Monitoring Thyroid Function After Head and Neck Cancer Treatment

This collection of images and data discusses the importance of monitoring thyroid function after head and neck cancer treatment, specifically focusing on post-treatment thyroid function tests, audits of practices in head and neck units, thyroid function post laryngectomy, and the significance of detecting hypothyroidism in patients. The images highlight various aspects of treatments, surgeries, and post-treatment evaluations related to thyroid function in individuals who have undergone head and neck cancer treatment. Recommendations are made to increase awareness of hypothyroidism post-treatment and implement automatic recall systems for annual thyroid function tests in head and neck cancer patients.

• Thyroid function
• Head and Neck cancer
• Monitoring
• Hypothyroidism
• Cancer treatment

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1. Monitoring TFTs after Monitoring TFTs after Head and Neck cancer Head and Neck cancer Mr. Ashley Hay ENT| Head and Neck | Thyroid Consultant Surgeon, NHS Lothian September 2021

2. Head and Neck Cancer

3. Treatments Treatments Head and neck radiation Larynx Oropharynx Adjuvant treatments

4. Surgery Surgery Thyroidectomy Laryngectomy Laryngopharyngectomy

5. Post Treatment thyroid functions tests ? Head and Neck surgery

6. How well is this checked? Audits of practice in the Head and Neck unit Post H&N irradiation Post Head and Neck Surgery

7. Post radiotherapy Audit by Karen Mactier (ST8) Timeframe: 1st clinic appointment 2017 n = 126 Before RT: 49/126 (39%) Two abnormal (1 subclin T4, 1 clin T4 After RT: 44/126 (35%) 10 abnormal (5 subclin T4, 3 clin T4 and 2 clin T4) Both before and after RT: 23/126 (18%) (6 abnormal) one clin T4 normalised; 4 normal became subclin T4 1 normal became clin T4

8. Thyroid function post laryngectomy and hemithyroidectomy - do all laryngectomy patients need thyroid replacement? Lucy Li, Michael Hopkins, Iain Nixon, Ashley Hay Department of Otolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh Laryngectomy patients 2006- 2019 102 patient

9. 5 patient presented acutely with hypothyroidism

10. Future Increase awareness of hypothyroidism after H&N treatment Request H&N patient are placed on an automatic recall for annual TFTs

11. Questions? Mr Ashley J Hay MBChB, MSc, FRCS ORL-HNS Honorary Clinical Senior Lecturer at The University of Edinburgh Consultant Surgeon Otolaryngology|Head and Neck Oncology|Thyroid NHS Lothian, Scotland Ashley.hay@nhslothian.scot.nhs.uk