Shaping better health
REMEDY : BNSSG referral pathways


Checked: 09-05-2018 by Rob.Adams Next Review: 09-05-2019


There are Clinical Knowledge Summary guidelines on management of thyrotoxicosis/ hyperthyroidism.

All patients with overt hyperthyroidism should be referred to an endocrinologist , the urgency depending on clinical judgement. Consider starting treatment while the patient is waiting to be seen. Specialist advice on treatment can be obtained via endocrinology SpR on call.




Endocrinology clinics are available at UHB, NBT and WGH via eReferral.

Red Flags

Admit as a medical emergency if symptoms of thyroid storm

  • Thyroid storm (thyrotoxic crisis) is a rare and potentially life-threatening, and may occur after trauma, childbirth, surgery, infection, or stroke, for example (in people with untreated or suboptimally treated hyperthyroidism) [Vaidya and Pearse, 2014].
  • Clinical features include tachycardia, fever, atrial fibrillation, heart failure, fever, diarrhoea, vomiting, dehydration, jaundice, agitation, delirium, and coma [Weetman, 2010; Bahn et al, 2011].

Consider 2WW referral for patients with a thyroid nodule or goitre if malignancy is suspected.