Content overview

What is the role of an endocrine nurse?

What are nurse-led clinics?

Who do endocrine nurses typically see in their clinics?

Looking at the bigger picture in thyroid health

How to get the most out of your consultation

Further information

At our February 2026 webinar, we heard from Advanced Nurse Practitioners in Endocrinology, Louise Breen and Lisa Shepherd, who both run nurse-led thyroid clinics in hospital.

They explained the role of the endocrine  nurses in managing benign thyroid conditions and helping you to navigate some of the challenges of living with  thyroid condition. They also shared their tips for getting the most out of your healthcare appointments. This is an overview of the points they discussed and you can watch the full webinar on our website.

What is the role of an endocrine nurse?

Endocrine nurses manage a wide range of endocrine conditions via nurse-led clinics, including thyroid disease. They work closely with the multidisciplinary team, playing a key role in service development and improvement.

Ideally, nurses undertaking nurse-led thyroid clinics should have a non-medical prescribing qualification allowing them to prescribe and monitor thyroid medications autonomously.Nurses tend to focus on a holistic approach to patient care, taking into consideration physical, social and  psychological factors which may play a role in your health. They will often give you ‘information prescriptions’ to help you manage your thyroid health. These provide clear instructions and information tailored to your  individual health needs.

Endocrine nurses can also support you with information to help you with decision-making about your treatment and refer you to the appropriate team (surgical, nuclear medicine etc.) to discuss your options in more detail.

Where they identify other issues that need further investigation, they will refer to the appropriate specialist, e.g.,  an ophthalmologist for management of Thyroid Eye Disease or notify your GP of any recommendations for further investigations, assessments and management.

What are nurse-led clinics?

These are hospital clinics where endocrine nurses manage your ongoing care. The structure of nurse-led clinics  varies across the UK. Some clinics will offer new and follow-up appointments, whilst others may only provide a 
follow-up service.

Reviews can be undertaken as face-to-face appointments and/or virtual reviews. Patients may see a doctor for  the first visit, and thereafter your review may be with the endocrine nurse.

Not all NHS Trusts will provide an endocrine nurse service however we are seeing positive changes following the Getting It Right First Time report, which made the strong recommendation that all hospital centres have an endocrine nurse.

Who do endocrine nurses typically see in a nurse-led thyroid clinic?

Endocrine nurses will typically manage people with hyperthyroidism, secondary hypothyroidism* and follow-up post thyroid surgery or radioiodine treatment. Nurses may also undertake specific clinics for antenatal and  postnatal management of thyroid disease. They will usually transfer the care of patients with hypothyroidism  back to their GP once their hypothyroidism is stable.

Patients are often referred to nurse-led clinics when additional support is needed, for example, managing thyroid medicine to improve adherence or to explain treatment options in more detail.

Although hypothyroidism is usually managed by GPs, sometimes the endocrine specialist nurse will receive  referrals to review patients, where thyroid function is variable, and/or the patient is trying to conceive or is pregnant.

*Secondary hypothyroidism is a rare form of hypothyroidism. This is caused by a disorder of the pituitary gland or hypothalamus, rather than the thyroid itself. The pituitary fails to produce enough Thyroid Stimulation  Hormone (TSH). This results in low TSH levels alongside low free T4 (thyroxine).

Looking at the bigger picture in thyroid health

In hypo/hyperthyroidism, symptoms can persist even when thyroid levels have been stabilised. Endocrine  nurses will often look at other factors that might be contributing to ongoing symptoms beyond the thyroid.

These include:

Physical considerations

Weight changes

If you are struggling with weight gain, they would consider lifestyle factors, such as whether you have recently  stopped smoking, had any changes to your diet or reduced normal physical activity. Other things they might explore are changes in menstrual cycle, which could be related to perimenopause, menopause or Polycystic Ovarian Syndrome (PCOS). Obstructive sleep apnoea or stress levels can also contribute to weight gain.

On the other hand, if you are losing too much weight, they might look at whether you have had any recent medication changes, been screened for coeliac disease, or the possibility of any other autoimmune diseases, like  Addison’s disease.

Changes in toilet habits

Nurses will explore possible causes for changes to normal toilet habits. For example if you are opening your bowels more frequently, gastrointestinal causes, such as coeliac disease would be considered. If you are passing urine more frequently they would consider screening for diabetes mellitus or, in men, a prostate issue.

Fatigue

If you are experiencing fatigue, possible causes beyond the thyroid could include menopause, obstructive sleep  apnoea, iron deficiency and stress. They may signpost you to NHS resources about sleep hygiene, sleep apnoea, or encourage you to speak to your GP about other physical causes for poor sleep.

Diet

Changes to our appetite can often indicate that things are not right with the thyroid. Your endocrine nurse may  also ask you about your diet to explore any possible intolerances, or imbalances in nutrition, especially if you are excluding major food groups. This can help to determine whether things like coeliac disease, or deficiencies in  minerals like iron and vitamins like B12, are causing thyroid-like symptoms. Again, where there is any suspicion of this, your endocrine nurse would encourage you to see your GP for further investigations. They may also ask you about your caffeine, alcohol and iodine intake and suggest adjustments.

Medications

As other medications and supplements can interfere with our thyroid function, they may want to look at  nything you are taking. For example, if you have hypothyroidism and are taking GLP-1s (weight loss injections), your  levothyroxine dose may need adjusting.

If you have lost a significant amount of weight, your dose may need to be reduced. GLP-1s can affect the  absorption of levothyroxine and more regular monitoring is required.

Iron, calcium salts, oral oestrogen and epilepsy drugs can also affect how well you absorb your levothyroxine dose. Some supplements, like biotin, can also interfere with assays which measure your thyroid hormone levels and may mean your blood test results can be misinterpreted. Where issues are identified, your endocrine nurse will include this in your information prescription so you have clear instructions about what to do. For example, if you are taking levothyroxine, the advice would be to leave a four-hour gap between taking this and iron or calcium supplements.

Your nurse may suggest vitamin D supplementation, especially if you have low exposure to sunlight due to spending a lot of time indoors or working night shifts. They may also recommend you take selenium supplements if you have mild thyroid eye disease. Other things they can help you with are safely exercising and getting support to stop smoking.

Psychological considerations

Psychological symptoms are common in thyroid disease. For this reason, psychological support and education  measures are a key part of endocrine nurse care. The nurses can explain and reassure you about likely timelines for symptom improvement and why there is sometimes a time lag between your blood results being ok and your physical and psychological symptoms persisting.

Tools like the Thyroid related Quality of Life questionnaire (ThyPRO) can be used to assess and monitor mood. Additional tools can be used to assess for the risk of sleep  apnoea, with abnormal results flagged to your GP for further review and action. Nurses also recommend the use of wellbeing apps to help with things like anxiety and sleep disturbance and may suggest NHS Talking Therapies  or referral to formal psychological support if needed.

Social and faith-based considerations

Studies have shown that thyroid outcomes are strongly affected by the world in which we live and work. Endocrine nurses will look at possible factors in your life that may influence this. Some of these factors can include:

• How easy is it to understand all the information you have been given? Do you need it in another format?
• Are there financial barriers like the cost of travel or prescriptions that are making it hard for you to attend appointments and/or take your medication?
• Or do you work shifts, have unpredictable hours or caring responsibilities that make this harder for you?
• Do any treatment options go against your religion or cultural beliefs?

Your nurse can discuss any potential issues and provide you with support to help you overcome these.

How to get the most out of your consultation

As waiting times can be long and the appointment time is limited, it is a good idea to prepare for your  appointment.

These are a few tips to help you get the most out of your appointment:

• Always bring your medication list. If possible, please include details of doses, timing, any supplements you are taking or recent changes to your prescription. Although most hospitals do have access to your local GP records, these are not always be up-to-date.

• Bring a symptoms diary. This might list any new or worsening symptoms. Noting things like your energy, weight, mood, tolerance to temperature and sleep can be helpful as a lot can change in between  appointments. Try to keep it concise and specific.

• If you have any recent test results, thyroid or others, these are useful to bring along too.

Write down the top two to three issues that you would like your healthcare worker to address in the  appointment.

Some of the key things you may find helpful to ask are:

•  What do my blood tests mean for my ongoing treatment?
•  What symptoms should improve and in what time frame?
•  What side effects should I look out for?
•  How often should I have blood tests and who isresponsible for doing them?
•  What should I do if I miss a dose or become unwell?
•  Are there any interactions between my thyroid medication and other medications or supplements?
•  Are there any special considerations I need to take into account e.g. if I travel, if I’m going to have surgery  or become pregnant?
• Confirm the next steps and your treatment plan. For example, what tests are they going to do? Will your  dose change?
• When can you expect your next appointment?
• How will you receive any appointments or prescriptions? Letters should be written to the patient and copied to the GP, rather than vice versa.
•  What happens if your symptoms worsen or you do not receive test results etc. within the agreed time  frame? Is there a facility for patient-initiated follow-up appointments?
• Ask for plain language explanations. You can requestwritten instructions if you would prefer these to digital ones.
• Bring a family member or friend if you find it hard to take in everything during your appointment.

Further information

Watch the full webinar