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“I keep gaining weight! I’m exhausted. My hair is falling out. And I’m constipated,” you tell the doctor. She’s barely listening as she busily types on her tablet. “Your thyroid levels are normal,” she says. “Stay on your prescription, come back in six months, and we’ll recheck you.”
“Is it possible I could benefit from some T3, or natural thyroid?” you ask. “Someone has been consulting Dr. Google, I see,” says the doctor, shaking his head and chuckling as he exits the exam room.
“I’m not a depressed person! That’s the truth, Doctor! These symptoms all started with my thyroid diagnosis,” you insist to the doctor. He looks at you, and says, “you know, you really should consider taking an antidepressant.”
Sound familiar?
It probably does if you are one of the millions of people diagnosed with—or still in the process of trying to get a diagnosis of—hypothyroidism.
What’s going on? I hate to tell you, but your thyroid doctor is just not that into you.
Don’t take it personally. Many doctors are just not that into the nuances involved in diagnosing and treating hypothyroidism. In school, many learn that an underactive thyroid is both easy to diagnose and easy to treat if they follow the traditional “three-step treatment process.”
Traditional three-step treatment process
Testing
Test your thyroid stimulating hormone (TSH) level.
Diagnosis
Diagnose hypothyroidism if the TSH level is above the lab’s cutoff. (If your levels fall within the reference range, you’re “normal.”)
Treatment
Treat hypothyroidism with a synthetic version of the thyroid hormone thyroxine (T4), known as levothyroxine.
Voila! Problem solved! Next patient…
It reminds me of speed dating! A fast conversation where you exchange names and jobs, describe what sort of relationship you’re looking for, and...“Time’s up! Next!”
I’ll be honest. Just like there are probably some couples out there enjoying happily-ever-after bliss thanks to speed dating, the three-step thyroid process does work for some thyroid patients.
But what about the rest of us? Some of you have borderline TSH levels and elevated thyroid antibodies, and you can’t find a doctor who will properly diagnose you. Some of you are still struggling with ongoing hypothyroidism symptoms—like fatigue, weight challenges, depression, and anxiety—despite treatment. It would help if you had more than a few minutes.
So, what do you do when the three-step process fails you? Are you supposed to accept poor health as your “new normal?” Are your doctors right when they tell you there’s nothing more to be done?
No. There’s so much that can be done. You just need to take the right steps with the right thyroid doctor.
Comprehensive hypothyroidism diagnosis and treatment
First, let’s look at what’s involved in comprehensive, patient-oriented hypothyroidism diagnosis and treatment.
Testing
Test the thyroid-stimulating hormone (TSH) level, free thyroxine (Free T4), free triiodothyronine (Free T3), and thyroid peroxidase (TPO) antibody levels. This testing can be done at a doctor’s office, a lab, or the easiest and most convenient way, at home using a thyroid test kit.
Diagnosis
Diagnose hypothyroidism if TSH levels are above the lab cutoff. Also, diagnose hypothyroidism if the TSH levels, Free T4 and Free T3 levels are within the reference range but not “optimal.”
Treatment
Treat hypothyroidism with whichever thyroid hormone replacement drug will safely and best optimize your thyroid levels. Types of thyroid medication include levothyroxine, liothyronine (synthetic T3), natural desiccated thyroid, or a combination.
Address autoimmunity
Address autoimmunity with medical, nutritional, and lifestyle recommendations designed to help lower TPO antibodies and reduce inflammation in patients with autoimmune Hashimoto’s thyroiditis.
Lifestyle modifications
Alleviate lingering symptoms by providing additional guidance and recommendations for nutritional and dietary changes, thyroid-supportive supplements, and lifestyle changes to maximize your health and wellness.
Retest and adjust
Retest and adjust your treatment as often as needed until your thyroid levels are optimized, and you experience relief of your symptoms.
In other words, your thyroid doctor doesn't give up until you feel well!
As you can see, there’s more to hypothyroidism care than “test, prescribe, repeat.” But to get more comprehensive care instead of a typical thyroid speed date, you need the right provider, one who’s totally into you and the mission to get you well.
How to find the right thyroid doctor for you
You may think that if you're struggling with hypothyroidism, the best choice is an endocrinologist. Endocrinologists have in-depth insight into the pathophysiology of endocrine diseases like hypothyroidism.
What's most important, though, is that you choose a thyroid-savvy health care provider with whom you feel comfortable and whose goal is to help you safely achieve thyroid balance and symptom resolution—not just "normal" lab test results.
So, where can you find that health care provider? Start by asking friends, family, colleagues, and other trusted providers in your area. You may get a referral for a great endocrinologist or another doctor. Often, primary care docs and gynecologists can be good choices. Or you may find a physician assistant (PA) or nurse practitioner (NP) who is up to the job.
You may also want to broaden your search by searching directories of integrative, holistic, and functional health care providers, including:
Don’t overlook the benefits of telemedicine! Since the onset of the COVID pandemic, virtual medical care has exploded onto the scene, and it can be a game-changer.
Not sure where to start? In an increasing number of states across the United States, you can now access thyroid doctors virtually through the only medical practice dedicated to hypothyroidism care: Paloma Health.
How will you know that you’ve found your perfect match—the thyroid health care provider who is totally into you?
You’ll know when he or she:
- Truly listens, takes your symptoms seriously, and considers your questions and requests willingly and thoughtfully.
- Focuses on relieving your symptoms and helping you safely feel well (and not just “normalizing” your lab test values).
- Makes you realize that you have a committed partner in your wellness journey!
Here’s to “happily ever after” for you and your thyroid care!
