Thyroid enlargement / thyroid nodules

ADULT
  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Stridor associated with a thyroid mass
    • Possible tracheal or superior vena cava obstruction from retrosternal thyroid enlargement
    • Refer to HealthPathways or local guidelines
    • Nodules suspicious of cancer refer to surgery
    • Thyroid nodules may not require further investigation if:
      • thyroid function is normal, and no local symptoms and likelihood of thyroid cancer is low (using TI-RADS recommendations)
      • age, comorbidities or other patient characteristics make diagnosis of thyroid cancer irrelevant
    • If a nodule is detected on USS, the report should include the TI-RAD score of the nodules and recommend follow-up. If this is not stated in the report, then it is recommended to discuss with reporting radiologist.
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Newly diagnosed symptomatic thyrotoxicosis with T4 and/or T3 >2x normal
Category 2
(appointment within 90 calendar days)
  • Diffuse goitre, multi-nodular goitre or solitary nodule without*:
    • unexplained hoarseness or voice changes associated with a goitre
    • goitre associated with symptomatic airway narrowing
    • 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)
    • lymphadenopathy
    • stridor, venous congestion on elevation of upper limbs
    • dominant nodule >4cm in size
    • abnormal cytology
  • *If any of these features, patient should be referred for urgent Thyroid surgeon assessment.

  • Persistent mild (T4/T3 <2x normal) or subclinical (normal T4/T3 with TSH <0.3) hyperthyroidism
  • Surveillance of treated thyroid cancer
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • USS, including prior imaging results if available
  • Cytology
  • TFTs – free T4, T3 and TSH

3. Additional referral information Useful for processing the referral

  • Thyroid nuclear medicine scan if thyrotoxic with thyroid nodule
  • CT neck without contrast if compressive symptoms
  • Consider FNAC according to TI-RADS score recommendation [TI-RADS calculator]

4. Request

  • Patient's 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

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    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.)
  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • 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.

Last updated: 2 December 2024

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