bluuebunny/crossref_metadata_2025_split huggingface dataset:
RF11 | PMON26 A Lump By Any Other Name: A Case of Diffuse Large B Cell Lymphoma of the Thyroid
Authors: Farghani Saima , Minhas Simran 
Published: November 2022

Abstract
Patient is a 49-year-old female with a past medical history of hypothyroidism who presented to the endocrinology office for evaluation of a neck mass. A thyroid ultrasound in 2020 had shown significantly enlarged and diffusely heterogenous thyroid gland compatible with diffuse thyroid goiter without nodules. Her neck swelling worsened and therefore a thyroid ultrasound was repeated and showed a large hypoechoic nodule in the left thyroid gland. She had no symptoms such as night sweats, fevers, or weight loss. A computed tomography (CT) scan of the neck with contrast was obtained on 7/20/2020 showing a markedly enlarged thyroid gland with multiple &gt;1 centimeter (cm) thyroid nodules, with a suspected exophytic extension nodule medial to the left lobe. Multiple adenopathy was present with an enlarged left lower cervical lymph node and a right-sided level 4 lymph node concerning for thyroid malignancy with local metastatic disease. She underwent a fine needle aspiration (FNA) with flow cytometry of the lymph node on 9/2/2020 which was benign. Her goiter continued to increase in size and she was referred to endocrine surgery for fine needle core biopsy of the left thyroid nodule which was favorable for diffuse large B cell lymphoma (DLBCL) with a germinal center phenotype on 4/5/2021. Flow cytometry was positive for CD-10 mature B cells. FNA biopsy of the left lower cervical lymph node showed polymorphic lymphocytes and rare macrophages. She was staged IIE. She underwent 4 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and received 18 rounds of consolidation radiation after completion of chemotherapy. She had near-complete response to treatment and is now monitored through routine follow-ups. Primary thyroid lymphoma is a rare condition characterized as a lymphomatous process involving the thyroid gland without any contiguous spread or distant metastasis at the time of diagnosis. It comprises nearly 1% to 5% of all thyroid malignancies and is more common in women. DLBCL is the most common histiotype and accounts for 50% to 70% of all cases. Patients may notice a unilateral or bilateral rapidly enlarging neck mass with compressive symptoms, but B symptoms are less common. Nearly 30% to 40% of patients carry a diagnosis of hypothyroidism at the time of diagnosis as the lymphomatous process replaces the normal thyroid parenchyma. Diagnosis is made usually via core needle biopsy and flow cytometry since FNA biopsy is frequently inconclusive. Treatment is with chemotherapy, usually R-CHOP, and radiation therapy with an overall 5-year prognosis of 34.5%. Surgical decompression may be necessary if compressive symptoms are present. While this is a rare disease, providers should be cognizant of DBLCL especially when faced with a presentation such as the one summarized in this report.
Presentation: No date and time listed
RF11 | PSAT249 Radiofrequency Ablation for Thyroid Nodules: The First Ecuadorian Prospective Cohort
Authors: Naranjo Eddy P Lincango , Garcia Cristhian , Tana Andrea S Cho , Cordero-Garate Juana , Solis-Pazmino Paola , Godoy Richard 
Published: November 2022

Abstract

Introduction
Radiofrequency ablation (RFA) is a promising, non-surgical method, used for the treatment of benign and malignant thyroid nodules (TN). While this minimally invasive technique has been studied extensively in Europe and Asia, it has been recently adopted in Latin America. The aim of our study is to describe the clinical outcomes following the first cohort of TN subjected to ablative radiofrequency in Ecuador.

Methods
This single-center, prospective study, carried out at ITECC (Instituto de la Tiroides y Enfermedades de Cabeza y Cuello) in Ecuador, included adults who underwent RFA for benign and malignant thyroid nodules (TN), between September 2020 and January 2022. The trans-isthmic approach and moving shot technique using the RF Medical equipment with an 18G needle and 5 or 7 mm tip were applied. Nodule size and volume, thyroid function, and complications were evaluated before and after RFA. Initial volume and change in TN volume were calculated with the ATA calculator and the independent-samples T-test.

Results
A total of 26 patients with 28 TNs were included. 25 TNs were benign (Bethesda II) and 3 were micropapillary thyroid cancer (MPTC) (Bethesda VI). In the benign lesions group, most were female (82.6%), &lt;55 years of age (73.9%), euthyroid (62.5%), and symptomatic (95.6%); had a mean maximum diameter of 3.3 ± 1.3 (range: 0.8–5.5) cm and a mean initial volume of 13.1 ± 11.6 ml; and had predominantly solid component (36.4%). A substantial volume reduction was observed since the first month after RFA (1 month: mean volume 8.6 ± 4.2 ml, p=0.01; 6 months: mean volume 4.5 ± 3.9 ml, p=0.04; and 12 months: mean volume 4.9 ± 6.9 ml, p=0.25; vs. baseline). All patients were asymptomatic at the last follow-up. In the MPTC group, two patients were males (66.7%); all were &lt;55 years of age (100.0%) and euthyroid (100.0%); most were asymptomatic diagnosed by routine US (66.7%); had a mean maximum diameter of 0.6 ± 0.1 (range: 0.5–0.8) cm and a mean initial volume of 0.056 ± 0.001 ml. At 1-month follow-up after RFA all TN were fibrosed and no lymph node or distant metastases were found. Finally, in both groups, no major complications were found and only one patient reported ecchymosis at the puncture site. Thyroid function was not affected.

Conclusions
To the best of our knowledge, we are the pioneers in Ecuador and the third country, after Brazil and Colombia, in Latin America that implemented RFA in the management of TN. In our first experience, RFA was a safe and effective technique. RFA induced a substantial volume reduction, improved symptoms, avoided cosmetic concerns, and did not affect normal thyroid function. 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., Saturday, June 11, 2022 1:30 p.m. - 1:35 p.m.
RF23 | PSAT258 Comparable Bioavailability of a Novel Levothyroxine Solution taken 10 or 30 minutes prior to a High-Fat, High-Calorie Breakfast
Authors: Washington Kris , Baron Michelle , Vandse Sunil 
Published: November 2022

Abstract
Levothyroxine (LT4) is the recommended treatment for hypothyroidism and the second most prescribed medication in the US. Several formulations are available, however most patients take LT4 tablets. Evidence suggests that absorption of levothyroxine tablets is decreased when taken with food, especially those rich in soy, iodine, and fiber. In order to avoid erratic absorption of LT4, it is recommended that oral formulations are taken on an empty stomach, 30-60 minutes before breakfast. However, compliance with this recommendation is often difficult for patients with busy schedules or on multiple medications, yet important in patients with conditions that are sensitive to changes in TSH levels such as pregnancy and thyroid cancer.There is evidence that oral liquid LT4 formulations that bypass the gastric dissolution phase of absorption may mitigate this food effect. ThyquidityTM (levothyroxine sodium) oral solution has demonstrated bioequivalence to Synthroid® under fasting conditions and allows individualized dosing flexibility. A bioavailability study was conducted to assess the rate and extent of absorption of the oral LT4 solution (100 mcg /5 mL) administered either 10 or 30 minutes before a standardized high-calorie, high-fat breakfast in an open-label, randomized, single-dose, 2-period, 2-sequence, crossover study. A single 600 μg oral dose of LT4 solution (ThyquidityTM, 30 mL) was administered to healthy adults either 10 or 30 minutes before consuming a 950 kcal, high fat (56%) breakfast in each study period and blood was collected for total (bound and free) T4 for 48 hours after drug administration. Treatment periods were separated by a 40-day wash-out period.The ratios of geometric LS means with corresponding 90% confidence intervals were calculated from the exponential of the difference between the LT4 solution administration 10 and 30 minutes prior to the meal for AUC0-48 and Cmax. An absence of food effect (bioequivalence) would be concluded if the baseline corrected 90% confidence intervals of this ratio fell within 80.00% to 125.00% for Ln-transformed AUC0-48 and Cmax.Forty healthy volunteers participated in the trial, 38 were included in the data analysis. There were no serious adverse events or discontinuations due to AEs. The geometric LS mean ratios of AUC0-48 and Cmax for baseline-adjusted LT4 were 88.74% (84.71-92.95%) and 85.07% (81.1-89.33%) respectively. The corresponding 90% CIs were included within the acceptable range for bioequivalence, indicating the absence of a meaningful difference in LT4 absorption when administering at 10 or 30 minutes before a meal.Based on these results, it may be possible to decrease the interval between the administration of Thyquidity (levothyroxine sodium) oral solution to 10 minutes before breakfast, thus offering patients further dosing flexibility.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Sunday, June 12, 2022 12:36 p.m. - 12:41 p.m.
RF35 | PSAT304 A Case of COVID-19 Infection; COVID-19 mRNA-Based Vaccine Induced Human Anti-Mouse Antibodies (HAMA) Interfering With TSH Testing
Authors: Hoang Thien , Patricia Luceri , Signore Valentina Del 
Published: November 2022

Abstract

A 71-year-old male presented to the endocrine clinic for evaluation of hypothyroidism which has recently been difficult for his primary care physician to control. He initially developed hypothyroidism in 1990 after neck radiation for squamous cell carcinoma of his sternocleidomastoid muscle. He was previously controlled for many years on levothyroxine 150mcg daily with TSH readings in the normal reference range. Patient was infected with COVID-19 in 2020 and was hospitalized for 10 days. He was treated with 5 days of Remdesivir and 10 days of Decadron. 6 months after the infection he received mRNA COVID-19 vaccination. Upon his first visit to the endocrine clinic post COVID-19 infection and vaccination, his TSH was elevated at 90 uIU/mL with a free thyroxine that was elevated at 1.8 ng/dL even after multiple attempts by his primary care physician to increase his Levothyroxine which was up to 225 mcg daily before he was referred to endocrinology. He is compliant with his levothyroxine and takes it on an empty stomach first thing in the morning without any of his other medications. He is not taking iron supplements, biotin or any other supplements or new medications. TSH values had been normal 1 month prior to his COVID-19 infection and was first noted to be abnormal 8 months after his COVID-19 infection and 2 months after his mRNA COVID-19 vaccine. There was no TSH drawn between when he had COVID-19 and when he received his vaccine. It was suspected that he may have a factitious elevation in his TSH due to antibody interference. Labs were drawn for a TSH with human anti-mouse antibodies (HAMA) treatment which resulted with a markedly suppressed TSH at 0.007 uIU/mL with an elevated free thyroxine of 1.94 ng/dL. HAMA antibodies came back elevated at 552 ng/mL.

Reference
Klee, G., 2000. Human Anti-Mouse Antibodies. Archives of Pathology & Laboratory Medicine, 124(6), pp.921-923.
Koshida, S., Asanuma, K., Kuribayashi, K., Goto, M., Tsuji, N., Kobayashi, D., Tanaka, M. and Watanabe, N., 2010. Prevalence of human anti-mouse antibodies (HAMAs) in routine examinations. Clinica Chimica Acta, 411(5-6), pp.391-394.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 1:00 p.m. - 1:05 p.m.
LBODP067 Primary Amenorrhea - A Common Referral With An Uncommon Cause
Authors: Shaikh Sheeba , Kapoor Ashutosh , Lewis Alexander 
Published: November 2022

Abstract

Introduction
Primary amenorrhea is a commonly encountered referral in the endocrine setting. Thorough history and clinical examination are integral in assessment to identify the cause. Although rare, congenital absence of the uterus and vagina constitutes the second most common cause after primary ovarian insufficiency. Once endocrine causes are excluded, anatomical causes must be explored.

Case
We present the case of a 17-year-old who was referred to our Endocrine unit by primary care with primary amenorrhea. Medical history was significant for acute myeloid leukaemia which was treated with chemotherapy and cranial radiotherapy at the age of 2 years. There was no family history of endocrinopathy. Physical examination revealed no significant abnormalities with a height of 154cm and Tanner staging of 5 in all areas. The patient and her parents were concerned about delayed puberty or hypogonadotropic hypogonadism due to previous oncology treatments. Biochemistry showed normal oestradiol 262 pmol/L, Prolactin 258 mU/L, LH 11.8IU/L, FSH 6.6IU/L, Testosterone 1.1 nmol/L, IGF-1 211 ug/L, TSH 1.7mu/L, T4 12.7 pmol/L, AMH 23.5 pmol/L. Bone age was 17 years 5 months, in keeping with chronological age. Considering normal endocrine investigations and development, anatomical causes of primary amenorrhoea were investigated with ultrasound and then subsequently MRI imaging. This demonstrated the absence of the uterus and upper two thirds of the vagina. Both ovaries were present, and she also had a single pelvic kidney. Results are in keeping with Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome type 2). The patient was counselled on the impact this would have on fertility and sexual functioning and offered psychological support with this diagnosis.

Conclusion
Mayer-Rokitansky-Küster-Hauser (MRKH) is a rare disorder with prevalence of 1 in 4500 and is usually diagnosed in adolescents with primary amenorrhea as first presentation. Genetic origins have been suggested and further research is required as this could impact fertility choices for patient moving forward. This case highlights many of the differential diagnoses at presentation and the need for cross sectional imaging to fully appreciate anatomical and therefore clinical consequences.
Presentation: No date and time listed
LBODP106 Multi-omics Analyses Of MEN1 Missense Mutations Identify Disruption Of Menin-MLL And Menin-JunD Interactions As Critical Requirements For Molecular Pathogenicity
Authors: Dreijerink Koen Marie Anton , Ozyerli-Goknar Ezgi , Koidl Stefanie , Van der Lelij Ewoud , Van den Heuvel Priscilla , Kooijman Jeffrey , Biniossek Martin , Rodenburg Kees , Nizamuddin Sheikh , Timmers Marc 
Published: November 2022

Abstract
Loss-of-function mutations of the multiple endocrine neoplasia type 1 (MEN1) gene are causal to the MEN1 endocrine tumor syndrome, but they are also commonly found in sporadic pancreatic neuroendocrine tumors and other types of cancers. The MEN1 gene product, menin, is involved in transcriptional and chromatin regulation, most prominently as an integral component of KMT2A/MLL1 and KMT2B/MLL2 containing COMPASS-like histone H3K4 methyltransferase complexes. In a mutually exclusive fashion, menin also interacts with the JunD subunit of the AP-1 and ATF/CREB transcription factors. After in silico screening of 253 disease-related MEN1 missense mutations, we selected a set of nine menin mutations in surface-exposed residues. The protein interactomes of these mutants were assessed by quantitative mass spectrometry, which indicated that seven of the nine mutants disrupt interactions with both MLL1/2 and JunD complexes. Interestingly, we identified three missense mutations, R52G, E255K and E359K, which predominantly reduce the interaction with MLL1 compared to JunD. This observation was supported by a pronounced loss of binding of the R52G, E255K and E359K mutant proteins at unique MLL1 genomic binding sites with less effect on unique JunD sites. These findings support the general importance of the menin-MLL1 and menin-JunD interactions in MEN1 gene-associated pathogenic conditions.
Presentation: No date and time listed
ODP539 AIPB is a Biomarker for ER+/PR+/Her2- Breast Cancers
Authors: Cubbedge Chandler , Perkins Edward , Burak William , Bose Himangshu 
Published: November 2022

Abstract
Aromatase, the rate-limiting enzyme in estrogen synthesis, is expressed in the ovaries of premenopausal, the placentas of pregnant women, and adipose tissue and skin cells in postmenopausal women, although to a lesser extent than in the ovaries. The direct mechanism of controlling breast cancer is to reduce estrogen synthesis by interfering with its production, via ovarian ablation in premenopausal women and use of aromatase inhibitors or inactivators. However, the latter results in drug resistance, making them ineffective for future treatment. In our laboratory, we identified a 22-kDa protein from human breast tissue, Aromatase Interacting Partner in Breast (AIPB), that interacts with aromatase. Western Blotting of the unaffected (nontumorigenic MCF-12A) and tumorigenic (MCF-7 ER+/PR+/Her2-) breast tissues as well as PCR amplification with the AIPB specific primers of the nontumorigenic and tumorigenic cells showed AIPB expression is maximum with the unaffected breast tissue but reduced in ER+/PR+/Her2- tumors. To confirm AIPB's regulatory role, we developed a conditional expression of AIPB by stably selecting with puromycin from MCF-7 cells and thus regulating AIPB expression under a tetracycline promoter. On addition of doxycycline followed by PCR amplification, the AIPB expression was enormously higher than the uninduced cells under identical condition. The estrogenic effect of the stable cells was reduced significantly compared to MCF-7 cells. In summary, our preliminary results suggest AIPB to be a potential biomarker with a potential for cell therapy-mediated decrease of estradiol in ER+/PR+/Her2- tumorigenic breast tissues.
Presentation: No date and time listed
ODP540 Aromatase interacting partner in Breast (AIPB) regulates estradiol in human breast
Authors: Moffitt Alyssa M , Bose Himangshu S 
Published: November 2022

Abstract
Aromatase (estrogen synthetase) catalyzes testosterone to estradiol. It is central in reproduction, reproductive diseases, and a target for inhibitor therapy in estrogen-sensitive diseases. The level of estradiol synthesis is 20-fold or more, during menopause and in breast tumorigenesis. Unfortunately, the mechanism of increased synthesis of estradiol in these affected women is still unknown. Our laboratory has identified aromatase interacting partner (AIPB) from unaffected human breast tissue. Biochemical characterization showed that AIPB is a 22-kDa protein, present in the Endoplasmic Reticulum (ER)along with aromatase. AIPB is stimulated by estrogen but not cAMP or inactivated cycloheximide. The expression of AIPB in unaffected breast tissue and wild-type MCF-12A breast cells showed similar level of AIPB expression. Western blot with tumorigenic human breast tissues showed decrease in expression in AIPB expression in ER+/PR+/Her2- tumors. We further identified that conditional overexpression of AIPB synthesized 3.52 pg/mL of estradiol in comparison to unaffected breast tissue and wild-type MCF-12A breast cells with 9.5 pg/mL and 11.56 pg/mL, respectively. Further incubation of AIPB stable cells with estrogen stimulator, zeranol, reduced estradiol with the increase in AIPB expression confirming that aromatase activity is directly regulated by AIPB. Therefore, AIPB is crucial in understanding the pathophysiology of breast tumor development and in maintaining proper estradiol levels post-menopause and at the start of tumorigenesis. We concluded that there is potential for future advancements in the early prediction of breast cancer with the identification of AIPB expression from breast tissue.
Presentation: No date and time listed
ODP544 Cumulative exposure of metabolic syndrome components and the risk of end-stage renal disease in the general population: a nationwide cohort study
Authors: Yoo Soon Jib , Kwon Prof Hyuk-Sang , Koh Eun Sil , Han Kyung D 
Published: November 2022

Abstract

Aims
Status of metabolic syndrome (MetS) and its components can changes over time. However, few studies have investigated the cumulative burden of MetS and its components on clinical renal outcomes in the general population.

Methods
Using nationally representative data from the Korean National Health Insurance System, 2,664,270 subjects who underwent health examinations for four consecutive years and were free from end-stage renal disease (ESRD) from 2009 to 2013. We used exposure-weighted scores in two ways: (1) cumulative number of MetS diagnosis at each health examination (MetS exposure score, range: 0 to 4); (2) the composite of its five components (MetS component exposure score, 0 to a maximum of 20). Hazard ratio and 95% confidence interval (CI) values for ESRD were analysed using the Cox proportional-hazard model.

Results
Overall, 63.4%, 14. 0%, 8.2%, 6.2% and 8. 0% met the MetS diagnostic criteria 0 to 4, respectively. After a median follow up of 5.3 years, 2,303 incident ESRD cases were identified. In the multivariate adjusted model, the hazard ratio (HR) and 95% confidence interval (CI) for the development of ESRD showed a gradual increase with increasing exposure score of MetS and its components, which was independent of age, sex, and baseline estimated glomerular filtration rate (each p for trend &lt; 0. 0001). The HR of ESRD was 6.48 (95% CI, 4.12 to 10.20) in subjects with a MetS component exposure score of 20 compared with those with a score of 0.

Conclusions
This provides evidence supporting the strategy of reducing MetS exposure to prevent the development of ESRD in the general population.
Presentation: No date and time listed