ultrasound and the Effectiveness of Radiofrequency Ablation
Authors: Idrees Zarwa , Morkos Michael 
Published: October 2023

Abstract
Disclosure: Z. Idrees: None. M. Morkos: None.
Objective: Thyroid nodules can cause dysphagia by direct esophageal compression. Diagnosis of esophageal compression during thyroid ultrasound has not been described. Radiofrequency ablation of thyroid nodules may be able to treat the compressive symptoms. Methods: We present a case series of four patients who presented with dysphagia due to compressive nodular goiter. Thyroid ultrasound was performed by a certified endocrinologist (Endocrine Certification in Neck Ultrasound) who assessed esophageal compression. Nodules were treated with thyroid radiofrequency ablation (RFA). Symptom score, ranging from zero (no symptoms) to ten (severe symptoms), was used to assess the severity of dysphagia before and one month after the procedure. Results: We report four patients who presented with symptomatic thyroid nodules, complaining of dysphagia at the level of the lower neck. Initial symptom scores were 10, 7, 8, and 2 respectively. Thyroid ultrasound demonstrated esophageal compression in all patients due to the culprit responsible nodules and two thyroid biopsies were done to rule out malignancy. Three patients declined surgery and preferred RFA, while the fourth was a poor surgical candidate. RFA was conducted in each by one endocrinologist. The culprit nodules were targeted for RFA, except in case two which was retrosternal. Therefore, a more superficial same-sided nodule was ablated in case two with the goal of reducing mass effect on that side. All the patients reported improvement in their dysphagia and decline in symptom score a month after the procedure to 0, 4, 2, and 0 respectively. Thyroid US demonstrated improvement of esophageal compression one-month after the procedure. No complications were noted. Conclusion: Thyroid ultrasound is a valuable tool in diagnosing dysphagia due to esophageal compression caused by thyroid nodules and in monitoring the response to therapy. Thyroid RFA is a minimally invasive and effective tool for treating symptomatic thyroid nodules.
Presentation Date: Saturday, June 17, 2023
SAT481 Metastatic Choriocarcinoma, A Rare Cause of hCG-Mediated Hyperthyroidism
Authors: Jain Shailee , Crabtree Matthew , Houston Caroline 
Published: October 2023

Abstract
Disclosure: S. Jain: None. M. Crabtree: None. C. Houston: None.
Background: Structural homology between human chorionic gonadotropin (hCG) and thyrotropin stimulating hormone (TSH) allows high levels of hCG to exert thyrotropic effects via TSH receptors. Although hCG-mediated hyperthyroidism is most frequently encountered in the context of pregnancy, it also occurs rarely as a paraneoplastic syndrome. We present a case of hCG-mediated hyperthyroidism due to metastatic choriocarcinoma in a postmenopausal woman. Case Presentation: A previously healthy 59-year-old woman was evaluated for shortness of breath and found to have multiple lung nodules concerning for metastatic malignancy. Further imaging demonstrated an enlarged heterogeneous uterus with an enlarged endometrial cavity. Endometrial biopsy revealed poorly differentiated carcinoma with some areas of possible squamous differentiation. Subspecialty cytopathology review was requested. One week after biopsy, the patient was brought to the emergency department with acute hypoxic respiratory failure following a seizure. She was found to be febrile, tachycardic, hypertensive, and minimally responsive. Head CT revealed a left frontal brain mass with surrounding vasogenic edema, concerning for metastasis. Laboratory evaluation revealed TSH of 0.03 mIU/L (normal 0.35-4.94) and free T4 of 2.30 ng/dL (normal 0.70-1.48). Thyroid stimulating immunoglobulin was negative. Beta-hCG was found to be significantly elevated at 982,093 mIU/mL after 1:100 dilution. She was started on treatment with propranolol, dexamethasone, and chemotherapy with etoposide and cisplatin. Meanwhile, cytopathology review identified scattered cells with features of choriocarcinoma and positive hCG immunostaining, felt to represent a diagnosis of poorly differentiated choriocarcinoma. After one cycle of chemotherapy, the patient’s beta-hCG decreased to 477,668 mIU/mL and free T4 decreased to 1.05 ng/dL. Due to progressive worsening of her clinical status, she was transitioned to palliative care and passed away on hospital day 14. Discussion: Hyperthyroidism mediated by hCG is most often seen in patients with hyperemesis gravidarum, gestational transient thyrotoxicosis, or gestational trophoblastic disease. Our case underscores the importance of considering hCG-mediated hyperthyroidism outside the context of pregnancy. Rare paraneoplastic sources of hCG include choriocarcinoma, seminoma, and other germ cell tumors. Hyperthyroidism in these cases is usually subclinical or mild, but instances of thyroid storm have been reported with metastatic disease. Beta blockers, glucocorticoids, and thionamides can be used as temporizing measures, but definitive therapy requires treatment of the causative malignancy.
Presentation Date: Saturday, June 17, 2023