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.

  • uncontrolled thyrotoxicosis
  • goitre with compression causing acute airway or swallowing difficulty
  • post-operative thyroid presentations with airway compromise, neck swelling, hypocalcaemia symptoms
  • symptomatic or severe hypercalcemia

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Regional Health Networks 

Barossa Hills Fleurieu Local Health Network

Eyre and Far North Local Health Network

Flinders and Upper North Local Health Network

Limestone Coast Local Health Network

Riverland Mallee Coorong Local Health Network

Yorke and Northern Local Health Network

Exclusions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • confirmed thyroid malignancy
  • multinodular thyroid disease with compression causing non-acute airway or swallowing difficulty
  • thyroid nodules with confirmed atypical or suspicious cytology (Bethesda 3-6)
  • thyroid nodules with highly suspicious imaging (TI-RADS 4 and 5) and non-diagnostic cytology
  • new adrenal masses - highly suspicious on imaging or greater than 4cm
  • referrals from medical endocrinology requesting urgent review

Category 2 (appointment clinically indicated within 90 days)

  • symptomatic indeterminate thyroid nodules on imaging (TI-RADS 3)
  • symptomatic thyroid nodules where biopsy unable to be obtained
  • symptomatic thyroid nodules with benign biopsy (Bethesda 2)
  • functioning and indeterminate adrenal masses for consideration of surgery

Category 3 (appointment clinically indicated within 365 days)

  • long-standing multi-nodular goitre without suspicious features

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.

Thyroid referrals

  • past medical/surgical/reproductive history
  • personal history of radiation exposure
  • 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
  • height/weight
  • 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
  • pathology
    • thyroid function tests (TFTs):
      • thyroid stimulating hormone (TSH)
      • free thyroxine (FT4)
      • free triiodothyronine (FT3)
      • thyroid auto antibodies

Parathyroid referrals

  • past medical/surgical/cancer history, including osteoporosis
  • current medications and dosages
  • use/frequency of alcohol, tobacco, and other drugs
  • allergies and sensitivities
  • onset, duration, and progression of symptoms
  • management history including treatments trialled/implemented prior to referral
  • physical examination results
  • blood pressure
  • bone mineral density (BMD) if minimal trauma fracture or loss of height including forearm, spine and hip - dual-energy X-ray absorptiometry (DXA) scan
  • relevant diagnostic/imaging reports, including location of company and accession number
  • pathology
    • plasma calcium (total and corrected) – repeat fasting if borderline
    • serum parathyroid hormone (PTH)
    • phosphate (PO4)
    • magnesium (Mg)
    • alkaline Phosphatase (ALP)
    • vitamin D 25-OH
    • albumin
    • urea, electrolyte, and creatinine (UEC)
    • erythrocyte sedimentation rate (ESR)
    • calcium-to-creatinine ratio fasting morning spot urine (2nd void)
    • Suspected primary hyperparathyroidism: 24-hour urine calcium paired with serum calcium and creatinine

Adrenal referrals

  • past medical/surgical/cancer history, including osteoporosis
  • current medications and dosages
  • use/frequency of alcohol, tobacco, and other drugs
  • allergies and sensitivities
  • onset, duration, and progression of symptoms
  • management history including treatments trialled/implemented prior to referral
  • physical examination results
  • blood pressure
  • adrenal computerised tomography (CT)
  • pathology
    • electrolytes (presence of hypokalaemia) and aldosterone/renin ratio if hypertension is present to screen for primary hyperaldosteronism
    • 1mg overnight dexamethasone suppression test (1DST) to screen for Cushing’s syndrome
    • on a separate day to 1DST:
      • adrenocorticotropic hormone (ACTH), this needs to be done at a major laboratory as ACTH must be put on ice and processed immediately
      • dehydroepiandrosterone sulphate (DHEAS)
    • plasma free metanephrines to screen for pheochromocytoma
    • serum testosterone if there is evidence of virilisation

Additional information to assist triage categorisation

Thyroid referrals

  • 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)

Parathyroid referrals

  • ultrasound (us) kidneys and urinary tract

Adrenal referrals

  • relevant diagnostic/imaging reports, including location of company and accession number

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.