Endocrine Abstracts

Graves’ disease is an autoimmune condition predominantly affecting middle aged women. It can be difficult to manage and consumes a lot of medical time and resources.

In Torbay Hospital, we introduced endocrine nurse specialist (ENS) follow up service to reduce medical burden. This has shifted the work-load of patient care but on the other hand, has resulted in identification of great need for support and increased nurse time.

We reviewed clinical notes of patients with Graves’ disease seen by doctors and later by ENS after definitive treatment.

We identified (n=54) patients using ENS database. We observed their management during 2011–12, final outcomes, duration of intervention, consultation sessions by doctors and ENS and compared them. Mean age was 17–82 years (median 51). There were 45 females (83%) and 9 males (16%). 48 (88%) presented for the first time while only 6 (11%) had relapsed. There were 398 consultations in total. 219 (55%) sessions were with medical team, while 169 (43%) were with ENS. Furthermore, ENS also provided support and services via phone calls (56), letters (116) and emails or texts (24). 33 (61%) patients received I131 therapy, 5 (9%) underwent thyroidectomy, 10 (18%) patients came off treatment and remained in remission and 6 (11%) are still actively treated. Duration of treatment lasted between 11 and 108 months (median 24 months). 30% patients required monitoring for more than 36 months after definitive treatment.

In summary, introducing endocrine nurse proved efficient service and identified unrecognised need for patient support. It can result in longer follow-up in service. Telephone and email contact is a good thing but presents challenges in recording of information and clinical governance. We believe and there is potential for a protocol driven IT solution to improve quality and effectiveness in the management of Graves’ disease.