Direct to an emergency department for:

  • Suspected myxoedema coma (impaired conscious state, hypothermia, bradycardia) with high thyroid stimulating hormone level.

Criteria for referral to public hospital specialist clinic services

  • Persistent hypothyroidism despite adequate replacement treatment
  • Pregnant women with thyroid stimulating hormone level (TSH) > 10 mU/L with a history of Graves' disease or treatment with radioactive iodine
  • Suspected or confirmed secondary hypothyroidism (i.e. low thyroid stimulating hormone level (TSH) and low free thyroxine (T4))
  • Persistent thyroiditis that has lasted for more than 6 months.

Information to be included in the referral

Information that must be provided

  • Free thyroxine (T4) results and thyroid stimulating hormone level (TSH). Please provide series of results over time if the referral is related to persistent thyroiditis
  • Thyroid related history including any history of surgery or Graves’ disease
  • Details of previous medical management including the course of treatment and outcome of treatment.

Provide if available

  • Anti-thyroid peroxidase (TPO) antibodies results.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Do not delay treatment initiation or modification where a referral has been made for a pregnant woman with hypothyroidism.

Thyroid ultrasound is not useful in assessing hypothyroidism.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

  • Clinically stable hypothyroidism
  • Primary hypothyroidism (except in patients with cardiac disease, pregnancy or if thyroxine treatment is contraindicated) that has not been treated with replacement therapy.