Cooper Rachel, Pinkney Jonathan, Ayling Ruth M
Clinical Biochemistry, Derriford Hospital, Plymouth, UK.
Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK.
Ann Clin Biochem. 2015 Jul;52(Pt 4):497-501. doi: 10.1177/0004563214568686. Epub 2015 Jan 9.
A practice hypothyroid register is part of the quality and outcomes framework. In literature, the prevalence of hypothyroidism is stated to be 2% but the prevalence, defined from quality and outcomes framework data, is 3.2% in the UK and 3.6% in Plymouth. We sought to investigate the diagnosis of hypothyroidism and reasons for prescription of thyroxine to patients on the hypothyroid register in Plymouth.
A letter was sent to the 10 practices with the highest prevalence of hypothyroidism requesting a list of patients on their registers. The hospital pathology system was used to identify those with biochemically documented hypothyroidism (defined as thyroid stimulating hormone >10 mU/L) For two large practices the clinical records of the remaining patients were reviewed to ascertain the reasons for prescription of thyroxine and whether it led to symptomatic improvement.
Seven practices responded with 1246 patients on their registers, of whom 43.6% had documented hypothyroidism. A review of notes of patients on the register, but without documented hypothyroidism, showed <25% to have an improvement in symptoms after prescription of thyroxine. Tiredness was the most common symptom prompting prescription of thyroxine.
Of the patients on the register, only 43.6% had documented biochemical evidence of hypothyroidism and, from notes review of those without documented hypothyroidism, at least two-thirds may have been prescribed thyroxine outwith current national guidance. If this is correct, it has significant resource implications, impacts upon the workload of primary care, pharmacy and the laboratory service and may have clinical implications for patients.
实践甲状腺功能减退登记册是质量与结果框架的一部分。文献中指出甲状腺功能减退的患病率为2%，但根据质量与结果框架数据确定的患病率在英国为3.2%，在普利茅斯为3.6%。我们试图调查普利茅斯甲状腺功能减退登记册上患者的甲状腺功能减退诊断情况以及甲状腺素处方的原因。
向甲状腺功能减退患病率最高的10家医疗机构发送信函，要求提供其登记册上的患者名单。利用医院病理系统识别那些有生化记录的甲状腺功能减退患者（定义为促甲状腺激素>10 mU/L）。对于两家大型医疗机构，审查了其余患者的临床记录，以确定甲状腺素处方的原因以及是否导致症状改善。
7家医疗机构做出回应，其登记册上有1246名患者，其中43.6%有记录的甲状腺功能减退。对登记册上但无记录的甲状腺功能减退患者的病历审查显示，服用甲状腺素后症状改善的患者不到25%。疲劳是促使开具甲状腺素处方的最常见症状。
在登记册上的患者中，只有43.6%有记录的生化甲状腺功能减退证据，从对无记录的甲状腺功能减退患者的病历审查来看，至少三分之二的患者可能是在当前国家指南之外开具的甲状腺素。如果情况属实，这将对资源产生重大影响，影响初级保健、药房和实验室服务的工作量，并且可能对患者产生临床影响。
