A joint thyroid clinic (JTC) was established in February 2007 with the aim of improving the care of patients in whom an endocrine surgical opinion was required. The monthly clinic is attended by a Consultant Endocrinologist and a Consultant Endocrine Surgeon who together assess patients with thyroid, parathyroid and adrenal problems. Using retrospective case record analysis, we aimed to assess the impact of the clinic by studying the care of people referred with thyrotoxicosis. Comparing patients with thyrotoxicosis seen in the Endocrine surgery clinic (ESC) before Feb 2007 compared with patients seen in the JTC, 21 vs 41% were treated with radioiodine 79 vs 39% with thyroidectomy, and 0 vs 20% with anti-thyroid drugs. The case mix was broadly similar (JTC vs ESC: 61 vs 64% Graves' disease; 33 vs 36% toxic multinodular goiter; 6 vs 0% toxic adenoma). The number of people treated with radioiodine and thyroidectomy for benign thyroid disease in Feb 2006Jan 2007 was 40 & 13, in Feb 2007Jan 2008 was 80 & 21, and in Feb 2008Jan 2009 was 89 & 26. In the period Jan 2005Dec 2010, 19 (17.3%) patients undergoing thyroidectomy for benign thyroid disease suffered a complication, 2 of which were permanent (RLN palsy and hypoparathroidism). 96% of patients referred to the JTC were treated within the 18-week referral to treatment standard. A joint thyroid clinic is associated with an increase in the use of both radioiodine and medical therapy and a reduction in the number of people undergoing thyroidectomy for thyrotoxicosis compared to referral to an endocrine surgery clinic. A substantial increase was seen in the use of both radioiodine and the number of patients undergoing thyroidectomy for benign thyroid disease in the observed period. The joint clinic may thus help to reduce the cost of treating thyrotoxicosis by reducing the number of patients undergoing thyroidectomy.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.