<html> <head> <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"/> </head> <body> <pre> Version Date from Date to Amendment 1.0 September 2014 September 2016 Original 2.0 Aug 2021 Aug 2023 Edited document OUTPATIENT GP REFERRAL GUIDELINES SOUTHERN ADELAIDE DIABETES and ENDOCRINE SERVICES (SADES) Southern Adelaide Local Health Network (SALHN) Hyperthyroidism 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 TFTs 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 disturbance 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 </pre> </body> </html>