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

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 their thyroid function with an expert, if it is abnormal, and if someone is considering assisted conception your clinic will usually want an endocrinologist to help get your thyroid function to be perfect before embarking on a cycle of ovulation induction, IVF, or embryo transfer.

Sub-Clinical Hypothyroidism

Many people require advice and guidance on what to do with 'sub-clinical' hypothyroidism, autoimmune thyroid disease and the management of thyroid disease in pregnancy.

Hyperthyoidism

Graves' disease is an antibody mediated thyrotoxicosis; it is more common in, but not restricted to, younger patients and patients can become very thyrotoxic. We can make your diagnosis and help you decide what is the right treatment for you.

 

As we age multi-nodular thyroid disease becomes slightly more common and some patient have thyrotoxicosis alongside this,, the treatment is subtly different than for Graves', antibody mediated thyrotoxicosis, especially in the long term.

A single nodule, a toxic adenoma, can also cause thyrotoxicosis, again the treatment is quite different so this is important to diagnose. 

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 why and how we go about this; we can arrange these scans at place that is convenient for you, but that at The Shard, 25 Harley Street, the London Clinic or at King's if necessary - we will always have the right person do your investigations, it is important to use the best people to give us the best information..

Very often hyperthyroidism requires consideration of drug treatment and I can discuss the options with you, both for short and longer term control..

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.

Nodular thyroid disease

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

This 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, radiology and neurosurgery colleagues in a small team managing Graves' ophthalmopathy./ thyroid eye disease (TED) uniquely placed to consider everything from the use of selenium, steroids, immunosuppressants, cosmetic surgery and orbital decompression.

Menopause

A larger part of my work is in the the diagnosis and management of the peri-menopause and menopause and consideration of both non-hormonal treatment and hormone replacement therapy. This includes the management of vasomotor symptoms of the menopause such as sweating and flushing, insomnia, cognition problems, 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 needs attention to the cause and the consequences of the disease as well as helping you understand the role of HRT.

We will usually discuss 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.

​Pituitary disease

Pituitary disease is rare, but the consequences are serious. We can consider if you have hypothalamus and/or pituitary failure and hyper-secretion, whether you have a pituitary or peri-pituitary tumour, including suspected and proven acromegaly or Cushing's disease and non-functioning pituitary adenomas.

Prolactin

Prolactin elevation is very common and Dr Kelly can quickly help work out what the problem is and how to treat it. Prolactinomas are also common and they can cause loss of the periods, erectile failure, loss of libido, inappropriate breast milk production and infertility.

Testicular failure and androgen deficiency

Concerns about testosterone are common; testosterone affects our sense of self, libido, sexual function (in both men and women) it is essential for the proper completion of puberty, and development and maintenance of the skeleton, and the management of testosterone problems is important as it can affect fertility. All these matters must be considered thoroughly and promptly in the relevant patients. This will always include a detailed clinical assessment, often include blood tests to find out the cause, sometimes seminal samples and on occasion MRI of the hypothalamus and pituitary. If you are deficient in testosterone then an accurate diagnosis is important, before getting you properly titrated and monitored, on an appropriate dose

Adrenal disease

Cushing's Syndrome

These glands are involved in Cushing's syndrome which requires very specialist consideration, and they can also be the site of adrenal tumours, including cancer.

Conn's syndrome

Conn's syndrome or primary aldosteronism is a common cause of hypertension, and an even more common cause of severe hypertension; again this requires very careful, specialist investigation working hand in hand with the laboratory, nurses, radiologists and sometimes surgeons, to diagnose, treat and sometimes completely cure you.

Addison's disease or

Primary adrenal failure

This is rare and very easy to miss; it is essential to diagnose it as it can be fatal if untreated and making patinet's safe and having them feel better is relatively straightforward; keeping patients well for the years and decades they might have Addison's is harder and requires very careful work between the patient, endocrinologist, laboratory, and nurses often brining in bone health and blood pressure control.

Secondary Adrenal Failure

This is common by distinction, patients on steroid tablets, inhalers, creams and drops are at risk of developing this. In some parts of the world steroids are found in over the counter cosmetics. It is very important to diagnose and treat it, for some patients, with skill full management, it is curable. Some of my work with colleagues in respiratory medicine has been around reducing the harm of steroids, which includes safe down titration of doses - improving patients long-term health.

Parathyroid disease

Hyperparathyroidism

This usually (but not always) causes elevation of the serum calcium; the elevation is why it is often found, on a blood test done for some other reason, but hypercalcaemia can leave people feeling unwell in very vague ways.

The commonest cause of primary hyperparathyroidism is a single benign tumour of a parathyroid - an adenoma - and if it can be removed the patient would be cured. There are very important diagnostic considerations to make before diagnosing primary hyperparathyroidism that usually 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 Surgeons I work most closely with is Mr Johnathan Hubbard, practicing at The London Bridge Hospital and Professor Fausto Palazzo at The Cromwell Hospital.

Hypoparathyroidism

This 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 & Mineral deficiency

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. While everyone should ensure their vitamin D intake is adequate there is no evidence that vitamin D supplementation reduces the likelihood or severity of coronavirus infection.

Magnesium deficiency

This is common; my colleagues and I at The Royal London Hospital were one of the early groups to consider and diagnose deficiency, caused by proton-pump inhibitors (stomach acid suppressants) and report on the problem; these medications are very commonly prescribed; alcohol and diuretics can cause magnesium wasting through the kidneys. We can consider alternatives to the common medications if they are causing you problems. Tests for intracellular stores are difficult, but a thorough consideration of your magnesium balance is still possible with quite simple tests..

Osteoporosis & osteomalacia

We can help you understand if you are on track in the early part of your life to establish peak bone mass, from puberty into early adulthood, whether your health is good enough to maintain it, and this may include your testicular and ovarian function, parathyroids, vitamin D levels, magnesium, connective tissue, alcohol and smoking habits. These run through to the menopause transition and completion, and beyond in women, and men. There are lots of considerations about calcium intake, whether in the diet or supplements, vitamin D, when to use DXA scanning, when to repeat it, and how we consider the use of agents to help the skeleton and/ or strengthen it - such as bisophosponates and denosumab and its newer cousins.

Sodium & water balance disorders

Hyponatraemia

This is extremely common and very easy to mis-diagnose and mis-treat; we feel it needs specialist attention earlier than it often receives it, not necessarily in every patient who might have a transient low sodium alongside a critical illness, but if it persists, and/or it is moderate or severe, it needs a thorough assessment to come to a diagnosis and plan mitigation and/or treatment.

Syndrome of Inappropriate ADH Secretion

Among the causes of hyponatraemia is the syndrome of inappropriate ADH secretion (SIADH or SIAD); because this can be associated with tumours in the brain or lung, or other disease across the body, it is important to diagnosis it. New treatments are available 'vaptans' which have revolutionised the treatment of this but they must be used under specialist supervision.

Thirst Disorders/ Polyuria and Diabetes Insipidus

Problems with thirst and/or passing too much urine are common. Mostly this is poorly controlled, or undiagnosed diabetes mellitus, but if it is not, then you have to see an endocrinologist to differentiate between problems where the patient produces too much urine - diabetes indipidus - and thus are thirsty to compensate, from those who drink too much - primary polydipsia - and produce too much urine to compensate.

Hypoglycaemia

Whether this occurs on fasting, after meals or unpredictably, whether you are certain you have it, or concerned it might be responsible for your symptoms, you need prompt investigation and we can do this efficiently and safely for the majority of patients, quickly and as an outpatient.

If you have hypoglycaemia in the context of Type 1 diabetes and/or insulin therapy please email first so we can have you seen by the right person straight away.

Metabolism

Problems with your metabolism may manifest with your weight, whether too much, trouble gaining and/ or losing, obesity, overweight, but also being underweight and having difficulty maintaining weight.

Obesity

This is the commonest manifestation, and whether diabetes, hypertension, cardiovascular disease, testosterone deficiency, ovarian function, PCOS, fertility problems, sleep apnoea, hypoventilation, or depression complication the picture or not, it is important to see someone who can assess you completely, someone who can consider whether there is anything behind the weight, such as adrenal or thyroid disease.

Underweight and/or losing weight

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

Lipid and cholesterol disorders

  • This includeshypercholesterolaemia and mixed dyslipidaemia; this includes individual assessment of cardiovascular risk and the pros and cons of lipid therapy.

Endocrine tumour syndromes & familial endocrine disease

  • If this is you diagnosis, and you are keen to consider ongoing care please email ahead and we consider exactly who is the right person for your condition and symptoms. If you are not sure what the matter is do let us know first but you will normally need an out-patient endocrine assessment in the first instance with Dr Kelly. If we do diagnosed a particular problem/ condition, we will ensure you are managed by the right p.

 

Long-terms effects of previous cancer treatment

  • As cancer treatment has become more successful, the long-term effects of that successful treatment become more apparent in more patients, This can affect the whole body, the hormone balance, the benign thyroid disease risk and cancer risk. If you are not sure where your health is a review might be helpful.​

Endocrinologist reviewing CT scan of the abdomen