Endocrine Abstracts

JOINT1606

Background: Radioactive iodine (RAI) therapy is an effective treatment for thyrotoxicosis and is recommended by the National institute for Health and Care Excellence (NICE) in the UK as the first line treatment. Hypothyroidism is one of the most common adverse effects of RAI and occur in up to 80% of patients receiving this treatment. The NICE guideline recommends thyroid function monitoring every 6 weeks for 6 months following RAI for early detection and treatment of hypothyroidism. A previous audit revealed that our centre fell short of the standard recommended by national guideline. A specialist nurse-led post-RAI care pathway was subsequently implemented in 2022. This study evaluates the impact of a nurse-led care pathway on patient outcomes and adherence to national guideline.

Methods: We conducted a retrospective study of adult patients who received RAI between May 2022 to July 2023 in a single tertiary hospital. The post-RAI care pathway involved thyroid function monitoring every 6 weeks, until serum thyrotropin was within the normal reference range. We included patients with a minimum of 12 months follow-up. Clinical data were retrieved from the hospital electronic medical records.

Results: A total of 54 patients (mean age: 56.9 ± 14.3 years, 79.6% female) were included. The majority (70%) had Graves’ disease (GD), followed by toxic multinodular goitre (19%), solitary toxic nodule (9%), and euthyroid goitre (2%). After implementing the ESN-led post RAI care pathway, the mean time to the first thyroid function check decreased from 51 to 39.6 days after RAI. The proportion of patients having their first thyroid function checked prior to 7 weeks after radioiodine therapy increased from 63.2% to 94.4%. The incidence of hypothyroidism at first follow-up review decreased from 9% to 4%. Among patients with Graves’ disease who had not restarted block and replace regime after RAI, the proportion who became hypothyroid by the time levothyroxine was initiated decreased from 61% to 44.4%. No patients developed severe hypothyroidism or TSH > 30 mIU/l when levothyroxine was initiated, as compared to 25% of patients, prior to the implementation of this new care model.

Conclusions: The implementation of an ESN-led post-RAI care pathway has significantly improved adherence to the national guidelines. The better monitoring of thyroid function has led to larger proportion of patients receiving thyroid hormone replacement in a timely manner and prevent severe hypothyroidism after RAI. This approach provides a care model that improve patient outcomes and increase consultant clinic capacity.