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Suppressive Thyroxine Treatment Card

The Problem

Part of the long-term management of patients with thyroid cancer is thyroid stimulating hormone (TSH) suppression with doses of thyroxine. TSH is a chemical messenger that circulates in the blood and drives thyroid tissue to make thyroid hormones. TSH also can stimulate thyroid tissue (including any remaining thyroid cancer in the body) to grow. It is therefore important to keep the level of TSH low in patients who have been diagnosed to have thyroid cancer. This can be achieved easily with thyroxine tablets. 
           
In the experience of consultants in The Newcastle upon Tyne Hospitals NHS Foundation Trust, GPs often are not aware of the differences in objectives between treating patients with thyroid cancer with suppressive doses of thyroxine to that of treating patients with primary hypothyroidism. This is understandable given that each practice is likely to have only one or no patients on thyroxine because of thyroid cancer, while an average practice will have up to 250 patients on thyroxine because of an underactive thyroid. This results in inappropriate adjustments of the dose of thyroxine of patients with thyroid cancer in primary care.
 
The impact on patients was reported to have been : confusion (59%), worry (41%), loss of confidence in doctors (59%), weight gain (48%), and contribution towards disease progression (4.5%). 
 

The Solution

A patient-held card was designed and produced by the NHS Innovations North in conjunction with the Butterfly Thyroid Cancer Trust and the North of England Cancer Trust. The card has write-on strips to enter the patient relevant data. In addition, the purpose and aim of TSH suppression is discussed with all new patients thus educating and empowering them. The discussion is reinforced with a letter to new patients and will be copied to their GP explaining the purpose of treatment and target blood tests

 
The card was authuorised for use in The Newcastle upon Tyne Hospitals NHS Foundation Trust at the end of 2008. It has been very successful in empowering patients and preventing GPs from changing thyroxine dosage. The Sheffield Hospitals Foundation Trust have adopted the card for use with their thyroid cancer patients.
 

Benefits to the NHS 

This idea will improve communication between GPs and secondary care and reduce the need for multiple blood tests and multiple consultations resulting from the results of unnecessary tests and unnecessary adjustments of medication dosage. There are potentially cost and time savings for primary and secondary care.

For further information please contact Barbara Marriner on 0191 5164400 or email barbara.marriner@nhsinnovationsnorth.org.uk

24/Feb/2010

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