Endocrine Abstracts

Background: In our Hospital, we have noticed a large number of thyroid profile are being requested without any clinical suspicion, which has led to difficulty in interpretation of the results, dilemmas in subsequent management and an increment of inpatient Endocrine referrals.

Objective and Aim: To evaluate our local practice in ordering thyroid function tests and to identify strategies to reduce unnecessary testing and inappropriate referral to endocrine department.

Methods: retrospective analysis; sample identified from inpatient endocrine referral list; 1st November 2020 - January 2021.

Summary: A total of 32 thyroid related inpatient referrals were received during this period. 19.35% known hypothyroid, 6.45% overt hyperthyroidism, 22.5% subclinical hyperthyroidism, 13% amiodarone induced thyroid dysfunction; 3.22% pregnancy related thyroid illness; and 25.8% had TFTs done during acute illness. Following Endocrine review 79% did not need any intervention. We have proposed a variety of interventions - removing the TFT request from routine blood test bundle; populating guidelines during doctors’ induction; e-learning decision aids for TFT request. We aim to repeat the study in 6 months to assess the improvement in our service.

Conclusion: In our lab the monthly expenditure for TFT is £ 8875. The low detection rate of new thyroid disease suggests that unselective screening of all admissions is not justified. However, the morbidity of untreated thyroid disease suggests that biochemical screening of TFTs in a selective group of medical inpatients patients may be justified. TFTs should be offered to only targeted group of patients with clinical symptoms or risk factors.

References: https://pubmed.ncbi.nlm.nih.gov/29105255/

https://pubmed.ncbi.nlm.nih.gov/2347087/

https://www.rcpjournals.org/content/clinmedicine/13/3/282

https://www.british-thyroid-association.org/sandbox/bta2016/uk_guidelines_ for_ the_use_of_thyroid_function_tests.pdf