REMEDY : BNSSG referral pathways & Joint Formulary


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Sub Clinical hyperthyroidism

Checked: 23-09-2022 by Vicky Ryan Next Review: 23-09-2022

Overview

 

These guidelines have been provided by the Endocrinology Team at NBT so pathways might be slightly different at UHBW

Definition 

Biochemically defined as a TSH below the normal range with a normal free T4 and T3

Important points

Rarely symptomatic and often doesn’t require treatment

Who to refer

Refer routinely if TSH <0.1mIU/L on 2 separate occasions or TSH <0.1mIU/L with a background of atrial fibrillation or osteoporosis.

Before referral

Further investigation

  • Repeat TFTs (TSH, free T4 and free T3) with TPO and TSH receptor antibodies, 2 weeks after the first blood test to ensure doesn’t represent non-thyroidal illness
  • If TSH ≥0.1mIU/L, monitor TFTs 6 monthly

 

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Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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