Radio-iodine therapy follow up in the 21st Century – ‘You have one new message’

Dr Benjamin Dowsing

Introduction: Radio-iodine therapy has been used in the management of Grave’s Disease since the 1940s. A single oral dose of 131-Iodine labelled sodium iodine is delivered achieving the desired outcome of hypothyroidism in 80-90% of Grave’s patients. The time to achieve hypothyroidism is variable often occurring within 12 weeks of therapy but taking up to a year in some cases. This necessitates regular thyroid function testing (a minimum of 3 weekly tests for 12 weeks) with endocrinology follow up to monitor, not only for adverse effects, but the point at which levothyroxine replacement needs to start. The means of achieving this are variable. Patients can of course be reviewed in clinics but this is extremely time consuming for patient and doctor alike. Telephone clinics are now the standard, with the aim of allowing numerous patients to be contacted quickly and efficiently.

The Charing Cross Radio-iodine therapy service relies on telephone follow up for all patient communication. For the average patient this will involve a minimum of 4 telephone consultations but is often much higher owing to continued follow up and the need for multiple calls. Given the constant and near universal access to modern communication such as email, does the telephone deserve to be the standard any longer?

Aims: To improve the follow up process for radio-iodine therapy patients at Charing Cross Hospital, predominately covering two major areas:

1)    Patient Satisfaction with the service

2)    Practicalities of the service

Method: A questionnaire consisting of 15 multiple choice questions and 3 open answer questions was provided to patient who had undergone radio-iodine therapy and completed at least 12 weeks of at Charing Cross hospital in 2014.

Results: Patients were highly satisfied with the service, describing their care as excellent or very good in all areas from communication to empathy and clarity of instruction. With regards to practicalities on the service, a highlighted issue was the ability to answer telephone calls – “you call when I’m at work” and “you called when I was on the train”.  When asked if they felt email had a place in the service the response was extremely positive with limited concerns about its use, “I worry about the doctors doing too much paperwork”, and most feeling it would be very useful – “I can respond in my own time”.

Discussion: Though extremely happy with their care patients noted problems with answering telephone calls. The typical patients are often working full time making conversations on the telephone for routine follow up difficult. Anecdotally as a doctor this translates to a lot of missed calls and frustration. Where the patient is happy, and most feel they would be, a movement towards email follow up should be the future of the service – allowing more efficient communication and giving the patient a more active role in their own care. An emphasis on email follow up is now due to be introduced into the radio-iodine follow up at Charing Cross Hospital.