Endocrine Abstracts

Aim: Audit the management of patients with thyrotoxicosis in the thyroid clinic at a District General Hospital, focusing on treatment methods and long term follow up.

Method: Prospective data collected from randomly selected 50 case notes and laboratory results over 4 months. Titration dose with Carbimazole or Propylthiouracil with close monitoring of thyroid function test is the treatment method followed.

Results: Eighty-six percent of the patients were females. Initial treatment was started by General Practioners (GP) in 54% of the patients. Six percent of telephone calls from the patients were documented in the notes. Four percent of the patients were non-compliant to the treatment.

Thyroid antibodies were checked in 62% and were positive in 10 out of 31 patients. Four percent of the patients had thyroid eye disease and 6% had associated other autoimmune diseases. Ninety-two percent of the patients were treated with carbimazole, 6% with propylthiouracil and 2% were not on any medications. Eight percent had complications with carbimazole. Forty percent of the patients had 20 mg of carbimazole as the starting dose. Three out of 8 patients who had radioactive iodine (RAI) had a period of early hypothyroidism. Two out of 8 patients had treatment with Levothyroxine following treatment with radioactive iodine. Discussion about Surgery or RAI had been documented in 66%.

Conclusion: Early treatment with carbimazole and propranolol (when needed) started in Primary care eventually reduces the number of hospital visits. Check thyroid antibodies as high levels would be more predictive of relapse. Documentation in the notes regarding the alternate treatment with surgery or RAI, explanation of the side effects of carbimazole and all telephone conversations with the patients is vital. It will be ideal to give the leaflet about hyperthyroidism, treatment options and details on side effects of carbimazole to the patient.