Specialist for Hyperthyroidism Treatment
Endocrinologists are the specialists who treat hyperthyroidism, with consultation recommended for moderate to severe cases, persistent thyrotoxicosis, or when specialized interventions are needed. 1
When to Refer to Endocrinology
Mandatory Endocrine Consultation
- Grade 3-4 hyperthyroidism (severe symptoms, life-threatening consequences, unable to perform activities of daily living) 1
- Persistent thyrotoxicosis lasting more than 6 weeks 1
- Suspected Graves' disease with ophthalmopathy or thyroid bruit 1
- TSH persistently <0.1 mIU/L requiring treatment decisions 1
Consider Endocrine Consultation
- Grade 2 hyperthyroidism (moderate symptoms, able to perform activities of daily living) 1
- Patients requiring thyroid suppression therapy for thyroid cancer or nodules 1
- Elderly patients with subclinical hyperthyroidism and cardiovascular risk 1
- Patients requiring radioactive iodine therapy or surgery 1
Primary Care Management Scope
Primary care physicians can initiate management for mild cases (Grade 1) while monitoring for progression 1. This includes:
- Beta-blockers (atenolol or propranolol) for symptomatic relief 1
- Close monitoring of thyroid function every 2-3 weeks 1
- Supportive care and hydration 1
However, most patients with overt hyperthyroidism should be referred for specialist management, with beta-blockers and sometimes antithyroid drugs initiated in primary care while awaiting consultation 2.
Common Pitfalls
Do not delay endocrine referral when physical examination reveals ophthalmopathy or thyroid bruit, as these findings are diagnostic of Graves' disease and warrant early specialist involvement 1. Additionally, hyperthyroidism in the elderly is easily overlooked and requires high clinical suspicion, making specialist consultation particularly important in this population 2.