This is a visual format of the pathway for more pathway information such as assessment and diagnosis go to the Clinical Guidance tab.
Direct Secondary care referral: (follow link for referral information)
If you are confident to treat simple hyperthyroidism then follow the steps below, if the patient has a more complicated presentation or if there is any question about the diagnosis, referral to Acute Hospital care may be more appropriate.
Continue monitoring TSH monthly for at least 12 months and then attempt to stop medication.
Repeat TSH 6-12 monthly thereafter as there is a high risk of relapse.
For patients where control is difficult using either Carbimazole or Propythiouracil, consider block and replace therapy with Carbimazole 30mg and Levothyroxine 50-100mcg with monitoring of TSH.
Patients with acute thyroiditis usually normalise after the acute episode.
For patients with Graves’ Disease, there is an increased risk of relapse.
For patients with multi-nodular goitre, remission is less successful and the patient may need an assessment for definitive therapy earlier.
Patients who relapse despite use of PPU/CMZ after prolonged treatment will require secondary care referral for assessment of definitive therapies of either partial thyroidectomy or Radioactive Iodine 131.
Please see Patient/Carer information for patient leaflets.