Endocrine Abstracts

Aims: To assess the diagnosis and management of patients with thyrotoxicosis in a district general hospital comparing with American Thyroid Association (ATA) recommendations.

Methods: Retrospective study, electronic case notes of patients referred to the endocrine clinic between May 2009 and April 2011 (n=148) were reviewed. A pro-forma was designed collecting details of demographics, investigations, diagnosis and treatments received.

Results: 33 patients with thyrotoxicosis identified; 24 (77%) female, 9 (23%) male. 8 (24%) diagnosed with Graves’ disease (GD), 6 (18%) autoimmune hyperthyroidism, 6 (18%) toxic multinodular goitre (TMNG), 5 (15%) unspecified and 3 (9%) other. The average number of appointments made prior to discharge was 5.3. All but one patient with clinical features of GD had confirmatory thyrotropin receptor antibodies (TRAb) testing. 4/25 (16%) patients without features of GD were referred for a radioactive iodine uptake scan (RAIU).

Anti-thyroid medications were initiated in 27 (82%) patients. All 27 were commenced on titrated doses of carbimazole (CBZ) of which 21 (77%) and 14 (49%) had baseline FBC and LFTs checked respectively. Definitive treatment with radioiodine was given to one patient diagnosed with relapsed GD after pre-treatment with CBZ. 3/6 (83%) patients diagnosed with TMNG were directly referred for either radioiodine therapy or surgery and started on pre-treatment with CBZ. Two relapsed after reducing regimes of CBZ and were consequently referred for radioiodine therapy. One patient chose to stay on low dose CBZ. 0/8 (0%) patients diagnosed with GD had TRAb testing prior to discontinuation of treatment.

Conclusion: Attempts to make an accurate diagnosis should be made. Ultimately ‘patient choice’ guides management but use of definitive treatment such as radioiodine/surgery should be considered. Measurement of TRAb levels prior to stopping oral treatment is recommended to aid the decision to stop treatment and chance of remission. An automated computerized thyroid register would aid monitoring and reduce the number of outpatient appointments.