Thyroid Clinic

Groote Schuur Hospital Specialist Surgical Endocrine Clinic Referral

This form is to be completed for all submissions to the Groote Schuur Hospital Surgical Endocrine Clinic. The form must be completed by a registered medical practitioner. Self-referrals will not be accepted.
Important information - COVID ALERT

Groote Schuur hospital Outpatient Clinics has been affected by the COVID pandemic again. Staff has been reallocated from outpatients to support the wards. As a result, we have been forced to de-escalate our clinic. Routine bookings will be available from September 2021. If you have a patient you feel needs to be seen urgently please send us an e-mail to breastsurgendo@gmail.com
Important information

Routine bookings are available at our clinic with a six to eight-week waiting time at the moment. If you have a patient you feel needs to be seen more urgently please send us an e-mail at breastsurgendo@gmail.com and we will respond with an earlier date if appropriate.
Important information

At present appointments made on the direct online booking platform will only be available for dates from 3 June 2021. If you would prefer a booking at an earlier date please send us an e-mail to breastsurgendo@gmail.com
I hereby agree to receive updates and future information regarding the Groote Schuur Surgical Endocrine Clinic to the email address provided later*

YesNo
Referral Type

New referral or previously discharged patient with persistant or new complaintFollow up (This option is only for doctors working in the Unit)Telephone clinic (This option is only for doctors working in the Unit)

Referring Health Care Worker Information
Name referring health care worker*

PrefixFirst NameLast Name
Health Professional Council / South African Nursing Council Registration Number*
Email address of the referring health care worker*
example@example.com
Phone Number of the referring health care worker*
Patient Information
Does your patient have an existing Groote Schuur Hospital or clinic number?*
Hospital / Clinic Number*
Name of patient*

First NameLast Name
Birth Date of patient*

DayMonthYear
Gender*

MaleFemale
Cellphone or home number of the patient (NOTE If no contact number available use 021 123456)*

HYPOTHYROIDISM

Hypothyroidism is managed medically with Eltroxin. We recommend a starting dose of 100ug and a repeat thyroid function test in 6 weeks. For further advice contact the Groote Schuur Hospital Medical Endocrine team using the VULA app

HYPERTHYROIDISM

Hyperthyroidism is managed by the Medical Endocrine team at Groote Schuur Hospital. For a booking please contact the Groote Schuur Hospital Medical Endocrine team using the VULA app

Adrenal Incidentiloma
If possible please initiate functionality tests before referral - Below is a guideline explaining what tests to request

Hyperaldosteronism: Aldosterone / renin ratio

Request Aldosterone / renin ratio should be requested after obtaing 2 bood tubes from the patient. A purple and yellow top tube are needed.

Minimum sample volumes: aldosterone 1.5 ml and renin 1.8 ml (avoid haemolysis).

Patients should maintain liberal dietary salt intake prior to testing.
Hypokalaemia should be corrected with supplemental potassium chloride tablets prior to testing (the absence of hypokalaemia does in no way exclude primary hyperaldosteronism).

Pheochromocytoma: 24 Hour Urinary Metanephrines Level

24-Hour Urine Collection

• The 24 hour collection container should be collected from the laboratory and labeled with appropriate patient identification.

The container must be acidified with hydrochloric acid, if you shake the bottle usually you can hear a small amount of liquid in the bottle

• Instructions for 24 hour urine collection for the patient:
─ Void (discard) first morning urine
─ Collect all urine passed for 24 hours including the first morning urine of the next day into a small clean container and after each void carefully transfer contents into the 24 hour urinecontainer
─ Return the 24 hour urine container to the clinic after completing the collection

Cushing syndrome: 24 Hour Urinary Cortisol Level

24-Hour Urine Collection

• The 24 hour collection container should be collected from the laboratory and labeled with appropriate patient identification.

The container must be empty with no additive

• Instructions for 24 hour urine collection for the patient:
─ Void (discard) first morning urine
─ Collect all urine passed for 24 hours including the first morning urine of the next day into a small clean container and after each void carefully transfer contents into the 24 hour urinecontainer
─ Return the 24 hour urine container to the clinic after completing the collection
Please make sure you read the guidelines above before referral*

I have read the information and want to continue with the booking

Please provide Name of the referring renal consultant in charge of the patient*

PrefixFirst NameLast Name
Please provide email address for the referring renal consultant in charge of the patient*
example@example.com

Patient referred by:*

Medical endocrinologyOther speciality
Please provide Name of the referring Medical endocrine consultant in charge of the patient*

PrefixFirst NameLast Name
Please provide email address for the referring medical endocrine consultant in charge of the patient*
example@example.com

Please note this section is for the use of doctors working in the surgical endocrine unit only, if you want to book a new referral, please return to the initial page by using the back button and select, New referral or previously discharged patient with persistent or new complaint
Please enter access code*

Referral letter
Please make sure you provide the patient with a handwritten referral letter and instruct them to bring it with them to the consultation. You can upload additional information if you want, just make a note on the referral letter to make us aware that you uploaded additional information.
Upload file

Cancelof
Appointment
PLEASE NOTE

Make sure you select a date and time slot on the calendar. Once you have selected a time slot a blue box should appear below the calendar reading "You’ve selected 7:00 AM on Wednesday and date" If you now hit submit your patient is booked. All patients should be at the clinic before 07h00.
New Patient Appointment*
PLEASE NOTE

Please make sure you click Submit AFTER selecting a date and time.

Please note this section is for the use of doctors working in the surgical endocrine unit only, if you want to book a new referral, please return to the initial page by using the back button and select, New referral or previously discharged patient with persistent or new complaint
Please enter access code*

This is just a placeholder page
PLEASE NOTE

Make sure you select a date and time slot on the calendar. Once you have selected a time slot a blue box should appear below the calendar reading "You’ve selected 7:00 AM on Wednesday and date" If you now hit submit your patient is booked. All patients should be at the clinic before 07h00.
PLEASE NOTE

Please make sure you click Submit AFTER selecting a date and time.

INCORRECT PASSWORD

Follow up clinic booking
Name*

First NameLast Name
Folder number of patient*
Phone Number of Patient*
Please enter a valid phone number.
Appointment (Follow up)*

Please note this section is for the use of doctors working in the surgical endocrine unit only, if you want to book a new referral, please return to the initial page by using the back button and select, New referral or previously discharged patient with persistent or new complaint
Please enter access code*

INCORRECT PASSWORD

Telephone clinic booking
Name*

First NameLast Name
Folder number*
Phone Number of Patient*
Please enter a valid phone number.
Appointment (Telephone Clinic)*
Should be Empty:

Groote Schuur Hospital Specialist Surgical Endocrine Clinic Referral

Adrenal Incidentiloma

Please note this section is for the use of doctors working in the surgical endocrine unit only, if you want to book a new referral, please return to the initial page by using the back button and select, New referral or previously discharged patient with persistent or new complaint

Referral letter

Appointment

Please note this section is for the use of doctors working in the surgical endocrine unit only, if you want to book a new referral, please return to the initial page by using the back button and select, New referral or previously discharged patient with persistent or new complaint

This is just a placeholder page

INCORRECT PASSWORD

Follow up clinic booking

Please note this section is for the use of doctors working in the surgical endocrine unit only, if you want to book a new referral, please return to the initial page by using the back button and select, New referral or previously discharged patient with persistent or new complaint

INCORRECT PASSWORD

Telephone clinic booking