When should I consider referring a patient with De Quervain's Thyroiditis to secondary care for further management?

Consider referring a patient with De Quervain's thyroiditis to secondary care if:

• There is diagnostic uncertainty or suspicion of alternative diagnoses such as malignancy, requiring specialist assessment and imaging.
• The patient has severe or persistent symptoms not adequately controlled by primary care management, including significant pain or thyrotoxic symptoms.
• There is evidence of complications such as marked thyroid enlargement causing compressive symptoms (e.g., breathing difficulty, hoarseness) or airway narrowing.
• The patient requires specialist investigations such as thyroid ultrasound, fine needle aspiration cytology, or measurement of thyroid autoantibodies to differentiate from other causes of thyroid disease.
• There is a need for specialist management of thyrotoxicosis if it occurs, including consideration of antithyroid drugs or other treatments.

In general, De Quervain's thyroiditis is often self-limiting and managed supportively in primary care, but referral is warranted when complications, diagnostic uncertainty, or treatment complexities arise.

References: NICE NG145