Novel pathways promoting thyroid tumourigenesis and growth

Lead Research Organisation: University of Birmingham
Department Name: Clinical and Experimental Medicine

Abstract

Thyroid cancers are the most common endocrine malignancies in England and Wales and their incidence is rising. Since these tumours have a tendency to recur following surgery, patients are often offered treatment with radioiodine (131I) to prevent tumour re-growth. In addition, benign thyroid gland enlargements (goitres) affect up to 50% of the population and 131I therapy is increasingly used in their management.
Although we remain unsure which mechanisms control the growth of these thyroid tumours, our studies have shown that a cancer-causing gene called pituitary tumor transforming gene (PTTG) plays a role. PTTG stimulates tissue growth through interactions with growth promoting molecules and our preliminary findings demonstrate that PTTG directly affects the uptake of radioiodine by thyroid cells. We propose to assess the ways in which PTTG interacts with a number of growth factors and which mechanisms are involved in this process using thyroid cells in culture. Additionally we will study the in vivo effects of reduced and increased PTTG expression in the thyroid using mouse models. Finally we propose to investigate if the effects of PTTG on radioiodine uptake can be inhibited in order to improve the treatment of thyroid diseases. These investigations will be carried out by researchers who have made significant contributions to characterising the role of PTTG in thyroid disease.

Technical Summary

Thyroid neoplasia (cancers) and hyperplasia (goitres) are common clinical entities and interactions between oncogenes and growth factors are pivotal in their pathogenesis. We have identified the pituitary tumor transforming gene (PTTG) as a novel molecular indicator of prognosis for thyroid cancers. PTTG has a dual role in thyroid tumourigenesis firstly by inducing genetic instability and subsequently by promoting tumour growth and angiogenesis. Interactions between PTTG and growth factors (e.g.FGF-2) are well described and we have demonstrated that this is regulated via PTTG‘s SH3-interacting domain. Recently mitogenic factors implicated in thyroid tumourigenesis (IGF-1, TGF?, HGF and EGF) were found to regulate PTTG in breast cancer and astrocytoma cells. Of particular clinical relevance are our preliminary findings that PTTG and its binding factor (PBF) repress expression and function of the sodium iodide symporter (NIS) thereby potentially affecting the treatment of thyroid diseases with radioiodine.
We hypothesise (i) that PTTG promotes the growth of thyroid tumours through paracrine/autocrine interactions with growth factors and (ii) that this is regulated via PTTG‘s SH3-interacting domain. (iii) Additionally, we propose that PTTG under-and overexpression affects thyroid gland growth and (iv) that amelioration of PTTG-induced NIS repression may improve treatment of thyroid diseases with radioiodine.
To test our first hypothesis we propose to use a number of in vitro techniques to unravel the autocrine/paracrine pathways of interaction between PTTG and growth factors such as IGF-1, EGF, HGF and TGF? in thyroid cells to identify potential therapeutic targets. Additionally we will relate the expression of these mitogens in our thyroid tissue cohort to our existing molecular and clinical findings to determine their role as prognostic markers. Secondly, we will explore the mechanism of growth factor-PTTG interaction using a mass spectrometry proteomics appr to identify functionally relevant proteins determining this interaction. Thirdly we will investigate the effects of PTTG under- and targeted overexpression on thyroid growth in mouse models. We will attempt to induce goitres in PTTG knockout mice (provided by Professor Melmed, University of California) and develop a thyroglobulin-driven PTTG transgenic mouse model in collaboration with Professor Fagin (University of Cincinnati). We will examine effects on thyroid specific gene expression and thyroid cell differentiation and function in both models. Finally we will investigate if amelioration of PTTG‘s effects could lead to improvements in the treatment of patients with thyroid disease with radioiodine. We will investigate the effects of PTTG/PBF on subcellular localisation and function of NIS and determine if disruption of PTTG-induced NIS repression represents a potential means of modulating the treatment of thyroid diseases with radioiodine.

Publications

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Boelaert K (2010) Thyroid gland: Revised guidelines for the management of thyroid cancer. in Nature reviews. Endocrinology

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Boelaert K (2013) Comparison of mortality in hyperthyroidism during periods of treatment with thionamides and after radioiodine. in The Journal of clinical endocrinology and metabolism

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Boelaert K (2009) The association between serum TSH concentration and thyroid cancer. in Endocrine-related cancer

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Boelaert K (2011) Thyroid cancer: finding the malignant thyroid nodule in the haystack. in Nature reviews. Endocrinology

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Boelaert K (2010) Treatment of Graves' disease with antithyroid drugs: current perspectives. in Thyroid : official journal of the American Thyroid Association

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Boelaert K (2013) Thyroid dysfunction in the elderly. in Nature reviews. Endocrinology

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Boelaert K (2010) Older subjects with hyperthyroidism present with a paucity of symptoms and signs: a large cross-sectional study. in The Journal of clinical endocrinology and metabolism

 
Description British Thyroid Association Executive Committee member
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact Improvements in the management of patients with thyroid disorders.
 
Description Course Organiser for National 131-I training scheme
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact An increased number of consultants applying for radioiodine licenses amongst endocrinologists.
 
Description Election to American Endocrine Society Self-Assessment Committee
Geographic Reach North America 
Policy Influence Type Influenced training of practitioners or researchers
Impact Member of panel setting question for professional licensing exam for US endocrinologists
 
Description Election to Diabetes and Endocrinology SCE Board
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Setting of questions for Diabetes and Endocrinology Exit exam
 
Description Participation in UK Low Iodine Diet Working Party'
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description Set-up of working group for national guidelines on management of thyroid disorders in pregnancy
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description SfE Clinical Update Course
Geographic Reach Europe 
Policy Influence Type Influenced training of practitioners or researchers
Impact Improved management of patients with thyroid nodules and thyroid cancer by educating clinicians in training
 
Guideline Title British Thyroid Association Guidelines for the Management of
Description Thyroid Cancer Development Group Guidelines
Geographic Reach National 
Policy Influence Type Citation in clinical guidelines
 
Description UK guidelines for management of thyroid disease in pregnancy
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description Clinical Endocrinology Trust Quality Improvement Project
Amount £20,000 (GBP)
Organisation Society for Endocrinology 
Sector Learned Society
Country United Kingdom
Start 12/2014 
End 12/2016
 
Description HTA project grant - commisioned call
Amount £1,350,000 (GBP)
Funding ID 12/19/04 
Organisation National Institute for Health Research 
Department Health Technology Assessment Programme (HTA)
Sector Public
Country United Kingdom
Start 11/2013 
End 11/2018
 
Description Large Project Grant
Amount £825,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 11/2016 
End 05/2020
 
Description MRC DPFS
Amount £976,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 03/2016 
End 07/2020
 
Description MRC DTA PhD studentship
Amount £76,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 10/2009 
End 10/2013
 
Description MRC Project Grant
Amount £313,615 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 12/2007 
End 12/2010
 
Description MRC Research Grant
Amount £649,169 (GBP)
Funding ID MR/J001414/1 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 07/2012 
End 07/2016
 
Description Siriraj Medical School PhD studentship
Amount £82,000 (GBP)
Organisation Siriraj Medical School 
Sector Academic/University
Country Thailand
Start 10/2013 
End 10/2016
 
Description Small Grant Award Scheme
Amount £14,000 (GBP)
Organisation Thyroid Eye Disease Charitable Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 12/2014 
End 12/2015
 
Description UHB Charities Research Grant
Amount £34,985 (GBP)
Organisation Queen Elizabeth Hospital Birmingham Charity (QEHB) 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2011 
End 08/2012
 
Description University of Birmingham, College of Medical and Dental Sciences, PhD consortium on Endocrine Cancer
Amount £150,000 (GBP)
Organisation University of Birmingham 
Department College of Medical and Dental Sciences
Sector Academic/University
Country United Kingdom
Start 10/2011 
End 10/2015
 
Title Epidemiological analysis of mortality in patients with overt and subclinical hyperthyroidism 
Description Collaboration with Dr Patrick Maisonneuve, European Institute of Oncology, Milan to analyse mortality data in patients with thyroid disease. 
Type Of Material Model of mechanisms or symptoms - human 
Provided To Others? No  
Impact Presentation of findings presented to national and international audiences. Results are likely to be published in high impact factor journal. 
 
Title Generation of Tg-PTTG transgenic mouse model 
Description We have generated a transgenic mouse model with targetted overexpression of PTTG in the thyroid gland. In parallel experiments within our group we have developed a model of thyroid specific overexpression of the PTTG Binding Factor (PBF). In addition we have generated a double trangenic mouse model with targetted overexpression of both PTTG and PBF. 
Type Of Material Model of mechanisms or symptoms - mammalian in vivo 
Provided To Others? No  
Impact We are currently in the process of characterising our transgenic mouse models and the results are being reported in abstracts submitted to national and international meetings. These results will in due course be disseminated in manuscripts to be submitted to high impact factor journals. 
 
Title Human thyroid sample collection 
Description We have increased our existing cohort of thyroid specimens including normal thyroid samples, goitres and thyroid carcinomas. In addition we have been able to establish a cohort of matched thyroid tissues where normal and tumourous tissue originating from the same thyroid gland have been collected. 
Type Of Material Biological samples 
Provided To Others? No  
Impact We have numerous peer reviewed publications based on our collection of thyroid specimens including: PMID 17297475, 16926250, 16394085, 15886233, 12727994. This expanding resource of samples in invaluable in our ongoing research into the pathogenesis of thyroid tumourigenesis 
 
Title Model to predict weight gain following treatment for hyperthyroidism 
Description Statisitcal model to predcit weight gain following treatment of hyperthyroidism 
Type Of Material Model of mechanisms or symptoms - human 
Provided To Others? No  
Impact This is likely to aid people in the decision making process regarding the most optimal treatment option for hyperthyroidism 
 
Title PICS database 
Description Use of hospital database for analysis of large patient cohorts 
Type Of Material Model of mechanisms or symptoms - human 
Provided To Others? No  
Impact Submission of abstracts to national and international meetings 
 
Title Primary human thyroid cell culture 
Description In collaboration with Dr Eggo, a world-renowned expert in the field of primary human thyroid cell culture we have improved this methodology and are now in a position to maintain primary human thyrocytes in culture for up to 4 weeks. In addition methodology of performing iodide uptake assays have been optimised. 
Type Of Material Technology assay or reagent 
Year Produced 2007 
Provided To Others? Yes  
Impact We have numerous publications involving primary human thyroid cell culture methodology including PMID: 17297475, 16926250, 15591026, 16394085. The results from our optimised techniques are currently being reported in abstracts to national and international meetings. In addition the results will be reported in manuscripts which will be submitted to high impact factor journals. 
 
Title Primary mouse thyroid cell culture 
Description We have established methodology to maintain mouse thyrocytes in primary culture for up to 3 weeks. In addition we have estblished methods of performing iodide uptake assays in these cultures, experiments which are all vital to the characterisation of our transgenic mouse models. 
Type Of Material Technology assay or reagent 
Provided To Others? No  
Impact Results from iodide uptake assays have been included in abstracts submitted to national and international meetings. These data will also be included in forthcoming peer reviewed publications on these results. 
 
Title Whole exome sequencing to identify novel genes in congenital hypothyroidism 
Description In collaboration with researchers in Cambridge we have analysed a number of samples and identified potential candidate genes 
Type Of Material Technology assay or reagent 
Provided To Others? No  
Impact This will help to further unravel the genetic basis of congenital hypothyroidism 
 
Title Database of patient with thyroid cancer in West Midlands 
Description Multicentre database collecting baseline data and outcomes of patients treated for thyroid cancer in 6 West Midlands secondary and tertiary care centres 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact Database in set-up. No outputs yet. Grant application in progress. 
 
Title Thyroid Clinic Database 
Description Continuation and improvement of database with multiple important outputs. 
Type Of Material Database/Collection of data 
Year Produced 2012 
Provided To Others? Yes  
Impact Multiple high impact factor papers 
 
Title multi-centre register of pregnant women with thyroid disorders 
Description Joint database in set-up. Collaboration between Birmingham and Cardiff. Collection of data and outcomes of women with thyroid disorders in pregnancy. 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact No noticeable impacts yet. A number of important outputs expected 
 
Description Analysis of data regarding mortality from hyperthyroidism 
Organisation European Institute of Oncology (IEO)
Country Italy 
Sector Charity/Non Profit 
PI Contribution Gathering of mortality data from large patient cohort with hyperthyroidism
Collaborator Contribution Collaboration with Dr Maisonneuve in the Unit of Clinical Epidemiology for analysis of large mortality study
Impact Abstract submitted to Annual Meeting of British Endocrine Societies. Masnuscript to be submitted to high impact journal early 2010
Start Year 2008
 
Description British Athletics 
Organisation British Athletics
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Advice on management of hypothyroidism in athletes
Collaborator Contribution Continued liaison and drafting of guidelines on management of hypothyroidism in athletes
Impact Drafting of guidelines on management of hypothyroidism in athletes Presented at British Association of Sports and Exercise Meeting
Start Year 2014
 
Description Determination of mouse serum TSH concentrations 
Organisation University of California, Los Angeles (UCLA)
Department Harbor-UCLA Medical Center
Country United States 
Sector Academic/University 
PI Contribution Generation of thyroid specific mouse model overexpressing PTTG in thyroid gland. Obtaining of mouse serum samples.
Collaborator Contribution In collaboration with Dr Parlow we have been able to determine serum TSH concentrations for our 2 current transgenic mouse models of overexpression of PTTG and PBF respectively.
Impact Data regarding mouse serum TSH concentrations are currently being incorporated into abstracts and manuscripts describing the mouse models.
Start Year 2008
 
Description Elastography in the diagnosis of thyroid cancer 
Organisation University Hospitals Birmingham NHS Foundation Trust
Department Radiology
Country United Kingdom 
Sector Hospitals 
PI Contribution Application for HTA-funded grant evaluating the usefullness of elastography in diagnosis of thyroid cancer
Collaborator Contribution Working towards submission of full application for HTA funded grant
Impact HTA-preliminary application accepted. Working on full application
Start Year 2012
 
Description Generation of transgenic mouse model 
Organisation University of Birmingham
Department College of Medical and Dental Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution Screening and characterisation of transgenic mouse model
Collaborator Contribution Generation of mouse model with targetted thyroid specific overexpression of PTTG.
Impact Abstract regarding initial results from characterisation studies submitted to Annual Meeting of BES.
Start Year 2007
 
Description HTA elastography trial 
Organisation Royal Victoria Infirmary
Department Department of Radiology
Country United Kingdom 
Sector Hospitals 
PI Contribution Successful HTA grant application
Collaborator Contribution Successful HTA grant application
Impact Successful grant application
Start Year 2012
 
Description HTA elastography trial 
Organisation University Hospitals Birmingham NHS Foundation Trust
Department Radiology
Country United Kingdom 
Sector Hospitals 
PI Contribution Successful HTA grant application
Collaborator Contribution Successful HTA grant application
Impact Successful grant application
Start Year 2012
 
Description Immunotherapy for Graves' disease 
Organisation Newcastle University
Country United Kingdom 
Sector Academic/University 
PI Contribution Centre in a first in man study of immunotherapy in patients with Graves' disease.
Collaborator Contribution Help with grant application. Identification of eligible patients. Planned treatment of patients.
Impact First in man study about to commence. No outputs yet.
Start Year 2015
 
Description Investigation of autocrine and paracrine pathways of interaction between PTTG and growth factors 
Organisation University of Birmingham
Department College of Medical and Dental Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution Gained expertise in primary culture of mouse thyroid cells which is an important part of the characterisation of our transgenic mouse models. Continued valuable discussions regarding pathways involving growth factors and their role in thyroid tumourigenesis
Collaborator Contribution Training of staff in primary human and mouse thyroid culture techniques. Intellectual contribution and shared expertise.
Impact Co-authors on numerous publications. PMID: 19706688, 17297475, 16926250, 16394085, 15886233, 15591026
Start Year 2007
 
Description Investigation of management of medullary thyroid cancer in multi-centre collaboration 
Organisation Ohio State University
Country United States 
Sector Academic/University 
PI Contribution Provision of data regarding diagnosis, management and outcomes of patients with medullary thyroid cancer.
Collaborator Contribution Provision of data, analysis of results, contribution to writing of manuscripts
Impact Publications: PMID 27604949 and PMID 23757627
Start Year 2011
 
Description Investigation of thyroid gland of PTTG knockout mice 
Organisation Cedars-Sinai Medical Center
Country United States 
Sector Hospitals 
PI Contribution Currently investigating thyroid status of PTTG knockout mice. Experiments of goitre induction to be set up in 2010.
Collaborator Contribution Professor Melmed has supplied PTTG knockout mice for studies of goitrogenesis and thyroid tumour growth
Impact Long standing collaboration. Co-authors on PMID: 15591026. Experiments involving PTTG knockout mice are currently being set up. Results expected by middle of 2010.
Start Year 2007
 
Description Iodine supplementation in pregnancy 
Organisation University of Surrey
Department Faculty of Health and Medical Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution Submission of outline grant application to HTA with succesful outcome
Collaborator Contribution Submission of outline grant application to HTA with succesful outcome
Impact Successful submission of outline HTA application
Start Year 2012
 
Description Novel genes in congenital hypothyroidism 
Organisation University of Birmingham
Department College of Life and Environmental Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution New Collaboration with Professor Eamonn Maher to fund project evaluating new candidate genes in congential hypothyroidism.
Impact Award of UHB Charities grant for whole exome sequencing on 200 samples from consanguinous familes with congenital hypothyroidism.
Start Year 2010
 
Description Outcomes relating to thyroid function testing 
Organisation University Hospitals Birmingham NHS Foundation Trust
Country United Kingdom 
Sector Public 
PI Contribution Set up of new study and submission of abstracts
Collaborator Contribution Set up of new study and submission of abstracts
Impact Abstract submission
Start Year 2012
 
Description Proteomics approach to investigate proteins interacting with PTTG 
Organisation University of Birmingham
Department College of Life and Environmental Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution Collaboration with Dr Ashley Martin, School of Cancer Sciences, University of Birmingham. We are currently employing mass-spectrometry appraoches to investigate the proteins interacting with and binding to PTTG and PBF. Protocols for experiments have been optimised.
Impact This collaboration has resulted in obtaining MRC funding for another Clinical Research Fellow and forms part of a University of Birmingham (College of Medical and dental Sciences)-funded PhD consortium.
Start Year 2010
 
Description Rituximab in young patients with Graves' disease 
Organisation Newcastle University
Department Institute of Genetic Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Obtained funding from the MRC-DFPS scheme for phase II trial of Rituximab in young patient with Graves' disease
Collaborator Contribution Collaborative wirting of grant proposal which has passed the outline stage of MRC-DFPS scheme
Impact Multidisciplinary collaboration between paeditricians, endocrinologists and genetecists
Start Year 2014
 
Description Set up of trial to evaluate Digital Infrared Thermal Imaging for Early Diagnosis and Disease Monitoring in Thyroid Eye Disease 
Organisation University Hospitals Birmingham NHS Foundation Trust
Department Ophthalmology
Country United Kingdom 
Sector Hospitals 
PI Contribution Application for grant funding and set up of trail evaluating this new technology
Collaborator Contribution Application of grant funding and set up of trail evaluating new technology
Impact Successful grant application
Start Year 2013
 
Description prevention of excessive weight gain following antithyroid treatment 
Organisation University of Oxford
Country United Kingdom 
Sector Academic/University 
PI Contribution Development of interventional trial
Collaborator Contribution Grant application to NIHR/RfPB planned
Impact Grant application to be submitted January-June 2014
Start Year 2011
 
Description 3. Christie Hospital Manchester Annual Educational meeting for Joint Endocrine Tumour Group. New UK thyroid cancer guidelines: highlights" 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presented main aspects of New UK Thyroid Cancer Guidelines which I co-wrote
Year(s) Of Engagement Activity 2014
 
Description 97th Annual Meeting of the Endocrine Society (Endo 2015). Meet the Professor Session, San Diego, USA, March 2015. "ESAP- Thyroid Cases" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presented difficult cases of thyroid Cancer at the largest international Endocrine Meeting.
Year(s) Of Engagement Activity 2015
 
Description A novel mechanism of reduced iodide uptake in differentiated thyroid cancer 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Gave 25 minute presentation on research results to the Association of Physicians Annual Meeting in Birmingham, April 2009

This presentation highlighted our novel findings and ongoing research into the pathogenesis of thyroid tumour growth. This was a particularly esteemed audience.
Year(s) Of Engagement Activity 2009
 
Description A novel mechanism of sodium iodide symporter repression in differentiated thyroid cancer. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 15 minute oral plenary abstract presented at the annual meeting of the American Thyroid Association. This was presented by Dr Vicki Smith

We have engaged in lively scientific discussions with other researchers working in similar fields.
Year(s) Of Engagement Activity 2008
 
Description ATA meet the professor 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 150 people attended talk which sparked questions and discussion.

Invited to give further talks in 2014
Year(s) Of Engagement Activity 2013
 
Description ATA symposium speaker 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Talk sparked questions and discussion afterwards

Invitations for further presentations
Year(s) Of Engagement Activity 2014
 
Description Academy of Medical Sciences Outreach and Mentoring Event 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Gave presentation on how to manage multiple roles in a Clinical Academic Career.

Stimulated interesting discussion and resulted in contact with several colleagues from across the university asking for advice when applying for fellowships.
Year(s) Of Engagement Activity 2011
 
Description BACO presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Gave presentation which sparked interesting discussions

Continued discussions with other helath professionals
Year(s) Of Engagement Activity 2012
 
Description BAETS 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Participants in your research and patient groups
Results and Impact Presentation of new UK thyroid cancer guidelines

Further invitations to deliver talks on the same subject
Year(s) Of Engagement Activity 2014
 
Description BTF Patient Forum - Hyperthyroidism and Graves' Disease 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Presentation to the GAH/BTF patient group with thyroid disorders sparking lively discussions
Year(s) Of Engagement Activity 2015
 
Description Bart's and The London Endocrine Club 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact 60 clinicians and scientists attended the grand round which sparked stimulating discussions

New interactions with other Endocrinologists were established.
Year(s) Of Engagement Activity 2011
 
Description Belgian Thyroid club 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Health professionals
Results and Impact 200 attendees attended key note lecture which sparked discussion afterwards

Increased international profile
Year(s) Of Engagement Activity 2012
 
Description Controversies and Innovations in the Assessment of Thyroid Nodules 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact 150 people attended an animated workshop with vibrant discussions. Current controversies and guidance on diagnosis and management of thyroid nodules were discussed.
Year(s) Of Engagement Activity 2016
 
Description Grand Round at the Mayo Clinic 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 50-60 Endocrinologists attended the grand round

Stimulated interesting discusssions with colleagues
Year(s) Of Engagement Activity 2011
 
Description Induction of hypothyroidism with radioactive iodine therapy is associated with improved survival in patients with hyperthyroidism 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Talk was attended by over 500 health professionals with vivid discussion following the presentation.

We have engaged in lively scientific discussions with other researchers working in similar fields
Year(s) Of Engagement Activity 2010
 
Description Management of Hypothyroidism 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Presented update on management of hypothyroidism according to recent guidance

Gave presentation to ~ 200 nurses which stimulated interesting discussions
Year(s) Of Engagement Activity 2012
 
Description Milton Keynes BTF meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Participants in your research and patient groups
Results and Impact 60 patients attended presentation and participated in lively discussion

Increased interaction with national patient group
Year(s) Of Engagement Activity 2013
 
Description National Radioiiodine Training Scheme 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Health professionals
Results and Impact 30 particiapnts who are now trying to obtain license for administration of radioiodine

Applications for 131-I adminstration licenses ongoing
Year(s) Of Engagement Activity 2012
 
Description Patient Forum Discussion 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Thyroid Eye Disease Charitable Trust meeting attended by around 50 patients.

Stimulated engaging discussions with patients and colleagues
Year(s) Of Engagement Activity 2011
 
Description Patient Forum Presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Participants in your research and patient groups
Results and Impact 60 patients attended presentation

A number of patients asked to be referred to my clinic
Year(s) Of Engagement Activity 2012
 
Description Paucity of symptoms and signs of hyperthyroidism in elderly people 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presented findings of our epidemiology research into the management of thyroid disorders in general

This talk highlighted the need for physicians to adopt a low treshold to perform thyroid function testing in elderly people.
Year(s) Of Engagement Activity 2009
 
Description Role of new TKIs in thyroid cancer 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presented the most recent evidence on use of novel drugs used in the management of thyroid cancer in a PechaKucha format.
Year(s) Of Engagement Activity 2016
 
Description Royal Marsden Conference: "ATA vs ETA vs BTA thyroid cancer guidelines. Is there a consensus?" 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Comparison of National, Europen and american Guideloines on the Management of Thyroid Cancer
Year(s) Of Engagement Activity 2015
 
Description SfE Clinical Update Course 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Type Of Presentation Workshop Facilitator
Geographic Reach International
Primary Audience Health professionals
Results and Impact Gave brief presentation and facilitated workshop

Improvement in part 3 exit exam results of participants
Year(s) Of Engagement Activity 2012
 
Description Symposium Speaker European Congress for Endocrinology 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 200 clinicians attended talk on "Thyroid Dysfunction in the Elderly"

Asked to write review article for Nature Reviews in Endocrinology.
Year(s) Of Engagement Activity 2011
 
Description Talk at local high school (KEHS) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Local
Primary Audience Schools
Results and Impact Talked to girls at local high school about life as a clinical academic. 100 girls attended and a long discussion was held afterwards.

School asked me to return in 2014.
Year(s) Of Engagement Activity 2013
 
Description Thyroid cancer: causes, treatments, side effects and recurrence 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Presentation to 35 patients with thyroid cancer followed by a question and answer session.

The presentation was well received with positive patient comments quoted on the BTF website.
Year(s) Of Engagement Activity 2010
 
Description Trustee GetAhead Charity 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Participants in your research and patient groups
Results and Impact Decided on funding of research applications

Stimulating exciting research projects
Year(s) Of Engagement Activity 2012,2013,2014