What are the indications for referring a patient with thyroiditis to a

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Indications for referring a patient with thyroiditis to an endocrinologist include:

Suspected subacute thyroiditis .
The presence of a goitre, nodule, or structural change in the thyroid gland . If malignancy is suspected, referral should be made via a suspected cancer pathway ,,.
Atypical or difficult to interpret thyroid function tests (TFTs) .
Suspected associated endocrine disease, such as Addison's disease . It is crucial not to start thyroid hormone replacement before specialist glucocorticoid replacement in suspected adrenal failure, as this can precipitate an adrenal crisis .
If the patient is a female planning a pregnancy .
A persistently raised thyroid-stimulating hormone (TSH) despite adequate or escalating levothyroxine (LT4) treatment doses .
For adults with subclinical hyperthyroidism, consider seeking specialist advice if they have two TSH readings lower than 0.1 mIU/litre at least three months apart, and evidence of thyroid disease (for example, a goitre or positive thyroid antibodies) or symptoms of thyrotoxicosis .
For all children and young people with subclinical hyperthyroidism, specialist advice should be considered .

What are the indications for referring a patient with thyroiditis to an endocrinologist?