A Specialist is not as Special as you Think
Tell me if this sounds familiar:
You've been diagnosed with low thyroid or hypothyroidism by your current doctor because you started to experience fatigue, weight gain, hair loss, and maybe even some depression or anxiety.
Despite taking thyroid medication you still aren't feeling any better and in fact, you may actually be slowly getting worse over the course of several years (the average is 5 to 10).
Because you simply aren't getting better you've started to do some research on your own and you've found some interesting information that you think could be the reason you aren't feeling better.
You've learned that not all patients do well on T4 only thyroid medications and you've found that your lab tests must be optimal in order for you to feel better.
These things make perfect sense to you and you want to give them a try.
You go to your general practitioner who doesn't feel comfortable with this type of approach so he/she recommends that you go to an endocrinologist.
You're excited because you finally think you'll get on the treatment and therapies that you need to finally start feeling better!
Is going to a thyroid specialist (otherwise known as an endocrinologist) the solution to your problem?
Unfortunately, there's a slim chance that this will happen (in fact, there's about a 99% chance that your endocrinologist won't be of much help at all).
And this brings me to the main point of this article:
A thyroid specialist is not as special as you might think.
You are probably lead to believe that they have some insider knowledge that general practitioners and family practice doctors don't have but you'd be dead wrong.
I can sum up how endocrinologists look at thyroid management in a few sentences:
- They look to see if your TSH is high.
- If it's high they give you T4 medication like levothyroxine or Synthroid until it lowers to a "normal" level.
- They don't check for any other thyroid labs, they don't care about thyroid antibodies or the diagnosis of Hashimoto's, they don't differentiate between optimal or normal, and they aren't interested in using other thyroid medications aside from levothyroxine and Synthroid.
If this sounds familiar it's because it's the exact same approach that general practitioners take.
And it's basically the complete opposite of the approach that I recommend taking and the reason I have hundreds of articles on the topic.
And, for those who aren't aware, an endocrinologist is the name of a doctor who specializes in treating the endocrine system which is another name for the hormone system.
BUT that is actually quite misleading.
While their name implies that they focus on the endocrine system, most endocrinologists end up treating only hypothyroidism and diabetes and a few rare diseases here and there.
For instance, endocrinologists don't really focus on treating people with sex hormone imbalances or using birth control pills and they aren't the right doctor to treat conditions like low testosterone even though both of these conditions are hormone imbalances.
Despite the fact that they treat patients with diabetes and thyroid diseases, I would argue that they are not the right type of doctor for that job.
They tend to look at people who have hormone imbalances as all the same, meaning they all need the same treatment.
But hormone imbalances are different for each individual and this sort of cookie cutter approach to hormone management does not work at all.
And this is part of the reason why so many patients who have hormone imbalances continue to suffer despite going to a "specialist".
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5 Reasons to Avoid an Endo for Managing your Thyroid
This is the type of information which is should be used by people who are new to thyroid management but they aren't likely to believe it yet because they haven't gone through the thyroid song and dance with their doctor.
So, unfortunately, the people most likely to agree with this are those who have already found that their endocrinologist is largely unhelpful.
But, if you by chance are new to managing your thyroid and you want to skip out on 5-10 years of hardship and continued symptoms and anger and frustration in trying to get your doctor to listen to you then you should pay attention.
Because I'm not kidding when I say this could help save you those years.
And, if you are someone who already knows what I'm talking about and has been through this please leave a comment below to help our your fellow thyroid patients!
With this in mind, let me share 5 reasons why an endocrinologist isn't likely to be of much help to you in managing your thyroid...
#1. They won't order the right tests.
The first reason is that endocrinologists don't believe in the necessity of advanced thyroid lab testing.
At most, your endocrinologist is likely to order what is called a TSH with reflex to free T4.
This particular lab test looks at your TSH and will only look at your free T4 if the TSH is abnormal.
If the TSH comes back in the normal range then a free T4 will not be ordered.
And I'm not even sure why they would look at your free T4 anyway because it's not like the value of that lab test will influence their treatment decision.
Because their treatment for hypothyroidism includes levothyroxine, levothyroxine, and some more levothyroxine on the side.
An endocrinologist will likely scoff at you if you suggest that you need any of the following thyroid lab tests:
You might hear that they are not accurate or not helpful or
But what cracks me up about comments like these is why would the lab tests exist if not to provide more information?
Furthermore, the primary reason they don't want to order them is not because they aren't helpful but because they simply don't care about the result.
Getting an abnormal free T3 or total T3 or reverse T3 isn't going to change their treatment recommendation of levothyroxine, levothyroxine, and some more levothyroxine.
Which is unfortunate because these lab tests help you understand whether or not your T4 medication is working, how well your body is converting T4 to T3, and other important bits of information which can help you feel better.
All backed by science, by the way.
#2. They all treat the same.
The next thing you should understand is that all endocrinologists will treat and look at you the exact same way.
I shouldn't say all because there are a handful of endocrinologists that don't do this but roughly 98 to 99% of all endocrinologists do fall into this category.
Your endocrinologist will only be concerned about your TSH and they will recommend the use of levothyroxine 99% of the time.
It doesn't matter what lab tests that you recommend that they order, what those results come back as if you can get them to order them, or how bad you are feeling while taking levothyroxine or Synthroid.
If your TSH is fine then YOU are fine (at least according to them).
And this sort of mentality exists among virtually all endocrinologists.
Because this is how they are taught.
In fact, this is how all doctors are taught including family practice doctors and general practitioners.
I know because this is exactly how I was taught.
As an internal medicine resident, I would occasionally ask about other thyroid medications such as natural desiccated thyroid only to be scolded for thinking about using unreliable pig thyroid.
Your endocrinologist is not interested in changing how they view thyroid management just because you are not feeling well on your thyroid medication, unfortunately.
#3. Endocrinologists don't necessarily know more than your PCP or Family Doctor
This one can be a bit difficult for some people to understand.
It would make logical sense on the outset that a specialist would know more than a general practitioner about a certain condition.
Surely if that specialist treats the same type of patients day in and day out they must know something that other doctors who don't have that kind of exposure don't.
You would think so but you would be wrong 99% of the time.
To an endocrinologist, the management of hypothyroidism is already a solved issue.
As far as they are concerned persistent symptoms of hypothyroidism when taking thyroid medication MUST be from some other cause.
They don't even recognize the thyroid as a problem if you are taking T4 medication and if your TSH is normal.
You should understand this because what this means is that it doesn't matter how much you complain or tell them about your symptoms, it won't make a difference to them.
And we see this is true based on the fact that surveys show that hypothyroid patients complain about the same symptoms for more than 10+ years to their doctors without seeing any improvement.
Most patients who go down this path end up on anti-depressants as a treatment instead of changes to their thyroid medication!
By the way, I'm not saying that all specialists don't know more than general practitioners because that simply isn't true.
In fact, most specialists (outside of endocrinologists) do know more than family practice doctors about certain conditions but this just doesn't hold true for endocrinologists.
#4. They tend to be more set in their ways than general practitioners.
You might think that being a specialist is a good thing because perhaps the specialist is more likely and willing to listen to new ideas or new therapies, right?
Unfortunately, you'd be dead wrong most of the time.
Endocrinologists by virtue of the fact that they treat thyroid patients day in and day out tend to be LESS likely to listen to any alternative treatment paradigm.
They are already set in their ways and think that they know the answer.
This is further reinforced by living in an echo chamber where they go to conferences which spout the same information, when they read articles and journals which support the same medications, and so on.
They are unlikely to ever hear about alternatives to thyroid management outside of the traditional TSH + levothyroxine thyroid model that when they do they automatically reject it.
Believe it or not, your family practice doctor or general practitioner is much more likely to help you out with new therapies when compared to your endocrinologist.
#5. It will be very difficult or almost impossible for you to convince your endo to change how they treat the thyroid.
The last one is kind of an extension of #4.
Many thyroid patients read information like this and they think that they can take this information to their doctor and they will be both happy to learn something new and eager to implement the new changes.
Again, unfortunately, you couldn't be farther from the truth.
Listen to this story:
When I was in my first year of practice out of residency I had some amazing success with a husband and a wife who were among my first ever patients.
Collectively they lost some 50+ pounds, had more energy than they could remember, got off of some of their prescription medications for blood pressure and cholesterol, and were overall doing amazing.
They were obviously excited by these changes and they went to their doctor to tell him about me and my therapies.
Instead of the doctor being happy for their success, he was upset that they went to see me and questioned my credentials and methods.
This is despite the fact that so much good had been done in their lives.
I learned pretty quickly that most doctors are really not interested in learning more or trying new things and they even feel threatened when they find someone who has more success than they do.
This isn't a universal thing but it absolutely does exist and it is more prominent than you would think.
The moral of the story is that doctors are not likely to change what they are doing even in the face of amazing success and positive results from others.
It's optimistic to think that they will change their mind and try something new and I do think it's worth a shot but don't be surprised when they are not interested at all.
If you find that this happens to you then it's often best to just seek out a new physician who is more willing to work with you and who will listen to you.
Who to see instead
So, what should you do if you can't get results from an endocrinologist?
What kind of doctor should you go see, which doctors will actually listen to you?
Here's how I would approach this problem:
First, you should always start with someone who takes insurance and who is local.
Go see your family practice doctor or your local endocrinologist and talk to them.
If you don't find success or if they are unwilling to work with you, don't be discouraged.
Just move on and try to find a new doctor.
You will probably find that some general practitioners (maybe 5% or so) are willing to work with you.
The likelihood that your endocrinologist is willing to work with you on these things is probably closer to 1-2%.
If this approach fails then you will probably need to seek someone with a different set of skills and training outside of the conventional medical system.
I find that doctors with training in integrative medicine, anti-aging medicine, and doctors who specialize in bio-identical hormone treatment tend to work best.
The only downside to these doctors is that they typically don't accept insurance and they may not be local to you depending on where you live.
But the extra price to pay for the right treatment will be worth it in the long run, at least in my opinion.
I get asked this question a lot so I will address it here:
I do not have any recommendations for any doctors that I can give you.
I wish I did but all of the information that I have here is self taught which means that in order for someone to understand it they must do the leg work on their own.
There are without a doubt doctors out there like this, I just don't personally know them.
When it comes to thyroid management, you would probably be surprised to learn that endocrinologists may not be your best option.
This kind of talk is considered heresy, especially among conventionally trained physicians and health providers but I honestly believe it to be true - at least for now.
I don't think that endocrinologists are malicious or want to keep thyroid patients from feeling better in any way.
Instead, they are just the victims of current thyroid management dogma and, from their perspective, see no reason to change.
In fact, it seems to be quite the opposite.
It's not uncommon for thyroid patients to become more educated, to ask questions, and to seek different therapies and tests.
In the face of this new wave of information, most endocrinologists are doubling down on the current treatment paradigm.
I've even seen a few new studies which refer to the education of thyroid patients as a big problem.
What a crazy world we live in.
My hope is that this changes in the coming 5-10 years when the burden of new clinical studies which support the sort of thyroid management that I talk about here (1) becomes so heavy that it will be impossible to ignore.
But, for now, it seems like thyroid patients have an uphill battle to fight.
Now I want to hear from you:
Do you feel that your current doctor is willing to listen and work with you?
Have you had success in getting treated by a family practice doctor over an endocrinologist?
Have you had success in getting treated by an endocrinologist?
If not, who is currently treating you?
If yes, share who you are seeing and where they practice below!
Leave your comments and questions below!
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