Endocrine Abstracts

Aim: The aim of this audit was to evaluate our adherence to current recommendations by Third International Workshop on the Management of Asymptomatic Primary Hyperthyroidism.

Method: We audited 50 cases from our database of patients with PHPT diagnosed between 2007 and 2012.

Results: 21/50 (42%) were referred for surgery with 19/21 operated. All referred patients had SESTA MIBI preoperative localisation scan. 19/21 had USS in addition. 28/50 (56%) patients were managed medically. 3 patients, who were not considered for surgery had localisation imaging done. 10/50 (20%) had calcium level > 2.85 mmol/l. 8/10 were referred for surgery, 1/10 was not a surgical candidate and in 1/10 ‘watch and wait’ strategy was adopted. 6/50 (12%) patients were <50 years, 4/6 were referred for surgery, 1/6 was thought to have no indications and 1/6 had severe mental disability.

Renal imaging was not routinely done with 58% patients having renal US done as part of work up. 8/29 (28%) patients had stones/nephrocalcinosis. 5/8 were referred for surgery. DEXA scan was requested in 35/50 (70%) patients. 5/35 (14%) patients had osteoporosis, 4/5 had parathyroid surgery. The remaining patient not referred for surgery was thought to have no surgical indication. 15/50 (30%) patients had no 24 h urinary calcium levels done as part of initial work up.

Conclusion: The majority of patients sampled were managed medically however a small number of patients who were not considered suitable for surgery had unnecessary localisation imaging. Imaging for complications of osteoporosis and renal stones was sub-optimal, occurring in 70 and 58% of patients respectively, suggesting that patients eligible for surgery may have been missed. In addition a small number of patients fulfilling criteria for surgical treatment were managed medically.