What are the indications for referring a patient with Hashimoto's Thyroiditis to an endocrinologist?

Patients with Hashimoto's thyroiditis should be referred to an endocrinologist if any of the following indications are present:

• Suspected secondary (central) hypothyroidism requiring specialist assessment of the underlying cause ¹.
• Suspected subacute thyroiditis ¹.
• Presence of a goitre, thyroid nodule, or structural changes in the thyroid gland, especially if malignancy is suspected, in which case referral should follow the suspected cancer pathway ¹.
• Suspected associated endocrine diseases such as Addison's disease, particularly before starting thyroid hormone replacement to avoid precipitating an adrenal crisis ¹.
• Women planning pregnancy, as specialist input is recommended for management in this context ¹.
• Atypical or difficult to interpret thyroid function tests (e.g., low TSH with low free T4), which may indicate rare disorders such as TSH-secreting pituitary adenoma or thyroid hormone resistance ¹.
• Suspected underlying causes of hypothyroidism related to drug treatments (e.g., amiodarone or lithium) that may require specialist advice ¹.

In the absence of these indications, primary care management with levothyroxine monotherapy and regular monitoring is appropriate ¹.