J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website http://www.jofem.org

Original Article

Volume 9, Number 1-2, April 2019, pages 3-17

Outpatient Endocrine Diagnosis and Treatment of Thyroid Diseases and Disorders in a Portuguese Public University Hospital

Figure 1. (a) Distribution of patient visits at the outpatient endocrine department between 2005 and 2016. Absolute numbers are indicated within the pie and percent numbers outside. (b) Thyroid diagnostics for patient visits at the outpatient endocrine department between 2005 and 2016. GD: Graves’ disease; HT; Hashimoto’s thyroiditis; SNG: simple nodular goiter; TN: thyroid neoplasia; TNG: toxic nodular goiter.

Figure 2. (a) Thyroid function at first and last visits for patients with Graves’ disease. (b) Treatment at first and last visits for patients with Graves’ disease. CHyper: clinical hyperthyroidism; SCHyper: subclinical hyperthyroidism; Euthyroid: euthyroidism; SCHypo: subclinical hypothyroidism; CHypo: clinical hypothyroidism; Iodide: radioactive iodide; medical treatment: anti-thyroid drugs and/or levothyroxine (see text).

Figure 3. (a) Thyroid function at first and last visits for patients with toxic nodular goiter. (b) Treatment at first and last visits for patients with toxic nodular goiter. CHyper: clinical hyperthyroidism; SCHyper: subclinical hyperthyroidism; euthyroid: euthyroidism; SCHypo: subclinical hypothyroidism; CHypo: clinical hypothyroidism; iodide: radioactive iodide; medical treatment: anti-thyroid drugs and/or levothyroxine (see text).

Figure 4. (a) Thyroid function at first and last visits for patients with Hashimoto’s thyroiditis. (b) Treatment at first and last visits for patients with Hashimoto’s thyroiditis. CHyper: clinical hyperthyroidism; SCHyper: subclinical hyperthyroidism; euthyroid: euthyroidism; SCHypo: subclinical hypothyroidism; CHypo: clinical hypothyroidism; iodide: radioactive iodide; medical treatment: anti-thyroid drugs and/or levothyroxine (see text).

Figure 5. (a) Thyroid function at first and last visits for patients with simple nodular goiter. (b) Treatment at first and last visits for patients with simple nodular goiter. CHyper: clinical hyperthyroidism; SCHyper: subclinical hyperthyroidism; euthyroid: euthyroidism; SCHypo: subclinical hypothyroidism; CHypo: clinical hypothyroidism; iodide: radioactive iodide; medical treatment: anti-thyroid drugs and/or levothyroxine (see text).

Figure 6. (a) Thyroid function at first and last visits for patients with thyroid neoplasia. (b) Treatment at first and last visits for patients with thyroid neoplasia. CHyper: clinical hyperthyroidism; SCHyper: subclinical hyperthyroidism; euthyroid: euthyroidism; SCHypo: subclinical hypothyroidism; CHypo: clinical hypothyroidism; iodide: radioactive iodide; medical treatment: anti-thyroid drugs and/or levothyroxine (see text).

**Table 1.** Common General Characteristics Across Diagnostic Groups
	GD	TNG	HT	SNG	TN
GD: Graves’ disease; TNG: toxic nodular goiter; HT: Hashimoto’s thyroiditis; SNG: simple nodular goiter; TN: thyroid neoplasia.
N	123	83	348	565	60
Sex-female (%)	81	86	90	90	88
Age (years)	44 ± 16	61 ± 14	51 ± 17	56 ± 15	53 ± 14
New cases (%)	69	85	69	77	67
Year of diagnosis	2004 ± 12	2007 ± 4	2005 ± 8	2009 ± 7	2007 ± 6
Year of first visit	2009 ± 5	2010 ± 4	2010 ± 6	2010 ± 5	2010 ± 5
Treatment at the first visit (%)	68	25	48	20	46
Thyroid dysfunction at first visit (%)	74	78	37	13	13
T3/4 (no dimensional)	24.6 ± 22.5	17.5 ± 6.2	15.8 ± 5.9	15.5 ± 3.8	14.7 ± 4.9
Tg (ng/mL)	225 ± 422	263 ± 475	93 ± 442	123 ± 323	782 ± 2,188
Calcitonin (pg/mL)	1.9 ± 1.0	3.9 ± 5.1	2.7 ± 1.6	3.1 ± 2.8	574 ± 3,380
Year at last visit	2014 ± 3	2014 ± 3	2014 ± 3	2014 ± 3	2014 ± 3
N of appointments	8 ± 6	6 ± 4	7 ± 4	5 ± 3	6 ± 4
Time since diagnosis at the last visit (years)	9 ± 9 (1-37)	5 ± 7 (1-41)	8 ± 8 (1-41)	6 ± 7 (1-33)	7 ± 6 (1-22)
Treatment at the last visit (%)	71	76	67	33	86
Retained (%)	60	66	66	68	64
Follow-up (years)	5 ± 5	4 ± 3	5 ± 4	6 ± 7	5 ± 4
Euthyroid (%)	65	65	74	86	62

Table 1. Common General Characteristics Across Diagnostic Groups

TNG

SNG

GD: Graves’ disease; TNG: toxic nodular goiter; HT: Hashimoto’s thyroiditis; SNG: simple nodular goiter; TN: thyroid neoplasia.

123

348

565

Sex-female (%)

Age (years)

44 ± 16

61 ± 14

51 ± 17

56 ± 15

53 ± 14

New cases (%)

Year of diagnosis

2004 ± 12

2007 ± 4

2005 ± 8

2009 ± 7

2007 ± 6

Year of first visit

2009 ± 5

2010 ± 4

2010 ± 6

2010 ± 5

Treatment at the first visit (%)

Thyroid dysfunction at first visit (%)

T3/4 (no dimensional)

24.6 ± 22.5

17.5 ± 6.2

15.8 ± 5.9

15.5 ± 3.8

14.7 ± 4.9

Tg (ng/mL)

225 ± 422

263 ± 475

93 ± 442

123 ± 323

782 ± 2,188

Calcitonin (pg/mL)

1.9 ± 1.0

3.9 ± 5.1

2.7 ± 1.6

3.1 ± 2.8

574 ± 3,380

Year at last visit

2014 ± 3

N of appointments

8 ± 6

6 ± 4

7 ± 4

5 ± 3

6 ± 4

Time since diagnosis at the last visit (years)

9 ± 9 (1-37)

5 ± 7 (1-41)

8 ± 8 (1-41)

6 ± 7 (1-33)

7 ± 6 (1-22)

Treatment at the last visit (%)

Retained (%)

Follow-up (years)

5 ± 5

4 ± 3

5 ± 4

6 ± 7

5 ± 4

Euthyroid (%)

**Table 2.** Graves’ Disease (n = 123)
	First visit	Last visit	P
T3: triiodothyronine; T4: thyroxine; TSH: thyroid stimulating hormone; fT4: free thyroxine; TPOAb: thyroid peroxidase antibody; TgAb: thyroglobulin antibody; TRAb: TSH receptor antibody; Tg: thyroglobulin.
	2009 ± 5	2014 ± 3
Sex	Female 81%
Age (years)	44 ± 16
T3 (ng/dL)	207 ± 176	125 ± 74	< 0.05
T4 (µg/dL)	10.5 ± 6.8	8.9 ± 2.8	< 0.05
FT4 (ng/dL)	1.8 ± 1.8	1.3 ± 0.7	< 0.05
TSH (µU/mL)	8.6 ± 26.6	4.5 ± 9.8	< 0.05
TPOAb (U/mL)	2,024 ± 12,176	745 ± 2,220	< 0.05
TgAb (U/mL)	204 ± 458	213 ± 565
TRAb (U/L)	28 ± 61	23 ± 15	< 0.05
Tg (ng/mL)	225 ± 422	60 ± 101
T3/T4 (no dimensional)	24.6 ± 22.5	14.1 ± 4.8	< 0.05
Enlarged thyroid (%)	61%
Thyroid nodules (%)	43%

Table 2. Graves’ Disease (n = 123)

First visit

Last visit

T3: triiodothyronine; T4: thyroxine; TSH: thyroid stimulating hormone; fT4: free thyroxine; TPOAb: thyroid peroxidase antibody; TgAb: thyroglobulin antibody; TRAb: TSH receptor antibody; Tg: thyroglobulin.

2009 ± 5

2014 ± 3

Sex

Female 81%

Age (years)

44 ± 16

T3 (ng/dL)

207 ± 176

125 ± 74

< 0.05

T4 (µg/dL)

10.5 ± 6.8

8.9 ± 2.8

< 0.05

FT4 (ng/dL)

1.8 ± 1.8

1.3 ± 0.7

< 0.05

TSH (µU/mL)

8.6 ± 26.6

4.5 ± 9.8

< 0.05

TPOAb (U/mL)

2,024 ± 12,176

745 ± 2,220

< 0.05

TgAb (U/mL)

204 ± 458

213 ± 565

TRAb (U/L)

28 ± 61

23 ± 15

< 0.05

Tg (ng/mL)

225 ± 422

60 ± 101

T3/T4 (no dimensional)

24.6 ± 22.5

14.1 ± 4.8

< 0.05

Enlarged thyroid (%)

61%

Thyroid nodules (%)

43%

**Table 3.** Toxic Nodular Goiter (n = 82)
	First visit	Last visit	P
T3: triiodothyronine; T4: thyroxine; TSH: thyroid stimulating hormone; fT4: free thyroxine; TPOAb: thyroid peroxidase antibody; TgAb: thyroglobulin antibody; Tg: thyroglobulin.
	2010 ± 4	2014 ± 3
Sex	Female 86%
Age (years)	61 ± 14
T3 (ng/dL)	172 ± 101	118 ± 34	< 0.05
T4 (µg/dL)	9.9 ± 3.9	10.2 ± 14.7
FT4 (ng/dL)	1.8 ± 2.0	1.2 ± 0.4	< 0.05
TSH (µU/mL)	0.9 ± 4.1	2.0 ± 3.4
TPOAb (U/mL)	43 ± 132	20 ± 17
TgAb (U/mL)	33 ± 91	20 ± 21	< 0.05
Tg (ng/mL)	263 ± 475	113 ± 185
T3/T4 (no dimensional)	17.5 ± 6.2	14.2 ± 4.6	< 0.05
Enlarged thyroid (%)	71%
Thyroid nodules (%)	97%

Table 3. Toxic Nodular Goiter (n = 82)

First visit

Last visit

T3: triiodothyronine; T4: thyroxine; TSH: thyroid stimulating hormone; fT4: free thyroxine; TPOAb: thyroid peroxidase antibody; TgAb: thyroglobulin antibody; Tg: thyroglobulin.

2010 ± 4

2014 ± 3

Sex

Female 86%

Age (years)

61 ± 14

T3 (ng/dL)

172 ± 101

118 ± 34

< 0.05

T4 (µg/dL)

9.9 ± 3.9

10.2 ± 14.7

FT4 (ng/dL)

1.8 ± 2.0

1.2 ± 0.4

< 0.05

TSH (µU/mL)

0.9 ± 4.1

2.0 ± 3.4

TPOAb (U/mL)

43 ± 132

20 ± 17

TgAb (U/mL)

33 ± 91

20 ± 21

< 0.05

Tg (ng/mL)

263 ± 475

113 ± 185

T3/T4 (no dimensional)

17.5 ± 6.2

14.2 ± 4.6

< 0.05

Enlarged thyroid (%)

71%

Thyroid nodules (%)

97%

**Table 4.** Hashimoto’s Thyroiditis (n = 349)
	First visit	Last visit	P
T3: triiodothyronine; T4: thyroxine; TSH: thyroid stimulating hormone; fT4: free thyroxine; TPOAb: thyroid peroxidase antibody; TgAb: thyroglobulin antibody; Tg: thyroglobulin.
	2010 ± 6	2014 ± 3
Sex	Female 90%
Age (years)	51 ± 17
T3 (ng/dL)	131 ± 45	109 ± 32	< 0.05
T4 (µg/dL)	8.7 ± 2.5	8.6 ± 2.4
FT4 (ng/dL)	1.3 ± 3.3	1.3 ± 0.6
TSH (µU/mL)	7.7 ± 29.2	3.9 ± 9.1	< 0.05
TPOAb (U/mL)	973 ± 4,237	538 ± 1,950
TgAb (U/mL)	775 ± 4,070	501 ± 2,402	< 0.05
Tg (ng/mL)	93 ± 442	50 ± 240
T3/T4 (no dimensional)	15.8 ± 5.9	14.1 ± 15.6	< 0.05
Enlarged thyroid (%)	34%
Decreased thyroid (%)	9%
Nodules (%)	70%

Table 4. Hashimoto’s Thyroiditis (n = 349)

First visit

Last visit

T3: triiodothyronine; T4: thyroxine; TSH: thyroid stimulating hormone; fT4: free thyroxine; TPOAb: thyroid peroxidase antibody; TgAb: thyroglobulin antibody; Tg: thyroglobulin.

2010 ± 6

2014 ± 3

Sex

Female 90%

Age (years)

51 ± 17

T3 (ng/dL)

131 ± 45

109 ± 32

< 0.05

T4 (µg/dL)

8.7 ± 2.5

8.6 ± 2.4

FT4 (ng/dL)

1.3 ± 3.3

1.3 ± 0.6

TSH (µU/mL)

7.7 ± 29.2

3.9 ± 9.1

< 0.05

TPOAb (U/mL)

973 ± 4,237

538 ± 1,950

TgAb (U/mL)

775 ± 4,070

501 ± 2,402

< 0.05

Tg (ng/mL)

93 ± 442

50 ± 240

T3/T4 (no dimensional)

15.8 ± 5.9

14.1 ± 15.6

< 0.05

Enlarged thyroid (%)

34%

Decreased thyroid (%)

Nodules (%)

70%

**Table 5.** Simple Nodular Goiter (n = 563)
	First visit	Last visit	P
T3: triiodothyronine; T4: thyroxine; TSH: thyroid stimulating hormone; fT4: free thyroxine; Tg: thyroglobulin; B: benign; ND: non-diagnostic.
	2010 ± 5	2014 ± 3
Sex	Female 90%
Age (years)	56 ± 15
T3 (ng/dL)	132 ± 37	111 ± 26	< 0.05
T4 (µg/dL)	8.6 ± 1.8	8.8 ± 6.0
FT4 (ng/dL)	1.2 ± 0.4	1.2 ± 0.6
TSH (µU/mL)	2.0 ± 3.6	2.5 ± 5.0
Tg (ng/mL)	124 ± 324	86 ± 391
T3/T4 (no dimensional)	15.5 ± 3.8	13.6 ± 4.6	< 0.05
Enlarged thyroid (%)	50%
Nodules (%)	97%
Cytology	B 97%, ND 8%

Table 5. Simple Nodular Goiter (n = 563)

First visit

Last visit

T3: triiodothyronine; T4: thyroxine; TSH: thyroid stimulating hormone; fT4: free thyroxine; Tg: thyroglobulin; B: benign; ND: non-diagnostic.

2010 ± 5

2014 ± 3

Sex

Female 90%

Age (years)

56 ± 15

T3 (ng/dL)

132 ± 37

111 ± 26

< 0.05

T4 (µg/dL)

8.6 ± 1.8

8.8 ± 6.0

FT4 (ng/dL)

1.2 ± 0.4

1.2 ± 0.6

TSH (µU/mL)

2.0 ± 3.6

2.5 ± 5.0

Tg (ng/mL)

124 ± 324

86 ± 391

T3/T4 (no dimensional)

15.5 ± 3.8

13.6 ± 4.6

< 0.05

Enlarged thyroid (%)

50%

Nodules (%)

97%

Cytology

B 97%, ND 8%

**Table 6.** Thyroid Neoplasia (n = 61)
	First visit	Last visit	P
T3: triiodothyronine; T4: thyroxine; TSH: thyroid stimulating hormone; fT4: free thyroxine; TPOAb: thyroid peroxidase antibody; TgAb: thyroglobulin antibody; Tg: thyroglobulin.
	2010 ± 5	2014 ± 3
Sex	Female 88%
Age (years)	53 ± 14
T3 (ng/dL)	129 ± 40	104 ± 26	< 0.05
T4 (µg/dL)	9.1 ± 3.2	10.9 ± 11.4
FT4 (ng/dL)	1.2 ± 0.3	1.4 ± 0.4
TSH (µU/mL)	1.5 ± 1.3	2.5 ± 4.8
TPOAb (U/mL)	190 ± 734	150 ± 874
TgAb (U/mL)	43 ± 66	22 ± 35	< 0.05
Tg (ng/mL)	882 ± 2,249	27 ± 95	< 0.05
Calcitonin (pg/mL)	558 ± 3,332	19 ± 96	< 0.05
T3/T4 (no dimensional)	14.7 ± 4.9	11.4 ± 3.4	< 0.05
Enlarged thyroid (%)	53%
Nodules (%)	87%
Cytology	Neoplasia 66%

Table 6. Thyroid Neoplasia (n = 61)

First visit

Last visit

T3: triiodothyronine; T4: thyroxine; TSH: thyroid stimulating hormone; fT4: free thyroxine; TPOAb: thyroid peroxidase antibody; TgAb: thyroglobulin antibody; Tg: thyroglobulin.

2010 ± 5

2014 ± 3

Sex

Female 88%

Age (years)

53 ± 14

T3 (ng/dL)

129 ± 40

104 ± 26

< 0.05

T4 (µg/dL)

9.1 ± 3.2

10.9 ± 11.4

FT4 (ng/dL)

1.2 ± 0.3

1.4 ± 0.4

TSH (µU/mL)

1.5 ± 1.3

2.5 ± 4.8

TPOAb (U/mL)

190 ± 734

150 ± 874

TgAb (U/mL)

43 ± 66

22 ± 35

< 0.05

Tg (ng/mL)

882 ± 2,249

27 ± 95

< 0.05

Calcitonin (pg/mL)

558 ± 3,332

19 ± 96

< 0.05

T3/T4 (no dimensional)

14.7 ± 4.9

11.4 ± 3.4

< 0.05

Enlarged thyroid (%)

53%

Nodules (%)

87%

Cytology

Neoplasia 66%