Specialty Clinic Referral Guidelines - Endocrine Clinic

Specializing in the management of endocrine disorders including thyroid cancer

• Contact: Dr. Arthur Guererro, Chief
  Clinic: (808) 433-6933
  Fax: (808) 433-2631
  


• Patients Served: All DEERS eligible DoD Beneficiaries, with priority to Active Duty, VA as space allows, Adult patients only. Patients will also be prioritized based on urgency of the clinical condition.
  


• Requirements for Endocrinology:
  
  
  • A referral from the Primary Care Provider
    
  
  
  • If Air Evac Patient, a completed Patient Movement Record, including patient information and PCP information
    
  
  
  • Thyroid cancer referrals-
    
    
    • The patient should have undergone a total thyroidectomy with documented pathology revealing thyroid cancer.
      
    
    
    • The patient should not be pregnant or breastfeeding.
      
    
    
    • The patient should be on a low iodine diet for 2-3 weeks prior to admission.
      
    
    
    • The patient should arrive at least 2 business days prior to the admission date (5 days prior to the ablation date) in order to prepare for admission and assess completeness of surgery.
      
    
    
    • The patient should anticipate staying for approximately 10 days post-ablation to complete post-treatment scans and receive clearance to return home.
      
    
    
    • The patient should not be accompanied by young children unless prepared to pay for a separate room for their housing post-discharge. A NMA is not required.
      
    
    
  • Thyroid cancer follow-up
    
    
    • Follow-up interval will be determined based upon original disease burden. Generally f/u at 6-12 months after initial ablation is required.
      
    
    
    • Follow up appointments require prior planning and discussion with the accepting physician.
      
    
    
    • Initial follow-up requires a 5 day sequence of testing. Testing cannot be done on weeks with federal/state holidays due to non-availability of staffing.
      
    
    
    • The patient should arrive in time for a Monday am appointment.
      
    
    
    • Determination whether a patient should be on a low-iodine diet will be made prior to AE.
      
    
    
    • The patient should remain on thyroid hormone medications.
      
    
    
  • Graves Disease
    
    
    • Patients with Graves disease not wishing to have ablation
      
      
      • Patients are accepted for care for Graves disease only if they wish to undergo thyroid ablation. The PCM must counsel all patients about the different forms of therapy for Graves disease and must manage all other hyperthyroid patients locally. TAMC Endocrine can provide an initial consult via the PATH system.
        
    
    
    • Thyroid ablation
      
      
      • Document patient has ongoing hyperthyroidism with repeat labs revealing tsh is abnormal over at least 2 months
        
      
      
      • Obtain thyroid uptake and scan to determine etiology of disease.
        
      
      
      • Assure patient is not pregnant and not planning pregnancy for one year post-ablation.
        
      
      
      • Discontinue antithyroidals at least one week prior to AE and check tsh prior to AE.
        
      
      
      • Patient will remain at TAMC for 3-5 days post-ablation.
        
      
      
  • Diabetes
    
    
    • Type 1 Diabetes Mellitus
      
      
      • Active Duty members with DM1 should be de-screened for overseas duty and returned to a large MTF on the mainland. Long-distance care is not available.
        
      
      
      • Family members with DM1 should be considered for overseas de-screening and loss of command sponsorship unless the overseas facility is able to provide all care. Long-distance management is not feasible.
        
      
      
      • Insulin Pumps cannot be started via a consult as they require long-term management and maintenance.
        
      
      
    • Type 2 Diabetes Mellitus
      
      • All type 2 Diabetics must be managed by their PCM overseas or consider de-screening and early return. Long term management not available.