Endocrine Abstracts

Background: Thyrotoxicosis is a common endocrine disorder in the UK, with a prevalence of 2% in females and 0.2% in men. Endocrine services at Barnet / Chase Farm Hospitals receive ~250 new referrals per year, equating to a local incidence of 50 per 100,000. There is often a significant delay between GP referral and Endocrine clinic review, resulting in delays to commencing anti-thyroid treatment. These delays have been exacerbated by the Covid crisis. A need was identified for a standardized treatment pathway to more efficiently assess and treat newly diagnosed patients with thyrotoxicosis.

Methods: A treatment pathway was developed for use in both the Emergency Department (ED) and Ambulatory Care (AEC) to provide a standardized approach to investigating and treating patients with confirmed thyrotoxicosis (suppressed TSH and elevated T4 or T3), identified either in the ED or by GP and referred to secondary care.

Results: Data were collected over a 7-month period in 2021. 44 eligible patients were treated using the pathway during this time. 75% were new diagnoses of Graves’ disease, 16% thyroiditis and 9% toxic goitre. The average time from initial identification of abnormal TFTs to initiation of anti-thyroid treatment (if appropriate) for these patients was 4 days. The average time to follow-up in Endocrine clinic was 6 weeks, greatly improving clinical effectiveness.

Conclusions: Feedback for the pathway was overwhelmingly positive from a wide range of sources – ED consultants, ED / AEC junior doctors, GPs made aware of the project and, most importantly, from patients. Both time to treatment and time to Endocrine clinic follow-up have been improved. Moving forward, plans include greater Primary Care involvement to streamline referrals and greater use of IT resources to aid pathway adherence.