Endocrine Abstracts

Background: Nice guideline recommends using TSH receptor antibody as a tool for classification of hyperthyroid patients; and considering technetium scanning of the thyroid gland if TRAbs are negative. Early diagnosis of TED is also essential for treatment to be effective. The most common way to assess the severity of TED is to use the Clinical Activity Score (CAS) 7-point scale.

Objectives: We aimed to evaluate if hyperthyroid patients are classified correctly and timely as per NICE guidelines. Also, to check if CAS score was done to assess severity of TED and referring to ophthalmologist was considered.

Methodology: Retrospective electronic case notes review of 33 patients who were seen for the first time in the endocrinology clinic and diagnosed with hyperthyroidism between 31/08/2020 to 31/08/2021. These patients had been transferred from consultant clinic to endocrine pharmacist’s thyroid clinic after their first appointment.

Results: n=33 (thyrotoxic patients reviewed in endocrinology clinic), TRAb was recorded for total 30 patients, among them 15 had TRAb done prior coming to the clinic. It was checked within 2 months for 13 patients and within 4 months for 2 patients. CAS score was done in total of 12 patients. Referral to ophthalmology was done for 3 patients. 29 patients were started on Carbimazole. 2 patients on Propylthiouracil, 2 patients were not started on any medication. 23 patients which is almost 70% had a review in thyroid clinic within 3 months of first clinic appointment.

Discussions: 1. While 90% had a TRAb test within 120 days since presentation, but there is room for improvement to make it as close as possible to 100% as recommended by NICE.

2. We should focus on calculation of CAS score as it helps in identifying thyroid eye disease patients. As missing the TED can have serious consequences on patient safety.