We are concerned about an increasing number of thyroid patients experiencing difficulties accessing appropriate specialist care given the rising pressures on the NHS due to Covid-19.  

The British Thyroid Association (BTA) and Society for Endocrinology (SfE) share these concerns and believe it is vital to continue providing specialist endocrine services to protect patient safety at this time.  

They have provided the following information to us to help patients access care at this time: 

‘We can confirm that larger hospitals are still offering endocrine appointments for the most urgent cases, including new or severe thyrotoxicosis and thyroid cancer services, especially where there is rapid progression. The ambition is to continue to offer at least 25% of usual endocrine services during the current pandemic. However, some smaller hospitals, and those in the worst Covid-19 affected areas, may unfortunately not have the resources to operate at this level.

To help bridge any temporary gaps in specialist endocrine services, the following options may be available to support patients: 

• Support for GPs
  • To access specialist advice, GPs are encouraged to use the NHS ‘Advice and Guidance’ service offered by most NHS Trusts. This is particularly appropriate for the management of new/severe cases of thyrotoxicosis.
  • The BTA/SfE 'Advice regarding resource-limited treatment of thyrotoxicosis during the Covid-19 pandemic’ provides guidance for GPs on Block and Replace treatment. GPs are also able to prescribe betablockers to help manage symptoms of thyrotoxicosis. 
  • Our guidance on the management of thyroid dysfunction addresses common questions to assist our primary care colleagues.
  • Our statement prepared with Thyroid Cancer Forum UK provides guidance on the treatment of patients with thyroid cancer during the Covid-19

• Advice from an experienced endocrine specialist nurse may be available in some NHS trusts. Many will be able to start treatments for patients and offer a helpline.
• We continue to offer virtual appointments wherever possible for suitable patients. Where this service is unavailable within your NHS Trust, specialists from outside your area may be able to offer virtual appointments. This would be booked by your GP referring you to the relevant hospital through the NHS e-referral portal and then usually the secretary will approach you with a date and with an option for face to face or virtual/phone consultation. It is very useful if your phone and email address are included in the referral.

The BTF also offers information resources and a peer support network to thyroid patients across the UK. This includes telephone contacts and a medical query service.  

We are all aware that the situation is variable throughout the UK and access to services will depend on Covid-19 cases locally, staff availability, and other pressures. However, we will continue to monitor the situation and provide updates when possible.’

 

Further information 

Management of thyroid dysfunction during Covid-19 (British Thyroid Association) 

Management of thyrotoxicosis during Covid-19 (British Thyroid Association)

Thyroid cancer and coronavirus (Covid-19)

BTF Covid-19 resources

Thyroid surgery and Covid-19 update 

We understand many of you will also be feeling concerned about possible delays to planned thyroid surgery due to Covid-19.  This reflects the higher personal risk of having surgery at a time when you might pick up the virus, as well as the redeployment of anaesthetic/critical care staff and lack NHS beds and operating facilities at this time.

The British Association of Endocrine and Thyroid Surgeons (BAETS) advise that thyroid surgery should continue to be offered to those patients most in need. Patients who may require more urgent assessment/treatment include those with: 

• significant airway compression 
• high risk or rapidly progressive thyroid cancer 
• uncontrolled Graves' disease in pregnancy 
• uncontrolled thyrotoxicosis for whom medical treatment or radioactive iodine is unsuitable
• severe or sight-threatening Thyroid Eye Disease (TED)

BAETS advises that thyroid surgery can safely be deferred in many patients with cancers considered to be low risk and in those with reasonably controlled thyroid disease.  
 
The availability of surgery will, of course, vary from region to region in this rapidly changing climate. However, your local healthcare team should be able to advise you on this. 
 
For patients with questions about thyroid surgery, please refer to our 'Thyroid Surgery' website resources, which includes a film of our ‘Ask the Expert' webinar on thyroid surgery as well as links to BAETS fact sheets about thyroid surgery.  If you have a very specific enquiry, please contact our medical query service [email protected] and we will try to assist.  

BTF thyroid surgery resources