Monitoring Thyroid Function in Patients on Levothyroxine. Assessment of Conformity to National Guidance and Variability in Practice

In my view, this is a deeply questionable paper.

It might be true that the frequency of TFT testing does not conform to their recommended intervals. The question should be "Why?". Not jumping to the conclusion that the lab should take over the responsibility of requesting tests.

There might be any number of reasons for the interval varying, including:

Patient convenience

Patient feeling so bad they request an early test

Patient seeing no benefit in having a test - after all, what would the GP do?, or the patient is feeling fine.

Patient referred to endocrinologist who requests repeat tests

If the GPs are failing to make approrpiate requests, then tell the GPs what they are doing wrong (in your view), and try to understand. Then make suggestions.

Exp Clin Endocrinol Diabetes. 2017 Apr 13. doi: 10.1055/s-0043-103018. [Epub ahead of print]

Monitoring Thyroid Function in Patients on Levothyroxine. Assessment of Conformity to National Guidance and Variability in Practice.

Scargill JJ1, Livingston M2, Holland D3, Duff CJ4, Fryer AA4, Heald AH5.

Author information

1 Department of Clinical Biochemistry, Salford Royal Hospital, Salford, UK.

2 Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK.

3 School of Pharmacy, Keele University Benchmarking Service, Keele University, Staffordshire UK.

4 Department of Clinical Biochemistry, University Hospitals of North Midlands, Stoke-on-Trent, UK.

5 The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.

Abstract

With demand for endocrine tests steadily increasing year-on-year, we examined thyroid function test (TFT) frequencies in patients on levothyroxine replacement therapy to assess the effect of initial TFT results and request source on TFT re-testing interval. All TFTs performed by the Clinical Biochemistry Departments at the Salford Royal Hospital (2009-2012; 288 263 requests from 139 793 patients) and University Hospital of North Midlands (2011-2014; 579 156 requests from 193 035 patients) were extracted from the laboratory computer systems. Of these, 54 894 tests were on 13 297 patients confirmed to be on levothyroxine therapy in the test cohort (Salford) and 67 298 requests on 11 971 patients in the confirmatory cohort (North Midlands). In the test cohort, median TFT re-testing interval in the total group was 19.1 weeks (IQR 9.1-37.7 weeks), with clearly defined peaks in TFT re-testing evident at 6 and 12 months and a prominent broad peak at 1-3 months. Median re-test interval was much lower than recommended (52 weeks) for those with normal TFTs at 31.3 weeks (30.6 weeks for the confirmatory cohort). Where thyroid-stimulating hormone (TSH) was elevated and free thyroxine (fT4) was below the reference range, re-test interval was much longer than is recommended (8 weeks) at 13.4-17.6 weeks (7.1-23.4 weeks in the confirmatory cohort), as was the interval when TSH was below and fT4 was above the normal range, at 16.7-25.6 weeks (27.5-31.9 weeks in the confirmatory cohort). Our findings show that the majority of TFT requests are requested outside recommended intervals and within-practice variability is high. A new approach to ensuring optimum monitoring frequency is required. Direct requesting from the clinical laboratory may provide one such solution.

© Georg Thieme Verlag KG Stuttgart · New York.

PMID: 28407667

DOI: 10.1055/s-0043-103018

ncbi.nlm.nih.gov/pubmed/284...

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6 Replies

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  • They should just get back to diagnosing upon cliical symptoms and giving a trial of thyroid hormones. They'd save pots of money and the patients would probably be better off too as well as happier :) Of course we should be given options of thyroid hormones too. :)

  • I think this is just another step along the way of automating medicine and reducing patients to being just cogs in a machine. Ever since Evidence Based Medicine became the latest wheeze for making patients lives a misery, the possibilities for saving money and getting rid of doctors have become more and more clear.

    I think the government wants to get rid of general practice as we currently think of it altogether and have it run by nurses instead. They are so much cheaper. Give the nurse a checklist with a bunch of tick boxes, what do you need a doctor for?

    And if a patient insists on seeing a real doctor then they will just have to pay for it. Win-win for the government and the insurance companies, and anyone rich enough to invest in healthcare companies.

  • What, exactly, is the point of this study???

    If a patient cannot tolerate levothyroxine, it makes B all difference if they are tested twice a day, they will still need a change of medication - which they are highly unlikely to get!!!

    Does nobody have sufficient brain cells to realise that a study, into exactly WHY there has been an increase in the number of tests, is desperately needed???

  • This may not be popular but the truth often isn't. The answer to this dogid nonsensical adherence to rules on pieces of paper along with complete blind indifference to patients can be answered in one word. Asbergers.

    Please read about this it will explain a lot.

    I personally refuse to have a doc or endo..with this syndrome, I did my time,16 years in which I discovered my husband suffered. No I will correct that, I suffered.

    I know that stats for cases in the population due to reach 50%. In USA in next 20 years. Frightening!

    Just say to yourself.. Any profession etc. Requiring " rote" learning contains a very high proportion.

    Don't get angry or upset, they don't care because they can't. So any reaction by you just hurts you. Walk away, run as fast as you can.

    I hope this helps you

    Keep smiling, telling jokes, it all helps the eminent system.

  • Is this a follow-up to your post of January 19?

  • It's in response to all the : what's the point of this study. Why do they keep saying I need a psychiatrist? Because " they" can't cope with emotions, people in general and patients in particular, they want to move you on, get rid of you.

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