Endocrine Abstracts

Background: Recent evidence favours the use of TRAB in patients with hyperthyroidism (a) at presentation to identify the aetiology and predict outcomes (b) at the time of withdrawal of medical therapy to predict remission and (c) during pregnancy. However, If TRAB is not requested at an appropriate time, it may not help, may mislead or add to cost.

Aim: To review the current process of requesting TRAB in line with available evidence and identify areas for service improvement.

Patients and methods: The proportion of patients, who had a request for TRAB, amongst new patients with hyperthyroidism between 01-07-2020 and 31-12-2020, was estimated. Hospital record of 56 patients with TRAB requests were reviewed retrospectively for demographics, details of hyperthyroidism, timing of TRAB request and clinical decisions made on the basis of the result.

Results: Only 126/505 (24.9%) newly diagnosed patients with hyperthyroidism had TRAB antibodies checked. 56 patients studied, had a mean age 49 years, 71.5% were females, mean T4 24.9pmol/l, T3 7.1pmol/l, 23.2% were smokers. TRAB was positive in 46% and was requested to (a) identify the aetiology in 44(79%) patients (b) to guide treatment withdrawal in 5(9%) patients and (c) to make management decisions during pregnancy in 7(12.5%) patients. Of those in group (a) in 32% patients the result was unhelpful due to incorrect timing of request. The initial result was used to guide long term treatment planning in only 4(9%) patients.

Conclusions: TRAB antibodies were checked only in a quarter of the patients with hyperthyroidism. They were mainly requested to identify aetiology but request was often incorrectly timed. TRAB was infrequently requested to guide therapeutic decisions or treatment withdrawal. Recommendations: A new well-structured care-pathway for requesting TRAB antibodies in specialist care and an auto-request mechanism for hyperthyroid samples received from primary care are needed.