Endocrine Abstracts

The NHS is an evolving organisation facing huge challenges while still striving to provide best possible patient care. Our Endocrine Specialist Nurses (ESNs) are an integral part of endocrine services. They create links between endocrinologists, surgeons, patients and community services to ensure high quality care for all. A dedicated ESN clinic with direct access to an endocrinologist was set up. The aim was to ensure blood tests, medication titration and patient education were provided in a timely manner to ensure achieving good control. We reviewed the clinical journey of 7 patients who underwent a total thyroidectomy for Graves thyrotoxicosis. Length of stay post op ranged from 1 to 9 days (mean 4.5 days) All patients were discharged on Adcal-D3 Chewable tablets and Alfacalcidol capsules in addition to Levothyroxine. All patients were given an appointment with the ESN for follow up blood tests 3-7 days post op (mean 4.3 days). No patient required re-admission for hypocalcaemia. 5 patients achieved normal PTH and were weaned off both Adcal-D3 and Alfacalcidol and were normocalcaemic within 0-15 days (mean 5 days). 2 patients remained on Adcal-D3 and Alfacalcidol. All 7 patients achieved a normal freeT4 ranging from 14.3 pmol/l to 20.2 pmol/l (mean 17.3 pmol/l). 6 patients were on Levothyroxine 100 mg daily and 1 patient was on 125 mg daily. It took 5 to 13 weeks (mean 8 weeks) to confirm normal thyroid results. Patients were seen 3 to 6 times to achieve both stable calcium and T4 levels over a mean duration of 8 weeks. The ESN endocrine clinic has enabled us to: • increase outpatient consultant appointment capacity by reducing the number of endocrine clinic follow-up visits. • improve patient satisfaction, education and care due to direct access to endocrine team. • reduce the burden on phlebotomy services.