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Hyperthyroidism

Emergency department referrals

Phone on call Diabetic and Endocrinology Registrar via:

  • Royal Brisbane & Women’s Hospital switch - (07) 3646 8111
  • The Prince Charles Hospital switch - (07) 3139 4000
  • Redcliffe Hospital switch – (07) 3883 7777
  • Caboolture Hospital switch – (07) 5433 8888

and send patient to the Department of Emergency Medicine (DEM) at their nearest hospital.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) 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)

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Pregnancy with hyperthyroidism with suppressed TSH (<0.05), elevated Ft4/Ft3 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 days is desirable

  • Hyperthyroidism that is stable with GP initiated therapy or T4 and/or T3 <2x normal

Category 3

Appointment within 365 days is desirable

  • Subclinical hyperthyroidism with TSH <0.3 mlU/L and normal free T4, free T3

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Refer to 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

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

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

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)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • 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

  • 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

  • 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

  • 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

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

  • 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.)
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