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Primary Care Liaison


  • Introduction

    • The common causes of hyperthyroidism in children and adolescents would be Graves’ disease and the acute phase of Hashimoto’s thyroiditis
    • A low thyroid stimulating hormone (TSH) that is low but above 0.2U/L with a normal free T4 level does not necessarily indicate hyperthyroidism. Many children will have a low TSH with normal free T4 after being unwell 
              - Would recommend repeating thyroid function test in 6 weeks in these cases, prior to referral

    Initial work up

    • TSH, fT4, fT3
    • TSH receptor antibodies (specific to Graves’ disease), anti-TPO and anti-thyroglobulin antibodies – antibody tests can be requested at time of next TFTs if not done initially

    When to refer

    Refer + phone call:

    • Low TSH and elevated fT4/fT3 
      • If clinically symptomatic (eg palpitations, significant weight loss) or TSH is below lower limit of detection of lab and fT4 is significantly elevated (>30pmol/l), please call the endocrinologist / fellow on call as urgent review ± instigation of therapy may be required.

    Routine referral:

    • If initial tests only mildly deranged and clinically well (eg TSH low but above 0.2U/l or fT4 is mildly elevated but <30pmol/l) suggest refer to OPD and also arrange repeat test in ~2-3 weeks (with autoantibodies as above if not done previously).

    Referral information needed

    • Clinical history / reason for testing
    • Copies of reports of abnormal thyroid function tests and antibody testing as above
    • Height and weight (and date of assessment)
    • Relevant family / personal history of thyroid disease or other autoimmunity

    Contact information

    • For clinical advice, the endocrinology fellow or endocrinologist on call can be contacted through the hospital switch board (03) 9345 5522
    • Outpatient booking enquiry information (03) 9345 6180


    • Guideline developed by RCH Endocrinology Department