Endocrine Abstracts

Presentation: A 20 year old student was brought to the Emergency Department with a 13 day history of heavy menstrual bleeding. On the day of her admission she had collapsed. On admission, she was noted to be pale with severe postural drop (70 mm Hg).Investigations: Haemogobin: 46 g/l. Blood film showed an iron-deficient picture. eGFR: 54ml/min/1.73m2. Creatinine: 124 μ mol/l. Free T4: <5.3 pmol/l. TSH: >500 mU/l. TPO antibodies positive (8.3...

Background: In 2014, Thy002 (the proportion of patients with hypothyroidism on the practice register with thyroid function tests recorded in the preceding 12 months) was removed as a Quality Outcome Framework (QOF) target.Aim: To audit the current management of hypothyroidism in primary care two years following the QOF changes.Method: Four local practices (total patient population: 37 200 (range 7300–1300 per Practice)) partic...

Aim: To investigate the relationship between baseline and stimulated cortisol responses in relation to the habitual time of rising and time of test.Method: The self-reported habitual rising time and time of cortisol testing were recorded in 63 consecutive patients (47F, 17M, age 18–94) undergoing standard stimulation testing with tetracosactide (SynActhen) 250 μg i.v. In total, 75 tests were analysed. A normal response was defined as a 30 min p...

Introduction: Symptoms of hypothyroidism are very variable and are frequently present in the healthy population. The diagnosis can easily be missed if considered only in patients with classical symptoms. Aim: To describe the range of presentations in patients diagnosed with hypothyroidism in primary care.Method: Patients were recruited via the British Thyroid Foundation and from a local GP surgery. Respondents were asked to complete a questionnaire for t...

Introduction: Hyponatraemia is not uncommon in primary care and its management can be complex. It is vital that initial assessment is carried out properly as mismanagement can have serious consequences.Aim: To investigate general practitioners’ views and perceptions on the management of hyponatraemia encountered in primary care.Method: Local general practitioners were surveyed with a questionnaire via email and at local postgr...

Introduction: Hyperthyroidism may mimic many conditions, and there is potential for under-diagnosis if testing is considered only in patients presenting with classical symptoms.Aim: To describe the range of presentations in patients found to have hyperthyroidism and referred from primary care.Method: Consecutive patients diagnosed with hyperthyroidism and referred to the endocrine clinic between Jan 2009 and Nov 2009 were studied. ...

Introduction: Thyroid quality indicators were removed from the Quality Outcome Framework (QOF) targets in 2014, resulting in discontinuation of statutory system alerts to remind GPs to check annual thyroid function in patients with primary hypothyroidism treated with levothyroxine.Aim: To investigate the impact of the discontinuation and reinstitution of the QOF thyroid e-alerts on the management of hypothyroidism in primary care.<p cla...

Introduction: Thyroid quality indicators were removed from the Quality Outcome Framework (QOF) targets in 2014, resulting in discontinuation of statutory system alerts to remind GPs to check annual thyroid function in patients with primary hypothyroidism treated with levothyroxine.Aim: To investigate the impact of the discontinuation and reinstitution of the QOF thyroid e-alerts on the management of hypothyroidism in primary care.<p cla...

Introduction: Thyroid hormone replacement is frequently suboptimal but interventions that are proven to optimise therapy are lacking. In 2017, we developed in EMIS an electronic Protocol for Monitoring Patients on Thyroxine in General Practice (‘e-Prompt GP’), to offer automated alerts to prompt GP's to test and address out of range thyroid function tests in patients with hypothyroidism.Aim: To investigate the long-term impact of an electronic ...

Introduction: Following the introduction of the Quality Outcome Framework (QOF), 98–100% patients with hypothyroidism received annual TSH checks during the period 2009–2014. However, there was no evidence this resulted in improved care. We have developed an electronic protocol in EMIS web to both emulate the former QOF thyroid e-alerts in prompting GP’s to check annual thyroid function in patients with treated primary hypothyroidism, and also to alert if TSH is ...