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The population attending the Medical Assessment Unit at our hospital comprises patients attending electively for investigation and acutely unwell patients presenting for unscheduled care. The standard panel of blood tests taken on arrival includes thyroid function tests (TFTs, i.e. TSH and free-T4), despite a recent review questioning the clinical utility of this practice [1]. We performed a retrospective audit to determine what proportion of our patients had abnormal thyroid function on presentation, and whether these abnormal test results were being followed up. Using the iSoft Clinical Manager software, a list was generated of all patients who attended the hospital between January 2018 and June 2018 inclusive. For each attendance, we recorded the date, medical record number, patient age, gender, and TFT result. Abnormal TFT results were classified as overt or subclinical hyper- or hypothyroid, or non-thyroid illness syndrome (NTIS), based on their admission TSH and free-T4. We then examined the hospital and primary care records of patients with abnormal TFTs to determine if they had ongoing thyroid follow up post discharge. In total, 2,298 patients attended over the 6-month study period. The mean patient age was 67.2 years, and 49% were female. Thyroid function tests were ordered on the day of attendance for 1,688 patients (73%). Of these, 181 results (11%) were abnormal: 20 overt hyperthyroid (11%), 72 subclinical hyperthyroid (40%), 12 overt hypothyroid (7%), 35 subclinical hypothyroid (19%), and 42 NTIS (23%). Twenty of these patients died within 3 months of the abnormal TFT result (4 overt hyperthyroid, 3 subclinical hyperthyroid, 3 overt hypothyroid, 6 subclinical hypothyroid, and 4 NTIS). Of the remaining 161 patients, 74 (46%) had not been followed up within 3 months (4 overt hyperthyroid, 34 subclinical hyperthyroid, 3 overt hypothyroid, 15 subclinical hypothyroid, and 18 NTIS). The low percentage of abnormal TFTs (11%) in this audit is in keeping with similar studies where thyroid function testing was performed on unselected hospital populations [1]. Subclinical hyperthyroidism was by far the most common abnormality found. A high percentage of abnormal tests (46%) were not followed up, with poor compliance with thyroid management guidelines [2]. Future work will investigate adoption of an ‘opt-in’ order system [3] and electronic alerts to flag abnormal results for follow-up. [1] Premawardhana LD. Thyroid testing in acutely ill patients may be an expensive distraction. Biochemia medica. 2017; 27(2): 300-307. [2] Ross DS et al. 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct; 26(10):1343-1421. [3] Leis B et al. Altering standard admission order sets to promote clinical laboratory stewardship: a cohort quality improvement study. BMJ Qual Saf. 2019; 28(10): 846-52.

Background Increasingly, Inflammatory Bowel Disease (IBD) patients are using social media to disseminate information, share experiences and address queries. Gastroenterologists can play an important role in IBD care by better understanding trends in patients’ perception of their disease. This study aimed to identify trending topics and misconceptions of disease for early targeted education based off patients’ interactions and activity on social media. Methods Utilising an established social media analytics program, we extracted social media posts relating to IBD over a 30-day period between 11/05/2020 and 10/06/2020. The most common hashtags and frequently used words were retrieved from these posts, analysed and qualitatively coded. Additional analysis was performed to evaluate user mentions for specific key words identified from the ECCO consensus for Complementary and Alternative Medicine (CAM) and psychotherapy. Results 22,375 social media posts were reviewed. Twitter was the most common platform with 12,977 posts (58%). Most posts originated from North America and Europe (81%). Amongst common hashtags and words, patients most frequently referenced community groups (n=8094) for example “#crohnswarrior”, followed by terms related to treatment (n=3256), and lifestyle (n=2446). Symptom-related terms were less frequently referenced (n=2031). Of mentions relating to diet and nutrition, ‘gluten free’ was mentioned most frequently (466/2911, 16.0%), followed by ‘vegan’ (374/2911, 12.8%), and ‘plant based’ (342/2911, 11.7%). There was a temporal association with these posts which was demonstrated by hashtags (n=1397) and mentions (n=485) referencing ‘World IBD Day’ which occurred on the 19th of May as well as hashtags (n=391) and mentions (n=1475) referencing the COVID 19 pandemic. Analysis of CAM mentions highlighted patients’ interest in “exercise” as a manipulative and body-based intervention (2015/2088, 96.5%), “cannabinoids” as a herbal and dietary intervention (816/2144, 38.1%) and “yoga” as a mind-body intervention (175/415, 42.2%). 3435 mentions were generated from our psychological key word search. These included terms such as fatigue (28.2%), anxiety (20.1%), depression (13.8%) and suicide (2.2%). Conclusion Our study identified areas where patients’ needs, concerns and queries may be unmet by current clinical practices. Further development of our analytical model can aid gastroenterologists in bridging this gap and providing more holistic patient care.