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Thyroid Disorders Referral Access Criteria

Thyroid Disorders Referral Access Criteria

Referrers should use this page when referring patients to public paediatric endocrinology and diabetes outpatient services for thyroid disorders. This RAC is applicable to referrals for patients aged <16 years only.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Thyrotoxicosis
  • Hypothyroid coma
  • Thyroid nodule with significant clinical concerns i.e. stridor or concerning features on ultrasound (US)
  • Hyperthyroidism with symptoms of sympathetic overactivity (tachycardia, hypertension)
  • Neonatal Grave’s disease
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days):
  • Nil

To contact the relevant service, see Clinician Assist WA: Acute Paediatric Assessment (external site)
Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Changes in activity levels
  • Unintentional weight gain or weight loss
  • Fatigue
  • Poor concentration
  • Palpitations
  • Constipation / diarrhoea
  • Dry skin
  • Tremors
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  • Relevant history, onset, duration and severity of symptoms
  • Current medication list
  • Any known allergies
  • Familial history of thyroid disease
Examination
  • Goitre, thyroid nodules
  • BP
  • HR
  • Exophthalmos
Investigations
  • TSH
  • Free T4
Highly desirable
History
  • Nil
Examination
  • Nil
Investigations
  • Free T3, TSH receptor and thyroid autoantibodies
  • Thyroid ultrasound (US) (thyroid nodule)
  • MRI brain in suspected central hypothyroidism 
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • Follow up clinic from emergency presentation
  • Solitary thyroid nodule (with suspicious features on ultrasound (US) or ≥1cm)
  • Neonate with abnormal Newborn Screening Test

Category 2

Appointment within 90 days

  •  Any thyroid disorders without acute symptoms or on treatment

Category 3

Appointment within 365 days

  • No defined category 3 criteria
Exclusions
  • Trisomy 21 with mildly elevated TSH levels (hyperthyrotropinaemia) and normal free T4
  • Positive thyroid antibodies but normal thyroid function tests
  • TSH levels between 5-10 mU/L and normal T4 and no goitre
  • In patients with obesity, slight elevations in TSH (5-10 mU/L) secondary to metabolic syndrome unless thyroid antibodies are positive.
  • See Clinician Assist WA: Thyroid Investigations (external site)
Useful information
  • See Australia and New Zealand Society for Endocrinology and Diabetes for clinical resources (external site)

Feedback

If you would like to submit feedback on the contents of the Referral Access Criteria, please complete this form.

Last reviewed: 18-03-2024
wa.gov.au