OE Oral Presentation-Endocrine (1-6

OE1

DIAGNOSTIC VALUE OF ADRENAL I-131 NP-59 SCINTIGRAPHY FOR PRIMARY ALDOSTERONISM: A RETROSPECTIVE STUDY AT A MEDICAL CENTER IN NORTH TAIWAN

1 WU MING-HSIEN, 1 LIU FENG-HSUAN, 2 LIN KUN-JU, 1 SUN JUI-HUNG, 1 CHEN SZU-TAH

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.; 2Molecular Imaging Center and Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan

Background: Primary aldosteronism (PA) is a common cause of secondary hypertension. Among the many leading causes of PA, the two most frequent are: bilateral adrenal hyperplasia (BAH) and aldosterone-producing adenomas (APA). Since a solitary APA may be cured surgically, but BAH needs lifelong pharmacologic therapy, confirmation is mandatory before surgery. We herein sought to determine the diagnostic value of I-131 1,6-beta-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy to distinguish PA from APA.

Methods: Patients clinically suspected of PA from March 2000 to October 2016 were retrospectively analyzed. A total of 145 patients, including 74 post-unilateral adrenalectomy and 7 post-radiofrequency ablation for adrenal mass, were reviewed. All patients received NP-59 adrenal

Results: Among 81 patients receiving interventional procedures for adrenal mass, adenoma was eventually diagnosed in 72 patients according to their pathologic results, with 60 unilaterally and 7 bilaterally localized lesions by NP-59 scintigraphy; nevertheless, there were five negative findings initially. The sensitivity, specificity and positive predictive value of NP-59 scintigraphy for APA detection were therefore 83.3%, 44.4% and 92.3%, respectively. Moreover, SPECT/CT scan increased 59 scintigraphy in this study.

Conclusions: NP-59 adrenal scintigraphy is a useful imaging test to detect APA. Lateralization by this modality prior to surgical intervention may reduce the need for such invasive procedures as adrenal venous sampling.

OE2

HYPERTHYROIDISM IS ASSOCIATED WITH HOSPITALIZATION FOR SEPSIS: A NATIONWIDE POPULATION-BASED STUDY

1LI-HSIN CHANG

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan

Background: Hyperthyroidism is a common endocrine dysfunction with systemic adverse effects in cardiovascular and skeletal system but the association with hospitalization for sepsis has not been studied. The purpose of this study is to demonstrate the association between hyperthyroidism and hospitalization for sepsis.

Methods: The population-based cohort study using data from 1996 to 2012 in the Taiwan National Health Insurance Research Database was conducted. A total of 5761 hyperthyroidism were identified and majority with age and gender fit the characters of Graves’ disease. 57610 controls matched by the propensity score were retrieved. The events of hospitalization for sepsis and outcomes after hospitalization were compared between two groups.

Results: rate was higher than control group (incidence rate 9.8% versus 8.8%, p = 0.002 by log-rank test). Subjects with hyperthyroidism were associated with higher risk of hospitalization for sepsis even after adjusting with all baseline characters (HR 1.18, 95% CIs 1.08-1.29, p < 0.001). The results were consistent in different infective sources and all subgroups. Patients with hyperthyroidism had lower inhospital mortality and hemodialysis rate when sepsis occurred.

Conclusions: Hyperthyroidism increases risk of hospitalization for sepsis but not worsens inhospital outcomes when sepsis occurs.

OE3

FACTORS PREDICTING ABNORMAL LIVER FUNCTION TESTS INDUCED BY HYPERTHYROIDISM

CHING JUNG HSIEH

Department of Internal Medicine, Paochien Hospital, Ping Tung, Taiwan

Background: Abnormal liver function tests (LFTs) are often found in patients with hyperthyroidism. The interaction between the thyroid and liver is for maintaining homeostasis in both organs. Thyroid hormones are glucuronidated and sulfated within the liver and subsequently excreted into bile. Thyroid hormones also could maintain the metabolism of bilirubin. There are few data demonstrating the factors or biochemical factors contributing to LFT abnormalities. The aim of this study was to investigate predicting factors for abnormal LFTs induced by hyperthyroidism.

Methods: Single-institution retrospective cohort study. care at a regional hospital between January 2009 to December 2017.

Inclusion criteria were a serum thyroid stimulating hormone [TSH] concentration 1.48 ng/ dL. The biochemical liver tests assessed were serum aspartate transaminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin. Serum levels of anti-thyroid peroxidase (anti-TPO) antibody, TSH receptor antibody (TRAb) were also recorded. All patients were divided into abnormal LFTs (group A) and normal LFTs (group B). Logistic regression analysis was used to determine predictive factors contributing to abnormal LFTs.

Results: There were 519 consecutive cases of newly diagnosed and untreated patients.

The overall incidence of any biochemical liver test abnormality within 6 months of hyperthyroidism was 17.9%. The frequencies of ALT, AST and TBIL abnormalities were 52.7%, 21.5%, 65.6%, respectively. In the univariate analysis, patients in group A had significantly higher FT4 concentration (3.44 vs 2.34 ng/dL, P = 0.004) and TRAb (28.9 vs 19.5 IU/L, P = 0.001) when compared with those in group B. Logistic regression analysis revealed higher FT4 levels, higher TRAb value and male gender to be independent risk predicting factors.

Conclusions: biochemical test result within 6 months of the diagnosis of new-onset untreated hyperthyroidism.

OE4

SEX DIFFERENCES IN ANDROGEN RECEPTOR ARE RELATED TO TUMORIGENESIS OF HUMAN PAPILLARY THYROID CARCINOMA

1CHEN-KAI CHOU, 2SHUN-YU CHI, 3HONG-YO KANG

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Taiwan, R.O.C; 2Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Taiwan, R.O.C; 3Graduate institute of Clinical medicine science, Chang Gung University, Taiwan, R.O.C

Background: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy, accounting for ~80% of all thyroid cancers. Gender variation in the incidence of thyroid cancer is well known, more women than men are diagnosed with the disease at a ratio of 3–5.5:1. While females have an increased incidence of thyroid tumors, males have a high rate of malignancy with poor prognosis. The aim of this study is to determine the role of Androgen receptor (AR) in PTC’s tumorigenesis.

Methods: The expression levels of AR of 116 PTC surgical specimens and its adjacent normal thyroid specimens from Kaohsiung Chang Gung Memorial hospital were assessed via quantitative real-time polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC). The association of clinical risk factors and AR expression were also analyzed.

Results: We noticed the majority of PTC specimens, both in male and female group exhibited lower AR expression level as compared to the normal thyroid tissues. Furthermore, the expression also notice those with higher cancer stage and extra-thyroidal extension had significant lower AR

Conclusions: These results highlight the importance of AR in PTC’s development and tumorigenesis, which may suggest the protective role of AR in PTC.

Key word: Papillary thyroid carcinoma: Androgen receptor

OE5

IODINE NUTRITIONAL STATUS OF PREGNANT WOMEN IN AN URBAN AREA OF NORTHERN TAIWAN WITH HIGH PREVALENCE OF PRENATAL MULTIVITAMIN INTAKE

1CHI-LUNG TSENG, 2CHANG-CHING YEH, 3CHEN-CHANG YANG, 4FAN-FEN WANG, 5CHUN-JUI HUANG

1Division of Gastroenterology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; 2Department of Obstetrics & Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; 3Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 4Department of Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan; 5Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

Background: Pregnant women has long been considered one of the most vulnerable group for pregnant women. However, the actual iodine nutritional status in pregnancy is unknown.

Design: status of pregnant women in Taiwan. In addition, dietary sources of iodine nutrition were investigated. A hospital-based cross-sectional survey of pregnant women was conducted in Taipei Veterans General Hospital in 2018. UIC was determined by inductively coupled plasma mass-spectrometry. A food frequency questionnaire was delivered.

Result: frequently consumed iodine-containing foods were dairy products. The use of iodine-containing dietary supplements was common (51.5% of the women consume multivitamins especially designed for pregnancy every day). The questionnaire also revealed that 42.3% of the women were unaware of the salt product (iodized or not) in their households.

Conclusion: The results indicate that the iodine status in pregnant women in Northern Taiwan is adequate. The difference in median UIC in pregnant women and women at child-bearing age generally may be related to the common use of iodine-supplement during pregnancy.

OE6

THERAPEUTIC PLASMA EXCHANGE IN THYROID STORM

1HSUAN-WEI LIN, 1,2CHIN-SUNG KUO

1Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; 2School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.

Background: Thyroid storm is an extreme manifestation of thyrotoxicosis with high mortality if inadequately treated. Agranulocytosis, a rare side effect of antithyroid drugs, poses further challenges which plasmapheresis was used preoperatively to treat thyroid storm complicated with agranulocytosis.

Case: A 57-year-old woman presented to the emergency department with fever, dyspnea, and sore throat. She was diagnosed with Graves’ disease 6 years prior and was treated with methimazole from then on, stopped for 3 months but resumed for 2 weeks by herself for progressive dyspnea and thyroid bicytopenia (WBC 1100/cumm, platelet 19000/cumm) and direct hyperbilirubinemia (total bilirubin 3.82 mg/dL) in addition to elevated troponin-I, undetectable TSH, and elevated free T4 > 5 ng/dL. Lugol’s solution was administered after one dose of propylthiouracil but discontinued both on the next day due to development of agranulocytosis (WBC 400/cumm, ANC 224/cumm). Plasmapheresis was started to control thyrotoxicosis. After 3 sessions of plasmapheresis, thyroid hormone levels decreased to normal range (free T3 2.2 pg/mL, free T4 0.86 ng/dL). 12 days later she received a total thyroidectomy uneventfully. She was subsequently discharged with levothyroxine replacement. Follow-up visit showed resolution of bicytopenia and hyperbilirubinemia.

Conclusions: Plasmapheresis has been used in the treatment of hyperthyroidism since 1970. While its role has not been established in the treatment of thyroid storm, prompt initiation of