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Mirjam Eiswirth, Ewan Clark, and Michael Diamond

the potentially mortal risks of severe hypoglycaemia and/or ketoacidosis. Before the advent of exogenous insulin, the only medical treatment available was a strict adherence to a low carbohydrate diet. Today, insulin is most commonly injected as a

Open access

Naweed Alzaman, Anastassios G Pittas, Miriam O'Leary, and Lisa Ceglia

. Treatment Over the following five days, doses of calcium carbonate were increased to 4 g, calcitriol to 4 μg, and vitamin D 2 to 50 000 IU daily. The chyle leak was managed by initiating both a medium chain fatty acid diet, which contained a low fat

Open access

Marianne Geilswijk, Lise Lotte Andersen, Morten Frost, Klaus Brusgaard, Henning Beck-Nielsen, Anja Lisbeth Frederiksen, and Dorte Møller Jensen

a woman with symptomatic HHF3 treated with octreotide injections in one pregnancy and with a low carbohydrate diet only in a subsequent pregnancy. During the first pregnancy with a viable fetus intrauterine growth retardation (IUGR) developed whilst

Open access

D Cappellani, C Sardella, M C Campopiano, A Falorni, P Marchetti, and E Macchia

). Figure 1 Insulin autoantibodies (IAA) concentrations during the follow-up. On the X axis time is represented in months from the first report of IAA. Treatment The patient’s diet was modified with the introduction of high frequent and

Open access

Sarah W Y Poon, Karen K Y Leung, and Joanna Y L Tung

insulin as an adjunct to lower the TG, followed by medium-chain triglyceride (MCT)-based diet, and subsequently, strict dietary fat restrictions as long-term management in a young infant with familial chylomicronemia syndrome (FCS) due to lipoprotein

Open access

Gordon Sloan, Amjad Ali, and Jonathan Webster

preceding four days. She had no significant past medical history and took no prescribed medications or recreational substances. She did not drink excessive quantities of alcohol. The patient had strictly followed a low carbohydrate diet for two years. She

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Michelle Maher, Mohammed Faraz Rafey, Helena Griffin, Katie Cunningham, and Francis M Finucane

may not be cost effective ( 6 ). The use of semi-skimmed milk (with micronutrient, salt and fibre supplementation) in a low-energy liquid diet (LELD) as an alternative to commercial meal replacement has not previously been described but may have

Open access

Albert S Kim, Rashida Hakeem, Azaliya Abdullah, Amanda J Hooper, Michel C Tchan, Thushari I Alahakoon, and Christian M Girgis

subject was kept in a fasting state for 72 h, following which she was commenced on a fat-restricted diet (<10 g/day). Betamethasone was administered to promote fetal lung maturation. The triglycerides improved and reached a nadir of 10.0 mmol/L (886.0 mg

Open access

Marcela Rodríguez Flores, Ruth Carmina Cruz Soto, Verónica Vázquez Velázquez, Reina Ruth Soriano Cortés, Carlos Aguilar Salinas, and Eduardo García García

Background Bariatric surgery is the most effective treatment to achieve significant and sustained weight loss in patients with moderate and severe obesity and to attain better control of comorbidities compared with diet and exercise. The

Open access

S Pearson, C Donnellan, L Turner, E Noble, K Seejore, and R D Murray


We present the case of a thirty-year-old female patient who was referred to the endocrinology team with an enlarging goitre and biochemical hypothyroidism. She had been dependent on total parenteral nutrition for the previous six years as a result of intestinal failure thought to be caused by possible underlying mitochondrial disease. The patient also suffers from a Desmin myopathy, and at present, the exact aetiology behind her intestinal failure is not certain. The goitre was smooth and had been enlarging slowly over the previous few months. Thyroid peroxidase antibodies were found to be within normal range. Further analysis of the case showed that twelve months earlier the patients total parenteral nutrition (TPN) feed had been altered as a result of manganese toxicity. The current feeding regimen did not contain a trace element additive which had previously supplied iodine supplementation. A little detective work established that iodine content to the TPN had been reduced, the trace element additive (Additrace) was recommenced providing 1 µmol of iodine per day, equating to 130 µg of iodine. Following this change, thyroid-stimulating hormone levels returned to normal and the goitre quickly reduced in size. We present a rare case of endemic goitre and hypothyroidism in a patient receiving inadequate iodine supplementation through total parenteral nutrition.

Learning points:

  • Endemic goitre and hypothyroidism secondary to iodine deficiency are rare in the developed world. However, the diagnosis should be considered in the setting of a diffuse goitre and negative thyroid antibodies.

  • Although rare, endemic goitre should be considered in patients who present with hypothyroidism and who are dependent on total parenteral nutrition.

  • Treatment with levothyroxine is not required in endemic goitre as thyroid function tests generally normalise with the addition of iodine to the diet/total parenteral nutrition regimen.

  • Iodine supplementation at a level recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) was observed to quickly normalise this patient’s thyroid function tests.