Rapid Access Thyroid Clinic referrals

The Rapid Access Thyroid Clinic facilitates streamlined and appropriate referral of patients with all thyroid nodules and urgent endocrine surgery at Fiona Stanley Hospital (FSH).

It utilises a one-stop model for thyroid nodule assessment where same day clinical consultation, ultra-sound, fine needle biopsy and cytology are arranged.

The weekly clinic is attended by specialist thyroid surgeons and has allocation for up to three add-on Category 1 patients weekly, in addition to the current endocrine surgery workload of thyroid, parathyroid and adrenal patients.

Patients meeting the urgent referral criteria below bypass the central waitlist and are seen directly within one week of referral via direct telephone contact – see urgent referral instructions below. This allows for more appropriate use of the Rapid Access Neck Lump Clinic for suspected squamous cancers of the head and neck.

Urgent (category 1) referral criteria

Patients with the following conditions are regarded as Category 1 endocrine surgery cases and are eligible for referral. 

Thyroid

• Thyroid mass with:
  • sonographic ATA intermediate or high risk of thyroid cancer.
  • cytology showing malignant thyroid cancer or suspicious thyroid cancer.
  • FDG-PET positive thyroid nodule.
  • rapid nodule growth.
  • symptomatic airway compromise or stridor.
  • unexplained hoarseness or voice change.
  • cervical lymphadenopathy.
  • personal history of neck irradiation.
  • family history of thyroid cancer or endocrinopathy.
• Severe Graves’ disease that is medically uncontrollable.

Parathyroid

• Hyperparathyroidism with severe hypercalcemia >3.0
• Hyperparathyroidism in pregnancy

Adrenal

• Adrenocortical cancer or highly suspected adrenocortical cancer
• Large adrenal mass (>4cm)
• Pheochromocytoma or paraganglioma
• Cushing’s syndrome

Lymph node

• Lymphadenopathy and suspected lymphoma

Exclusions

• Aerodigestive cancer, head and neck cancer, squamous cell cancer.

Urgent referral instructions

• Health professionals are asked to make direct telephone contact with the Endocrine Surgery Registrar through the FSH Helpdesk by phoning 6152 2222. If the registrar is unavailable please ask to speak with the Consultant Endocrine Surgeon.
• A written referral should be sent to the Department of Endocrine Surgery at FSH via e-mail to FSH.rapidaccessthyroidclinic@health.wa.gov.au.
• Your patient will be seen and assessed within one week of referral.
• Please print the FSH Rapid Access Thyroid Clinic patient information and give to your patient.

Routine endocrine surgery referral criteria

Routine endocrine surgery patients who do not meet the urgent referral criteria will be seen at the Rapid Thyroid Access Clinic, usually within 30 days of referral. Routine referral criteria are as follows:

• incidentally discovered thyroid nodule
• thyroid nodule with inadequate, indeterminate or atypical (follicular neoplasm) cytology
• ·non-compressive thyroid nodule or goitre
• primary hyperparathyroidism (high serum calcium and high PTH)
• secondary or tertiary hyperparathyroidism due to renal failure
• incidentally discovered adrenal mass (< 4 cm)
• Conn’s syndrome.
• ·need for lymph node biopsy or splenectomy.

Routine referral instructions

Routine referrals to the clinic must follow the process below.

• Referrals must be submitted using the WA Health General Adult Referral Form (external site).
• Referrals must include documentation of the referral criteria that has been met and a relevant medical history.
• Fax referrals directly to FSH Referrals on 6152 9762 marked ' Routine referral to Rapid Access Thyroid Clinic.

More information

Health professionals should phone the FSH Helpdesk on 6152 2222 between 8:30am–4pm, Monday to Friday and ask to be connected to the Endocrine Surgery Registrar.