Patients with hypothyroidism can expect to be referred if:

• aged <16
• pregnant or post partum
• evidence of pituitary disease
• newborn infant

Referral should also be considered if (2)

• there are particular problems such as "active and unstableischaemic heart disease (2)" or treatment with amiodarone or lithium
• symptoms do not respond or worsen after treatment with levothyroxine
• serum TSH level is persistently raised while on full dose of levothyroxine (2)

Patients with hyperthyroidism can reasonably expect to be referred for a specialist opinion at diagnosis.

Reference:

• (1) Franklyn J (1996). Concensus statement for good practice and audit measures in the management of hypothyroidism and hyperthyroidism.BMJ, 313, 519.
• (2) Vaidya B, Pearce SH. Management of hypothyroidism in adults. BMJ. 2008;337:a801