bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP570 Immunotherapy and its Implications for the Future of Endocrinology: A Case Discussion of Pembrolizumab Induced Myxedema Coma
Authors: Coppinger Anna , Meek Jessica A , Demoranville Beatriz , Al Dulaimi Ahmed 
Published: November 2022

Abstract

Introduction
Immunotherapy is a relatively new type of cancer treatment that has been successful in prolonging survival time and improving quality of life for patients with a wide variety of cancers.1 While these therapies do not usually have the same systemic toxicities seen in traditional chemotherapies, they can lead to significant autoimmune disorders due to their method of action.2 We present a case of pembrolizumab induced Hashimoto's thyroiditis leading to myxedema coma. Case A 67-year-old male presented to the hospital ED via EMS after being found unconscious in his car by his neighbor. On arrival, he was confused, lethargic, unable to answer questions, and had a Glasgow Coma Scale of 12. He was hypotensive 87/55 mmHg, bradycardic 55 bpm, respirations 12 breaths/min, SpO2 99% on room air, temperature 37 °C. Past medical history included type 2 diabetes mellitus on insulin and non-small cell lung cancer metastatic to bone and brain treated with pembrolizumab, denosumab, steroids, and radiation therapy. Initial labs revealed elevated TSH of 47. 01 with undetectable T3 and T4, glucose 514 mg/dL and elevated beta hydroxybutyrate 1.61, WBCs 3.9, hemoglobin 11.7, platelets 105. TPO antibodies were elevated 44.5IU/ml. Patient was treated with IV levothyroxine, hydrocortisone, insulin, and fluids and his condition improved rapidly. Patient was transitioned to oral levothyroxine with plans for outpatient endocrinology follow upon discharge. Thyroid tests done during a prior hospitalization following the initiation of pembrolizumab six months earlier demonstrated a low TSH of &lt;0. 003 and an elevated free T4 of 2. 09. The diagnosis of autoimmune thyroiditis induced by immunotherapy was made.

Discussion
Pembrolizumab is one of several immune-checkpoint inhibitors (ICIs) used to treat cancer by blocking the programmed-death (PD-1) receptor, allowing T-cells to detect malignant cells and mount an immune response. ICIs are part of a larger therapeutic class known as immunotherapy which acts to enhance the body's own detection and elimination of cancerous cells.1 As a result, approximately 10% of patients treated with immunotherapy develop autoimmune reactions.2 In this case, the patient had positive thyroid autoantibodies for Hashimoto's thyroiditis, that eventually lead to his profound hypothyroid state and myxedema coma. As these therapies become more widely utilized, the incidence and prevalence of autoimmune induced endocrine disorders will naturally increase. Awareness of the mechanisms and implications of immunotherapy in patients presenting with endocrine disorders will led to early recognition, treatment and improved patient outcomes.
Waldman AD, et al Nat Rev Immunol. 2020;20(11): 651-668.
Barroso-Sousa R, et al. . JAMA Oncol. 2018;4(2): 173-182.
Presentation: No date and time listed
OR11-4 Teprotumumab Markedly Improves Disease-related Quality of Life: Lessons From Two Randomized, Placebo-controlled Trials
Authors: Douglas Raymond S , Holt Robert , Qashqai Anahita , Sile Saba , Smith Terry J , Vesel Claudia , Kahaly George J 
Published: November 2022

Abstract

Background
Thyroid eye disease (TED) can result in eye-bulging (proptosis) and double-vision (diplopia) and inflammation, which frequently impacts quality of life (QoL). Teprotumumab, an insulin like growth factor-1 receptor inhibitory antibody, improves TED outcomes and QoL1 as measured by the Graves Ophthalmopathy-Quality of Life (GO-QoL) questionnaire and its appearance (AP) and visual function (VF) subscales. The primary factors driving QoL improvement in TED are unknown; therefore, we examined outcomes associated with improvement as observed in 2 placebo-controlled trials.

Methods
Data from Phase 2/3 placebo-controlled trials of teprotumumab were examined with a mixed-effect model with change in overall GO-QoL, AP, and VF scores as dependent variables to explain within-patient variability. Independent variables included demographics, visits, treatment, symptoms (Gorman diplopia scores [0-3], proptosis change (mm), spontaneous orbital pain, gaze-evoked orbital pain). Variability between subjects was tested over the 24-week study.

Results
Teprotumumab treatment significantly correlated with improved overall GO-QoL, VF and AP scores. Improvements in diplopia, proptosis, gaze-evoked and spontaneous orbital pain were associated with those in overall GO-QoL score (coefficient -4.01, -1.00, -31.21 and -4.37, respectively, all p&lt;0.001). Improvements in diplopia scores and spontaneous orbital pain were significantly correlated with higher VF scores (coefficients -5.51 and -6.66, respectively, both p&lt;0.001). Improvements in diplopia and proptosis correlated significantly with higher AP scores (coefficients -2.98, -1.62, both p&lt;0.001). Patients with pain had lower AP scores (coefficient -38.21, p&lt;0.001). Increasing age was positively correlated with higher GO-QoL AP scores (coefficient 0.41, p&lt;0.001), but negatively correlated with GO-QoL VF scores (coefficient -0.29, p&lt;0.001). Variability between subjects was considerable, accounting for &gt;60% of random variance.

Conclusions
Improvements in diplopia, proptosis, and pain drove improvements in QoL. In older patients, changes in AP impacted QoL to a lesser degree, while reduced VF had a greater negative impact on QoL.

References
Kahaly et al, Lancet Diabetes and Endocrinol 2021; 9(6): 360-372
Presentation: Sunday, June 12, 2022 11:45 a.m. - 12:00 p.m.
PSAT235 The Role of Systemic Immune Activation in the Development of Thyroid Dysfunction in COVID-19
Authors: Kolpakova Evgenia , Elfimova Alina , Nikankina Larisa , Troshina Ekaterina 
Published: November 2022

Abstract

Background
The research of cytokine-induced thyropathies in the midst of continuing COVID-19 pandemic is a very important and urgent problem. This work is based on the hypothesis that the hyperactivation of the immune system during COVID-19 is accompanied by a massive production of proinflammatory cytokines, and this could lead to thyroid gland disruption.

Aim
The primary endpoint is to assess the relationship between the levels of thyroid-stimulating hormone (TSH), free triiodothyronine (T3f), and free thyroxine (T4f) with the inflammatory process markers. The secondary endpoint is the identification of an association between TSH, T3f, T4f values, and patient survival.

Materials and Methods
This retrospective, single-center study included 122 patients hospitalized at the National Endocrinology Research Centre with a clinical and laboratory analysis of COVID-19 and bilateral polysegmental viral pneumonia. To assess the functional status of the thyroid gland all patients underwent observation of the TSH, T3f, T4f, AT-TPO, and AT-recTSH. Additionally, the markers of the inflammatory process were assessed in all patients, including: interleukin-6 (IL-6).

Results
Five patients (4%) were found with subclinical thyrotoxicosis. Serum TSH values were inversely correlated with IL-6 (r: -0.221; p = 0.024). Analysis of the level of hospital mortality, stratified by TSH, revealed statistically significantly lower TSH values in the group of deceased patients (p = 0.012). The median TSH in surviving patients was 1.34 [0.85; 1.80], for the deceased 0.44 [0.29; 0.99]. Based on the hypothesis that the immunosuppressive effect of genetically engineered biological therapy may have a protective role against thyroid damage in the development of cytokine storm, a comparative analysis of TSH values in two groups of patients with cytokine storm was performed (p=0.080).

Conclusion
Our research shows that the trigger of thyropathies in coronavirus infection is most likely thyroid tissue damage by the proinflammatory cytokines. In addition to the pathophysiological aspects of thyrotoxicosis, this study shows some specific clinical aspects regarding the clinical relevance in patients with thyrotoxicosis and COVID-19, namely, the high hospital mortality rate. The results obtained indicate a high risk of developing cytokine-induced thyropathies in patients with COVID-19. In support of the hypothesis of thyroid tissue damage being caused by pro-inflammatory cytokines, the differences in detected TSH values rose to the level of a statistical trend in 2 groups of patients with cytokine storm (i.e., patients who received tocilizumab therapy, and patients who received symptomatic therapy).
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT241 Variation in the Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features (NIFTP) in the United States
Authors: Chen Debbie , Rob Farizah , Mukherjee Rik , Giordano Thomas , Haymart Megan , Banerjee Mousumi 
Published: November 2022

Abstract

Background
The North American Association of Central Cancer Registries (NAACCR) develops and promotes uniform data standards for cancer registries, such as uniform cancer coding, and is used by all central cancer registries in the United States (US) and Canada, including Surveillance, Epidemiology and End Results (SEER). Effective January 1, 2017, the NAACCR modified its coding scheme and noninvasive encapsulated follicular variant of papillary thyroid cancer (EFVPTC) was reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) to reflect the indolent nature and very low risk of adverse outcomes of this thyroid tumor. The diagnostic use of NIFTP was anticipated to impact tens of thousands of patients in the US. Since NIFTP is no longer considered a cancer, as of January 1, 2021, it was no longer a reportable diagnosis in SEER. However, little is known about how the diagnosis of NIFTP was utilized across different regions and patient populations in the US when it was a reportable diagnosis.

Methods
Data was extracted from the US SEER-21 cancer registry (2000-2018). The study cohort comprised of individuals diagnosed with papillary or follicular thyroid cancer (2000-2018), or NIFTP (2017-2018). We examined the annual incidence of thyroid cancer by subtypes and NIFTP. Using data for 2018, we determined the rates of NIFTP for each of the 16 sites included in SEER-21. In addition, we compared the demographics of patients diagnosed with NIFTP to that of patients diagnosed with papillary and follicular thyroid cancer using Chi-square test.

Results
Between 2010 and 2018, we identified a total of 191,107 cases (182,893 PTC, 7,445 FTC, and 769 NIFTP). Incidence of FVPTC sharply declined from 2015 to 2018, with observed increases in NIFTP and encapsulated PTC/ invasive EFVPTC each accounting for 17% and 10% of the decline in FVPTC, respectively. High heterogeneity was observed in the regional incidence of NIFTP in 2018, with incidence rates ranging from 0.0% (Alaska) to 5.8% (Seattle-Puget Sound). Based on 2018 data, a diagnosis of NIFTP (2.2% of total thyroid cancer cases) was significantly associated with female sex (P=0.001), Black race (P&lt;0.001), and non-Hispanic ethnicity (P&lt;0.001) compared to diagnosis of papillary and follicular thyroid cancer.

Conclusion
There is marked variation in the use of the NIFTP diagnoses. The recent NAACCR coding change that resulted in NIFTP, a tumor with uncertain malignant potential and for which there is no long-term outcome data available, no longer being a reportable diagnosis will disproportionately affect women and Black patients, and patients who reside in regions with higher rates of NIFTP diagnoses.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT250 Thyroid Carcinoma – the Diagnostic Value and Management: the Single-Centre Real-World Retrospective Study 2019–2021 (Part I)
Authors: Rasa Ingvars , Pokšāne Diāna , Fokins Vladimirs Vladimirs 
Published: November 2022

Abstract

Background
Ultrasound imaging and fine-needle aspiration (FNA) is the mainstay in evaluating thyroid nodules. There is a substantial lack of recent data from Latvia on thyroid carcinoma.

Aim
This study aimed to determine effectiveness in a particular service medical tool called Green Corridor. We collected the data on the prevalence of thyroid carcinoma by FNA and after surgical intervention and compared both data since the malignant result in the FNA is an indication for surgery.

Methods
We provided the single-centre real-world retrospective observational study (2019–2021). We analysed patients sent to physicians along the Green Corridor with code Z03.173 (ICD-10) in Riga East Clinical University Hospital. After surgical interventions, we collected FNA data, treatment types, thyroid cancer types, comorbidities, and thyroid antibodies. The data indicated the number of malignancies cytologically, starting from Bethesda III (atypia of undetermined significance or follicular lesion of uncertain significance) and histologically. We compared the two methods. We analysed the efficiency of the Green Corridor. The statistical analysis was conducted using IBM SPSS.

Results
We manually analysed the medical records of 563 patients for three years. Thyroid cancer was confirmed in 153 patients (27.2%); women were 123 patients (80.4%). The average age was 53.5 ± 14.3 SD years. 147 patients had surgical intervention (total thyroidectomy (91.5%) or hemithyroidectomy) and confirmed thyroid cancer histologically (mainly papillary carcinomas – 82 pts (59.4%)). Four patients (2.6%) had radiation therapy, two patients (1.3%) had palliative care due to an inoperable condition. FNA results of malignancy coincided with the histological analysis in 114 patients (77%). In 84 (73.7%) patients, FNA results of malignancy types coincided with the histological analysis.

Conclusion
The fine-needle aspiration biopsy is the gold standard for malignancy diagnostic in thyroid cancer and has proven its high diagnostic value in combination with cost-effectiveness and minimal invasiveness. According to the Green Corridor, the distribution of patients has proven its effectiveness, taking into account its percentage as far as the disease is histologically confirmed.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT325 Unmasking the Effect of IgG4 Disease Surge on Thyroid Gland: A Case of Bilateral Sialadenitis in Patient with Past History of Graves.
Authors: Baez Karla , Madera Arelis , Shaaban Noreen 
Published: November 2022

Abstract

Introduction
Immunoglobulin G4-related disease is a fibrous-inflammatory disease characterized by lymphoplasmacytic tissue infiltration of IgG4 positive plasmablasts and small lymphocytes, that may be related to storiform fibrosis, obliterative phlebitis and modestly increased tissue eosinophils. This condition was recently recognized in 2013. It has unknown pathophysiology. The common characteristics shared by the different entities that make up the IgG4-related disease are: raised serum IgG4 levels, alterations in the imaging tests with neoplastic-like swelling of the affected organs, specific histopathological characteristics, and in immunostaining, as well as a good response to treatment with glucocorticoids.

Clinical Case
A 75-year-old male with a history of Grave's disease with ophthalmopathy, osteopenia, gastroesophageal reflux disease, obstructive sleep apnea, and benign prostatic hypertrophy presented to the clinic after a neck ultrasound and CT neck were ordered for investigation of bilateral "neck lumps". Neck ultrasound was evident for the heterogeneous appearance of submandibular glands and a hypoechoic nodule in the left neck with internal vascularity below the left jaw. CT neck with IV contrast showed evidence of possibly sialadenitis and lobular soft tissue thickening in the inferior aspect of the left submandibular gland measuring approximately 3.5 cm. Surgical pathology report of the left submandibular gland demonstrated a significant increase with IgG and IgG4 plasma cells and CD38 confirmed a dense plasmacytic infiltrate. IN the laboratory, IgG4 was elevated, 462 mg/dL (2-96 mg/dl)

Conclusion
As with many autoimmune diseases, it is unknown what triggers the Immunoglobulin G4-related disease. Given that the latter has just recently been diagnosed and recognized it is imperative to continue to record and develop data regarding it to better understand it. Multiple endocrine organs could be involved in the pathology of IgG4 related disease. The health care providers need to be cognizant of this condition and the wide variety of manifestations it could have. This disease can be first encountered by any medical field due to the broad spectrum of clinical findings that it could encompass.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT351 Thyroiditis following COVID-19 vaccination
Authors: Choksi Palak , Esfandiari Nazanene 
Published: November 2022

Abstract

Background
COVID-19 vaccination has resulted in several unexplained side effects. However, thyroiditis has not been commonly reported.

Clinical Case
A 46- year-old woman without notable past medical history presented with new neck tenderness that began five days after the 1st Pfizer COVID vaccine. Symptoms progressed to nightsweats, heat intolerance, palpitations, mild tremors and fever of 101 F. Her neck tenderness was 4 out of 10 with muscle stiffness and 3 lb weight loss after receiving the vaccine. She took NSAIDS for fever every 12-24 hours. She denied any compressive symptoms, visual symptoms or sleep disturbances. She had no cough, sore throat or close contact with a COVID positive individual/sick contact. RT-PCR was done for COVID-19 and was negative. There was no personal history of radiation exposure or family history of Graves’ disease. There was no prior history of drug allergies.
On examination, she was afebrile. Right thyroid gland was visible and tender to touch without overlying redness. A right thyroid nodule was appreciated without discrete margins and was not fluctuant. Left lobe was palpable without any nodules. She was tachycardic and had fine tremors on her hands. The remaining of the exam was unremarkable.
Laboratory data showed TSH 0.01 mIU/L (0.3-5.50) with elevated FT4 of 3.05 ng/dL (0.76-1.70) and FT3 of 10.5 pg/mL (1.9-3.9). CBC showed a mild anemia with normal white blood cell count. ESR was elevated. TPO antibodies, thyroglobulin antibodies and Thyroid stimulating Immunoglobulins (TSI) were unremarkable but thyroglobulin level was significantly elevated at 1132 ng/mL (0-35). Thyroid scan demonstrated thyroiditis. Neck US showed diffusely heterogenous thyroid gland with asymmetric enlargement of the right lobe and isthmus and a new right exophytic thyroid nodule measuring 0.6×1.0×1.2 cm. Vascularity was not increased. Several non-enlarged lymph nodes were noted as well.
Beta blockers was started in addition to NSAIDs. Neck tenderness resolved within 2 weeks. She received her second dose of COVID-19 vaccine as scheduled. Within 2 months of the initial presentation, thyroid functions normalized. Four months from the initial presentation, symptoms of mild hypothyroidism were noted with a TSH of 5.88. Levothyroxine 50 mcg daily was initiated. Repeat thyroid labs were normal. Follow up thyroid US showed resolution of the right exophytic thyroid nodule, and atrophic thyroid gland. She has remained on levothyroxine replacement with biochemical and clinical euthyroidism.

Conclusion
Clinicians should be aware of thyroiditis as rare side effect of COVID-19 vaccine on thyroid gland.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT366 Liquid L-thyroxine (L-T4) Formulation Normalizes TSH in Hypothyroid Patients Treated with Tablets L-T4
Authors: Antonelli Alessandro , Ferrari Silvia Martina , Fallahi Poupak , Elia Giusy , Ragusa Francesca , Paparo Sabrina Rosaria , Balestri Eugenia , Botrini Chiara , Patrizio Armando , Mazzi Valeria 
Published: November 2022

Abstract
The absorption of L-thyroxine (L-T4) can be affected by different factors, such as the manner of L-T4 assumption (during breakfast, or with food), the age of the patient, the interference with other drugs, absorption kinetics, adherence to therapy, and others. L-T4 tablets malabsorption can occur due to the increased gastric pH in patients in treatment with proton pump inhibitors (PPI; omeprazole, pantoprazole, lansoprazole) for gastritis, gastric ulcer, etc.
We enrolled 25 patients in treatment with L-T4 in the tablet formulation, and with elevated serum thyroid-stimulating hormone (TSH) levels; they were switched to the same dose of an oral liquid L-T4 preparation.
A normalization, or reduction, of circulating TSH levels occurred after the switch from L-T4 in tablet formulation to the liquid one (at the same dose). Eleven of these subjects who, for different reasons, were switched back again to assume L-T4 in tablets (with the same dosage), had a worsening of TSH levels, reaching the hypothyroid range.
Our results show that the pH alteration issue due to PPI could be overcome by the assumption of the oral L-T4 liquid formulation. Other future studies are needed to investigate liquid L-T4 formulation also in other conditions of altered L-T4 absorption.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
PSAT371 Thyroid Ultrasound, Biopsy and Cancer in a US Veteran Population
Authors: Arif Azka , Gosmanov Niyaz , Gosmanova Albina , Scofield Robert Hal , Limon Ahmad Abu , Cantu-Clatza Antonio , Shakir Nabeela 
Published: November 2022

Abstract

Background
Thyroid cancer is a common malignancy and has an increasing incidence. The most common demographic is young adult women with papillary thyroid cancer, which constitutes about 75% of the disease. The decision to perform a fine needle aspiration biopsy of a thyroid nodule is based on the ultrasound appearance of the nodule. Both the American Thyroid Association and the American College of Radiology have systems by which to grade these nodules such that the risk of malignancy is predicted and biopsy is recommended.

Methods
We reviewed the medical records of all patient undergoing evaluation of a thyroid nodule at the Oklahoma City US Department of Veterans Affairs Medical Center. We recorded results of the biopsy as well as ultrasound findings and surgical pathology.

Results
Among 162 subjects undergoing evaluation of a thyroid nodule, 81% were men and average ago was &gt;60 years. Only 7 of the 162 had a malignancy diagnosed. Neither age, sex, nor nodule size was associated with malignancy. All with malignancy had a TiRADS score or either 4 or 5 on ultrasonic study of the thyroid, but only a minority of TiRADS 4 (3.6%) or TiRADS 5 (5.5%) had thyroid cancer. Punctate calcium was found in 6 of the 7 with thyroid cancer and was the only finding statistically associated with malignancy. No patient with a Bethesda Classification of III or IV had malignancy

Conclusion
The presently available estimates of cancer using thyroid ultrasound are based on a general population are not applicable to this older, predominantly male population. Determination of the need for biopsy and surgery for thyroid nodules should take age and sex into account.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.