Thyroid disorders

​​​​​​​​Emergency

If any of the following are suspected, seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary)

  • Agranulocytosis in a child or young person taking carbimazole or propylthiouracil
  • Hyperthyroidism complicated by cardiac, respiratory compromise, pregnancy, or other indications of severe illness (fever, vomiting, labile blood pressure, altered mental state)
  • Hyperthyroidism with hypokalaemia or paralysis
  • Neonatal Graves' disease
  • Neonate with abnormal newborn screening test
    Note: emergency medical advice via phone is indicated
  • Possible tracheal or superior vena cava obstruction from retrosternal thyroid enlargement
  • Stridor associated with a thyroid mass
  • Suspected myxoedema coma (altered consciousness, hypothermia, fluid overload, bradycardia, hyponatraemia)

When public outpatient services are not routinely provided

  • Positive antibodies in setting of normal thyroid hormone levels
  • Sub-clinical hypothyroidism as indicated by thyroid stimulating hormone (TSH) levels between 5-10 mU/L, normal thyroxine (T4) and no goitre
  • Trisomy 21 with mildly elevated TSH levels (i.e. hyperthyrotropinaemia) and normal free thyroxine (fT4)
    Note: these patients should already be under the care of a general paediatrician​

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.

  • Aged < 3 years with hypothyroidism
  • Newly diagnosed Graves' disease
  • Significantly elevated thyroid stimulating hormone (TSH) levels > 10mIU/L and a low free thyroxine (fT4) below the reference range
  • Solitary thyroid nodule > 1cm with suspicious features on ultrasound​
​Category 2
Recommended to be seen within 90 calendar days.
  • ​Any thyroid disorders without acute symptoms or on treatment​

Category 3
Recommended to be seen within 365 calendar days.

  • Nil

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptoms and their duration
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Familial history of thyroid disease
    • Presence of goitre
    • Presence of thyroid nodules
    • Presence of exophthalmos
    • Amount of weight gain or loss
    • Blood pressure (one-off measurement)
    • Heart rate (one-off measurement)
    • Thyroid stimulating hormone (TSH)
    • Free thyroxine (fT4)​

If available

  • Thyroid stimulating hormone (TSH) receptor antibody
  • Thyroid autoantibodies
  • Thyroid ultrasound
  • Magnetic resonance imaging (MRI) brain (in suspected central hypothyroidism)​

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team. 

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing