Endocrine Abstracts

Background: Some forms of thyroid disease (TD) pose significant diagnostic difficulties. The quarterly complex thyroid clinic (CTC) at SVUH facilitates diagnosis and management of less common forms of TD.

Methodology: We reviewed the clinical notes of patients attending the CTC from January 2021 to March 2024.

Results: 59 patients attended the clinic. The average age was 41.7 years, the majority were female (73%). Referrals were from GPs (70%), adult endocrinology (20%), paediatric endocrinology (5%) and other sources (5%). Most were from Dublin (49%), Wicklow (24%) and Wexford (8%), however patients from eight other counties attended the service. 78% (46) of patients were referred with discordant TFTs, 7% (n4) with abnormal TFTs post definite treatment of hyperthyroidism, 7% (n4) with complicated primary hypothyroidism, 5% (n3) with congenital hypothyroidism and 2% (n2) with fluctuating TFTs. Patients attended the CTC on average for 4.5 visits and received a diagnosis within 3 visits. 72% (n42) of patients had lab samples tested on Biominis assay. 52% (n31) of patients had detailed biochemical interference testing through the UK SAS laboratory and genetic testing was performed on 49 patients. A diagnosis was established in 74% (n44) of patients, investigations are ongoing in 25% (n14) and in 1% (n1) the diagnosis remains unknown. Complicated hypothyroidism 19% (n11) and complicated Graves’ disease (15%) were the two most common diagnosis. However, a diagnosis of RTH Beta 7% (n4), Assay interference 7% (n4), FDH 3% (2), TTR mutation 3% (n2), TSHoma, reset HPT axis, thyroxine malabsorption, non-thyroidal illness, amiodarone induced TD and non-thyroidal illness were also made in one patient each, respectively.

Conclusion: The spectrum of TD diagnosed and managed at the CTC is highly variable. Access to a specialist clinic that is linked with international centres facilitates the timely diagnosis and appropriate management of complex and rare TD.