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Thyroid enlargement / thyroid nodules

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

  • In the setting of abnormal thyroid function.
  • The following conditions are to be referred if accompanied with normal thyroid function:
    • unexplained hoarseness or voice changes associated with a goitre
    • goitre associated with symptomatic airway narrowing
    • cervical lymphadenopathy associated with a thyroid mass (usually deep cervical or supraclavicular region)
    • a rapidly enlarging thyroid mass over a period of weeks (a rare presentation of thyroid cancer and usually associated with anaplastic thyroid cancer or thyroid lymphoma)
    • lymphadenopathy
    • stridor, venous congestion on elevation of upper limbs
    • dominant nodule >4cm in size
    • abnormal cytology

Category 2

Appointment within 90 days is desirable

  • Diffuse goitre, multi-nodular goitre or solitary nodule (<4cm in size)

Category 3

Appointment within 365 days is desirable

  • No category 3 criteria

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 local Healthpathways
  • Nodules suspicious of cancer refer to surgery
  • Thyroid nodules may not require further investigation if:
    • thyroid function is normal and no local symptoms and likelihood of thyroid cancer is low (nodule <10mm)
    • age, comorbidities or other patient characteristics make diagnosis of thyroid cancer irrelevant
  • If a nodule is detected on USS, the report should include the TI-RAD score of the nodules and recommended follow up.  If this is not stated in the report, then it is recommended to discuss with reporting radiologist.
  • Clinical resources

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

  • Previous imaging or cytology results
  • TFTs – free T4, T3 and TSH results
  • USS, CXR results

Additional Referral Information (Useful for processing the referral)

  • Thyroid nuclear medicine scan if thyrotoxic with thyroid nodule
  • CT neck without contrast if compressive symptoms
  • Consider FNAC according to TI-RADS score recommendation (TI-RADS calculator]

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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