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SoP Library › Hyperthyroidism and thyrotoxicosis

Statement of Principles

Hyperthyroidism and thyrotoxicosis — DVA SoP factors

Every factor in the Repatriation Medical Authority Statements of Principles for Hyperthyroidism and thyrotoxicosis. DVA can only accept a claim for Hyperthyroidism and thyrotoxicosis if at least one of these factors is met and connected to your service. Reasonable Hypothesis (RH) applies to operational service; Balance of Probabilities (BoP) applies to peacetime service.

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Source: Repatriation Medical Authority Statements of Principles as held by the Veterans Health Centre. SoPs are amended and replaced regularly; always confirm the current instrument at rma.gov.au before relying on it.

Hyperthyroidism and thyrotoxicosis

RH No. 5 of 2022 · BoP No. 6 of 202246 factors

Meaning of hyperthyroidism and thyrotoxicosis: For the purposes of this Statement of Principles, hyperthyroidism: (a) means a functional endocrine disorder in which the thyroid gland synthesises and secretes excessive amounts of thyroid hormone sufficient to produce clinical symptoms and signs of thyroid hyperfunction or to warrant medical treatment; and (b) excludes: (i) euthyroid hyperthyroxinaemia; (ii) gestational transient thyrotoxicosis; (iii) Graves disease; (iv) sick euthyroid syndrome; and (v) toxic multinodular goitre and toxic thyroid adenoma.

Reasonable Hypothesis (RH) — Statement of Principles No. 5 of 2022

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting hyperthyroidism or thyrotoxicosis or death from hyperthyroidism or thyrotoxicosis with the circumstances of a person's relevant service:

  1. (1)
    having iodine excess within the 6 months before the clinical onset of hyperthyroidism or thyrotoxicosis;

    Note: Iodine excess may be due to consuming foods, dietary supplements or medications with a high content of iodine.

    Note: iodine excess is defined in the Schedule 1 - Dictionary.

  2. (2)
    being administered an iodine-containing radiographic contrast agent within the 6 months before the clinical onset of hyperthyroidism or thyrotoxicosis;
  3. (3)
    taking amiodarone for a continuous period of at least 2 weeks, within the 1 year before the clinical onset of hyperthyroidism or thyrotoxicosis;
  4. (4)
    taking a drug from the specified list of drugs within the 6 months before the clinical onset of hyperthyroidism or thyrotoxicosis;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

  5. (5)
    taking minocycline for at least the 6 months before the clinical onset of hyperthyroidism or thyrotoxicosis;
  6. (6)
    taking a drug containing at least 10 milligrams of iodine daily for a continuous period of at least 4 weeks, within the 6 months before the clinical onset of hyperthyroidism or thyrotoxicosis;
  7. (7)
    having a thyroid-stimulating, hormone-secreting pituitary adenoma at the time of the clinical onset of hyperthyroidism or thyrotoxicosis;
  8. (8)
    having a chorionic gonadotrophin-secreting neoplasm at the time of the clinical onset of hyperthyroidism or thyrotoxicosis;

    Note: chorionic gonadotrophin-secreting neoplasm is defined in the Schedule 1 - Dictionary.

  9. (9)
    having a primary or metastatic neoplasm involving the thyroid gland at the time of the clinical onset of hyperthyroidism or thyrotoxicosis;
  10. (10)
    for hyperthyroidism or thyrotoxicosis first presenting as thyrotoxic crisis only, having an acute precipitating event within the 48 hours before the clinical onset of hyperthyroidism or thyrotoxicosis;

    Note: acute precipitating event and thyrotoxic crisis are defined in the Schedule 1 - Dictionary.

  11. (11)
    for thyrotoxicosis only: (a) having struma ovarii at the time of the clinical onset of thyrotoxicosis; (b) having metastatic thyroid carcinoma containing functional thyroid tissue at the time of the clinical onset of thyrotoxicosis; (c) having a form of thyroiditis from the specified list of forms of thyroiditis at the time of the clinical onset of thyrotoxicosis; (d) having trauma involving the thyroid gland within the 14 days before the clinical onset of thyrotoxicosis; (e) ingesting excess thyroid hormone in medication, dietary supplements or in food containing thyroid extracts within the 3 months before the clinical onset of thyrotoxicosis;

    Note: struma ovarii is defined in the Schedule 1 - Dictionary.

    Note: specified list of forms of thyroiditis is defined in the Schedule 1 - Dictionary.

    Note: trauma involving the thyroid gland is defined in the Schedule 1 - Dictionary.

  12. (12)
    having iodine excess within the 6 months before the clinical worsening of hyperthyroidism or thyrotoxicosis;

    Note: Iodine excess may be due to consuming foods, dietary supplements or medications with a high content of iodine.

    Note: iodine excess is defined in the Schedule 1 - Dictionary.

  13. (13)
    being administered an iodine-containing radiographic contrast agent within the 6 months before the clinical worsening of hyperthyroidism or thyrotoxicosis;
  14. (14)
    taking amiodarone for a continuous period of at least 2 weeks, within the 1 year before the clinical worsening of hyperthyroidism or thyrotoxicosis;
  15. (15)
    taking a drug from the specified list of drugs within the 6 months before the clinical worsening of hyperthyroidism or thyrotoxicosis;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

  16. (16)
    taking minocycline for at least the 6 months before the clinical worsening of hyperthyroidism or thyrotoxicosis;
  17. (17)
    taking a drug containing at least 10 milligrams of iodine daily for a continuous period of at least 4 weeks, within the 6 months before the clinical worsening of hyperthyroidism or thyrotoxicosis;
  18. (18)
    having a thyroid-stimulating, hormone-secreting pituitary adenoma at the time of the clinical worsening of hyperthyroidism or thyrotoxicosis;
  19. (19)
    having a chorionic gonadotrophin-secreting neoplasm at the time of the clinical worsening of hyperthyroidism or thyrotoxicosis;

    Note: chorionic gonadotrophin-secreting neoplasm is defined in the Schedule 1 - Dictionary.

  20. (20)
    having a primary or metastatic neoplasm involving the thyroid gland at the time of the clinical worsening of hyperthyroidism or thyrotoxicosis;
  21. (21)
    for thyrotoxic crisis only, having an acute precipitating event within the 48 hours before that clinical worsening of hyperthyroidism or thyrotoxicosis;

    Note: acute precipitating event and thyrotoxic crisis are defined in the Schedule 1 - Dictionary.

  22. (22)
    for thyrotoxicosis only: (a) having struma ovarii at the time of the clinical worsening of thyrotoxicosis; (b) having metastatic thyroid carcinoma containing functional thyroid tissue at the time of the clinical worsening of thyrotoxicosis; (c) having a form of thyroiditis from the specified list of forms of thyroiditis at the time of the clinical worsening of thyrotoxicosis; (d) having trauma involving the thyroid gland within the 14 days before the clinical worsening of thyrotoxicosis; (e) ingesting excess thyroid hormone in medication, dietary supplements or in food containing thyroid extracts within the 3 months before the clinical worsening of thyrotoxicosis;

    Note: struma ovarii is defined in the Schedule 1 - Dictionary.

    Note: specified list of forms of thyroiditis is defined in the Schedule 1 - Dictionary.

    Note: trauma involving the thyroid gland is defined in the Schedule 1 - Dictionary.

  23. (23)
    inability to obtain appropriate clinical management for hyperthyroidism or thyrotoxicosis;

Aggravation-only factors: the factors in subsections 9(12) to 9(23) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

Balance of Probabilities (BoP) — Statement of Principles No. 6 of 2022

23 factors

At least one of the following factors must exist before it can be said that, on the balance of probabilities, hyperthyroidism or thyrotoxicosis or death from hyperthyroidism or thyrotoxicosis is connected with the circumstances of a person's relevant service:

  1. (1)
    having iodine excess within the 3 months before the clinical onset of hyperthyroidism or thyrotoxicosis;

    Note: Iodine excess may be due to consuming foods, dietary supplements or medications with a high content of iodine.

    Note: iodine excess is defined in the Schedule 1 - Dictionary.

  2. (2)
    being administered an iodine-containing radiographic contrast agent within the 3 months before the clinical onset of hyperthyroidism or thyrotoxicosis;
  3. (3)
    taking amiodarone for a continuous period of at least 2 weeks, within the 1 year before the clinical onset of hyperthyroidism or thyrotoxicosis;
  4. (4)
    taking a drug from the specified list of drugs within the 3 months before the clinical onset of hyperthyroidism or thyrotoxicosis;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

  5. (5)
    taking minocycline for at least the 6 months before the clinical onset of hyperthyroidism or thyrotoxicosis;
  6. (6)
    taking a drug containing at least 10 milligrams of iodine daily for a continuous period of at least 4 weeks, within the 3 months before the clinical onset of hyperthyroidism or thyrotoxicosis;
  7. (7)
    having a thyroid-stimulating, hormone-secreting pituitary adenoma at the time of the clinical onset of hyperthyroidism or thyrotoxicosis;
  8. (8)
    having a chorionic gonadotrophin-secreting neoplasm at the time of the clinical onset of hyperthyroidism or thyrotoxicosis;

    Note: chorionic gonadotrophin-secreting neoplasm is defined in the Schedule 1 - Dictionary.

  9. (9)
    having a primary or metastatic neoplasm involving the thyroid gland at the time of the clinical onset of hyperthyroidism or thyrotoxicosis;
  10. (10)
    for hyperthyroidism or thyrotoxicosis first presenting as thyrotoxic crisis only, having an acute precipitating event within the 48 hours before the clinical onset of hyperthyroidism or thyrotoxicosis;

    Note: acute precipitating event and thyrotoxic crisis are defined in the Schedule 1 - Dictionary.

  11. (11)
    for thyrotoxicosis only: (a) having struma ovarii at the time of the clinical onset of thyrotoxicosis; (b) having metastatic thyroid carcinoma containing functional thyroid tissue at the time of the clinical onset of thyrotoxicosis; (c) having a form of thyroiditis from the specified list of forms of thyroiditis at the time of the clinical onset of thyrotoxicosis; (d) having trauma involving the thyroid gland within the 14 days before the clinical onset of thyrotoxicosis; (e) ingesting excess thyroid hormone in medication, dietary supplements or in food containing thyroid extracts within the 3 months before the clinical onset of thyrotoxicosis;

    Note: struma ovarii is defined in the Schedule 1 - Dictionary.

    Note: specified list of forms of thyroiditis is defined in the Schedule 1 - Dictionary.

    Note: trauma involving the thyroid gland is defined in the Schedule 1 - Dictionary.

  12. (12)
    having iodine excess within the 3 months before the clinical worsening of hyperthyroidism or thyrotoxicosis;

    Note: Iodine excess may be due to consuming foods, dietary supplements or medications with a high content of iodine.

    Note: iodine excess is defined in the Schedule 1 - Dictionary.

  13. (13)
    being administered an iodine-containing radiographic contrast agent within the 3 months before the clinical worsening of hyperthyroidism or thyrotoxicosis;
  14. (14)
    taking amiodarone for a continuous period of at least 2 weeks, within the 1 year before the clinical worsening of hyperthyroidism or thyrotoxicosis;
  15. (15)
    taking a drug from the specified list of drugs within the 3 months before the clinical worsening of hyperthyroidism or thyrotoxicosis;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

  16. (16)
    taking minocycline for at least the 6 months before the clinical worsening of hyperthyroidism or thyrotoxicosis;
  17. (17)
    taking a drug containing at least 10 milligrams of iodine daily for a continuous period of at least 4 weeks, within the 3 months before the clinical worsening of hyperthyroidism or thyrotoxicosis;
  18. (18)
    having a thyroid-stimulating, hormone-secreting pituitary adenoma at the time of the clinical worsening of hyperthyroidism or thyrotoxicosis;
  19. (19)
    having a chorionic gonadotrophin-secreting neoplasm at the time of the clinical worsening of hyperthyroidism or thyrotoxicosis;

    Note: chorionic gonadotrophin-secreting neoplasm is defined in the Schedule 1 - Dictionary.

  20. (20)
    having a primary or metastatic neoplasm involving the thyroid gland at the time of the clinical worsening of hyperthyroidism or thyrotoxicosis;
  21. (21)
    for thyrotoxic crisis only, having an acute precipitating event within the 48 hours before that clinical worsening of hyperthyroidism or thyrotoxicosis;

    Note: acute precipitating event and thyrotoxic crisis are defined in the Schedule 1 - Dictionary.

  22. (22)
    for thyrotoxicosis only: (a) having struma ovarii at the time of the clinical worsening of thyrotoxicosis; (b) having metastatic thyroid carcinoma containing functional thyroid tissue at the time of the clinical worsening of thyrotoxicosis; (c) having a form of thyroiditis from the specified list of forms of thyroiditis at the time of the clinical worsening of thyrotoxicosis; (d) having trauma involving the thyroid gland within the 14 days before the clinical worsening of thyrotoxicosis; (e) ingesting excess thyroid hormone in medication, dietary supplements or in food containing thyroid extracts within the 3 months before the clinical worsening of thyrotoxicosis;

    Note: struma ovarii is defined in the Schedule 1 - Dictionary.

    Note: specified list of forms of thyroiditis is defined in the Schedule 1 - Dictionary.

    Note: trauma involving the thyroid gland is defined in the Schedule 1 - Dictionary.

  23. (23)
    inability to obtain appropriate clinical management for hyperthyroidism or thyrotoxicosis;

Aggravation-only factors: the factors in subsections 9(12) to 9(23) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

A VHC Diagnostic Assessment addresses each of these factors one by one against your service record and clinical history. See how a VHC DVA claim works, see all fees ($600 + GST per stage) or book an appointment.

About Dr Thomas Perkins

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Founding doctor of the Veterans Health Centre in Ipswich, Queensland, and one of Australia's most experienced practitioners in veterans' medicolegal medicine.

Dr Perkins has spent more than thirteen years working exclusively with current and former ADF members — treating their conditions, writing their reports and navigating the DVA system alongside them. With over 100,000 claims submitted and 2,000 Permanent Impairment Assessments completed, he has seen precisely what separates an accepted claim from a rejected one at every level, from initial liability to the Veterans' Review Board.

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