Approach to the Patient With Thyrotoxicosis Using Telemedicine

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Context</jats:title> <jats:p>The potential for endocrine care via telemedicine has been recognized since the early 2000s when clinical outcome data demonstrated improvements in glycemic control with telemedicine. The widespread use of telemedicine during the COVID-19 pandemic has pushed telemedicine beyond diabetes care and into clinical areas with a paucity of published data. The evaluation and treatment of thyrotoxicosis heavily relies on laboratory assessment and imaging with physical exam playing a role to help differentiate the etiology and assess the severity of thyrotoxicosis.</jats:p> </jats:sec> <jats:sec> <jats:title>Case Description</jats:title> <jats:p>We describe a patient presenting for evaluation of new thyrotoxicosis via telemedicine, and describe modifications to consider for thorough, safe evaluation via telemedicine.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Telemedicine may be an ideal way to assess and treat patients with thyrotoxicosis who are not able to physically attend a visit with an endocrinologist but still have access to a laboratory for blood draws. Potential challenges include access to imaging and high-volume surgeons if needed. Clinical and economic outcomes of telemedicine care of thyrotoxicosis should be studied so that standards of care for endocrine telemedicine can be established.</jats:p> </jats:sec>

Patient Satisfaction With the Use of Telemedicine in the Management of Hyperthyroidism

“…The emergence of the COVID-19 pandemic has highlighted the importance of telemedicine, which was originally introduced to rural areas where access to healthcare services was sometimes difficult [ 2 ]. A recent work highlighted the challenges involved in using telemedicine for the initial evaluation of patients with hyperthyroidism during the COVID-19 pandemic, such as inability to perform an initial physical examination and access to imaging [ 10 ]. A reduction in the burden of face-to-face consultations for the endocrinologist when telemedicine was used for other thyroid disorders was highlighted by another published work [ 11 ].…”

Management of thyroid disorders during the COVID-19 outbreak: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM)

“…The same applies for patients recently diagnosed with hypothyroidism or in whom treatment has not been initiated yet. An exception should be made for patients who manifest symptoms of uncontrolled hypothyroidism, in whom serum TSH and free T4 levels should be measured (39,40); telemedicine is an option for adjustment of levothyroxine dose in these patients (43).…”

“…Alternatively, prolonged use of lowdose ATD may be considered, as it is safe and may increase the chance of GD remission (46,47). During the pandemic, telemedicine may be an alternative to manage patients with hyperthyroidism (43). If possible, definitive treatment of GD (radioiodine therapy or TT) may be carried out after the pandemic is over.…”

Thyroid and COVID-19: a review on pathophysiological, clinical and organizational aspects

“…Follow-up visits in cases of papillary thyroid cancer with an excellent or indeterminate prognosis may be postponed, according to epidemiological complaints, for a post-operative neck ultrasound. Patients could also be managed through telemedicine [72], as a valuable strategy for improving the standard of care in endocrinology during the pandemic [152], also guaranteeing reasonable patient satisfaction despite restrictions [153]. Social media messaging, email service, telephone consultations, and, where available, virtual digital visits could be considered reliable for educational purposes and to ensure a regular follow-up in patients with stable diseases.…”