Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
Northern Adelaide Local Health Network
- Lyell McEwin Hospital
(08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
- clinically stable hypothyroidism
- hypothyroidism without cardiac disease or pregnant women, and where thyroxine treatment is contraindicated without first-line management
- suspected or confirmed thyroid nodule malignancy - refer to Breast and Endocrine
- unexplained fatigue without endocrine disorder
Further investigation may not be necessary for thyroid nodules if the following criteria are met:
- asymptomatic nodules with normal thyroid function
- asymptomatic nodules with less than 10mm in size or thyroid imaging reporting and data system (TIRADs) of 1 or 2
- in cases where this data is absent from the report, further follow up is recommended with the radiologist responsible for reporting
Category 1 - appointment clinically indicated within 30 days
- abnormal/inconclusive fine-needle aspirate cytology
- thyroid nodules with hyperthyroidism with at least one of the following:
- unexplained hoarseness or voice changes associated with a goitre
- goitre associated with symptomatic airway narrowing (stridor, venous congestion on elevation of upper limbs)
- cervical lymphadenopathy associated with a thyroid mass (usually deep cervical or supraclavicular region)
- a rapidly enlarging thyroid mass over a period of weeks (a rare presentation of thyroid cancer and usually associated with anaplastic thyroid cancer or thyroid lymphoma)
- dominant nodule greater than 4cm in size
Category 2 — appointment clinically indicated within 90 days
- diffuse goitre, multi-nodular goitre or solitary nodule less than 4cm in size
Category 3 — appointment clinically indicated within 365 days
- euthyroid multinodular goitre without airway compromise
For information on referral forms and how to import them, please view general referral information.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- past medical/surgical/reproductive history
- family history
- current medications and dosages, including supplements
- onset, duration, and progression of symptoms
- management history including treatments trialled/implemented prior to referral
- physical examination results
- body mass index (BMI)
- thyroid ultrasound (US) including thyroid imaging reporting and data system (TIRADs)
- relevant diagnostic/imaging reports including location of company and accession number
Thyroid function tests (TFTs):
- thyroid stimulating hormone (TSH)
- free thyroxine (FT4)
- free triiodothyronine (FT3)
Additional information to assist triage categorisation
- thyroid nuclear medicine scan if thyrotoxic with thyroid nodule
- computerised tomography (CT) of neck without contrast if compressive symptoms
- fine needle aspiration biopsy according to thyroid imaging reporting and data system (TIRADs)
Clinical management advice
Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.
Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.
Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.
- Therapeutic Guidelines - Thyroid Disorders: Overview
- Thyroid Imaging Reporting and Data System (TI-RADS) Online Calculator