67-year-old lady for left hemithyroidectomy

Background

• Moderate COPD. Can walk 100m on flat. Ceased smoking 10 years ago.
• OSA –Compliant with CPAP
• BMI 41
• Bipolar Affective Disorder – severe anxiety. Lives alone. Brother is enduring guardian
• Multinodular Goitre for many years. Euthyroid.

Issues

• Surgical letter states worsening dyspnoea. Uncertain if due to goitre.  Some tracheal deviation but no retrosternal extension
• Chronic dyspnoea. Documented over many years by respiratory physician
• Extensive investigations:  Spiro and DLCO around 50% of predicted

  Cardiac investigations including stress echo NAD

• Difficult to gain accurate history over phone. Patient not answering phone.
• Distance patient. No transport options
• Brother lives far away but calls her every night
• Discussed with brother – doesn’t feel she is any worse. SOB for many years
• Independent with ADLs. Shops and cooks for herself.
• GP declined to share medical information
• Referred back to respiratory physician; “better than she was 10 years ago.’ unsure why she needs a thyroidectomy.
• Discussion with surgeon who liaised with respiratory physician and GP. Decision to cancel as procedure not required.

Discussion

Phone consultation in Distance patients

• Clinical assessment can be very challenging in these circumstances.
• Surgeon seems to have had the same difficulties with telehealth
• How can we best assess distance patients? Face to face appointments would be the best way to assess but not always possible.
• Can we videocall vs ask GP for clinical assessment – again would require significant set-up
• Asking a local physician who knew the patient well turned out to be an ideal solution in this situation.