Endocrine Abstracts

Prior to May 2011, we ran four separate consultant-led endocrine services with six-eight new patient referrals identifiable per week with hyperthyroidism. These were seen ‘ad hoc’ in general endocrine clinics, where their needs were not prioritised compared to other endocrine referrals, resulting in concern around the timeliness of their care.

We identified 203 patients under active follow-up (FU) (active=on anti-thyroid medications or within 6 months of radioactive iodine). The first audit cycle was carried out to determine care received by patients with thyrotoxicosis in the general endocrine clinics and the time interval between outpatient clinic appointments (OPAs).

Using the July 2006 UK guidelines for use of TFTs, our standards were:

i) All patients with abnormal thyroid function under treatment should be seen within 6 weeks (±7 days)

ii) All euthyroid patients under treatment should be seen within 3 months (±7 days).

Intervention: Following this review of the ‘ad hoc’ service, we introduced a dedicated ‘weekly multi-disciplinary clinic’ hyperthyroid service to streamline care and allow for appropriate follow-up as well as opportunity for liaison with other specialists in those patients who require it.

Results: Standard 1

66% of thyrotoxic/hypothyroid patients were seen within target compared to 32% prior to the new service. Mean FU was 7 weeks compared to 20 weeks.

Standard 2

100% of all euthyroid patients were seen within target compared to 56% prior to the new service. Mean FU was 8 weeks compared to 30 weeks.

More patients achieved euthyroidism in the new hyperthyroid service at both 2nd and 3rd visits.

Conclusion: These data highlight that dedicated hyperthyroid services led to improvements in care quality and outcomes for patients, as well as better use of services and resources. More patients were seen within specified target standards with euthyroid status achieved earlier. There was a significant reduction in re-appointment and non-attendance rates.