Adequate training for the next generation of endocrinologists is crucial to maintain delivery of state-of-the-art care for patients with endocrine diseases. The Society collaborates in the delivery of two national training courses on thyroid disorders.

NATIONAL THYROID ULTRASOUND COURSE FOR ENDOCRINOLOGY TRAINEES

Led by Samantha Anadappa and Anand Velusamy

Thyroid nodules are a common finding in endocrinology, with studies demonstrating a prevalence of up to 67% on high-resolution ultrasound examination.1 Amongst the nodules detected on ultrasound, only 3–7% are palpable on clinical examination,2 and approximately 5–15% of all thyroid nodules are malignant.3

In the UK, the incidence of thyroid cancer continues to rise, with approximately 3900 new cases diagnosed each year. This is predicted to increase to 11 cases per 100,000 of the population by 2035.4

There are both modifiable and non-modifiable risk factors for thyroid cancer. Endocrinologists can identify patients at higher risk through a thorough clinical history, physical examination and appropriate investigations. It is therefore essential that clinicians understand both the appropriate use and the limitations of thyroid ultrasound in clinical practice. In our centre, we run a one-stop thyroid clinic with endocrinologists, endocrine surgeons and thyroid ultrasound, offering fine-needle aspiration with rapid on-site evaluation by our biomedical scientists.

The Thyroid Ultrasound Course, delivered in collaboration with the Society for Endocrinology, has been running since 2022. It was established to equip endocrinologists with the knowledge required to appropriately utilise and interpret thyroid ultrasound, enhance clinical practice, and provide an initial step for clinicians wishing to further develop their skills in thyroid ultrasonography.

Through a combination of lecture-based teaching and practical hands-on experience, the course provides both a theoretical foundation and an introduction to the technical skills required to initiate training towards competence in thyroid ultrasonography. Candidates rotate through a series of practical sessions, including the use of different ultrasound machines and their settings, practising fine-needle aspiration on training models, and gaining experience in slide preparation and fixation. The course has received outstanding feedback and has been fully booked each year.

Ensuring that thyroid ultrasound remains within the clinical remit of endocrinologists is essential. This course enables clinicians to critically appraise imaging reports and actively contribute to multidisciplinary team discussions, ultimately facilitating gold-standard patient care.

NATIONAL TRAINING SCHEME FOR THE USE OF RADIOIODINE IN BENIGN THYROID DISEASE

Led by Niki Karavitaki and Kristien Boelaert

Treatment with the radioactive isotope 131I has been used for the management of patients with thyroid disorders for more than 80 years. Radioiodine is used to ablate the thyroid gland in people with hyperthyroidism,5 benign euthyroid goitre6 and differentiated thyroid cancer.7 Current NICE guidelines recommend the use of 131I as first-line in most patients with Graves’ disease, relapsed hyperthyroidism and toxic nodular disease.8

Radioiodine is given as a capsule which is rapidly absorbed in the gastrointestinal tract and concentrated in follicular thyroid cells through uptake via the sodium–iodide symporter. It is a highly effective treatment, with cure rates for hyperthyroidism of up to 90%: a significant improvement on remission rates with antithyroid drugs.5 In patients with large non-toxic goitres, it is used to shrink the thyroid gland, especially if thyroid surgery is contraindicated.6

The administration of a radioactive substance such as 131I requires a practitioner licence from the Administration of Radioactive Substances Advisory Committee (ARSAC). Traditionally, radioiodine was administered for benign thyroid conditions by oncologists but, with a significant increase in patients with cancer diagnoses, this was no longer felt to be within the remit of clinical oncologists. In 2006, the National Training Scheme for the Use of Radioiodine in Benign Thyroid Disease was set up as a joint venture between the Royal College of Physicians and Royal College of Radiologists. Since 2019, the course has been run in collaboration with the Society for Endocrinology.

In order to apply for an ARSAC practitioner licence, candidates need to demonstrate adequate training and experience to ensure safe delivery of a radioactive substance and good understanding of radiation protection guidance. This is usually in the form of (i) a certificate of attendance of the National Radioiodine Training Scheme, (ii) evidence of self-study relating to radiation protection guidance, and (iii) a logbook of mentored cases.

The National Training Scheme consists of two parts:

•    The morning session focuses on reviewing the legislation around 131I administration, the nuclear physics aspects of the process, challenging cases from a physicist’s perspective and feedback on the pre-course multiple choice questions. Attendees are required to prepare for the course using e-learning modules focused on nuclear physics and to complete a questionnaire. Those who fail to pass the questionnaire will be given a second chance after the course, during which expert nuclear physicists discuss the cases.

•    The afternoon session of the course focuses on the clinical indications for radioiodine administration, and provides an overview of the Radioiodine Service in Birmingham as an example of how a busy thyroid clinic may function effectively. Since caution needs to be employed when administering radioiodine to patients with thyroid eye disease, an expert session is delivered by Ms Reena Kumari, Consultant Orbital Surgeon in Birmingham, highlighting safe practice in relation to patients with Graves’ ophthalmopathy. The final session of the day is a case-based discussion of challenging cases of radioiodine administration, emphasising evidence-based and individualised decision making to patients.

More than 800 attendees have participated in the course since its inception, including a variety of professionals, such as specialist trainees and consultants in endocrinology, endocrine specialist nurses and nuclear physicists. More than 100 people have successfully applied for an ARSAC licence following the course and completion of a mentored logbook. The course continues to receive excellent feedback and is a glowing example of multidisciplinary working between endocrinologists, nuclear physicists and ophthalmologists.

SAMANTHA ANANDAPPA
Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, and Maidstone and Tunbridge Wells NHS Trust

ANAND VELUSAMY
Guy’s and St Thomas’ Hospital NHS Foundation Trust, London

NIKI KARAVITAKI
Department of Metabolism and Systems Science, College of Medicine and Health, University of Birmingham

KRISTIEN BOELAERT
Department of Applied Health Research, College of Medicine and Health, University of Birmingham

REFERENCES

1. Tan GH & Gharib G 1997 Annals of Internal Medicine https://doi.org/10.7326/0003-4819-126-3-199702010-00009.
2. Hegedüs L 2004 New England Journal of Medicine https://doi.org/10.1056/nejmcp031436.
3. Jemal A et al. 2010 CA: A Cancer Journal for Clinicians https://doi.org/10.3322/caac.20073.
4. Cancer Research UK 2026 Thyroid Cancer Statistics https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/thyroid-cancer.
5. Chaker L et al. 2024 Lancet https://doi.org/10.1016/s0140-6736(23)02016-0.
6. Campennì A et al. 2023 European Journal of Nuclear Medicine & Molecular Imaging https://doi.org/10.1007/s00259-023-06274-5.
7. Ringel MD et al. 2025 Thyroid https://doi.org/10.1177/10507256251363120.
8. NICE 2023 Thyroid Disease: Assessment & Management, NG145 https://www.nice.org.uk/guidance/ng145.