Endocrine Abstracts

Objectives: To establish the proportion of patients locally with potentially significant thyroid pathology not receiving specialist endocrine input. To look at the management of hyperthyroid patients within the Endocrinology service.

Patients and methods: Utilising the laboratory database, 121 patients identified (97 female, 24 male; age range 17–93 years, average 55 years) with TFTs suggesting hyperthyroidism (raised fT4/fT3, and/or suppressed TSH) during July 2006. Patients with known treated hypothyroidism excluded. Data on management and outcomes 12-months later gathered from laboratory/radiology/clinical databases, and analysed using Excel.

Results: About 54/121 patients predominantly with Graves disease, received specialist endocrine input. No diagnosis was apparent for the majority of patients not seen in clinic; laboratory data suggest several patients have potentially significant/symptomatic thyroid disease, and treatment either not initiated, or ineffective. In both primary and secondary care, there was considerable variation in the extent of further investigation (antibody status, ultrasonography, Pertechnate scan) and TFT frequency over a 12-month period (ranging from 0 to 14 repeat tests; average =4). The majority of clinic Graves’ patients received anti-thyroid tablets, with radioactive iodine 131-I in 4 cases, and thyroidectomy in two cases. An episode of biochemical hypothyroidism occurred in 32 cases within the entire cohort; 22 of these under the care of the endocrine clinic.

Conclusions: This study suggests a significant proportion of patients with hyperthyroidism are not receiving specialist endocrine input. Some of the patients identified are likely to have subclinical hyperthyroidism or levothyroxine over-replacement; specialist endocrine input may not be necessary, as long as the potential hazards are recognised/addressed. We identified a need to rationalise investigation of the hyperthyroid patient, and to reduce the incidence of iatrogenic hypothyroidism: more frequent follow-up requiring increased clinic capacity. A standardised ‘Thyrotoxicosis’ proforma has been designed to address these issues, and improve documentation within the Endocrinology service.