What are the indications for referring a patient with Hashimoto's Thyr

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Patients with Hashimoto's thyroiditis should be referred to an endocrinologist if any of the following indications are present:

Suspected secondary (central) hypothyroidism requiring specialist assessment of the underlying cause .
Suspected subacute thyroiditis .
Presence of a goitre, thyroid nodule, or structural changes in the thyroid gland, especially if malignancy is suspected, in which case referral should follow the suspected cancer pathway .
Suspected associated endocrine diseases such as Addison's disease, particularly before starting thyroid hormone replacement to avoid precipitating an adrenal crisis .
Women planning pregnancy, as specialist input is recommended for management in this context .
Atypical or difficult to interpret thyroid function tests (e.g., low TSH with low free T4), which may indicate rare disorders such as TSH-secreting pituitary adenoma or thyroid hormone resistance .
Suspected underlying causes of hypothyroidism related to drug treatments (e.g., amiodarone or lithium) that may require specialist advice .

In the absence of these indications, primary care management with levothyroxine monotherapy and regular monitoring is appropriate .

What are the indications for referring a patient with Hashimoto's Thyroiditis to an endocrinologist?