<meta charset="UTF-8"/>
<meta name="tikaGenerated" content="true"/>
<meta name="date" content="2021-10-11T01:21:58Z"/>
<meta name="creator" content="Mary Dickson"/>
<meta name="xmp:CreatorTool" content="Acrobat PDFMaker 15 for Word"/>
<meta name="Company" content="SDGP"/>
<meta name="meta:author" content="Mary Dickson"/>
<meta name="meta:creation-date" content="2021-10-10T23:30:19Z"/>
<meta name="created" content="Mon Oct 11 10:00:19 ACDT 2021"/>
<meta name="dc:creator" content="Mary Dickson"/>
<meta name="xmpTPg:NPages" content="1"/>
<meta name="Creation-Date" content="2021-10-10T23:30:19Z"/>
<meta name="dcterms:created" content="2021-10-10T23:30:19Z"/>
<meta name="Last-Modified" content="2021-10-11T01:21:58Z"/>
<meta name="dcterms:modified" content="2021-10-11T01:21:58Z"/>
<meta name="Last-Save-Date" content="2021-10-11T01:21:58Z"/>
<meta name="meta:save-date" content="2021-10-11T01:21:58Z"/>
<meta name="SourceModified" content="D:20210928070444"/>
<meta name="Author" content="Mary Dickson"/>
<meta name="producer" content="Adobe PDF Library 15.0"/>
<meta name="modified" content="2021-10-11T01:21:58Z"/>
<meta name="Content-Type" content="application/pdf"/>
Version Date from Date to Amendment 
1.0 September 2014 September 2016 Original 

2.0 Aug 2021 Aug 2023 Edited document 


Southern Adelaide Local Health Network (SALHN) 

  Management depends on the underlying cause
  Common causes:

- Graves  disease, toxic adenoma or multi-nodular goitre, subacute, silent or post-partum
thyroiditis, excessive thyroid hormone administration and iodine induced (often from
radiological contrast media and Amiodarone)

Information Required 
  Presence of Red Flags
  Duration of symptoms
  Associated symptoms
  Current and previous drug use (e.g. amiodarone, lithium)
  Recent potential iodine source (e.g. contrast media)
  Concomitant medical problems and family history

Investigations Required 
  TSH receptor antibodies if Graves 

disease is suspected
  Nuclear thyroid scan

Investigations not Required
  Thyroid ultrasound is not usually helpful

Fax Referrals to 
GP Plus Marion 7425 8687  GP Plus Noarlunga 8164 9199 

Red Flags 
Atrial fibrillation or other cardiac rhythm 
Cardiac failure or ischaemia 
Rapid weight loss, significant myopathy  
Obstructive symptoms from a goitre 

Hypokalaemia or periodic paralysis, particularly 
in SE Asian origin patients 
Severe or progressive thyroid eye disease 
Pregnancy (current or intended) or breastfeeding

Suggested GP Management 
  If red flag present discuss with on call registrar
  Nuclear thyroid scan and serum Thyroid receptor antibodies if cause unclear
  Avoid iodinated contrast agents wherever possible
  Consider beta blocker for symptom control
  If hyperthyroidism is not due to excess exogenous thyroid hormone, transient thyroiditis or iodine load

start carbimazole (or PTU if pregnancy possible). Note that serious adverse reactions to these drugs are
not uncommon and patients must be fully informed

  Repeat TFTs within a week of clinic appointment

Clinical Resources 
Therapeutic Guidelines Endocrinology Version 6 (2018) 

General Information to assist with referrals and the and Referral templates for SALHN are available to download from the SALHN Outpatient Services website 
www.sahealth.sa.gov.au/SALHNoutpatients and SAFKI Medicare Local website www.safkiml.com.au 

Identifier: CC1.2716