Endocrine Abstracts

We analysed thyroid function tests (TFT; tT4 +TSH ±fT4) and clinical outcomes in patients with thyrotoxicosis managed with the aid of a computerised Thyrotoxicosis Shared-Care Scheme (TSC) between 1994 and 2001. During this 7-year period, 900 patients had been managed via TSC. 319 were in TSC since receipt of the initial referral letter, of whom 268 commenced TSC by mid-2000 with at least 6 months subsequent follow up (FU) data in the same tT4 assay and were analysed in detail.

Of this 268 (80% female; median age 42.9y, range 15-88y), 3700 sets of TFT were available over 843 patient-years of follow up (median 3y FU). Overall, tT4 and/or fT4 were normal in 84% of TFT, TSH normal in 51% and both normal in 48%; >90% TFT had normal tT4 after 1 year of FU. 99% had started at least 1 course of carbimazole (CBZ), 87% had stopped CBZ (median course 18.2 months); 15% had eventually proceeded to RAI and 5% to thyroidectomy. 56% had started thyroxine (most 'block & replace') and 42% stopped it. Of 195 who completed at least a 6 month course of CBZ (and not had RAI or surgery), 42% had relapsed during median FU of 2 years after the course, with relapse occurring at a median 9 months after stopping CBZ.

Compared to 109 controls (presenting in 1991-1993 prior to TSC) well-matched for age and sex, TSC had a median of 3 (range 1-17) and controls a median of 10 (range 3-24) outpatient visits (mean of 1.90 vs 3.77 OPD/year; p<0.001) in median 3yr of FU for both groups.

A computerised shared-care scheme using a Clinical Workstation can achieve good control of thyrotoxicosis and allow accurate audit of outcomes while minimising outpatient visits.