The Investigation Of The Prognostic Effects On The Patients With Subclinical Hypothyroidism By Telephone Follow-up Interventions

Objective: To explore the effect of telephone follow-up intervention mode on medication adherence, symptoms, degree of goiter, the thyroid function and blood lipids related indicators of the patients with subclinical hypothyroidism.Subclinical hypothyroidism(SCH) is a common endocrine and metabolic disease in clinical. It is the early stage of hypothyroidism. SCH is the laboratory diagnosis and defined as the higher level of serum thyroid stimulation hormone(TSH) above the upper limit of the normal reference range while the serum free T4 concentration within its normal reference range.At home and abroad a number of studies have confirmed the disease have an effect on cardiovascular function and lipid metabolism. It can lead to atherosclerosis, coronary heart disease, etc. and do harm to human health.Because the patients with SCH have no typical symptoms, so it is likely to be ignored by patients. Some patients with memory loss, not in accordance with the requirements for the doctor’s advice dose of levothyroxine sodium(L-T4) drugs, or a leak phenomenon. Some patients for various reasons can’t return on time, and adjust the dosage according to the results of the thyroid function, thus affect the control of the disease and prognosis. Studies at home and abroad have proved that the telephone follow-up interventions can provide patients with individualized instruction, improve the patients understanding of disease and medication compliance, improve prognosis, and outcome of the disease.This study improves the knowledge of disease in patients with SCH and medication compliance by exploring the result of telephone follow-up interventions, helps regular treatment in time, timely return visit, improves the patient’s symptoms and thyroid function with, prevents SCH to the progress of clinical hypothyroidism, promote the prognosis and outcome of the patients.Methods:1 Research objectsSelect 120 outpatients from the endocrinology department of the Second hospital of Hebei medical university from January 2014 to June as the research subjects who have clinic testing thyroid function abnormalities, TSH>4.31 m U/L,(the normal reference range is 0.35~4.31 m U/Lin this hospital) while FT4 is normal and accord with SCH diagnosis standard. Age from 18 to 65-year, include 10 male cases, 110 female cases.2 Research methodsBy Adopting the method of clinical randomized control, according to a random number table, 120 patients were randomly divided into control group with 60 patients and experiment group with 60 patients. Patients of control group received endocrine physician’s routine examination and treatment plan according to the disease to guide proper diet, medication and return visit time and issue the brochures of subclinical hypothyroidism disease knowledge.On this basis, telephone follow-ups were given to the patients of intervention group in 3-7 days after the first visit and a week before return visit. Depending on the situation of patients, 4 to 6 follow-ups were given every person. Good compliance was followed up four times, poor compliance was followed up for 5 to 6 times The content of telephone follow-ups is asking about the current state of the patient to learn whether patients understand the illness and medication compliance, give lectures and guidance according to the patient’s answers at any time, ease the negative emotions of patients, guide proper diet, medication and referral time, thus ensuring the correct medication, timely referral, then observe differences of both groups in the indexes of mastery of disease knowledge,medication compliance and other aspects between the early diagnosis and after 3 months’ intervention.3 Statistical analysisAll data were analyzed by using statistical software SPSS17.0. After doing normality test, measurement data meet the result of the normal distribution standard deviation. The results is expressed by x ±s, by using t test on two sample compare means, it does not meet the normal distribution with the result of the median plus or minus quarterback spacing, namely to M±QR, by using the Mann- Whitney Z test method on the rank and inspection of two independent samples nonparametric test,level data using rank and inspection, Count data using four table card party inspection or R * C table card party,All inspection method adopts double side, inspection level a = 0.05.Results:1 There have no statistical difference(P>0.05) between two groups in terms of gender, age, education level and other general aspects.2 Before the intervention, there was no significant difference(P>0.05) on the subclinical hypothyroidism knowledge scores between the two groups. After the intervention, subclinical hypothyroidism knowledge scores between the experiment group and the control group were statistical different(P<0.05). The experiment group knows better than control group.3 After the intervention, medication compliance in experiment group becomes better than patients in the control group, there was statistical difference(P<0.05).4 Before the intervention,there was no statistically significant difference between two groups of patients in symptoms, thyroid size, thyroid function, blood lipids, thyroid ultrasound abnormalities and so on.(P>0.05). After the intervention, the experiment group is better than the control group in symptom improvements such as unresponsive, chills, skin changes, weight gain and the degree ease of thyroid enlargement,there was a statistically significant difference between two groups(P<0.05). TSH and TPOAb of thyroid function in the experiment group is better than the control group, there was a statistically significant difference(P<0.05). FT3, FT4 and lipids as well as the size of the thyroid gland and thyroid ultrasound abnormalities showed no statistically significant difference(P> 0.05).Conclusions:1 Telephone follow-up intervention can improve the subclinical hypothyroidism patients understanding of disease.2 Telephone follow-up intervention can improve the subclinical hypothyroidism patients’ medication adherence.3. Telephone follow-up intervention in patients with subclinical hypothyroidism symptoms improved effect is better. than the control group.4 Telephone follow-up intervention group patients TSH and TPOAb levels and goiter reduce degree is better than the control group.5 Telephone follow-up interventions in patients with subclinical hypothyroidism has little effect on blood lipid and abnormal thyroid ultrasound, there is no statistical difference.