Endocrine Abstracts

Background: With increasing numbers of patients accessing endocrine antenatal services, a pilot was undertaken for Endocrine Specialist Nurse (ESN) management of thyroid disorders in pregnancy. An audit was completed to review the impact and efficacy.

Audit Methods: 1. Identified pregnant patients with thyroid disorders in the Endocrine antenatal clinic, seen by the ESN from May -Dec 2023. 2. TFT results during pregnancy reviewed to:

1. Assess whether TSH pregnancy targets were achieved and maintained throughout pregnancy.

2. Ensure appropriate TRAb surveillance completed for those with Graves’ disease

3. Were GP management plans provided for those with hypothyroidism

4. Were there follow-up appointments for those with hyperthyroidism postpartum

Results: Total of 37 patients reviewed by the ESN. Primary Hypothyroidism 22, secondary Hypothyroidism 7, Hyperthyroidism 8. Hyperthyroidism (Grave’s disease)

Thyroid receptor antibodies:

• 6 patients negative • 2 positive • 4 patients relapsed

100% of patients with hypothyroidism had a GP management plan and had their 6 week postpartum blood test. 100% patients with hyperthyroidism received postpartum follow-up clinic appointments with ESN. 43% had recurrence of hyperthyroidism requiring thionamides restarting up to 24 weeks postpartum.

Conclusion: The ESN role in managing thyroid disorders during pregnancy is effective and releases consultant time for complex patients. Postnatal follow-up pathway of Hyperthyroidism is required due to high relapse rate a prenatal thyroid ESN led clinic due to significant percentage of patients with above target TSH on referral.