Improvement of Free T4 in Newly Diagnosed Graves Disease Patients Through a Multifaceted Quality Improvement Approach.

Introduction: Graves disease (GD) is the most common cause of pediatric hyperthyroidism, and if untreated, may result in multisystem complications and decreased quality of life. Through a multifaceted quality improvement (QI) approach, we aimed to address treatment barriers after a new diagnosis of GD and increase the percentage of patients attaining an euthyroid state within 3 months from diagnosis and sustain for 12 months. Methods: Using standard QI methodologies from January to November 2023, our plan, do, study, act cycles focused on an educational handout and checklist at diagnosis, a standardized methimazole dose based on initial free thyroxine (T4) and age, and frequent provider check-ins with phone call at 2 weeks, telehealth visit at 4 weeks with laboratories, and continued QI follow-up for 3 months as process measures. Outcome measure was the percentage of patients achieving normalization of free T4 level by 3 months. We used an electronic dashboard to track patients. Results: Of the 46 patients, 76% (34) received written education; 67% (30) were initiated on standardized methimazole dosing; 80% (37) and 70% (32), respectively, attended the 2-week telephone and 1-month telehealth visits, and 83% (38) obtained 1-month laboratories. By 3 months, the outcome measure increased to 78% (36/46) from 47% (15/32) ( Conclusions: Through a multifaceted QI approach, we increased the percentage of newly diagnosed GD patients with normal free T4 levels and sustained for 6 months. Extension of follow-up is planned.