When to refer

• Doubt about diagnosis, diagnostic tests or optimum replacement dosage

• Apparent secondary hypothyroidism, severe illness and associated ischaemic heart disease

• Concurrent autoimmune disease

• Hypothyroidism with goitre, postpartum and in the neonate

• Myxoedema coma


Hyperthyroidism (thyrotoxicosis) is also relatively common and may affect up to 2% of women, who are affected 4 to 5 times more often than men.

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