Background: Radioiodine treatment (RIT) for benign functioning thyroid disease is an effective treatment for patients with hyperthyroidism. The safety, preparation, administration and follow-up of treatment demands time and organisation. The planning of this elective treatment is affected by the patients availability which makes adequate and timely treatment of the subsequent hypothyroidism challenging. A quality improvement project was therefore set up to mitigate this.
Methods and Results: We audited the RIT phone clinic (RITPC) at UCLH from January 2015 to December 2016. We established a RIT referral pathway with set follow-up arrangements which ensured a smooth transition from hyperthyroidism to treated hypothyroidism. A total of 47 patients were treated under the RITPC over the 24 months. Suitable patients were identified during the face to face appointment, before referral. During RITPC, our endocrine team made a detailed assessment, with completion of a safety questionnaire, consent and request of RIT. The timing of RIT was entirely dependent upon patients availability which was helpful in minimising non-attendance rate. The patient was then reviewed at RITPC with monthly thyroid function tests three consecutive months post therapy. Appropriate initiation of thyroxine replacement was judged by the reduction of free T4<12 nmol/l and TSH>5 miU/l. The average dose of 627 Mbq was prescribed by a nuclear medicine physician (JB). Of the 47 patients 33 had Graves disease (1 required repeat treatment) and 14 had toxic multinodular goiter or toxic adenoma. Overt hypothyroidism was evident in 15 patients by the second month, 11 patients by the third month and 13 patients by 4 -6 months post treatment. There were no reported non-attendances for the patients who were referred for RIT during the three months follow-up.
Discussion: We have established an effective and efficient outpatient pathway which is safe and convenient for patients with a minimal non-attendance rate.