Endocrine Abstracts

In August 1999, to reduce pressure on an overcrowded outpatient department and the incidence of undetected early hypothyroidism, we implemented a new protocol for the follow-up of patients undergoing radioiodine treatment for recurrent thyrotoxicosis. Suitable patients are invited to participate in follow-up by telephone. Thyroid function tests are checked at 3, 6, 9 and 12 weeks post-treatment. Patients who become hypothyroid post-treatment (fT4 <14 picomoles per litre) are telephoned and started on thyroxine 100 micrograms daily. Those who are biochemically toxic are telephoned, asked about clinical symptoms and may be restarted on anti-thyroid medications as appropriate. All patients are seen in the outpatient department for follow-up 4 months post treatment or earlier if clinically necessary. We present a 24 month audit of this clinic from August 1999-August 2001. Comparison data is also presented on 62 patients followed in the conventional way in the outpatient department. Results: 75 patients (22 male, 53 female) followed by telephone, have been treated with a total of 81 doses of radioiodine (mean dose 540 plus/minus 92 MegaBecquerels). Currently, 53 patients are hypothyroid on thyroxine replacement, 7 euthyroid off all medications and the remainder either recurrently toxic or have not yet reached 12 weeks of follow-up. 62 patients (17 male, 45 female) followed conventionally, have been treated with a total of 65 doses of radioiodine (mean dose 600 plus/minus 75 MegaBecquerels). 34 of these patients are hypothyroid on thyroxine replacement, 8 euthyroid off all medications and 23 either recurrently toxic or lost to follow-up. Mean peak TSH reached during follow-up was 6.0 milli-International Units per litre ( <0.05-107) in the group followed by telephone vs. 25.3 milli-International Units per litre ( <0.05-98.6) in the conventionally followed patients. Mean delay between radioiodine treatment and first outpatient review in the conventionally followed group was 63 days. The telephone clinic has hugely improved the outcome of these patients, in particular by the early detection and treatment of hypothyroidism.