Audit of follow-up after radio-iodine treatment for hyperthyroidism in East and North Hertfordshire NHS Trust
Sunil Nair1, Sharif Hossain1, Tom Lumbers1, Rebecca Walker1, Peter Winocour1, Alan Makepeace2 & Ann Ainsworth1
Objective: To assess adherence to RCP guidelines on radioiodine (RAI) treatment (1995) and management of thyroid eye disease, and also to look at patterns of thyroid function following RAI treatment.
Method: Retrospective case notes review of 78 randomly selected patients from one acute trust. An audit performa was developed, based on the RCP guidelines.
Results: The audit demonstrated significant deviations from standards. Communication from oncology department following treatment was only present in 66% of cases. Time lag between RAI treatment and 1st TFT: median 40/41 days (range 4246 days). Time lag between RAI treatment and 1st review in Endocrine clinic: median 56 days (range 15428 days). 14% of patients were lost to follow up after RAI treatment.
Thyroid status at the time of audit: 49% hypothyroid on thyroxine, 37% euthyroid, 7% on antithyroid drugs and 7% unknown status.
8 patients with mild dysthyroid eye disease, which were not covered with prednisolone, did not have any worsening. 1 out of 5 patients with moderate/severe eye disease had deterioration following RAI treatment.
Recommendations: An up-to-date database of patients referred for radio-iodine treatment needs to be maintained which will help with structured follow-up. There is a need for coordinating follow-up and thyroid function checks following treatment; usually one of the roles of an endocrine nurse in many centres. Patient and GP should receive written information regarding the recommended frequency and timings of thyroid function tests and clinic follow-up after radio-iodine treatment. These deviations from standards are more likely in district general hospitals referring patients to other centres for Radio-iodine treatment, making good inter-departmental communication crucial for patient safety.