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Primary Care Liaison


  • Introduction

    • Mild elevation in thyroid stimulating hormone (TSH <10U/l), is commonly seen and in many cases will often improve without treatment.

                    - This is particularly common in children and adolescents with a BMI in the overweight or obese range, and will improve with improvement in BMI

                    - These children do not require referral, but should have repeat thyroid function tests in 3 months

    • Children with mildly elevated TSH should have anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin antibodies checked

                    - Mild elevation in these antibodies is common, and can occur following a viral infection

                    - Very elevated anti-TPO antibodies suggests Hashimoto’s thyroiditis

                    - Many cases of subacute thyroiditis or Hashimoto’s thyroiditis will resolve without treatment

    • Those with positive anti-thyroid antibodies and normal or mildly elevated TSH do not require referral, but should be monitored with surveillance thyroid function tests in 3 months

    When to refer

    • If TSH >20U/l and/or fT4 below the normal lab reference range;
      • Please also phone to discuss with endocrinologist / fellow on call as treatment before endocrine OPD review likely warranted
    • TSH between 10 and 20U/l (even if fT4 normal) on two occasions
      • Repeat test in ~6 weeks to ensure no significant change pre outpatient review (include anti-thyroid peroxidase (TPO) and anti-thyroglobulin antibodies on repeat test if not yet done)
      • For children <2 years of age, consider earlier retesting and discussion with endocrinology team as there is a lower threshold for earlier treatment

    Please note: Children with possible central / pituitary cause for hypothyroidism may not be able to raise their TSH level and so an isolated low fT4 with ‘normal’ TSH in children with a relevant history (eg structural brain abnormality / lesion) is sufficient cause for concern.

    Initial work up

    • TSH and T4 (and previous thyroid function tests if available)
    • Anti-thyroid peroxidase and anti-thyroglobulin antibodies (if done)
    • Please note: routine ultrasound of children with hypothyroidism is not required

    Referral information needed

    • Clinical history / reason for testing
    • Copies of reports of abnormal thyroid function tests and autoantibody testing as above
    • Current height and weight (including 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