bluuebunny/crossref_metadata_2025_split huggingface dataset:
OR11-3 Steroid Treatment in the Management of Destructive Thyrotoxicosis Induced by PD1 Blockade
Authors: Antonangeli Lucia , Antonuzzo Andrea , Brogioni Sandra , Chella Antonio , Cremolini Chiara , Latrofa Francesco , Lupi Isabella , Marcocci Claudio , Montanelli Lucia , Pierotti Laura , Santini Ferruccio , Sardella Chiara , Sgrò Daniele , Viola Nicola , Brancatella Alessandro 
Published: November 2022

Abstract

Background
Destructive thyroiditis is the most common endocrine immune related adverse event (iRAEs) in patients treated with anti-PD1/PD-L1 agents. Given its self-limited course, current guidelines recommend no treatment for this iRAE. Nevertheless in patients with enlarged thyroid volume and a poor performance status, thyrotoxicosis may be particularly severe and harmful. Aim of the study is to evaluate if steroid treatment might be useful in improving thyrotoxicosis in subjects with a poor performance status.

Methods
We conducted a case-control study, comparing the course of thyrotoxicosis of 4 patients treated with oral prednisone at the dosage of 25 mg/d (tapered to discontinuation in three weeks) and an enlarged thyroid volume to that of 8 patients with similar thyroid volume who were left untreated.

Results
No difference was found between the two groups at the onset of thyrotoxicosis (time 0) in demographic characteristics and in the levels of thyroid hormones. The levels of thyroid hormones were lower in subjects treated with prednisone compared to those untreated at time 7, 14, 21, 28, 35, 42, 60 and 90 days (P&lt;0.05 at each time). The median time to remission of thyrotoxicosis was 24 days in patients treated with steroids and 92 days in untreated patients (P&lt;0.001). At 6 months, the rate of evolution to hypothyroidism was similar in the 2 groups (4/4 in steroid group vs 7/8 in untreated group, P=0.74) and no difference was found in tumor progression (Progression free survival in treated group 5.1 months vs 5.0 months in untreated patients, P=0.89).

Conclusion
A short period of prednisone therapy is useful to restore more quickly euthyroidism in patients with a poor performance status and a severe destructive thyrotoxicosis induced by PD-1 blockade. This treatment does not impair the efficacy of immunotherapy.
Presentation: Sunday, June 12, 2022 11:30 a.m. - 11:45 a.m.
OR19-3 Differential Interactions of Vitamin D Binding Protein and Vitamin D Receptor in Different Ethnic Groups with Aggressive Thyroid Cancer
Authors: Gray Austin , Laxa Ria , Perez Mia , Rood Kristiana , Simental Alfred , Yamauchi Celina Romi , Khan Salma 
Published: November 2022

Abstract
Thyroid cancer affects ethnic groups at different rates and severity. Despite this, thyroid cancer health disparities are still an understudied area. Our laboratory has shown a differential expression of vitamin D binding protein (DBP) in Filipino Americans (FA) versus European Americans (EA) [1]. Higher DBP levels correlate to a better prognosis. A study has revealed a DBP-dependent vitamin D receptor (VDR) promoter activation. In this study, we investigated whether VDR and DBP are expressed differentially in different ethnic groups, such as African Americans (AA), Hispanic Americans (HA), EA, and FA. We were also able to determine the differential DBP polymorphisms, VDR variant expressions, and DBP-VDR interactions within different ethnicities. By PCR-Restriction Fragment Length Polymorphism (PCR-RFLP), we determined a higher frequency of DBP gene polymorphism in FA versus EA. Analyzing the Cancer Genome Atlas (TCGA) thyroid cancer datasets with the UALCAN assay, we found the differential expressions of DBP and VDR genes based on cancer stages, sample types, race, and histological subtypes. By immunohistochemistry, we detected strong nuclear VDR (nVDR) and very low membranous VDR (mVDR) expression that correlated with low DBP in FA thyroid cancer tissues. In contrast, there was a higher expression of both mVDR and DBP in HA versus the other ethnicities. Co-immunoprecipitation analysis revealed a stronger DBP interaction with mVDR in FA compared to other ethnicities. Our data suggest that low DBP correlates with low mVDR in FA, whereas high DBP correlates with high mVDR in the other ethnicities. In conclusion, the strong interaction of DBP with mVDR in FA may implicate the potential role of DBP-mVDR crosstalk in aggressive thyroid cancer. Future research goals will be aimed at determining pathways involved in BDP-mVDR crosstalk in thyroid cancer health disparities.
B. Mull, R. Davis, I. Munir, M.C. Perez, A.A. Simental, S. Khan, Differential expression of Vitamin D binding protein in thyroid cancer health disparities, Oncotarget 12(7) (2021) 596-607.
Presentation: Monday, June 13, 2022 11:30 a.m. - 11:45 p.m.
PSAT271 The Impact of Maternal Autoimmune thyroid disease on neonatal thyroid conditions in Urban City Population
Authors: Murthy Deepa Badrinath , Mally Pradeep , Shah Bina 
Published: November 2022

Abstract

Background
There is a wide spectrum of maternal autoimmune thyroid disorders (AITD) in pregnancy ranging from Graves’ hyperthyroidism (GD) to Hashimoto thyroiditis (HT), both of which share similar immunological properties. A variety of maternal thyroid autoantibodies can cross transplacentally which may potentially cause varying degrees of neonatal thyroid dysfunction.

Objective
To study the neonatal outcomes of thyroid function in mothers with AITD in urban setting.

Methods
Mothers with AITD and newborns were included for retrospective analysis over 12 months. AITD encompassed all mothers diagnosed prior/during pregnancy with either HT or GD.

Results
Maternal Data: A total of 147 mothers were included (HT 87%, GD 13.6%). Among mothers with HT, thyroid auto-Abs were tested in 51/127 (40%) mothers, of which 32/47(68%) were positive for TPO, 11/21(2%) positive for ATA, 2/6(33%) positive for TSI, 1/2 (50%) positive for TRAb. L-Thyroxine was administered to 90% HT mothers. Among mothers with GD, thyroid auto-Abs were tested in 17/20 (85%) mothers, of which 7/17(41%) were positive for TSI, 6/10(60%) positive for TRAb, 7/14(50%) were positive for TPO, 3/5 positive for ATA. Methimazole (MMI) was administered to 25% GD mothers.
Neonatal outcome: A total of 150 neonates (115 FT, 35 PT) were born to AITD mothers. Newborn screen was abnormal in 2 infants. 7 neonates (4.6%) were tested for thyroid auto-Abs, of which 1/2 was positive for TPO, 1/2 positive for ATA, 3/3 negative for TSI, 5/5 negative for TRAb. Serum TFTs were performed in 62/150 neonates; majority 57/62(92%) were normal, 3 had mild compensated hyperthyrotropinemia (mean TSH 17.1 mIU/L, FT4 1.93 ng/dl) and were followed elsewhere. 2 neonates developed congenital hypothyroidism requiring L-Thyroxine. Infant 1: TSH 4.56mIU/L, FT4 1.1 ng/dl, TPO and ATA positive on DOL7 and had ectopic thyroid, infant born to TPO positive HT mother on Synthroid. Infant 2: TSH 149.5mIU/L, FT4 0.8 ng/dl, TSI negative on DOL7 and had hyperemic thyroid, born to TSI, TPO and TRAb positive GD mother on MMI. Overall, only 3.3% of neonates had evidence of thyroid function abnormality which may have either been transient or permanent.

Conclusion
Although rare, mothers with AITD might potentially impair neonatal thyroid function. This may be due to various thyroid auto-Abs or anti- thyroid medication that cross transplacentally. Maternal history of AITD should therefore raise suspicion to screen neonates and thus warrants continued vigilance.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT296 Graves’ Disease and Hurthle Cell Carcinoma: A Rare Presentation
Authors: Bhatt Plukshi J , Madhavan Parvathy 
Published: November 2022

Abstract

Introduction
Hurthle cell carcinoma is a rare thyroid malignancy, only accounting for 3-5% of all thyroid malignancies. Thyroid tumors are classified as Hurthle cell carcinomas when they contain more than 75% Hurthle cells. Hurthle cells are oncocytic cells with an acidic cytoplasm and can contain up to 5,000 mitochondria. In the thyroid, oncocytic changes are associated with conditions such as cell-mediated autoimmune thyroiditis, humoral-mediated hyperthyroidism (Graves’ disease), and hyperplastic nodules seen in multinodular goiters.

Case Presentation
A 64-year-old Polish female with a medical history of hypertension, hyperlipidemia, and smoking presented with fatigue, weight loss of 18kg in 6 months, palpitations, tremors, anxiety, heat intolerance, and diarrhea. Family history was pertinent for thyroid lobectomy in older sister and thyroidectomy in niece with reportedly benign pathology. She denied any family history of thyroid cancer. She resided 1,000 kilometers away from Chernobyl at the time of the nuclear accident.

Diagnosis and Treatment
Hyperthyroidism was attributed to Graves’ disease, and she was started on methimazole with improvement in symptoms. Fine needle aspiration of 3.4cm right thyroid nodule showed moderate to high cellularity with abundant discohesive Hurthle cells with granular cytoplasm, large nuclei with prominent nucleoli and mild nuclear atypia consistent with Hurthle cell carcinoma with a 25-40% risk of malignancy. She had a total thyroidectomy that revealed a 3cm minimally invasive Hurthle cell carcinoma with a benign lymph node. She was started on levothyroxine 100mcg. Post-surgery labs showed thyroglobulin 3 ng/mL [1.3-31.8], undetectable thyroglobulin antibody, suppressed TSH and normal calcium levels. Further course was complicated by Graves’ orbitopathy, worsened by smoking. She was started on teprotumumab and tapered dexamethasone before receiving 30 mCi radioactive iodine for remnant ablation.

Discussion and Conclusion
Graves’ disease is the most common cause of hyperthyroidism accounting for 60%- 80% of hyperthyroid cases. Graves’ disease has been reported to be associated with aggressive thyroid carcinomas, 88%being papillary thyroid cancers. Some studies note an increased mortality in patients with differentiated thyroid cancer associated with Graves’ disease when compared to euthyroid controls. Hurthle cell carcinoma is a rare thyroid malignancy and is uncommonly seen in conjunction with Graves’ disease.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT320 Does Iodine Deficiency Increase the Risk of Subacute Thyroiditis after Postcovit Period?
Authors: Kale Banu 
Published: November 2022

Abstract
Subacute thyroiditis (SAT, de Quervain thyroiditis) is usually a self-limiting inflammatory condition of thyroid. The clinical presentation usually includes painful diffuse goiter with thyrotoxicosis. Post-viral subacute thyroiditis has been reported following viral infection. A limited number of SAT after covit infection have been reported in literatura up to now.
This abstract reports two cases of SAT after covit infection. Thyroid ultrasonography of the patients indicate enlarged hypoechoic thyroid with decreased vascularity and heterogenous echotexture. Elevated CRP is detected at the time of SAT diagnosis. There is a difference between these two cases and previouse described ones in litratura. Urinary iodine exclusion detected as lower than normal ranges. Does iodine deficiency increase the risk of subacute thyroiditis after postcovit period?
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT322 A "Natural Thyroid Booster" Induced Hyperthyroidism
Authors: Ziganshina Anna , Joseph Jalaja 
Published: November 2022

Abstract

Background
In the recent years market got filled with a variety of freely available and not FDA regulated supplements that claim to ensure thyroid gland "support", "activation", "boost", "restoration", "drive", "edge", "strength" and a midst of other positive effects. These supplements are often not considered as medications and often are not reported during medication reconciliation. We present a case of hyperthyroidism in a patient using a supplement containing potassium iodide

Clinical Case
54-year-old male with newly diagnosed atrial fibrillation in Feb 2021 presented in September 2021 with non-ST elevation myocardial infarction. He continued to have persistent atrial fibrillation. At presentation TSH was nearly suppressed at 0.02 MIU/ml, FT4 was normal at 1.6 ng/dl, TT3 increased at 241 ng/dL. During endocrinology evaluation in October 2021 thyroid function values remained the same, TSI and TRAB were negative and TGAB were increased at 8 IU/ml. Imaging studies were not consistent with thyroiditis (heterogenous and hypervascular gland on ultrasound, normal RAI), a possibility of antibody negative Graves’ disease was entertained, however thyroid function tests in November 2021 were quite different and showed elevated TSH of 71 MIU/L, FT4 low at 0.3 ng/dl, low TT3 at 48 ng/dl. At this time patient recalled being on thyroid supplement in the recent past, per patient he did not realize that it was relevant information to disclose to the physician. He was on "Thyroid PX" from September 2020 to February 2021 per recommendation from naturopathic doctor for symptomatic subclinical hypothyroidism when in September 2020 TSH was noticed to be mildly elevated at 6.73 MIU/ml, FT4 normal at 1. 0 ng/dl and TT3 normal at 99 ng/dl.

Conclusion
This case represents an example of thyroid supplement use related thyrotoxicosis. He was taking "megadoses" (80 times the recommended daily dose) of iodine that likely have caused Jod-Basedow phenomenon, which is a hyperthyroidism following exposure to the excess of iodine. Among documented ingredients of "Thyroid PX" are potassium iodide, cholecalciferol, methylcobalamim, Ashwagandha root, Ginger root, Nettle leaf and others. Each capsule contains 6000mcg of Potassium Iodide (daily dose – 2 capsules) with recommended daily iodine dose for adults of 150mcg. Hyperthyroid stage was followed by the stage of profound hypothyroidism. The patient could have been predisposed to Jod-Basedow phenomenon due to Hashimoto thyroiditis. This illustrates an importance of obtaining detailed history of use of any/thyroid supplements in all patients with unexplained hyperthyroidism.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT323 Ultrasound-guided Percutaneous Ethanol Ablation for the treatment of Benign Cystic Thyroid Nodules: Report of Three Cases on The Initial Ecuadorian Experience
Authors: Naranjo Eddy P Lincango , Garcia Cristhian , Tana Andrea S Cho , Cordero-Garate Juana , Solis-Pazmino Paola , Godoy Richard 
Published: November 2022

Abstract

Introduction
Ultrasound-guided Percutaneous Ethanol Ablation (UPEA) is one of the first-line treatments for benign pure cysts and predominantly cystic thyroid nodules (TN). This non-surgical procedure has been used for years worldwide, however, in Latin America, this was recently adopted. Therefore, the aim of this report is to characterize our initial experience with UPEA in Ecuador.
Clinical cases description: We report on the cases of a woman (F1: 49 y) and two men (M1: 38 y, M2: 69 y) that underwent UPEA for three predominantly cystic TN at ITECC (Instituto de la Tiroides y Enfermedades de Cabeza y Cuello) in Ecuador. All nodules were non-functioning and graded as Bethesda II. Our approach in regards to the total ethanol volume injected was approximately calculated at 1/3 of the TN volume, using 75% ethanol. 10 ml of 2% lidocaine was used for anesthetic purposes. Initial volume and change in TN volume were calculated with the ATA calculator. Patient F1 had a 40 mm (23.5 ml) right lobe TN and underwent needle extraction of 5 ml of cystic fluid before the injection of 6 ml of ethanol. At 1-month follow-up, the nodule reduced 78.1% in volume (28 mm, 5.1 ml). Similarly, patient M1 had a 59 mm (44.8 ml) right lobe TN treated with 6 ml of ethanol after 20 ml of cystic fluid was extracted from the TN. At 3-month follow-up, the nodule reduced 99% in volume (7 mm, 0.1 ml). Finally, patient M2 had a 36 mm (14.5 ml) right lobe TN treated with 5 ml of ethanol. At 6-moth follow-up, the nodule reduced 99% in volume (0.5 mm, 0.04 ml). No patients developed complications and only needed one session.

Conclusions
To the best of our knowledge, we are the pioneers in Ecuador and the fourth country in Latin America that implemented UPEA in the management of cystic TN. In this small report, UPEA seems to be an effective and safe treatment option for cystic TN. Patients had &gt;75% reduction in cyst volume along with symptomatic relief and no complications. Our results are consistent with other series. Data on a longer follow-up are needed to confirm long-term efficacy.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT327 Can Cannabis Use Lead to Central Hypothyroidism
Authors: Farasat Sadaf , Chang Amy 
Published: November 2022

Abstract

Background
Marijuana has been legalized for medical use in 36 states and for recreational use in 18 states. Its effects on thyroid function and hypothalamic-pituitary-thyroid axis in humans is not known.

Clinical Case
72 years old male presented to his primary care physician with occasional difficulty swallowing. He reported fatigue for 4-5 years, trouble falling asleep for 2 months, weight gain 8 pounds over last few weeks, occasional diarrhea, and intermittent episodes of heat intolerance. His past medical history included controlled type 2 diabetes mellitus, recurrent herpes simplex infection, arthritis of hip joints, short-term memory loss, anemia, carpal tunnel syndrome and benign prostatic hyperplasia. Medications included glimepiride, lisinopril, acyclovir, tamsulosin, finasteride, escitalopram. He had been smoking marijuana regularly since he was a teenager. He denied using any other supplements. His physical exam was normal with stable vital signs and normal BMI.
His labs showed a low TSH (0.096 mcIU/mL, n: 0.358-3.8 mcIU/mL), normal free T4 (0.90 ng/dL, n: 0.76-1.46 ng/dL), normal total T3 (70 ng/dL, n: 60-180 ng/dL). Review of his labs showed low TSH for last 4 years progressively getting worse with normal free T4 levels. TSH-receptor antibody and TPO Antibody level were negative. His white cell count, hemoglobin and platelets were normal. His electrolytes, kidney function and liver function tests were also normal.
Thyroid Ultrasound showed 2 small sub-centimeter hypoechoic nodules in the left thyroid lobe. Two years ago, a radioactive Iodine scan showed normal iodine uptake. A recent radioactive iodine uptake scan showed generalized decreased iodine uptake with no evidence of graves’ disease or toxic multinodular goiter.

Conclusion
Currently there are no controlled studies on the effect of marijuana use on thyroid function in humans. A cross-sectional analysis using National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012 showed recent marijuana use was significantly associated with lower levels of TSH but was not associated with thyroid dysfunction (1). This study suggests that marijuana use is associated with low TSH levels. This could be due to hypothalamic suppression of TSH or may indicate a protective role against hypothyroidism. Older studies in rodents showed that cannabis exposure may lead to suppression of TSH and hypothalamic function (2).
The data related to human subjects is scarce. Therefore, pathophysiologic mechanisms are speculative, although animal data support potential mechanism of hypothalamic suppression.

References
1. Malhotra S, Heptulla RA, Homel P, Motaghedi R. Effect of Marijuana Use on Thyroid Function and Autoimmunity. Thyroid. 2017;27(2): 167-173. 2. Hillard CJ, Farber NE, Hagen TC, Bloom AS. The effects of delta 9-tetrahydrocannabinol on serum thyrotropin levels in the rat. Pharmacol Biochem Behav. 1984;20(4): 547-550.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT341 Hashimoto's Thyroiditis After Allogenic Bone Marrow Transplantation
Authors: Melhim Abdullah , Arnason Jon , Gavrila Alina 
Published: November 2022

Abstract

Introduction
Hashimoto's thyroiditis or chronic lymphocytic thyroiditis is a common autoimmune-mediated thyroid disease triggered by an inappropriate T and B cells response. We present a case of a female without personal or family history of autoimmune disease, who developed Hashimoto's thyroiditis with severe hypothyroidism after undergoing bone marrow transplant (BMT).

Clinical Case
A 57-year-old woman with hypoplastic myelodysplastic syndrome (MDS) was initially started on immunosuppressive therapy, complicated by autoimmune hemolytic anemia and thrombocytopenia. Three years after diagnosis, she underwent allogenic BMT from a matched unrelated donor. A year later, she presented with weight gain, fatigue, cold intolerance, insomnia, eye puffiness and lower extremity weakness, developed over a month. Exam was notable for periorbital edema and delayed DTRs. Laboratory workup revealed an elevated TSH at 302 µIU/mL (0.27-4.2) with undetectable free T4 and total T4 levels and elevated anti-thyroglobulin antibodies of 2698 IU/mL (0-40) and antiTPO antibodies of 90 IU/mL (0-35). Cortisol was normal at 14 µg/dL. TSH was normal prior to the BMT. Thyroid ultrasound revealed a normal-sized thyroid with a slightly heterogeneous echotexture, suggestive of thyroiditis without distinct nodules. Myxedema coma was ruled out at the time of diagnosis. The patient was started on levothyroxine and noticed a significant improvement of her symptoms within few weeks.
Our patient does not have a personal or family history of thyroid disease or other autoimmune disorders. She did not receive radiation treatment or steroid treatment prior to her hypothyroidism diagnosis. She had an RSV upper respiratory infection two months prior to the diagnosis of hypothyroidism without associated neck pain. The clinical and biochemical picture suggest that her hypothyroidism could be related to her allogenic BMT. The presumed mechanism for the autoimmune thyroid dysfunction noted in this patient is the transfer of autoantibodies and donor lymphocytes during BMT.

Conclusion
Adoptive autoimmune hypothyroidism can occur post-BMT, especially if the donor has genetic susceptibility. It is now accepted that autoimmune thyroiditis can be transferred from donors to recipients during BMT.

Reference
Buxbaum NP, Pavletic SZ. Autoimmunity Following Allogeneic Hematopoietic Stem Cell Transplantation. Front Immunol. 2020 Aug 25;11: 2017.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.