Specialty: Endocrinology
Age group: Adult
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) greater than 10 milliunit per litre 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.
Reviewed 30 May 2025