Graves’ disease (GD) is typically diagnosed in primary care, with referral to Endocrinology for further management(1). During the active phase of GD, patients are often reviewed 6-8 weekly to titrate antithyroid drugs (ATDs), placing a substantial burden on specialist health services. Evidence-based recommendations could allow for development of shared care pathways between primary and secondary care(2). The interaction of GD patients with Australian health services, particularly in regional areas, is unknown.
To review the clinical course of GD patients referred to Bendigo Health (BH) and their interaction with the outpatient service
New GD patients referred to BH between 1st January 2020 and 31st December 2021 were identified via clinical coding. Data werecollected from the electronic patient record system.
22 patients were included: 17 (77%) female with a mean age of 44 years, located 10km (median, range 3-218km) from BH. 6 patients (28%) lived in the lowest socio-economic decile. For the majority (18 patients, 82%), this was their first episode of GD. Patients were reviewed in clinic for a mean 8 appointments 13.5 weeks apart. 87 (49%) appointments were telehealth, 59 (34%) in person and 30 (17%) mode not documented. Doses of ATDs were adjusted at median 3 appointments. 2 patients (9%) experienced liver derangement and 3 (14%) described an intolerance to ATDs. 3 patients (14%) became hyperthyroid following ATD cessation. 12 patients (55%) selected definitive therapy, mostly due to persistent GD; 7 (58%) underwent thyroidectomy and 5 (42%) radioactive iodine. 4 patients (18%) failed to attend appointments.
The sample size was limited by accuracy issues with clinical coding. Appointments to titrate ATDs were less frequent than expected with a high proportion opting for definitive therapy. Further work is needed to define GD-associated healthcare costs and conduct stakeholder analyses to explore the potential for shared management between Endocrinology and primary care.