Patients treated with radioiodine (RAI) for thyrotoxicosis, secondary to Graves or a toxic nodule, require close follow up to determine whether they have become hypothyroid or have a recurrence. National guidelines state that patients should have their first blood test at about six weeks post RAI. Telephoning patients with their results, rather than reviewing them at outpatient appointments, can be a more convenient and efficient method of follow up.
To assess the efficiency of telephone follow up post RAI in preventing undetected hypothyroidism and identifying recurrent thyrotoxicosis.
121 patients who had had RAI therapy for thyrotoxicosis, had their thyroid function checked at 3, 6, 9 and 12 weeks post RAI. At each time point they were telephoned with their results and their symptoms and weight were recorded. They were given a supply of thyroxine in advance and when their free thyroxine level (FT4) was <14 pmol/l they were telephoned to commence thyroxine replacement therapy.
62% of patients took less than 10 days to be put on thyroxine replacement therapy after their FT4 level fell below 14 pmol/l post RAI. 6% of patients took between 10 and 20 days and 10% of patients took more than 20 days before being put on thyroxine replacement. Adherence to the protocol for blood test was good, 78% of patients had all their blood tests at the appropriate weeks.
The telephone follow up protocol does appear to be an effective method of patient follow up and reduced the number of outpatient clinic appointments required. However, 16% of patients were hypothyroid for more than 10 days post RAI due to communication problems. Alternative methods of follow up post RAI, such as the telephone clinic should be considered. Other methods include the use of email or a secure website containing results and instructions.
06 - 07 Nov 2006
Society for Endocrinology