Authors (including presenting author) :
Wong SN(1), Too LC(1), HT Fung(1), Chan PF(1), Chow TL(2)
Affiliation :
(1) Department of Family Medicine and Primary Health Care, Kowloon East Cluster, Hospital Authority, Hong Kong
(2) Department of Surgery, United Christian Hospital (UCH), Kowloon East Cluster, Hospital Authority, Hong Kong
Introduction :
In order to provide an earlier assessment and management for routine referrals of common surgical problems to Surgical Specialist Out-patient Clinic (SOPC), Family Medicine Triage Clinic (FMTC) was set up at Kwun Tong Community Health Centre in February 2015. Thyroid nodules were one of the pre-defined surgical conditions managed at the FMTC. Comprehensive assessment by FM specialists and access to relevant hospital investigations has been made available to facilitate the workflow of the FMTC.
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 March 2020 to 28th February 2021 were included in the review. Relevant clinical data were retrieved from Clinical Management System for analysis.
Result & Outcome :
54 patients were referred to FMTC for thyroid nodules during this period, with a mean age of 58.0 years old and 85.2% were female. The mean waiting time for the clinic was 8.1 months. The durations of the thyroid nodules ranged from 1 month to 9 years, with a mean and median of 15 months and 10.5 months respectively. The measured size of the nodules by physical examination ranged from 0.5 cm to 5 cm in diameter, with a mean of 2.2 cm. Ultrasonography of thyroid with and without fine needle aspiration for cytology (FNAC) was arranged in 64.8% (N=35) and 29.6% (N=16) of patients respectively. About half of these patients (51.0%, N=26) opted to have the investigations done in private sector. The most common findings of imaging and cytology studies were adenomatous or hyperplastic nodule (37.9%, N=11), suspected malignancy (13.8%, N=4), thyroid cysts (10.2%, N=3), colloid nodule (10.2%, N=3) and benign follicular lesion (6.9%, N=2).
Most patients (53.7%, N=29) had continued follow-up in FMTC, while 17.2% (N=5) patients could be discharged from the clinic with no follow-up. Only 29.6% (N=16) patients required referral to the Surgical SOPC for further assessment and management. The main reasons of referral included confirmed or suspected malignancy (43.8%, N=7) and substernal goiter or increased goiter size (37.5%, N=6).
Conclusion:
Family physician led Triage Clinic could successfully manage patients with thyroid nodules, make timely diagnosis and referrals for those suspected to have more serious pathology and reduce the workload in secondary care.
