Thyroid peroxidase antibodies (TPO) and TSH receptor antibodies (TRAB) sometimes co-exist in patients with Graves disease (GD) but not always. Some studies have suggested a functional and prognostic role for TRAB but the phenotypic characteristics of the patient with positive TPO (with or without TRAB) and the infl uence of TPO on the clinical course of GD are not known.We therefore set out to examine the demographic and clinical profi le of patients with GD to assess for any association between TPO antibody expression (with or without TRAB) and the clinical course of the disease.We reviewed the health records of 14 patients with GD who were being followed up in the endocrine Clinic in East Kent between 2010 and 2011. Patients were divided into TPO-ve and TPO+ve groups and demographic and clinical data collected. Data are expressed in %, mean + SD and a p value of 0.05 was deemed signifi cant 9 Patients were TPO+ve . They were predominantly female (89%) and younger compared to the TPO-ve group. A positive family history was present in 60% TPO+ve patients but in none of the TPO-ve patients. TPO+ve patients were treated for longer and had 30% relapse rate within 12months of discontinuing therapy and 20% needed radioactive iodine therapy (RAI) early. None of the TPO-ve relapsed nor required RAI. TRAB was also higher in the TPO-ve patients This study has demonstrated that the presence of TPO in Graves disease results in a phenotype of patients with a more aggressive disease pattern that occurs mainly in females and younger age group, takes longer to treat and has a higher relapse rate compared to TPO -ve patients. This fi nding has practical implications for the management of GD but larger studies will be required to confi rm the fi ndings. Putting patients f irstEast Kent Hospitals University NHS Foundation Trust NHS

No abstract

Infective endocarditis remains an interesting and challenging disease in which the presenting features have been modified by medical progress. We report a case of a 63-year-old woman who presented with pyrexia, weight loss, night sweats and fatigue over a period of 7 weeks, at the end of which she developed severe right hypochondrial pain, mimicking acute abdomen. She was provisionally diagnosed with and treated for acute cholecystitis to no avail. An abdominal computed tomography scan was performed and revealed the presence of right kidney infarction, the source of which was later proven to originate from aortic valve endocarditis. The patient made a remarkable recovery following 6 weeks of treatment with intravenous antibiotics. This case demonstrates that endocarditis can present as an acute abdomen which is caused mainly by embolism in various organs (the kidney in our patient).

No abstract