Dr Philip Kelly & Dr Martin Whyte
King's Private, The Guthrie Wing,

King's College Hospital

London SE5 9RS

All content Copyright © 2019 Dr Philip Kelly

Dr Philip Kelly
9 Harley Street

London W1G 9GY

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LondonSwissMedical Ltd | Registered in England & Wales No: 10933216 | Registered Address 7 Lindum Terrace, Lincoln, LN2 5RP

Endocrinology

Endocrinology

I am a member of British Thyroid Association and the Society for Endocrinology.

My private clinical practice covers general & specialist endocrinology including:

  • Thyroid disease:

    • Thyroid disease is very common, particularly an underactive thyroid (hypothyroidism), and it can cause fatigue and weight gain. It is important to consider that these symptoms are far more common than an underactive thyroid and this sometimes requires some skill to work out whether the thyroid might be responsible. Anaemia, electrolyte disturbance, vitamin or mineral deficiency or adrenal dysfunction might be the cause so it pays to see someone who can look at the whole patient.

    • Hypothyroidism can be very subtle and whether to have a trial of therapy is an important decision. It can be very important in women of childbearing age to consider the pros and cons of their thyroid function with an expert if it is abnormal.

    • Hyperthyoidism in Graves' disease is common but it is not the only cause of, thyrotoxicosis; it can be due to nodular thyroid disease and the treatment is subtly different, especially in the long term.

    • More rarely the thyroid might be overactive because of transient inflammation and in this case the treatment is completely different. If you require a scan of the thyroid structure or function we can discuss the pros and cons, and arrange it at King's if necessary with our experts in thyroid imaging.

    • Very often hyperthyroidism requires consideration of drug treatment and I can discuss the options with you. and hypothyroidism, advice and guidance on what to do with 'sub-clinical' hypothyroidism, autoimmune thyroid disease and the management of thyroid disease in pregnancy.

    • Not every medication is suitable for every patient, intolerance or allergies to carbimazole or propylthiouracil do occur, it is important you are advised about them and that you are managed appropriately.

    • Thyroid disease also includes the very common clinical concern of thyroid nodules whether they are solitary or many nodules (a multinodular goitre).

    • The thyroid can be diffusely enlarged and in this case how long it has been enlarged, whether it is changing and what its consistency is are relevant as is the thyroid function.

    • While thyorid nodules are very common, thyroid cancer is rare, most cases are curable with prompt treatment. I work as part of a multidisciplinary team including specialist ultrasonographers, doctors, nuclear medicine doctors, pathologists, cytologists, specialist nurses and importantly other thyroid specialists so decisions about your treatment are considered by a team around you, helping us to make the best decisions. Very often this is to exclude cancer but sometimes it is to give a prompt diagnosis and work out who is best to help treat you.

    • Thyroid eye disease is important to consider and recognize, this can include a detailed ophthalmological assessment and treatment for Graves' ophthalmopathy. I also work with my specialist ophthalmology colleagues managing Graves' ophthalmopathy.

  • Parathyroid disease

    • Hyperparathyroidism usually causes elevation of the serum calcium, indeed that is why it is often recognized - the commonest condition it primary hyperparathyroidism secondary to a single benign tumour of a parathyroid - an adenoma - and if it can be removed you would be cured. There are very important diagnostic considerations to make before diagnosing primary hyperparathyroidism that often require a trained endocrinologist. Even then one must work with a surgeon who operates regularly on the parathyroids - the key decision is choosing a good surgeon! Many patients benefit from having their post-operative care alongside an endocrinologist, and we can arrange your operation at King's or  a hospital in London, sometimes elsewhere, of your choice but most importantly with the best surgeon for you.

      • The Surgeon I work most closely with is Mr John Lynn, practicing from The Lister Hospital and Harley Street, he is meticulous in preparation, helping the patients decide what is best for them, and if surgery might be necessary has an excellent team for parathyroid localisation, and during surgery will routinely use intra-operative recurrent laryngeal nerve monitoring and intra-operative PTH measurement - his results are excellent.

    • Hypoparathyroidism is most often a consequence of thyroid surgery, but can occur after radiotherapy, or more rarely the immune system damages the parathyroids. Increasingly magnesium deficiency is recognised as a cause. All these conditions can cause low calcium, muscle cramps, weakness and instability of the heart. Maintaining your calcium, magnesium and phosphate is critical. These all contribute to your bone and kidney health and getting the right balance is critical to keep you healthy for decades to come.

  • Vitamin D deficiency - this is extremely common and we understand more and more about the effects of it. Vitamin D is important for bone and muscle health; some patients who are deficient have fatigue and muscle aches. It is simple to check for, including if it is causing parathyroid overactivity. Your assessment can include advice on short and long term treatment and prevention, and this advice can be as relevant for you as it is for your family/ children.

  • Magnesium deficiency is common; my colleagues and I at The Royal London Hospital were one of the early groups to consider it alongside stomach medication and report on the problem. Alcohol and diuretics can contribute to magnesium wasting through the kidneys. The stomach drugs that can limit adequate magnesium absorption are common, if they are possibly interfering we can consider alternatives. Tests for intracellular stores are difficult and in my view at the edges of routine care, but a thorough consideration of your magnesium balance is still possible with quite simple tests..

  • Sodium and water balance disorders - hyponatraemia, diabetes insipidus, syndrome of inappropriate ADH secretion (SIADH), cerebral salt wasting and obligatory salt wasting of ageing or with renal disease.

  • Pituitary failure and hyper-secretion, pituitary and peri-pituitary tumours, including suspected and proven acromegaly or Cushing's disease and non-functioning pituitary adenomas.

  • Prolactin elevation, prolactinoma, amenorrhoea and infertility

  • Testicular failure and androgen deficiency, andrology and tesosterone replacement therapy

  • Adrenal disease, Cushing's syndrome and adrenal tumours including Conn's syndrome

  • Primary and secondary adrenal failure including Addison's disease, its diagnosis and long term management

  • Hypoglycaemia - fasting or after meals

  • Endocrine tumour syndromes and familial endocrine disease - though these will often be diagnosed and passed onto colleagues who specialise in their management.

  • Osteoporosis

  • Obesity

  • Lipid disorders, hypercholesterolaemia and mixed dyslipidaemia; this includes individual assessment of cardiovascular risk and the pros and cons of lipid therapy.

  • Disorders of weight, exercise and activity, particularly if causing loss of menstruation, erectile failure and/or osteoporosis

  • Long-terms effects of previous cancer treatment.

  • The diagnosis and management of the peri-menopause and menopause and consideration of non-hormonal treatment and hormone replacement therapy. This includes the vasomotor symptoms of the menopause, cognition, fatigue, lethargy and loss of libido and vaginal health, and general and bone health.

  • Premature ovarian failure, particularly in the context of hypothalmo-pituitary disease.

  • The use of testosterone to treat female androgen deficiency (FAD) and/ or hypoactive sexual desire disorder (HSDD), incuding the monitoring of your health on testosterone.

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