Endocrine Abstracts

Introduction: Thyrotoxicosis is one of the common referrals to the endocrine clinic. Management of the thyrotoxicosis depends on establishing the correct aetiology. The aim of the audit was to compare the management of patients with thyrotoxicosis against the guidelines proposed by the Royal College of Physicians.

Methods: One hundred and two consecutive patients referred to outpatient endocrine unit in a University Hospital over 6 months were included. Data was collected from the referral letters, clinic notes and investigations. Information on average waiting times for first clinic appointment, documentation in clinic notes, investigations and management plan was recorded. Data was analysed and compared with the standards recommended by the Royal College of Physicians.

Results: The average waiting period to see a consultant was 2 months. All patients received anti thyroid drugs prior to appointment but beta blockers were prescribed for only 20%. History of smoking, BMI, menstrual history, contact with children, thyroid eye disease and warning about potential side effects were poorly documented in 40% of patients. Eighty percent had antibody levels checked and 50% had imaging investigations. Aetiological diagnosis was established in only 60% (30% Grave’s disease, 30% multi-nodular goitre). The date of start of anti thyroid drug was not recorded in 50% patients. There was considerable variation in the duration of anti thyroid treatment with 25% patients still on anti thyroid drugs after18 months. Definitive treatment was to 80% patients but the amount of information given to the patients such as leaflets was poor.

Conclusions: The audit highlighted deficiencies in the care of patients with thyrotoxicosis and guidelines were not followed in many aspects of management. Poor documentation, failure to establish aetiological diagnosis and inconsistencies in treatment remain cause for concern. Introduction of care pathways as per the recommendations of Royal College may help improve the standards of care.