Objective: Despite being the most common endocrine malignancy, the management of thyroid cancer in the UK remains sub-optimal, with reduced survival rates compared with Western Europe. The British Thyroid association published national guidelines in March 2002 to help standardize and improve the management and survival of thyroid cancer in the UK. We have audited the management of thyroid cancer in a large district hospital comparing the results to the standards set by the British Thyroid Association guidelines.
Methods: A retrospective case-note review of 64 patients diagnosed with differentiated (papillary or follicular) thyroid cancer between the years 1979 and 2002 managed at the Royal Berkshire hospital-Reading.
Points investigated were:-
Referral to the specialist multidisciplinary clinic.
Appropriateness of investigations before surgery.
Adequacy of surgery and surgical complications.
Appropriate referral & administration of the ablative dose of radio-iodine.
Adequacy of T4/T3 treatment.
Adequacy of monitoring of TSH and Thyroglobulin measurements.
Adequacy of note documentation.
Results: 83% of subjects were females and the median age at diagnosis was 40 years. 70% of patients had a papillary carcinoma. 83% of all patients were followed up in the Multidisciplinary clinic. Although 82% of patients had their thyroid function checked prior to surgery, only 51% had had fine needle aspiration cytology. 66% of surgery met the guidelines and radioiodine ablation was given when indicated in 88% of patients. At follow up, 86% had thyroglobulin measurements and abnormal results were acted upon in all but 1 case. TSH was measured in 92% and was suppressed in 89% of patients.
Conclusions: This audit identifies deficiencies in the management of differentiated thyroid cancer, particularly regarding the preoperative use of fine needle aspiration cytology and adequacy of surgery. It is hoped that by adhering to the national guidelines the quality of care offered to patients with thyroid cancer and their clinical outcome may improve.