Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Refer a patient with hyperthyroidism to an endocrinologist if any of the following criteria are met:
- There is a confirmed diagnosis of overt hyperthyroidism based on thyroid function tests (TFTs) NICE CKS.
- Symptoms suggest a serious complication such as thyrotoxic crisis, requiring emergency admission NICE CKS.
- A pituitary or hypothalamic disorder is suspected, warranting urgent specialist assessment NICE CKS.
- The patient has a goitre, thyroid nodule, or structural thyroid changes, especially if malignancy is suspected; in such cases, refer urgently via a suspected cancer pathway NICE CKS,NICE NG145.
- The patient is planning a pregnancy, as specialist management may be needed NICE CKS.
- There is troublesome symptomatology despite beta-blocker treatment, or beta-blockers are contraindicated or not tolerated, prompting consideration of antithyroid drugs under specialist advice NICE CKS.
- The patient is at risk of complications from hyperthyroidism or is on drugs such as amiodarone or lithium that affect thyroid function, requiring liaison with endocrinology NICE CKS.
- Subclinical hyperthyroidism is persistent with TSH <0.1 mIU/L on at least two occasions three months apart, with evidence of thyroid disease or symptoms of thyrotoxicosis, especially in adults over 65, postmenopausal women not on oestrogens or bisphosphonates, or those with cardiac risk factors, heart disease, or osteoporosis NICE CKS,NICE NG145.
- In children and young people with subclinical hyperthyroidism, specialist advice should be sought regardless of severity NICE NG145.
While awaiting specialist assessment, consider beta-blocker therapy for symptom control in adults without contraindications and seek specialist advice before starting antithyroid drugs in primary care NICE CKS.