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TFT Monitoring Audit
Thyroid monitoring Audit
Amit Patel and Dr Bolarum
Bushloe Surgery 2016/17
Do we meet the target?
Do we meet the target?
Audit Outline
Thyroid monitoring is important
British Thyroid Association says once controlled, for annual bloods
Are 100% of our patients on thyroxine
having annual blood tests?
Monitoring TFTs
Monitoring TFTs
TIME
Are we hitting 100%?
Are we hitting 100%?
What can we do to improve?
What can we do to improve?
Doctor's Name
Nurse’s Name
Thyroid function
Both T3 and T4:
- increase cell metabolism
- facilitate normal growth
- normal - mental development
Treatment and Management
Treatment and Management
Treatment and Management
Hypothyroidism
Thyroxine
Aim of treatment is to restore normal thyroid hormone concentration and to provide symptomatic relief for the patients
Once normal function achieved, need annual blood tests
Hyperthyroidism
drug treatment
surgery
Radioiodine
Tailor treatment and doses to response and levels
Why is it important?
Why is it important?
Prevalence of spontaneous hypothyroidism in UK is
approx 1%-2% (M:F = 10:1)
Onset is extremely insidious and symptoms may be unnoticed for several years
Note - may take several months before symptoms of hypothyroidism are resolved after biochemical correction of hypothyroidism
Why is it important?
Slowing down of the mental and physical processes of t...
Slowing down of the mental and physical processes of the whole body
heavier and longer periods
fertility problems
low libido
weight gain
puffy face and bags under the eyes
slow speech, movements and thoughts
low mood or depression
memory problems
fatigue and tiredness
increased awareness of the cold
dry and coarse skin
dry and thinning hair
hoarse or croaky voice
constipation
muscle weakness,
cramps and aches
pins and needles in the fingers and hands
raised cholesterol
slowed growth (in children)
difficulty in concentration
slow heart beat
slightly raised blood pressure
Potentially dangerous!
Potentially dangerous!
Increased IHD and CVD risk
Problems with enlarged
goitres
Myxoedema
Birth Defects
Tachycardia
Arythmias
Atherosclerosis
The Audit
Guidelines for monitoring
Guidelines for monitoring
At least annual monitoring
Association of clinical biochemistry, British thyroid association, British thyroid foundation.
It is important that all patients meet this guideline
Increased function in hyperthyroidsim and reduced function in hypothyroidism can potentially be dangerous
Hyperthyroid crisis rare but dangerous (of 0.2 cases per 100,000)
Approximately 1-2% of patients with hyperthyroidism progress to a hyperthyroid crisis
What we did
Do 100 % of patients at Bushloe Surgery on thyroxine have their TFT’s monitored at least annually?
Identify patients who have been on thyroxine over 3 months from January 2017 (and remain in thyroxine)
When were their last two TFT blood tests
What proportion of patients did not have TFTs within 13 months?
Do those not having annual bloods, have normal TSH levels?
Results
493 patients identified to be on Thyroxine
10% random sample taken – i.e. 50 patients
13/50 had more than a 13month gap from the last thyroid function blood test – ie 26%
One patient had a 45month gap between last two TFTs, despite medication review in between
This is significant as we do annual medication reviews for all patients on medication where we check the blood tests
Recommendations
1. Educating patients – made aware that need annual bloo...
Recommendations
1. Educating patients – made aware that need annual bloods. Possibly a letter when diagnosed
2. Admin staff – check had TFTs within a year when medication requested – (too much work?)
3. Doctors - Medication reviews
4. Run a report twice a year to identify patients
Re-Audit
Re-Audit
References
References
CG, Ladenson PW. Hypothyroidism. Lancet. 2004;363(9411):793-803
Association for Clinical Biochemistry (ACB), British Thyroid Association (BTA),
British Thyroid Foundation (BTF) 2006.
UK guidelines for the use of thyroid function tests
Vaidya B, Pearce SH. Management of hypothyroidism in adults. BMJ. 2008;337:a801
BTA www.british-thyroid-association.org/current-bta-guidelines-
BTF www.btf-thyroid.org/professionals/197-guidelines
GP notebook – www.gpnotebook.co.uk/simplepage.cfm?ID=1174798342&linkID=74026&cook=yes