Thyroid Function Measurement: Case Study

Audit of Thyroid Function Measurement

Intoduction
Hypothyroidism is a common condition in general practice occuring in 2% of women and 0.2% of men. Guidelines from the British Thyroid Association 2006 suggest that all patients receiving thyroxine replacement should have their TFTs measured annually. If the dose of thyroxine is altered, TFTs should be re measured after 2-3 months. The gold standard should be 100%, ie all patients receiving thyroid replacement should have TFTs measured at least annually.
Criteria 1
All patients should have TFTs measured annually
Data Collection Tool
1. No of patients reviewed
2. No of patients with TFTa measured on an annual basis

Criteria 2
No of patients with an dose adjustment of thyroxine should have TFTs
The study parameters included patients on this medication between 1/10/2011 and 1/10/2012, ages 0-100, Eltroxin dose 25mcg, 50mcg, 75mcg,100mcg, 125mcg and 150mcg. This list of patients was printed out based on medication dose. The individual patient files were examined with particular reference to the frequency of thyroid function testing in the specified audit period. The results were entered into an excel file. A reaudit period existed from 1/10/2012 to 30/04/2012. Patients who did not have a thyroid function performed or who had an abnormal result were followed up to check improvement in adhering to the
Table 1 illustrates the numbers of patients on eltroxin receiving doses from 25mcg-150mcg. Table 2 demonstrates the frequency of TFT measurement based on individual doses, and the amount of patients who demonstrated abnormal TFTs which required a dose adjustment Overall 89% of patients had TFTs measured on an annual basis (49/55). This was the highest in patient receiving doses above 50mcg and lowest in patients receiving 50mcg (21/25). 3/21 patients receiving 50mcg eltroxin, 2/5 patients on 75mcg eltroxin and 1/10 patients receiving 100mcg demonstrated abnormal tfts requiring a dose adjustment.
In the reaudit phase, of those whose TFTS were not recorded annually both patients who receive 25mcg and 100mcg respectively had their tfts recorded within the audit period. 2/4 (50%) of those patients receiving 50mcg eltroxin who had less than annual measurement had their TFTs recorded. All patients who received dose adjustments of eltroxin received repeat TFT measurement within 3 months

Conclusion
Overall the practice achieved 89% compliance with Criteria 1 and 100% compliance with Criteria 2. Reaudit phase achieved a 50% improvement in TFT measurement of those who did not receive annual TFT