Endocrine Abstracts

Introduction: Graves’ disease (GD) is the most common cause of thyrotoxicosis with antithyroid drugs (ATD) being first-line management. Consultations and monitoring required for ATD therapy are resource intensive. We evaluated the potential for a digital thyrotoxicosis monitoring pathway (DTP) on GD treatment outcomes and efficiency of care.

Methods: We constructed a dashboard using Palantir Foundry to identify patients with a coded diagnosis of thyrotoxicosis, excluding nodular disease. A historical control cohort was identified using the same diagnostic codes to identify those treated pre-dashboard. A pharmacist-led protocol to identify those requiring dose adjustments from the dashboard was developed. Clinic appointments continued as standard care during this initial evaluation. Demographic data, free thyroxine (fT4) results, and appointment details were collected from electronic health records and compared between patients who were being currently managed with and before the DTP.

Results: 280 patients were included in this study, with 134 in the dashboard cohort and 146 receiving prior standard care. The mean age of participants was 46.8±14.7 years and 83.9% were female. No statistically significant difference was noted between the cohort’s time to fT4 <23.0 pmol/l or <14.4 pmol/l (P= 0.8656). The dashboard cohort had a significantly greater risk of hypothyroidism (P= <0.0001). As the dashboard was used in parallel with standard care in this initial study, patients in the dashboard cohort received a significantly higher mean number of total appointments (5.9 vs. 2.5, P= <0.001), but with a significant difference in the number of face-to-face, telephone and virtual review consultations (P= <0.0001).

Conclusion: The DTP facilitated more remote modes of monitoring, such as note reviews, while providing as effective clinical outcomes as standard care. A full evaluation will now proceed to determine if the dashboard can fully replace clinic attendances.