bluuebunny/crossref_metadata_2025_split huggingface dataset:
PSAT329 A Delayed Diagnosis of Subclinical Hypothyroidism Due to Interferences with Thyroid Function Immunoassays
Authors: Khine Aye , Yin Ngwe 
Published: November 2022

Abstract

Introduction
Automated immunoassays used to evaluate thyroid function tests (TFTs) are susceptible to various forms of interference that can lead to inaccurate results and misdiagnosis.

Case Description
A 55-year-old male was diagnosed with abnormal TFTs since 2017 [TSH 7.32 mIU/L (range 0.4-4.5), FT3 5.1 pg/mL (range 2.3-4.2), and FT4 1.2 ng/dL (range 0.9-2.2)]. Thyroid peroxidase antibody and thyroglobulin antibody were positive. He was on levothyroxine 50 mcg daily since 2017, and he did not feel significantly different despite treatment. He was referred to endocrine clinic in 2021. He had no symptoms of hypothyroidism or hyperthyroidism except occasional palpitations and headache. He reported blurred vision due to cataracts. He denied thyroid diseases in first degree relatives. He denied taking biotin or desiccated thyroid extract. Physical examination was unremarkable. Differentials included TSH-producing adenoma, assay interference, exogenous T3 use, T3 thyrotoxicosis with interference of TSH assay, and thyroid hormone resistance. Levothyroxine was discontinued in May 2021. Other pituitary hormones including alpha-subunit and MRI pituitary were unremarkable, which ruled out TSH-producing adenoma. Human anti mouse antibody (HAMA) was normal. In June 2021, prior to seeing genetics, FT4, FT3 and Total T3 were checked with equilibrium dialysis method and values were 1.2 ng/dL (range 0.9-2.2), 238 pg/dL (range 210-440) and 105 ng/dL (range 76-181), respectively and TSH 9.13 mIU/L (range 0.40-4.50), thyroglobulin 0.6 ng/ml (range 2.8-40.9), reverse T3 LC/MS/MS 12 ng/dL (range 8-25). Labs were therefore consistent with subclinical hypothyroidism, and he was started back on levothyroxine 75 mcg every morning.

Discussion
TFTs are usually measured by automated immunoassays, and this will have accurate results in most cases. However, immunoassays are vulnerable to interferences that can affect clinical decisions. It is important to consider assay interference such as this and to confirm with equilibrium dialysis method before pursuing further aggressive workup.

Conclusion
Potential interferences in TFTs should always be suspected whenever discrepancies arise. Awareness of these conditions is critical to the institution of appropriate therapy and preventing misdiagnosis.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT333 Case Of a Large Adenomatoid Hyperplastic Thyroid Goiter
Authors: Lott David , Moll Teresa , Subauste Jose , Garla Vishnu , Lien Lillian 
Published: November 2022

Abstract
An 81-year-old woman presented to the emergency department for evaluation of shortness of breath, dysphagia and chest tightness. In the emergency department, imaging was obtained, with CXR showing complete opacification of R hemithorax. Follow up imaging with CT Chest showed large mediastinal mass contingent with the right lobe of the thyroid, along with large volume (transudative) pleural effusion. Patient underwent thoracentesis with improvement in her shortness of breath, but chest tightness persisted. IR biopsy was obtained, which confirmed the mass was indeed thyroid in origin. At this time, Endocrinology was consulted for concerns of thyrotoxicosis, along with the goiter, as lab work returned with suppressed TSH (&lt;0.01 mcIU/mL), normal Free T4 (1.14 ng/dL). On examination, the Endocrinology team found the patient to be clinically euthyroid, with normal vital signs and only ongoing complaints of chest tightness with deep inspiration. Decision was made to go forward with resection of the mass, with a multidisciplinary approach involving ENT and Cardiothoracic Surgery. The ENT team began the procedure by dissecting the right lobe from the remaining thyroid tissue. The gland was noted to track inferiorly and posteriorly into the chest, and the decision was made to truncate the portion of the gland superior to the clavicle. At the time it was felt that further manipulation of the gland was a high risk from this position. The patient was then handed off to the cardiothoracic surgery team who, using robotic assistance, took a transdiaphragmatic approach. After roughly 3 hours of dissection, the goiter was placed in an endo-catch bag and was able to be removed through a transabdominal/diaphragmatic incision. The remainder of the left lobe was safely left in place. In the end the removed portion of the goiter was found to be 13.7 cm in length and weighed 532 g. Average thyroid weight in iodine replete populations remains roughly 20 g. Pathology returned as adenomatoid hyperplasia in all 4 specimens. Postoperatively the patient did well and follow up with Endocrinology was scheduled.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT337 Thyroid Storm Triggered by Thyroid Nodule Fine-Needle Aspiration Biopsy
Authors: Rios Paola , Eatz Tiffany Alyssa , PenaHerrera Carlos , Lagari Violet 
Published: November 2022

Abstract

Background
Thyroid storm is a severe and life-threatening thyrotoxicosis precipitated by an acute event such as thyroid gland manipulation, infection, trauma, or an acute iodine load. Patients with known hyperthyroidism or low TSH with the presence of multinodular goiter should undergo radionuclide thyroid scan before deciding on fine-needle aspiration (FNA) biopsy. We present a case of a patient with history of multinodular toxic goiter disease, who had a thyroid storm after she underwent an FNA thyroid biopsy, requiring emergent total thyroidectomy.

Clinical Case
62-year-old female patient with history of multinodular goiter (MNG) disease diagnosed in another country one year prior to admission. She was on methimazole for a few months but was off the medication upon presentation. She was admitted for evaluation due to worsening compressive symptoms. On presentation, she was hypertensive, tachycardic, with dysphonic voice and had a large goiter palpated bilaterally with extension over the sternocleidomastoid muscle. Laboratory results confirmed that she had thyrotoxicosis. TSH was 0.05 mclU/mL, n: 0.27-4.2mclU/mL; FreeT4 &gt; 7.77 ng/dL, n: 0.93-1.70ng/dL; T3 was 552 ng/dL, n: 80-200 ng/dL; TSI and TRAB were elevated: 476 and 23 respectively. In view of this, methimazole 40 mg daily, prednisone 20 mg daily, cholestyramine 4 mg four times a day, potassium iodine 50 mg three times per day, and propranolol were started. Chest CT demonstrated a thyroid gland that was heterogeneous in appearance and markedly enlarged with a right thyroid lobe measuring approximately 6.2×5.8 cm and the left lobe measuring approximately 5.5×5.0 cm. Patient underwent ultrasound guided FNA biopsy of the right thyroid lobule ordered by another team two days after the medication regimen was initiated. One day after procedure, patient had altered mental status, stridor, acute respiratory failure, worsening of hypertension and tachycardia, requiring intubation. It was not possible to place an oral gastric tube, so propylthiouracil 400 mg was given via rectal route every 8 hours and her steroid dose was increased. Her FreeT4 decreased to 3.99 ng/dL and T3 to 165 ng/dL the following day. However, patient condition continued to deteriorate, and she underwent emergent total thyroidectomy, despite not being euthyroid. Patient tolerated the procedure and was able to be extubated the following day without postoperative complications. At the time of discharge, patient was on Levothyroxine 150 mcg oral daily.

Conclusion
FNA biopsy of toxic thyroid nodules are rarely indicated due to the risk of thyroid storm in patients with underlying hyperthyroidism. Control of the hyperthyroid state should be the priority prior to FNA of any thyroid nodule. Total thyroidectomy may be performed in the hyperthyroidism state as a life-saving procedure when there is failure control hyperthyroidism, as is the case here.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT355 A Case Report Identifying Graves’ Ophthalmopathy in a Myasthenia Gravis Crisis and Response to Teprotumumab
Authors: Zia Abdul , Paul Kristy , Noor Abdullah , Hanson Jeremy , Romo Karina , Uwaifo Gabriel 
Published: November 2022

Abstract

Background
Thyroid disease is relatively common in patients with Myasthenia Gravis (MG), affecting 5%–10% of patients, conversely, the prevalence of MG in patients with Graves’ disease is 0.14%. Of thyroid diseases seen in MG, Graves’ Disease (GD) is the most common. Graves ophthalmopathy (GO) is a known complication associated with GD, however, in patients with MG, its identification may be difficult, as both GD and MG may present with similar ocular signs and subtle differences. This case identifies GO in a MG crisis and its response to teprotumumab.

Clinical Case
A 53-year-old-woman with MG presented with one year of worsening bilateral eye and arm weakness, fatigue, eye pain, headaches and palpitations. Examination revealed bilateral ptosis, eyelid edema, and ⅘ bilateral upper extremity strength. Workup revealed suppressed TSH (&lt;0.010, n 0.5-5.0 ml U/L) and elevated antibodies: Thyroid Stimulating Immunoglobulin (4.86, n &lt;0.54 IU/L) and Thyrotropin Receptor Antibodies (TRAb) (8.08, n ≤1.75 IU/L). Thyroid ultrasound showed several bilateral cystic nodules and increased thyroid parenchyma vascularity without thyromegaly, suggestive of GD. Thyroid Uptake and Scan showed diffusely elevated 24-hour uptake (71%, n 10-30%) consistent with GD. Treatment was initiated with methimazole 5 mg daily. At follow up, she had symptoms of eyelid weakness, diplopia, headaches, and muscle weakness. Graves’ Ophthalmopathy Clinical Activity Score (CAS) was 5/10. Examination showed bilateral ptosis with eyelid edema, proptosis, conjunctival redness, and chemosis. Extraocular muscle movements intact without pain, normal pupils and visual fields. Ophthalmology review and orbital CT showed bilateral exophthalmos with extraocular muscle thickening consistent with thyroid eye disease (TED). The classic coke-bottle-sign of the anterior tendon of the inferior rectus muscles was noted. Given her presentation, clinical course and progression of TED, she commenced a teprotumumab treatment trial. Clinical improvement of GO was noted upon follow-up assessment after 5 doses of teprotumumab: CAS 2/10, decreasing proptosis on exam, and TRAb (3.86, n ≤1.75 IU/L).

Conclusion
This case highlights the potentially misleading clinical findings and difficult diagnoses of coexisting GO and MG. Although muscular weakness is common in GD, concomitant MG is rare and may cause profound additional morbidity. Ocular signs in both diseases may cause diagnostic confusion, although ptosis is more consistent with MG and lid retraction with GD alone. GO can mimic some of the neuromuscular and ophthalmologic signs of MG and can be easily missed or mistakenly attributed to either MG or GD. This may result in a delayed diagnosis/inappropriate treatment of GO, thus, clinicians should maintain suspicion for coexisting diagnoses.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT361 Severe Hyponatremia in a Patient with Myxedema Coma
Authors: Nemati Maryam , Rubinow Katya 
Published: November 2022

Abstract

Introduction
Patients with myxedema coma present with hypothermia, bradycardia, hypotension, altered mental status, and hyponatremia. We present an interesting case of myxedema coma with severe hyponatremia and discuss hyponatremia management.

Case presentation
Patient is a 67-year-old female with history of hypothyroidism following thyroidectomy for papillary thyroid carcinoma, hypertension, and medication nonadherence who was found down and brought to the hospital for altered mental status. On presentation she had a temperature of 35 °C, heart rate of 49, BP of 130/105, and intermittent O2 desaturations due to hypoventilation. On exam she was somnolent with nystagmus and lateral gaze deviation. She was moving all extremities. Lung and heart exam were normal. Labs showed sodium of 102 mEq/L (135-145 mEq/L) and serum osmolality of 243 mOsm/kg (280-300 mOsm/kg). TSH was 35U/mL (0.4-5 U/mL), and free T4 was &lt;0.2 ng/dL (4.8-10.8 ug/dL). CBC and creatinine were normal. Head CT and chest XR were unremarkable. In the ER, she received hypertonic saline 3% as a 150mL bolus along with 1L of isotonic saline. Her sodium rapidly corrected to 117 mEq/L over 2.5 hours. She was given 3 doses of desmopressin 2mcg to control the overcorrection. She received hydrocortisone 100mg IV followed by 50mg IV q8hr. After the first dose of hydrocortisone, she was given levothyroxine 100mcg IV once followed by 75mcg IV daily. Hydrocortisone was discontinued after her cortisol level returned at 49 ug/dL (5.0-22.6 mcg/dL). Plasma sodium stabilized at 114meq/L in 48hrs. With continued IV levothyroxine alone, plasma sodium increased to 122 mEq/L by day 3 and then rose to 134 mEq/L on day 4. Free T4 improved to 0.4 ng/dL on day 3. Her mentation improved slowly and returned to baseline by day 6.

Discussion
In patients with chronic, severe hyponatremia, treatment usually entails hypertonic saline delivered either by bolus or continuous infusion with a targeted sodium correction rate of ≤8 mEq/L in any 24-hour period. However, when hyponatremia is due specifically to hypothyroidism, hypertonic saline confers high risk of overcorrection, as was evident in this patient. The pathogenesis of hyponatremia in myxedema coma is multifactorial, involving reduced free water clearance due to lower renal perfusion, inappropriately elevated ADH levels due to decreased cardiac output, and tubular dysfunction. Therefore, isotonic IV fluids and levothyroxine therapy directly address the mechanisms underlying hyponatremia and avoid the undue risk of hypertonic saline. Myxedema coma constitutes a unique context for the etiology and treatment of severe hyponatremia.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT376 Utility of lncRNAs in thyroid cancer diagnosis
Authors: Kim Daham , Yu Juyeon , Kim Jiwon , Hwang Yoon-a , Kim Jin Kyong , Ku Cheol Ryong , Yoon Jung Hyun , Kwak Jin Young , Nam Kee-Hyun , Lee Eun Jig 
Published: November 2022

Abstract

Objectives
Improved molecular testing for common somatic mutations and identification of mRNA and microRNA expression classifiers have emerged as the most promising approaches for diagnosis of thyroid nodules. However, it is necessary to effectively increase diagnostic accuracy further. Currently, lncRNA research has moved to the forefront of human cancer research, as recent findings have revealed a crucial role of lncRNAs in gene modulation. We evaluated the diagnostic value of the selected lncRNAs from The Atlas of Noncoding RNAs in Cancer (TANRIC) thyroid cancer dataset.

Methods
Using TANRIC thyroid cancer dataset, we compared 12,727 lncRNAs from the thyroid cancer tissues of 59 thyroid cancer patients with paired normal thyroid tissues. lncRNAs with significantly increased or decreased expression in thyroid cancer tissues were selected as candidates for thyroid cancer diagnosis. The expression levels of candidate lncRNAs were confirmed in patients with thyroid nodules who underwent surgery at the Severance Hospital. Subsequently, the candidate lncRNAs were applied to actual fine needle aspiration to verify their diagnostic value.

Results
LRRC52-AS1, LINC02471, LINC02082, UNC5B-AS1, LINC02408, MPPED2-AS1, LNCNEF, LOC642484, ATP6V0E2-AS1, and LOC100129129 were selected as candidates for thyroid cancer diagnosis. The expression levels of LRRC52-AS1, LINC02082, UNC5B-AS1, MPPED2-AS1, LNCNEF, and LOC100129129 were significantly increased or decreased in malignant nodules compared to their expression levels in benign nodules or paired normal thyroid tissues in our surgical tissue samples. The combination of LRRC52-AS1, LINC02082, and UNC5B-AS1 showed favorable results, with 89% sensitivity and 100% specificity, for thyroid cancer diagnosis using fine needle aspiration.

Conclusions
lncRNA expression analysis could be a promising approach for advancing molecular diagnosis of thyroid cancer. Further studies are needed to discover lncRNAs of additional diagnostic value.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT380 Characteristics and prognosis of Differentiated Thyroid Cancer in patients with Graves Disease
Authors: Panthi Sujata , Crow Hanna M , Bantis Leonidas , Choudhary Chitra 
Published: November 2022

Abstract

Background
The incidence of thyroid cancer in the United States and worldwide has increased 300% over the last three decades.1 Graves’ disease (GD) is the most common cause of hyperthyroidism. GD occurs due to activating antibodies to the TSH receptor. Thyroid-stimulating antibodies can result in intrinsic and genetic factors to favor the tumor growth process.2 Recent studies show that the incidence of thyroid cancer is higher among patients with GD when compared to toxic multinodular goiter.3 The current study compares the outcomes of Differentiated Thyroid Cancer (DTC) in patients with GD with non-GD patients.

Objective
The aim of the study was to compare demographics, pathology, stage, and prognosis of DTC in patients with GD with non-GD patients.

Methods
This was a retrospective chart review of 42 patients with a diagnosis of DTC with or without GD. Patients were selected using HERON (Healthcare Enterprise Repository Ontological Narration) software. We compared age at diagnosis, type and size of the tumor, radioactive iodine (RAI) use, and DTC recurrence amongst patients with GD with non-GD patients. We used the Chi-square to test for independence among the categorical variables at a nominal level of 0.05. The comparison of continuous variables was based on the t-test.

Results
The mean age of patients was 50 years (range 23–86). Out of 42 patients, 29 patients had GD and 13 patients did not have GD. 92% had papillary thyroid cancer and the mean tumor size was 1.3 cm (range 0.09–7.5). 86% of the patients had Stage 1 and 2 DTC. Patients with GD were diagnosed with DTC at a younger age (mean age 46 years) when compared to the patients without GD (mean age 59 years) with a p-value of 0.013. There was no difference in patients with GD in regard to the type of DTC (P = 0.54) and the stage of DTC (p-value 0.139). Both groups of patients had a similar rate of recurrence and RAI use (Table).

Conclusion
The current study concludes that patients with GD were diagnosed with DTC at an earlier age when compared to patients without GD. The stage of DTC and recurrence rate were similar in the two groups. The study was limited to a small number of patients.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT383 Tension-free Thyroidectomy in the Treatment of Thyroid Cancer and Follicular Neoplasia: Experience of the First 100 Cases
Authors: Sleptsov Ilya , Sablin Ilya , Chernikov Roman , Pushkaruk Alexander , Fedotov Yuri 
Published: November 2022

Abstract

Background
and aims. The safety of thyroid surgery in terms of recurrent laryngeal nerve palsy and hypoparathyroidism was increasing in the last decade. In this study, we present a new method of tension-free thyroidectomy (TFT), which could be used to further decrease the complication rate after thyroidectomy.

Patients and Methods
The procedure is based on the medial approach to the recurrent laryngeal nerve and the parathyroid glands after the division of isthmus and successive total dissection of Barry ligament. One hundred consecutive patients (128 nerves at risk) underwent "tension-free thyroidectomy" (TFT) from August to November 2021 performed by one surgeon. There were 80 females and 20 male patients (ratio 4: 1) with a mean age of ninety-two 46,4 (range from 17 to 75). Lobectomy was carried out in 74 (74%) patients, total thyroidectomy in 26 (26%). In 42 cases patients additionally underwent central or/and lateral neck dissection. Indications for surgery were papillary carcinoma (N=52), medullary cancer (N=2), follicular neoplasia - Bethesda IV group after fine-needle biopsy (N=46). Mean thyroid nodule size was 25,3 mm (ranged 7 - 120 mm). Intraoperative transient neuromonitoring was used in all the cases (5 mA), in 20 cases permanent neuromonitoring was also used. Translaryngeal untrasound or direct laryngoscopy were routinely used prior and after surgery to evaluate vocal cords mobility. Calcium and parathormone level were measured in patients after thyroidectomy on the first, 14th and 30th postoperative days.

Results
The mean operating time of lobectomy was 80±39 (range: 25-120), for total thyroidectomy 80 ±36 (range: 55-130). There was no conversion to the conventional lateral-to-medial approach. No fluctuation of electric activity of laryngeal nerves during surgery was revealed. Intraoperative loss of signal (LOS) due to thermal effect of electrocautery and subsequent transient unilateral laryngeal nerve palsy occurred in 3 cases (2,3% from the total number of nerves at risk). In all these patients normal vocal fold function was confirmed on the 30th day after surgery. No permanent nerve palsy cases revealed. Three patients (out of 26 in the total thyroidectomy group – 11,5%) exhibited a decrease of parathyroid hormone level on the postoperative day 1 which was resolved in two weeks under the substitution therapy with calcium and alfacalcidol. No cases of permanent hypoparathyroidism occurred.

Conclusion
TFT (tension-free thyroidectomy) can be considered a safe and feasible operation in patients with thyroid cancer and follicular neoplasia. Larger and comparative (randomized) studies with conventional dissection technique should be performed to investigate the hypothesis that this approach can provide a lower complication rate.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSUN38 Incidence and prognosis of amiodarone induced thyroid dysfunction: a nationwide cohort study in Korea
Authors: Sohn Seo Young , Cho Sung Woo , Lee Jae Hyuk 
Published: November 2022

Abstract

Background
Amiodarone is commonly associated with thyroid dysfunction. Incidence of amiodarone induced thyroid dysfunction is variable in the literature and prognosis of patients who developed amiodarone induced thyroid dysfunction compared to euthyroid patients is still unclear.

Results
During a mean follow up of 7.4 years, 777 (3.9%) developed thyrotoxicosis (incidence rate 3.96 per 1000 person years) and 2,225 (11.3%) developed hypothyroidism (incidence rate 11.93 per 1000 person years). Patients with thyrotoxicosis or hypothyroidism had a lower MACE rate compared to euthyroid patients (45.2% vs. 50.2% and 48.5% vs. 50.2%). Multivariate analysis revealed that older age (&gt;65 years), chronic kidney, ischemic heart disease and chronic obstructive lung disease were independent risk factors of MACE. Patients who developed thyrotoxicosis or hypothyroidism had a lower risk of MACE than euthyroid patients (HR=0.75 [95% CI: 0.68-0.83] and HR=0.73 [95% CI: 0.69-0.77]).

Conclusion
The incidence of amiodarone-induced thyrotoxicosis was higher compared to hypothyroidism. The patients with thyrotoxicosis or hypothyroidism had lower cardiovascular events in patients treated with amiodarone.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.