What are the indications for referring a patient with abnormal TFTs to secondary care for further evaluation?

For patients with abnormal thyroid function tests, referral to secondary care for further evaluation should be considered in specific circumstances:

• Subclinical Hyperthyroidism in Adults: Specialist advice should be considered for adults with subclinical hyperthyroidism if they have two Thyroid-Stimulating Hormone (TSH) readings lower than 0.1 Miu/litre at least three months apart, alongside evidence of thyroid disease (such as a goitre or positive thyroid antibodies) or symptoms of thyrotoxicosis ¹.
• Subclinical Hyperthyroidism in Children and Young People: Specialist advice should be considered for all children and young people with subclinical hyperthyroidism ¹.
• Suspected Thyroid Cancer: If there is a clinical suspicion of thyroid cancer, such as with thyroid enlargement accompanied by 'red flag' symptoms (e.g., shortness of breath, rapid growth of nodules, hoarse voice, or swallowing difficulties), referral should follow the NICE guideline on suspected cancer ¹,².