bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP472 Creation of the Anaplastic Care Team (ACT) protocol: Establishing a Benchmark for Timely Access to Care for Anaplastic Thyroid Cancer Patients
Authors: Pulipati Priyanjali , Chitagi Pritha 
Published: November 2022

Abstract

Introduction
Novel Coronavirus 19 (COVID19) has been shown to involve multiple organs. Its reported effects on the endocrine system have been via subacute thyroiditis, functional hypopituitarism, and triggering type 1 diabetes with ketosis. We describe a case of COVID19 infection presenting as adrenal insufficiency.

Case
A 35-year-old female with a history of developmental delay, anxiety, and hypothyroidism presented to the emergency department (ED) from her group home with complaints of abdominal pain and 2-3 episodes of nausea and vomiting per day for one week. She denied any changes in bowel habits, chest pain, shortness of breath. On physical examination, there was mild diffuse abdominal tenderness without any skin hyperpigmentation. In the ED, her vitals showed blood pressure 99/56, heart rate 94, respiratory rate 23, saturating at 100% on room air. Laboratory tests were remarkable for hyponatremia (sodium 123), hypokalemia (potassium 1.9), hypochloremia (chloride 88), hypophosphatemia (phosphorus 2), metabolic acidosis with bicarbonate of 14. Her COVID19 test was positive. She was admitted to the intensive care unit as her blood pressure continued to drop to as low as 76/37. Potassium, phosphorus was replaced, and normal saline infusion was started at 75ml/hr with minimal improvement in blood pressure to 94/53 and sodium to 126 in 24 hours. Urine electrolytes showed sodium &lt;15, making SIADH less likely. On day 3, we suspected adrenal insufficiency due to persistent hypotension. Results showed am cortisol of 1 and ACTH of 10. ACTH stimulation test was unable to be done. She was started on hydrocortisone which improved her blood pressure as well as electrolytes. CT abdomen showed no adrenal abnormality. She was able to be tapered off the steroids in 2 weeks.

Conclusion
COVID19 associated hypocortisolism presents both as primary and transient secondary adrenal insufficiency (via suppression of the hypothalamic-pituitary-adrenal axis, like in our case). Similar reversible hypocortisolism post-SARS infection was observed in 24 of 61 patients (39.3%) during the 2005 outbreak. Autopsy studies on patients with COVID19 showed adrenal necroptosis of the adrenal cortex. Although critical illness-related cortical insufficiency is not a new concept, the cortisol levels in COVID19 critically ill patients have been shown to be lower than non-COVID19 critically ill patients. Prompt addition of stress dose steroids can be lifesaving in critically ill COVID patients, especially when associated with resistant hypotension.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
LBODP095 Radiofrequency Ablation Performed By Endocrinologists Is A Viable Treatment Option For Recurrent Thyroid Cancer In The Outpatient Community Setting In The United States
Authors: Ahmad Shahzad , Aljammal Jules , Orozco Ian James , Nikravan Sean P , Zulfiqar Fizza , Raashid Sheharyar , Hussain Iram 
Published: November 2022

Abstract

Objective
To determine if radiofrequency ablation (RFA) performed by endocrinologists for recurrent thyroid cancer in the neck is a treatment option in the outpatient community setting in the USA.

Methods
A review of 9 patients with 12 recurrent thyroid cancer lesions in the neck who were treated with RFA was conducted (July 2020 to November 2021). Recurrence was defined as biochemical and structural identification of disease. Recurrence was confirmed with ultrasound guided fine needle aspiration (US-FNA) cytology and measurement of thyroglobulin (Tg) washout concentration in cases of papillary thyroid cancer (PTC) and calcitonin washout concentration in medullary thyroid cancer (MTC). Informed consent was obtained. RFA was done in the outpatient setting with standard aseptic techniques, conscious sedation, and local anesthesia. Real time US imaging was used to perform hydro-dissection and a limited "moving shot" technique with a medial to lateral approach. Node volume in mL (length x depth x width×0.525) and tumor markers were recorded before at 6 to 12 weeks and at 6 months (m) after RFA. The volume reduction percentage (VRP) for each nodule was calculated using the following equation: VRP = {[baseline volume in mL - final volume in mL]/baseline volume in mL}×100 A VRP of more than 50% was considered a significant response, and VRP of 100% was considered complete response.

Results
A total of 9 patients with 12 nodes were included in the study. 7 patients had nodal recurrence of PTC in the neck. RFA was recommended for 1 patient as palliative treatment while on treatment with chemotherapy. 1 patient had recurrent MTC. There were no serious complications. 6 m data was unavailable for 2 patients. 9 of 10 (90%) nodes for which data is available had a volume decrease of at least 50% at 6 m. The only patient without at least a partial response to therapy was on chemotherapy. 4 of the 10 (40%) metastatic nodes of papillary thyroid cancer had a complete response. Mean volume reduction for all lesions at 6 mos was 0.339 mL, P = 0. 012. Median change in Tg level at 6 months was 0.4 IU/ml with a downward trend in 4/5 (80%) of patients with recurrent papillary thyroid cancer who were not receiving chemotherapy.

Discussion
Complete response may be expected in about 40% of patients after RFA at 6 m, however, this may potentially be improved with extended follow up time or multiple RFA sessions. Patients who are not surgical candidates, refuse surgery, or require palliative treatment may be potential candidates for this procedure. Therefore, RFA appears to be a viable treatment option in selected patients with recurrent thyroid carcinoma.
Presentation: No date and time listed
LBODP097 Malignant Struma Ovarii: Long Term Successful Treatment. Outcome
Authors: Mandal Kaushik , Liao Huijuan , Ashorobi Damilola , Kumar Salini Chellappan , Rosenthal David S 
Published: November 2022

Abstract
18 year old African American female saw her GYN in 9/2008 for abdominal pain. CT: bilateral adnexal masses (10×8 cm left; 6.3×3.1 cm right). Surgical pathology reported a left benign cystic teratoma and right corpus luteum cyst. Pain recurred in 2010. MRI showed: 9×7.5×4 cm right adnexal mass. Repeat surgery was done. Pathology: benign cystic teratoma with focal thyroid tissue - "Struma Ovarii". Abdominal pain recurred yet again in 2012. Sonography revealed a mixed solid/cystic pelvic mass measuring 10.6×7.9×7.6 cm. Exploratory laparotomy 9/2012 revealed a right adnexal mass and widespread peritoneal nodules. Pathology reported follicular tissue with colloid in the nodules - "Peritoneal Strumatosis" suggesting benignity. Upon further review was reclassified as metastatic well differentiated follicular thyroid cancer of ovarian origin with follicular thyroid tissue identified in peritoneal lymph nodes, spleen, bladder and rectal wall. The patient was then referred to endocrinology at our facility. On exam she was clinically euthyroid without thyromegaly or nodularity. Thyroid hormone levels were normal. Antithyroid antibodies were absent. Serum Thyroglobulin (Tg): elevated (229; normal 2-35 ng/ml) as was CA125 (64; normal &lt;21 U/ml). Immunohistochemistry: positive for Tg and Thyroid transcription factor-1. Molecular markers: no mutations in BRAF, RAS, or TP53. In preparation for radioactive iodine (RAI) therapy, total thyroidectomy was performed 4/13/2013 and reported as normal thyroid tissue. Dosimetry findings: very iodine avid tissue with prolonged retention (33% at 6 days). Maximum tolerated dose: 200 mCi. A 62.8 mCi RAI was administered 7/13/2013. Post RAI whole body scan (WBS): numerous focal areas of increased uptake in abdomen and pelvis consistent with metastatic disease. Treatment with L-thyroxine was given to suppress TSH. Follow up WBS 12/26/2013 showed persistent increased uptake in abdomen and pelvis. Serum Tg was high (198. 0). A second RAI dose of 104.8 mCi was given. Post RAI WBS confirmed multiple areas of metastatic disease in abdomen and pelvis. Subsequent serum Tg levels down trended. WBS 11/12/2014: only two residual abnormal foci in the lower neck and one inferior to the liver without abdominal or pelvic foci. Given the dosimetry issue and the reassuring serum Tg levels, surveillance was continued. WBS 9/25/2015: unchanged. Now age 27, WBS 1/26/2022: only residual faint lower neck uptake, resolution of the focus inferior to the liver and no distant foci. Stimulated Tg was normal at 2.2 ng/ml with stimulated TSH &gt;110. 0 uIU/ml.
Presentation: No date and time listed
ODP580 A Case of New Onset Primary Adrenal Insufficiency in COVID Infection
Authors: Beshay Lauren , Yang Qin , Beshay Lauren 
Published: November 2022

Abstract

Background
Accumulating body of evidence shows that SARS-CoV-2 infection in COVID-19 is linked to a variety of autoimmune complications including autoimmune endocrinopathies. Here we report a case of newly diagnosed Addison's disease post-COVID-19 infection.

Case Description
A 23-year-old male with a history of three episodes of acute disseminated encephalomyelitis (ADEM) in childhood, was brought into the emergency department (ED) by EMS after being found down with a blood glucose of 28 at the field. Prior to presentation, he reported 3 days of sore throat, nausea, vomiting, fatigue, and chills. He takes no home medications, and is not vaccinated against COVID-19. In the ED, the physical exam is notable for temperature 39°C, pulse 145, BP 80/42, RR 39, and no mucocutaneous hyperpigmentation. Labs revealed a positive COVID test, serum sodium 125 mmol/L (135-145), potassium 3.1 mmol/L (3.5-4.1), and persistent hypoglycemia. TSH 1.89 μIU/mL (0.45-4.12). A morning baseline cortisol was 4 mcg/dl (ref: &gt;18) with ACTH level of &gt;1250 pg/ml (0-45). A high-dose 250 mcg ACTH stimulation test followed; with cortisol levels of 3, and 3 mcg/dl (ref: &gt;18) at 30, and 60 minutes; respectively. Aldosterone &lt;3. 0 ng/dl (4. 0-31. 0), and anti-21-hydroxylase antibody was positive (ref: negative). A CT scan of the abdomen with contrast demonstrated mildly atrophied bilateral adrenal glands. The hypotension and hyponatremia resolved after initiation of intravenous hydrocortisone, and he was discharged on hydrocortisone and fludrocortisone.

Conclusion
The patient's symptoms, elevated ACTH, low cortisol, and presence of 21-hydroxylase antibodies, are consistent with autoimmune Addison's disease. Since ADEM is an autoimmune condition, it is likely that the patient had underlying undiagnosed Addison's disease and COVID-19 triggered an adrenal crisis. There is also a possibility that SARS-CoV-2 infection may have induced a higher titer of adrenal antibody, leading to the exacerbation of Addison's disease. The case highlights the importance of considering adrenal insufficiency as a diagnostic differential in hemodynamically unstable COVID-19 patients, especially those with underlying autoimmune conditions.
Presentation: No date and time listed
LBODP104 Thyroid Plasmapheresis: An Alternative Option For Thyroid Storm
Authors: Khine Aye , Yin Ngwe 
Published: November 2022

Abstract

Introduction
Thyroid storm is a rare, life-threatening condition with a high mortality rate approaching 10-30%. The mainstay of treatment includes initiation of therapy directed against the thyroid, supportive intensive care, and treatment of any precipitating factors. We report three cases of patients with thyroid storm and successful therapeutic use of plasmapheresis when traditional therapy was contraindicated.

Clinical Cases Case 1
A 22-year-old male with no known past medical history, presented with fever, shortness of breath, and syncope. Labs showed TSH 0. 014 mIU/L (range 0.4-4.5), FT4 4.30 ng/dL (range 0.9-2.2), TSI 546% (range &lt;140), and TPO 20 U/mL (range &lt;60). He was diagnosed with thyroid storm due to Graves’ disease (Burch-Wartofsky score of 60). He was initially treated with propylthiouracil (PTU), hydrocortisone, propranolol, and Lugol's iodine solution. He developed transaminitis and shock liver so was not able to continue PTU or trial methimazole. He underwent 4 rounds of plasmapheresis with improvement in thyroid hormone levels and eventually had thyroidectomy.

Case 2
A 37-year-old female with known Graves’ disease (non-adherent to antithyroid drug), presented with shortness of breath and palpitations. Labs showed TSH &lt;0. 01 mIU/L (range 0.4-4.5), FT4 4.83 ng/dL (range 0.9-2.2), and FT3 6. 0 pg/mL (range 2.3-4.2). Burch-Wartofsky score was 40 and supported the diagnosis of thyroid storm. She was initially treated with methimazole, hydrocortisone, propranolol, and Lugol's iodine solution. She developed transaminitis and there was also concern for methimazole-induced insulin autoimmune syndrome, so methimazole was discontinued. She underwent 3 rounds of plasmapheresis with improvement in thyroid hormone levels and eventually had thyroidectomy.

Case 3
A 31-year-old female with no known past medical history, presented with shortness of breath and altered mental status requiring intubation. Labs showed TSH &lt;0. 01 mIU/L (range 0.4-4.5), FT4 4.65 ng/dL (range 0.9-2.2), FT3 25.2 pg/mL (range 2.3-4.2), TSI 467% (range &lt;140), TPO 375 U/mL (range &lt;60). She was diagnosed with thyroid storm due to Graves’ disease (Burch-Wartofsky score of 90). She was initially treated with methimazole, hydrocortisone, propranolol, and Lugol's iodine solution. She developed pulmonary alveolar hemorrhage and it was unclear if this was due to methimazole, thus methimazole was discontinued. She underwent 5 rounds of plasmapheresis with improvement in thyroid hormone levels and eventually had thyroidectomy.

Conclusion
Plasmapheresis can be an effective and safe treatment option in thyroid storm when there are contraindications for antithyroid drugs or when rapid normalization of thyroid hormone levels is needed. It should be considered as a stabilizing measure as it leads to marked improvement of thyrotoxicosis within 3-5 days, allowing thyroidectomy for definitive therapy.
Presentation: No date and time listed
ODP450 A Case of Metastatic Medullary Thyroid Cancer Presenting with Pathologic Hip Fracture
Authors: Watari Jessica , Miller Jeffrey 
Published: November 2022

Abstract

Introduction
Medullary thyroid cancer accounts for less than 5% of thyroid malignancies. Distant metastatic disease typically presents in lymph nodes, lung, liver and bone. We present a patient who initially presented with a pathologic hip fracture with bone biopsy revealing medullary thyroid carcinoma.

Case Description
A 44-year-old male with no past medical history presented to the emergency department for right hip pain following a mechanical fall. Imaging showed a right femoral neck pathologic fracture as well as lytic lesions within the right femoral neck and right ilium. Family history was significant for pancreatic cancer and breast cancer. The patient underwent bone biopsy of the right femur followed by total hip arthroplasty. Bone biopsy revealed metastatic medullary thyroid carcinoma. Thyroid ultrasound showed a 1.2 centimeter right solid hypoechoic nodule along with extensive cervical lymphadenopathy. Further imaging revealed metastatic disease throughout the thoracic spine, mediastinal lymphadenopathy, and a left 2.2 centimeter adrenal lesion with peripheral enhancement and possible necrosis. Carcinoembryonic antigen (CEA) level was 551 ng/mL (normal &lt;4.7), calcitonin was 2,498 pg/mL (normal &lt;10), and calcium levels were normal. Plasma free metanephrines were normal and plasma normetanephrines were less than two times the upper limit of normal. Genetic testing on the bone biopsy specimen revealed a RET p. C618S variant. Germline RET testing was collected. The patient was discharged with close follow-up with oncology to initiate systemic therapy and follow-up with endocrinology for the adrenal mass.

Discussion
Majority of cases of medullary thyroid carcinoma are sporadic. Patients typically present with a thyroid nodule with many having cervical lymph node involvement at diagnosis and 5-10% having distant metastatic disease. Our patient's initial presentation was unique in that he presented with a pathologic fracture. Bone metastases can be seen in about 30% of cases of metastatic medullary thyroid carcinoma. Calcitonin levels greater than 500 pg/mL require additional imaging to exclude metastatic disease. If RET mutational status is unknown, patients should be screened for primary hyperparathyroidism and pheochromocytoma. Screening for pheochromocytoma is critical in preoperative management of these patients. Treatment for patients with metastatic disease involves surgery, external beam radiotherapy, and kinase inhibitors.
Presentation: No date and time listed
ODP480 Failure to achieve remission post Radioactive iodine therapy
Authors: Paliou Maria , Tahir Marium , Trousdale Rhonda 
Published: November 2022

Abstract

Background
Radioactive iodine-131 (RAI) therapy is used to treat hyperthyroidism secondary to toxic multinodular goiter (TMNG) and Graves’ Disease (GD). The treatment failure (TF) rate for RAI as reported in previous studies is 8-16% (1). Most patients respond to RAI with normalization of thyroid function tests and improvement of clinical symptoms within 4–8 weeks. Previous studies also report higher TF rates amongst Black patients (2), but due to the low number of Blacks included in the study, identification of factors related to higher TF rates was difficult.

Study Purpose
Determine treatment failure rates in patients who underwent RAI treatment for hyperthyroidism and characteristics related to Treatment Failure.

Methods
This is a retrospective study that included patients treated with RAI for either TMNG or GD from 2014-2021 at an urban hospital. Patients with thyroid cancer, less than 18 years, or toxic adenoma were excluded. TF was defined as persistent hyperthyroidism 6 months after RAI. Remission was defined as euthyroid or hypothyroid state off of anti-thyroid hormones 6 months after RAI. Factors evaluated included age at RAI, gender, race, cause of hyperthyroidism, percentage uptake in pretreatment scan, peak Ft4 / Ft3 pre-treatment, RAI dose, and treatment with methimazole post RAI. Comparison of TF to those who achieved remission was performed using two-sample t-test or the Wilcoxon rank-sum test for continuous variables and fisher tests for categorical variables.

Results
66 patients were included in the analysis. Mean age was 49 years, majority female (76%), African (21%), African American (45%), GD (68%), TMNG (32%). 19 had TF (28.7%). There was no significant difference in characteristics between TF and remission groups prior to RAI. The RAI dose was not significantly different between the groups (21. 0;21.1mCi). However, patients given methimazole shortly after RAI were at significantly higher risk of TF compared to patients who did not receive methimazole after RAI (64% vs 89%, p=0. 04).

Conclusion
Previous studies report TF after RAI as high as 16%. Patients at our Hospital with TMNG or GD who underwent RAI had a higher TF rate of 28.7%. The high TF rate was not due to low RAI treatment dose. Randomized Controlled Trials have found 61%-86% (1) success with RAI dose ranging from 5.4 -15.7 mCi (1). In comparison, mean RAI dose at our hospital was high at 21. 0. Patients prescribed methimazole within 4 weeks of RAI were more likely to have TF at 6 months. Based on the results of this study, we will initiate a change in protocol at our institution to hold methimazole for at least 4 weeks after RAI to see if this lowers the TF rates.

References
1. Ross, Douglas S., et al. Thyroid 26.10 (2016): 1343–1421. 2. Mohamadien, N. R., & Sayed, M. H. (2020). American Journal of Nuclear Medicine and Molecular Imaging,10(5), 235.
Presentation: No date and time listed
ODP492 Longitudinal Prospective Study of Thyroid Function Tests In Pregnancy
Authors: Davern Recie , Hatunic Mensud 
Published: November 2022

Abstract
Current thyroid function test (TFT) reference ranges in pregnancy are obtained from TPO antibodynegative women in each trimester. Recent international recommendations suggest using specific reference ranges based on local and national population data. Our aim is to study a longitudinal prospective model of TFTs by classifying individuals into groups according to their differing trajectories of TSH and FT4 during pregnancy. We performed a prospective study of TFTs in each trimester in pregnant women attending a national maternity centre. We conducted TFT testing at 12 weeks, between 24-28 weeks and between 34-36 weeks’ gestation. TPO antibody were tested in the second trimester.490 women with no prior history of thyroid disorder have been recruited to date. Mean age was 34+/-5.3. Primiparity was 36.83%. First trimester TSH (median) was 1.44 mmol/L (0.9850-1.90), FT4 14.3 mmol/L (12.90-15.65), second trimester TSH 1.46 mmol/L (1. 09-1.91), FT4 12 mmol/L (10.95-13.15) and third trimester TSH 1.5 mmol/L (1.125-2. 015) and FT4 11.7 mmol/L (10.5-132.2). 20% of women were TPO antibody positive. There were 6 new hypothyroidism diagnoses, all TPO antibody positive and required treatment. Subclinical hypothyroidism was diagnosed in 13 participants with 76.9% TPO antibody positive and 10 requiring treatment. We made 7 new diagnoses of hyperthyroidism, 3 who were antibody positive and requiring treatment. Patients were grouped into three categories based on first trimester TSH: 4 with TSH &lt;0. 05 mmol/L, 409 with TSH 0. 05-2.5 mmol/L and 77 with TSH &gt;2.5 mmol/L. This represents the first longitudinal study of TFTs measured across each trimester of pregnancy in Irish women. 26/490 (5.3%) of women had TFT dysfunction with 19 requiring treatment during pregnancy. One fifth of women had TPO antibody positivity which is a higher proportion than reported in previous studies of thyroid disease in pregnancy.
Presentation: No date and time listed