Hyperthyroidism

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Hyperthyroidism complicated by cardiac, respiratory compromise or other indications of severe illness (fever, vomiting, labile blood pressure, altered mental state)
    • Neutropenic sepsis in patient taking carbimazole or propylthiouracil
    • Hyperthyroidism with hypokalaemia or paralysis
    • Suspected myxoedema coma (altered consciousness, hypothermia, fluid overload, bradycardia, hyponatraemia)
    • Refer to local HealthPathways or local guidelines
    • No USS is required in the routine assessment of hyperthyroidism or hypothyroidism
    • Avoid iodinated contrast agents wherever possible if suspected thyroid disease
    • Consider ß blocker for symptom control
    • Repeat TFTs within a week of clinic appointment
    • If hyperthyroidism is not due to excess exogenous thyroid hormone, transient thyroiditis or iodine load, then start carbimazole (or Propylthiouracil if pregnancy confirmed). Note that serious adverse reactions to these drugs are not uncommon and patients must be fully informed. Please phone the local hospital endocrinology on-call service if advice is required on how to start carbimazole OR utilise an eConsult Request for Advice service for this information if available locally
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Pregnancy  with hyperthyroidism  with suppressed TSH (< 0.05), elevated fT4/fT3 or relevant symptoms
  • Newly diagnosed symptomatic thyrotoxicosis with T4 and/or T3 >2x normal
  • Inadequate response to anti-thyroid medication or intolerant of medication
Category 2
(appointment within 90 calendar days)
  • Hyperthyroidism that is stable with GP initiated therapy or T4 and/or T3 <2x normal
Category 3
(appointment within 365 calendar days)
  • Subclinical hyperthyroidism with TSH <0.3 mIU/L and normal fT4, fT3

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Duration of symptoms
  • Associated symptoms
  • Relevant current and previous drug use (e.g. amiodarone, lithium)
  • Recent potential iodine source (e.g. contrast media, kelp and alternative therapies)
  • Recent pregnancy
  • Concomitant medical problems and family history
  • FBC, ELFT, ESR
  • TFTs – TSH, T4, T3
  • Thyroid Stimulating Immunoglobulin or TSH Receptor antibody

3. Additional referral information Useful for processing the referral

  • Nuclear technetium thyroid scan if cause of thyrotoxicosis unclear (please ensure serum TSH performed or repeated close to scan time)
  • Thyroid ultrasound only required if palpable nodules, or evidence of nodules on nuclear technetium thyroid scan
  • Weight, height, BMI and weight history (weight loss or weight gain)
  • Neck pain if present (subacute thyroiditis)

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 2 December 2024

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