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Hypothyroidism

Emergency 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.

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

  • Suspected or confirmed secondary hypothyroidism (low T4 without a raised TSH)
  • Pregnant

Category 2

Appointment within 90 days is desirable

  • Hypothyroidism with difficulty normalising TFTs despite thyroxine therapy
  • Hypothyroidism within 12 months of delivery of a child
  • Pre-pregnancy counselling
  • NB Category 2 cases can be referred to local/regional general physician if endocrinologist access is not locally available

Category 3

Appointment within 365 days is desirable

  • Problems with management of primary or secondary hypothyroidism

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

  • No USS is required in the routine assessment of hyperthyroidism or hypothyroidism
  • Refer to Healthpathways or local guidelines
  • 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
  • Usually primary hypothyroidism should be able to be managed in general practice
  • Patients with positive thyroid antibodies and normal TFT do not need to be referred to an endocrine service 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

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

  • TSH  free T4 results
  • Thyroid antibodies if primary hypothyroidism
  • Specific thyroid history eg thyroiditis, thyroid disease in pregnancy, mx hyperthyroidism

Additional Referral Information (Useful for processing the referral)

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

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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