Hypothyroidism

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.

    • Suspected myxoedema coma (altered consciousness, hypothermia, fluid overload, bradycardia, hyponatraemia)
    • Refer to HealthPathways for assessment and management recommendations.
    • No USS is required in the routine assessment of hyperthyroidism or hypothyroidism
    • Consider other autoimmune glandular conditions if autoimmune hypothyroidism (e.g. pernicious anaemia, coeliac disease and Addison's)
    • Commence low dose thyroxine and gradually titrate over months if cardiac disease
    • Newly diagnosed primary hypothyroidism, including subclinical hypothyroidism should be able to be managed in general practice (and is out of scope in the Endocrinology CPC) – Note: in women of childbearing age who are pregnant or wishing to become pregnant or not using contraception, thyroxine should be commenced and titrated, aiming for a TSH less than 2.5
    • Patients with positive thyroid antibodies and normal TFTs, do not need to be referred to an endocrine service (and is out of scope in the Endocrinology CPC) and recommend TSH to be monitored annually
    • Where indicated, cortisol must be replaced before thyroxine
    • TSH cannot be used to guide replacement thyroxine therapy in patients with pituitary dysfunction. Aim to keep T4 in mid-to-upper range of normal
    • If difficultly normalising thyroid function please review correct dose is being administered, correct thyroxine storage, correct administration (on an empty stomach 30-60 minutes prior to food or other medications), consider malabsorption (including coeliac disease).
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • New onset secondary hypothyroidism (low T4 and TSH)
  • Hypothyroidism in pregnancy
Category 2
(appointment within 90 calendar days)

NB Category 2 and 3 cases can be referred to local/regional General Physician if Endocrinologist access is not locally available

  • Pre-pregnancy counselling with known hypothyroidism
Category 3
(appointment within 365 calendar days)
  • Primary or secondary hypothyroidism with difficulty normalising TFTs despite thyroxine therapy

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

  • TSH, free T4
  • Specific thyroid history eg thyroiditis, thyroid disease in pregnancy, management of hyperthyroidism

3. Additional referral information Useful for processing the referral

  • Weight, height, BMI and weight history (weight loss or weight gain)
  • Family history

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: 11 June 2021

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