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Thyroid enlargement / thyroid nodules

Find assessment and management information at Brisbane South HealthPathways under:

Useful management information

  • In the setting of normal thyroid function, refer category 1 conditions to general surgery
  • For patients with a thyroid nodule and abnormal TFT, refer to endocrine clinic
  • If the patient has a thyroid nodule and is euthyroid, refer to breast endocrine surgical clinic
  • Thyroid nodules may not require further investigation if:
    • thyroid function is normal and no local symptoms and likelihood of thyroid cancer is low (nodule <10mm)
    • age, comorbidities or other patient characteristics make diagnosis of thyroid cancer irrelevant
  • If a nodule is detected on USS, the report should include the TI-RAD score of the nodules and recommend follow-up. If this is not stated in the report, then it is recommended to discuss with reporting radiologist.

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark “urgent” on your referral

  • In the setting of abnormal thyroid function, refer to endocrinology.
  • The following conditions are to be referred if accompanied with normal thyroid function to general surgery:
    • unexplained hoarseness or voice changes associated with a goitre
    • goitre associated with symptomatic airway narrowing
    • cervical lymphadenopathy associated with a thyroid mass (usually deep cervical or supraclavicular region)
    • a rapidly enlarging thyroid mass over a period of weeks (a rare presentation of thyroid cancer and usually associated with anaplastic thyroid cancer or thyroid lymphoma)
    • lymphadenopathy
    • stridor, venous congestion on elevation of upper limbs
    • dominant nodule >4cm in size
    • abnormal cytology
Category 2
(appointment within 90 calendar days)
  • Diffuse goitre, multi-nodular goitre or solitary nodule (<4cm in size)
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)


Essential referral information for Thyroid enlargement / thyroid nodules referrals (Referral will be returned without this)

  • Previous imaging or cytology results
  • TFTs – free T4, T3 and TSH results
  • USS, CXR results

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Thyroid enlargement / thyroid nodules referrals

  • Thyroid nuclear medicine scan if thyrotoxic with thyroid nodule
  • CT neck without contrast if compressive symptoms
  • Consider FNAC according to TI-RADS score recommendation [TI-RADS calculator]

Out of Catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 18 November 2022