Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • hyperthyroidism associated hypokalaemia or paralysis
  • hyperthyroidism complicated by acute cardiac complication including:
    • atrial fibrillation (AF)
    • cardiac ischaemia
    • respiratory compromise
    • systemic features
    • nausea/vomiting pressure,
    • delirium or cognitive impairment
  • neutropenic sepsis in medication use e.g. carbimazole or propylthiouracil
  • suspected tracheal/superior vena cava obstruction from retrosternal thyroid enlargement
  • thyroid mass associated stridor

If concerning features present discuss with on-call endocrine registrar

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Category 1 - appointment clinically indicated within 30 days

  • hyperthyroidism in pregnancy
  • hyperthyroidism with hypokalaemia or paralysis
  • inadequate response to anti-thyroid medication or intolerant of medication
  • newly diagnosed symptomatic thyrotoxicosis with:
    • free thyroxine (FT4) and/or
    • free triiodothyronine (FT3) greater than x2 upper limit of normal
  • severe thyroid eye disease

Category 2 — appointment clinically indicated within 90 days

  • hyperthyroidism without concerning features
  • stable hyperthyroidism with:
    • first-line medical management or
    • free thyroxine (FT4) and/or
    • free triiodothyronine (FT3) less than x2 upper limit of normal

Category 3 — appointment clinically indicated within 365 days

  • subclinical hyperthyroidism
    • low thyroid stimulating hormone (TSH) and normal free thyroxine (FT4) and free triiodothyronine (FT3) on repeat testing

For more on outpatient referrals, see the general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • past medical/surgical history
  • family history
  • onset, duration, and progression of symptoms
  • current medications and dosages e.g. amiodarone, lithium
  • use/frequency of alcohol, tobacco, and other drugs
  • allergies and sensitivities
  • recent potential iodine sources e.g. contrast media
  • management history including treatments trialled/implemented prior to referral
  • physical examination
  • height/weight
  • body mass index (BMI), including weight loss/gain trends
  • thyroid nuclear scan if cause is unclear
  • relevant diagnostic/imaging reports, including location of company and accession number


  • complete blood examination (CBE)
  • urea, electrolyte, and creatinine (UEC)
  • thyroid function tests (TFTs):
    • thyroid stimulating hormone (TSH)
    • free thyroxine (FT4)
    • free triiodothyronine (FT3)
  • erythrocyte sedimentation rate (ESR)
  • if suspected Grave’s disease
    • thyroid antibodies

Clinical management advice

Management of hyperthyroidism depends on the underlying cause. Common causes can include:

  • Graves’ disease
  • toxic adenoma or multi-nodular goitre
  • subacute, silent or post-partum thyroiditis
  • excessive thyroid hormone administration
  • iodine induced (often from radiological contrast media and amiodarone)

Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.

Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.

Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.

Suggested General Practitioner management

  • avoid iodinated contrast agents wherever possible
  • consider beta blocker for symptom control
  • if hyperthyroidism is not due to excess exogenous thyroid hormone, transient thyroiditis or iodine load, start carbimazole or propylthiouracil (PTU) in likelihood of pregnancy
  • note that serious adverse reactions to these drugs are not uncommon e.g. rash, jaundice, neutropenia) and patients must be fully informed
  • nuclear thyroid scan and/or serum thyroid receptor antibodies if cause unclear
  • repeat thyroid function tests (TFT)s within a week of outpatient appointment
  • it is not recommended to undertake ultrasound of thyroid for hyperthyroidism unless palpable nodules or goitre present.

Clinical resources

Consumer resources