1. TFT Monitoring in patients taking Amiodarone Dr Naznaz Mohammed ST2 General Practice

2. Aims: Quantify adherence to published guidelines / recommendations for serial monitoring of chronic amiodarone therapy > 6 month. The UK Guideline for the use of TFT regarded as a measure of appropriate monitoring.Aims: Quantify adherence to published guidelines / recommendations for serial monitoring of chronic amiodarone therapy > 6 month. The UK Guideline for the use of TFT regarded as a measure of appropriate monitoring.

3. Criteria: All patients should have their TFT monitored every 6 months after starting amiodarone this include TSH, T4 and T3. Standard: 90% of patients should have had their TFT measured and recorded in the last 6 months. Criteria: All patients should have their TFT monitored every 6 months after starting amiodarone this include TSH, T4 and T3. Standard: 90% of patients should have had their TFT measured and recorded in the last 6 months.

4. Method: Practice staff helped to pull out a list of patients on chronic amiodarone therapy. 20 patients were taking amiodarone Ages range between 61-87 years Duration of therapy 8 months -15 years Method: Practice staff helped to pull out a list of patients on chronic amiodarone therapy. 20 patients were taking amiodarone Ages range between 61-87 years Duration of therapy 8 months -15 years

5. Results/ Data: Results/ Data: 10 out of 20 have has their TSH measured and recorded in the previous 6 months All of the patients who have had their TFT yearly, only one of those has had his TSH measured every 6 months. Results/ Data: Results/ Data: 10 out of 20 have has their TSH measured and recorded in the previous 6 months All of the patients who have had their TFT yearly, only one of those has had his TSH measured every 6 months.

6. Conclusion: 50% of patients have their TSH measured compared to standard which is 90% The patients taking amiodarone longest have had the smallest % of recorded TFT every 6 months. The monitoring of TFT in patients on Amiodarone is less than ideal. Conclusion: 50% of patients have their TSH measured compared to standard which is 90% The patients taking amiodarone longest have had the smallest % of recorded TFT every 6 months. The monitoring of TFT in patients on Amiodarone is less than ideal.

7. Recommendations To improve outcomes involve: Doctors : Guidelines awareness ( algorithms for managing abnormal TFT) Patients: Amiodarone and TFT leaflets / handouts Letters explaining follow-ups Choices where to take test Staff: Educate and involve in monitoring Designate a member to check TFT twice yearly. IT : Identify those not taking tests and generate notices. Include new patients and make sure they have similar monitoring. Re Audit in 6 months Recommendations To improve outcomes involve: Doctors : Guidelines awareness ( algorithms for managing abnormal TFT) Patients: Amiodarone and TFT leaflets / handouts Letters explaining follow-ups Choices where to take test Staff: Educate and involve in monitoring Designate a member to check TFT twice yearly. IT : Identify those not taking tests and generate notices. Include new patients and make sure they have similar monitoring. Re Audit in 6 months

8. References Monitoring the use of amiodarone : compliance with guidelines Internal Medical Journal, vol.36 Issue 5 UK guidelines for the use of TFT British Thyroid Association British Thyroid Foundation The association for clinical biochemistry 1 st July 2006 Amiodarone –Induced Thyrotoxicosis Medscape Today References Monitoring the use of amiodarone : compliance with guidelines Internal Medical Journal, vol.36 Issue 5 UK guidelines for the use of TFT British Thyroid Association British Thyroid Foundation The association for clinical biochemistry 1 st July 2006 Amiodarone –Induced Thyrotoxicosis Medscape Today

9. Any Questions ? Any Questions ?