Endocrine Abstracts

Background: Hypothyroidism is characterised by insufficient secretion of the thyroid and its detection measured by elevated serum TSH levels.

Although relatively common during pregnancy, untreated maternal hypothyroidism is associated with adverse obstetric and neonatal outcomes such as preeclampsia, placental abruption and miscarriage, or foetal neurodevelopment defects.

Highlighting a nurse led specialised telephone clinic in the close monitoring and care of these women is vital.

Aims: To provide for pregnant women with hypothyroidism a specialised Nurse-led Clinic, with structured pathways, in collaboration with multidisciplinary teams, to ensure:

•Continuity of care with reduction in requirement for face-to-face appointments.

•A streamlined service supported by evidence based practice.

•Earlier detection of elevated TSH levels above 2.5 IU/l.

•Optimising treatment management.

•Providing support and education, enhancing adherence and reducing non-attendance.

Structure:

•Referral of women with history of hypothyroidism, or TSH levels above 2.50 IU/l.

•Medical history and results discussed with physician.

•Appointments booked within 2 weeks where condition education, support and treatment management are reviewed.

•Electronic recording of visit.

•On-going review throughout each trimester prior to discharge.

Caseload: Seventy-three new referrals were reviewed over a 3-month period, of those 30% within their first-trimester, and 44% in their second trimester presented, with elevated TSH levels above 2.5 IU/l on referral.

This reflects positive identification patients at risk, due to improved multidisciplinary team communication facilitated by the specialist nurse.

Conclusion: Standardised protocols ensure earlier referral; resulting in the provision of high-quality patient focused Nurse-led care, treatment management and patient education of gestational hypothyroidism. Through a service systematically developed for continual improvements that are directly relayed to the patients, while providing a cost effective service for patients and service providers, while ensuring nursing activity is recorded and can be audited.