ECE2006 Poster Presentations Thyroid (174 abstracts)
What is the most effective screening interval in the long-term follow-up of stable hypothyroid patients on thyroxine?
AK Viswanath 1 , A Avenell 2 , S Philip 1 , S Acharya 1 , G MacLennan 2 , K Dalziel 3 , O Pereira 1 , SA Copland 1 , JS Bevan 1 & P Abraham 1
1Thyroid clinic, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, United Kingdom; 2HSRU, University of Aberdeen, Aberdeen, United Kingdom; 3IM&T, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
Background and methodology: In the long-term surveillance of treated hypothyroid patients, annual surveillance (with thyroid function testing) is widely recommended. This is largely based on consensus, as there is limited evidence to support this practice. Currently around 20,000 patients are registered in our hospital based thyroid register and the majority are on 18 monthly follow-up. We carried out a retrospective analysis to see if there is evidence to support increased frequency of testing.
Results: We identified 2,125 patients with a minimum of 10 years follow-up (89% female, 65% autoimmune hypothyroidism, and mean age at registration was 51 years). There were 2 groups: 1182 (56%) had been allocated to 18 monthly follow-up and the rest had annual surveillance. There was no significant difference between the groups in relation to baseline characteristics: age, sex and thyroxine dose. A slightly larger proportion of patients on 18 monthly follow-up (68% vs 62%; P<0.05) had autoimmune hypothyroidism.
The median duration of follow-up was 15.5 years (range 10–30). On statistical analysis we found no significant difference in the following outcomes between the 2 groups: initial and final thyroxine dose, number of screening interval changes, dose changes; death or the number of patients with hyperthyroid tests (FT4>25 pmol/l; normal range: 10–25 pmol/l or TSH<0.01 mU/l). The number of patients with one or more hypothyroid tests (TSH >4 mU/l or FT4<10 pmol/l) during follow-up was less in the 18-month group (52.5% vs 60%; P<0.01). As we carried out multiple hypothesis testing, a P value of <0.01 was considered significant.
Conclusions: Our results do not support a change to more frequent testing, which has cost implications. 18 monthly testing (surveillance) should be an option for stable hypothyroid patients when there is an adequate register or recall system for the follow-up of these patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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