Authors (including presenting author) :
Too LC, Chan PF, Chao DVK
Affiliation :
Department of Family Medicine and Primary Health Care, United Christian Hospital
Introduction :
In order to provide an earlier assessment and management for routine referrals of common surgical problems, Family Medicine Triage Clinic (FMTC) was set up at Kwun Tong Community Health Centre in February 2015. Thyroid nodule has been one of the pre-defined surgical conditions to be managed at the FMTC since April 2016. Access to relevant hospital investigations has been made available.
Objectives :
To evaluate the diagnoses and outcomes of patients with thyroid nodules referred to the FMTC.
Methodology :
All patients with thyroid nodules attended the FMTC from 1st April 2016 to 31st December 2017 were included in the review. Relevant clinical data were retrieved from Clinical Management System for analysis.
Result & Outcome :
Results:
122 patients with thyroid nodules were seen during this period. The mean age of patients was 54.8 years old and 87.7% were female. The mean waiting time for FMTC was 9.8 weeks. The mean and median durations of thyroid nodules were 16.6 months and 5.0 months respectively. The measured size of the nodules by physical examination ranged from 0.5 to 5 cm in diameter. 3.3 % patients were hyperthyroid and 3.3% were hypothyroid. Ultrasonography (USG) of thyroid with and without FNA was arranged in 65.6% (N=80) and 25.4% (N=31) of patients respectively. 64% of these patients attended private imaging centres for these investigations. The most common findings of imaging and cytology studies were adenoma (13.9%, N=17), thyroid cysts (11.5%, N=14), multinodular goiter (7.4%, N=9) and hyperplastic nodule (7.4%, N=9). 7.4% (N=9) of patients required no investigations. 37.7% of patients needed follow-up imaging studies. 13.9% of patients were discharged while 24.6% had defaulted follow-up. 26.2% of patients required referral to the Surgical Specialist Out-patient Clinic for further assessment and management. 25% patients (N=8) were referred due to abnormal FNA cytology which included papillary carcinoma (N=2), follicular lesion of undetermined significance (N=2) and Hurthle cell neoplasm (N=2). Other referral indications include symptoms of local invasion (25%, N=8), large nodule (18.7%, N=6), suspicious USG findings (15.6%, N=5), pressure symptoms (9.4%, N=3) and toxic nodule (3.1%, N=1). Outcome:
Family Physicians successfully managed patients with thyroid nodules at a relatively shorter waiting time, make timely diagnosis and referrals for those suspected to have more serious pathology and reduce the workload in secondary care.
Co-location with:
