What to Look for in a Thyroid Doctor to Start Feeling Better
Does it feel like your current thyroid treatment isn't working?
Have you been reading a lot about your thyroid but now you are more confused?
If you fall into these categories then the answer may be to find the right Thyroid Doctor.
There is no substitute for an experienced physician who understands the importance of thyroid function and who can guide you through your symptoms, treatment and recovery.
The difficult part is finding the "right" thyroid doctor and finding one who can put everything together.
In this guide I will walk you through some tips and tricks designed to help you find a good thyroid doctor to help you on your path to recovery:
Dealing with Thyroid Problems?
Thyroid problems include disease states such as Hypothyroidism (sluggish thyroid), Hashimoto's thyroiditis, Hyperthyroidism, Thyroid nodules and thyroid cancer.
Why is it that so many patients are unhappy with their current thyroid treatment?
We don't have to look far to see that this is the case:
Entire websites are dedicated to help you understand thyroid function and to help you be an advocate for your own health.
There are hundreds of stories of patients who relate their encounters and experience in switching doctors or medications or therapies who then get their life back.
Why is this the case?
Some of this may have to do with the current understanding and treatment of thyroid disease states.
The prevailing conventional thought is that thyroid disease is easily treated, that the treatment is essentially the same for all patients and that if you continue to experience symptoms despite following this treatment that those symptoms must be related to some other cause such as depression or anxiety.
There are a lot of good reasons to believe that this approach to thyroid treatment is not accurate and that taking a more personalized approach to thyroid management leads to optimal and better results.
It seems, though, that the only Doctors who take this approach tend to be those who fall into the integrative, holistic or functional group.
The reality is that most patients follow the conventional route of care which means that they tend to see Endocrinologists and Family practice doctors who then manage their thyroid.
And this may not be a problem for many patients.
But for those who do not respond to this typical treatment paradigm it can be a big problem and dramatically alter their quality of life.
So how do you go about finding a "good" thyroid Doctor?
What makes a Thyroid Doctor "Good"
I've created a list of attributes that you may want to look for when determining which kind of Doctor to see.
One of the most important aspects to consider when looking for a Doctor is to find one that is willing to try and work with you.
If you find that your Doctor is unwilling to listen to your concerns or explore other options then it may be time to seek out a second opinion.
It's not worth wasting your time trying to educate your physician on what you've read on the internet - this approach will never work!
Instead spend your time and energy finding someone who will actually work with you.
#1. Willingness to Explore Medications Outside of Levothyroxine
The first, and probably most important, point on the list is the willingness to explore medications outside of Levothyroxine.
It may actually come as a surprise to you that there are MANY different types of thyroid medications and they can be used with success in different circumstances.
Levothyroxine represents a T4 only thyroid medication and it is the first line therapy when treating thyroid disease.
The problem with T4 thyroid medication is that it simply may not work for every single person.
Thyroid conversion is the process by which your body takes the T4 thyroid medication and "activates" it by turning it into the active thyroid hormone T3.
Many patients, due to genetic SNP changes, may not efficiently utilize this process.
For some patients that means that they may not be experiencing the beneficial effects of thyroid medication even though they take it faithfully.
In addition to genetic factors there are also other anatomical issues that may prevent this type of medication from working.
One example is the issue of thyroid hormone absorption in the gastrointestinal tract.
Some individuals simply do not absorb Levothyroxine or Synthroid as well as others and may benefit from taking different formulations of thyroid hormone which are easier to digest.
These are just some examples which explain why various patients don't do well on the conventional or typical thyroid medication.
The hallmark of a good thyroid doctor is that they are willing to explore other thyroid medications.
These medications include:
#2. Willingness to Order the Complete Thyroid Lab Test
In addition to using other medications you want to make sure that your physician is willing to order more than just the conventional TSH and perhaps T4.
The standard of care when treating thyroid dysfunction is to evaluate the function of the thyroid gland, and the effectiveness of thyroid medication with the use of the TSH test.
The evaluation of the TSH can be a helpful tool, but simply using this tool doesn't allow for evaluation of other important thyroid markers in the blood.
Other markers that can help guide treatment include:
- Evaluation of Thyroid Conversion
- Evaluation of free thyroid hormone concentration
- Evaluation of thyroid auto antibodies
- Consideration of nutrient deficiencies and their impact on thyroid function (Such as Iodine, Zinc and Selenium)
In order to evaluate these factors you will need much more than just the TSH and standard free T4 level.
The complete thyroid lab panel includes the following thyroid function tests:
These lab tests help you understand if your body is utilizing thyroid hormone effectively in your body, if the proper feedback loops are working properly and if thyroid hormone is making it to the target tissues and cells.
While the TSH is important, it may be insufficient to fully understand what is happening in each person (though it should always be ordered).
Finding a physician who is willing to order all of these tests (preferably without you asking) and also who is able to interpret these lab values will help you dramatically.
#3. Understanding that All Patients are Different
Another important factor when dealing with a thyroid doctor has to do with their understanding of you as an individual.
It may come as no surprise to you that you look, think and act different than your neighbor.
Why then should it come as a surprise to you that your treatment with thyroid hormone should be different from that same person?
We are each genetically unique and therefore require different treatments, therapies, medication doses and so on.
Doctors are well aware of these differences, especially when using conventional medications.
For some reason they seem to regress to a basic understanding of physiology whenever hormone therapy is involved.
This treatment paradigm has been boiled down to the idea that every person is treated in the same way with the same medication regardless of body type, weight, metabolic function, genetic factors and so on.
Make sure that your physician is willing to look into your personal history, learn more about your unique circumstances and take into account these important factors when determining treatment for you.
It may be wiser to use a medication such as Tirosint which has fewer inactive fillers and may therefore better tolerated.
This type of logic and understanding should be expanded to other factors in your personal history.
#4. Understanding of Other Hormone Systems
Is your Doctor only focusing on thyroid function?
You should be thinking about your body (and hormone systems) as an intricate spider web.
There isn't a way to pull out a single spindle without altering the structure of the entire system.
This concept holds true for hormonal systems in your body.
These hormones tend to become dysregulated in cases of thyroid dysfunction and may also need to be treated.
In addition some of these hormonal imbalances may result in symptoms which mimic hypothyroidism and may "muddy" the picture of your health.
If you are in a situation in which treating your thyroid only provided some relief to your symptoms then you may need to be evaluated for these other hormones.
#5. Understanding of the Importance of Thyroid Antibodies
The presence of thyroid antibodies may be a clue that you have a condition known as Hashimoto's thyroiditis.
In many cases the standard and conventional approach to this condition is to simply "watch and wait".
In this condition your body creates antibodies which eventually destroy your thyroid gland and lead to reliance upon thyroid medication indefinitely.
Many physicians ignore even testing for this condition because they feel that knowing it exists doesn't change treatment or management.
This may be a mistake for many reasons...
It's also important to know if this condition exists because some lifestyle changes and therapies may be effective in reducing thyroid antibodies.
Make sure that you find a physician who is willing to test for thyroid antibodies and who is willing to explore potential treatment options.
How to Find a Good Doctor
It can be very difficult to find a physician who fits the criteria as a "good" doctor but it doesn't mean that you should give up or stop looking.
There are many resources, tips and tricks that you can use to try and find one.
I've included some below that you may consider:
- Contact local compounding pharmacies and ask for a list of Doctors that prescribe bio-identical hormones including T3 and NDT (you can also try local regular pharmacies)
- Use Doctor directories from Integrative and Functional medicine training centers
- Look for Doctors who write blog posts or who have written books on the subject
- Use facebook support groups for patient references
- Contact advanced laboratory testing centers and ask for a list of Doctors who utilize these tests
- Call local offices and ask if the Doctors prescribe NDT and/or T3 medications
- Look for Doctors who have certifications in anti-aging medicine, hormonal therapy, integrative medicine and functional medicine
These may not seem like easy options but unfortunately they are the only ones available.
Why is it so hard to find a Doctor who treats this way?
Much of the reason has to do with the training system that physicians undertake.
All physicians are taught to treat pretty much the same way in medical school and residency and it's only the physicians who take extra training who understand some of the concepts discussed here.
This can make it difficult to find a good Doctor because the training isn't standardized.
Because of this the skill between practitioners varies even if they have both taken the same courses after their conventional training.
Integrative & Functional (Holistic) Doctors
Should you switch to an integrative or functional Doctor?
In many cases this may be the preferred option, but some reasons may make the transition difficult.
Most of the time integrative and functional Doctors operate outside of the insurance model which means that you will need to pay cash for visits.
This can be difficult if funds are tight.
In addition not all providers in this category have the same knowledge or skill.
This may lead to you spending significant amounts of money and not getting the results you are looking for.
To fight this you can stick to the guidelines listed above.
In some cases you may be able to find a physician who has an advanced mindset but that is also in the insurance model.
These Doctors are not common, but it's worth looking into.
Bottom Line: Integrative and functional medicine Doctors are more likely to prescribe medications that contain T3 such as NDT and T3 only medications. These Doctors tend to operate outside of the insurance model and may cost more money than conventional physicians.
Conventional Doctors (Endocrinologists)
Can you get help by using an endocrinologist?
The answer is maybe.
The more unconventional your case is the less likely you are to get help from the conventional model.
But if you fit the "standard" patient case then you will most likely have results with an endocrinologist.
Just remember that endocrinologists, despite being hormone doctors, don't really focus in bio-identical hormone replacement and they tend to all treat and evaluate the same way.
This has to do with their training.
Modern medicine is remarkable in the sense that training throughout the United States is quite standardized.
This is good if you fit the "standard" but bad if you fall outside of it!
Endocrinologists tend to prescribe T4 only thyroid medications and are more resistant to prescribing medications that contain T3.
You may have success in asking your Doctor to switch T4 medications such as switching from Levothyroxine to Tirosint.
Bottom Line: Conventional Endocrinologists may provide relief to those people who fit the "standard" thyroid treatment mold. Those with non-typical or advanced cases may do better with integrative physicians.
Wrapping it up
When it comes to finding a Thyroid Doctor it's worth spending time and energy researching and looking for the right person.
There is nothing more important than your health and suffering for years trying to get your Doctor to understand your situation is probably not worth your time.
I recommend looking for a Thyroid Doctor who is open to using various thyroid medications, who orders a complete thyroid lab panel, who understands your individual scenario and one who also evaluates your symptoms in the context of other hormones.
Now I want to hear from you:
Do you have a great thyroid Doctor?
Are you still searching?
What tips or tricks have you found to find a good doctor?
Share them below so that you can help others who are struggling!