Urgent Referral

Clinical Findings

URGENT REFERRAL IF:

  • Palpable nodule > 1.0 cm
  • Family history of thyroid cancer or MEN (multiple endocrine neoplasia)
  • Increasing size of nodule

Referral Timeframe

URGENT: Call MD on-call to discuss and start treatment. If symptomatic, call MD on-call to discuss
On-Call Phone #
Day: (512) 628-1830
After Hours: (512) 323-5465

Pre-Referral Workup

  • Current TSH, Total T4 or Free T4, Anti-Thyroglobulin Antibodies and Anti-TPO Antibodies
  • Calcitonin if recommended by Dell Children’s Specialist in Endocrinology
  • Thyroid Ultrasound

Referral Requirements

  • All clinical notes, laboratory or ultrasound results and growth chart
  • Fine Needle Aspiration may be indicated

Routine Referral

Clinical Findings

ROUTINE REFERRAL IF:

  • Non-palpable nodule < 1.0 cm
  • Nodule on thyroid ultrasound

Referral Timeframe

If concern for thyroid cancer, please call MD on-call to discuss

Pre-Referral Workup

  • Current TSH, Total T4 or Free T4, Anti-Thyroglobulin Antibodies and Anti-TPO Antibodies
  • Calcitonin if recommended by Dell Children’s Specialist in Endocrinology
  • Thyroid Ultrasound

Referral Requirements

All clinical notes, laboratory or ultrasound results and growth chart

Facts to Remember

  • We often see slight elevations in TSH (5-10 uU/ml) in obese children secondary to metabolic syndrome and obesity. No endocrine referral is indicated unless the thyroid antibodies are positive.
  • Alopecia or hair loss with normal TSH, Total T4 or Free T4 does not indicated an endocrinopathy and referral is unnecessary.
  • Obtaining a T3 Uptake or Free T4 Index is not usually helpful. Instead it should be a Total T3 level or Free T4.
  • Children with Trisomy 21 often have mildly elevated TSH levels (hyperthyrotropenemia) with normal Total T4 or Free T4. Generally referral is not needed unless there are positive thyroid antibodies, or rising TSH. Call with questions.
  • Children with positive thyroid antibodies but normal thyroid function tests may never go on to develop hypothyroidism. The thyroid function tests just need to be followed periodically and if abnormal, referral is appropriate.
  • Thyroid Nodules: There is a rising incidence of thyroid nodules in the pediatric population. Small nodules (1.0 cm require an urgent referral to r/o thyroid cancer. A fine needle aspiration may be indicated.