What are the indications for referring a patient with thyroiditis to an endocrinologist?

Indications for referring a patient with thyroiditis to an endocrinologist include:

• Suspected subacute thyroiditis ¹.
• The presence of a goitre, nodule, or structural change in the thyroid gland ¹. If malignancy is suspected, referral should be made via a suspected cancer pathway ¹,²,³.
• Atypical or difficult to interpret thyroid function tests (TFTs) ¹.
• Suspected associated endocrine disease, such as Addison's disease ¹. It is crucial not to start thyroid hormone replacement before specialist glucocorticoid replacement in suspected adrenal failure, as this can precipitate an adrenal crisis ¹.
• If the patient is a female planning a pregnancy ¹.
• A persistently raised thyroid-stimulating hormone (TSH) despite adequate or escalating levothyroxine (LT4) treatment doses ¹.
• For adults with subclinical hyperthyroidism, consider seeking specialist advice if they have two TSH readings lower than 0.1 mIU/litre at least three months apart, and evidence of thyroid disease (for example, a goitre or positive thyroid antibodies) or symptoms of thyrotoxicosis ³.
• For all children and young people with subclinical hyperthyroidism, specialist advice should be considered ³.