​​​Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar:

  • thyroid mass with any of the following:
    • airway compromise
    • breathing difficulty
    • drooling
    • haemoptysis
    • severe odynophagia
    • stridor
    • sudden increase in size or pain over days to weeks
    • sudden voice change.

When public outpatient services are not routinely provided

  • Low risk (< 1 cm) thyroid nodules, unless otherwise concerning features.
  • Non-bacterial thyroiditis.
  • Uniform, enlarged gland suggestive of thyroiditis without other symptoms.

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Cytologically confirmed malignancy (Bethesda VI).
  • Cytologic atypia or cytology suspicious for neoplasm or malignancy.
  • Intermediate to high suspicion of malignancy on thyroid ultrasound where fine needle aspirate (FNA) cannot be performed promptly (TI RADS 4-5).
  • Multinodular goitre or thyroid enlargement with symptoms of moderate to severe compression (for example dyspnoea, stridor, exercise intolerance, dysphagia, thoracic outlet obstruction – Pemberton’s sign).
  • Cervical lymphadenopathy associated with a thyroid mass (central or lateral neck).

Category 2
Recommended to be seen within 90 calendar days.

  • Thyroid nodule > 4 cm regardless of imaging and cytology findings.
  • Increase in size of previously identified thyroid nodule > 1 cm.
  • Repea​​t non-diagnostic FNA cytology of a thyroid nodule.
  • Thyroid nodule with FNA biopsy showing Bethesda III.

Category 3
Recommended to be seen within 365 calendar days.

  • Multinodular goitre or generalised thyroid enlargement without compressive symptoms or with symptoms of mild compression (for example minor exercise intolerance, mild dysphagia).
  • Recurrent thyroid cysts (non-obstructive).

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition, including symptom history and their duration.
  • Provisional diagnosis.
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • physical examination findings
    • thyroid stimulating hormone (TSH) and free thyroxine (T4) results
    • diagnostic ultrasound and fine needle aspirate (FNA) biopsy results (include copy of results, test location and date).

If available

  • Personal or family history of thyroid cancer or familial endocrine neoplasia syndromes.
  • Previous head and/or neck malignancy.
  • Previous head and/or neck radiation treatment.
  • Whether the patient is currently taking antiplatelet or anticoagulant medication.
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ or among a vulnerable, disadvantaged or priority population.
  • If the patient is willing to have surgery (where clinically relevant).
  • If the patient is suitable for virtual care or telehealth.
  • If the patient has special needs or requires reasonable adjustments to be made.
  • If the patient requires an interpreter (if so, list preferred language).

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

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Current as at: Monday 17 June 2024
Contact page owner: System Purchasing