Hyperthyroidism

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Useful Management Information

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 PTU if pregnancy possible). Note that serious adverse reactions to these drugs are not uncommon and patients must be fully informed
Mild hyperthyroidism is well tolerated in pregnancy and does not necessarily require urgent investigation or intervention. If symptomatic hyperthyroidism is present, request TSH, T4, TRabs and refer to endocrinology for review.
Gestational hyperthyroidism is the result of bHCG cross-reacting with the TSH receptor, causing suppression of TSH and in some cases, elevation of T4. It is more common in conditions where the bHCG is markedly elevated including twin pregnancy, hyperemesis gravidarum and molar pregnancy. Treatment is almost never needed. If the TRab is negative and no clinical concerns the TSH can be monitored every 6-8 weeks until normalization.

Clinician Resources:

Thyroid Function Testing and Management in Pregnancy

Minimum Referral Criteria

Category 1	Severe thyroid eye disease Pregnant Newly diagnosed symptomatic thyrotoxicosis with T4 and/or T3 >2x normal Inadequate response to anti-thyroid medication or intolerant of medication
Category 2	Hyperthyroidism that is stable with GP initiated therapy or T4 and/or T3 <2x normal
Category 3	No category 3 criteria
If your patient doesn't meet the minimum referral criteria If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: 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

Standard Referral Information

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

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
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

Essential Referral Information

Duration of symptoms
Associated symptoms
Relevant current and previous drug use (e.g. amiodarone, lithium)
Recent Pregnancy
Recent potential iodine source (eg. Contrast media, kelp and alternative therapies)
Concomitant medical problems and family history
FBC
ELFT
ESR
TFTs – TSH, T4, T3
TSH receptor antibodies

If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons a clinical override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

Nuclear technetium thyroid scan if cause of thyrotoxicosis unclear
Weight, heights, BMI and weight history (weight loss or weight gain)

Send Referrals To

Smart Referrals

Coming Soon

Internal Referrals

Diabetes/Endocrinology (E-Blueslips)

Fax

5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Service Availability

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.