Introduction

This guideline relates to hyperthyroidism in paediatric patients. 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.

• repeat testing of thyroid function in 6 weeks is recommended in these cases, prior to referral.

When to refer

Urgent Referral and phone call:

• Low TSH and elevated fT4/fT3
  
• If clinically symptomatic (e.g. 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:

• Initial tests only mildly deranged and clinically well (E.g if 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)

Wait time for appointments 

Specialist Clinic wait times

Services available closer to home

Alternative paediatric services available in Victoria

• Monash Children's Hospital

Pre-referral work up/management

• 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

Referral criteria/required information

• 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

How to refer

Specialist Clinics referral

Please complete the above and submit via:

• Facsimile (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query  call ED admitting officer, endocrinology fellow or endocrinologist on-call (03) 9345 5522

Acknowledgements

The development of this guideline was coordinated by the Department of Endocrinology. Guideline reviewed in July 2025.