Introduction: Radioiodine is used for the treatment of Thyrotoxicosis when medical treatment (anti-thyroid drugs) has failed or cannot be tolerated and surgical treatment is not an option. Our previous audit in 2011 demonstrated substantial adherence to the Royal College of Physicians (RCP) guidelines for Radioiodine treatment, but one patient was lost to follow-up. It was recommended that we improve our re-call system. We aimed to re-audit our service.
Methods: Notes and blood results for patients with thyrotoxicosis who received radioiodine treatment between January 2013 and December 2016 were retrospectively reviewed for information on pre-treatment, treatment and the post-treatment follow-up period.
Results: One hundred and four patient-notes were retrieved (27 males, 77 females). They had an average (range) age of 57 (2189) years and duration of thyrotoxicosis of 4 (0.2515) years. The average (range) radioiodine dose was 637 (513870) MBq. Hypothyroidism occurred in 88% of patients within 6 months of treatment. As a result 7.7% of patients remained euthyroid and 9.6% continued to have thyrotoxicosis after treatment (a third of these went on to have surgery). Table 1 shows the audit results compared to those of the previous audit done in 2011. There was 100% adherence to all of the standards apart from the 6-week telephone follow-up call for thyroid function test (TFT) results, where one patient was missed, but had appropriate follow-up with the General Practitioner.
Conclusion: This audit demonstrates that we are 100% compliant with the RCP guidelines for use of radioiodine for treating thyrotoxicosis. Our results are comparable to that of other centres. We need to ensure that the details of all patients who receive radioiodine treatment for thyrotoxicosis are on our re-call register for the 6-week TFT follow-up.
|Audit Criteria||Standard (Target)||2011 (1st Cyde)||2017 (2nd Cycle)||Compliance with standards|
|Patient information sheet given||100%||100%||100%||Fully Compliant|
|Risk assessment questionnaire filed||100%||100%||100%||Fully Compliant|
|Informed consent form signed and filed||100%||100%||100%||Fully Compliant|
|ATDs stopped a week before radioiodine||100%||100%||100%||Fully Compliant|
|Steroids for thyroid eye disease||100%||100%||100%||Fully Compliant|
|Yellow information card given to patient||100%||100%||100%||Fully Compliant|
|Pathology request form for 6 week TFT check||100%||100%||100%||Fully Compliant|
|Letter sent to GP||100%||100%||100%||Fully Compliant|
|6-week telemedicine follow-up done for patient||100%||97%||99%||Fully Compliant|
|Final Compliance||Fully compliant|