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What Some Doctors Don't Understand About Hypothyroidism

How to find a doctor to effectively diagnose and manage your hypothyroidism.
What Some Doctors Don't Understand About Hypothyroidism
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"Your thyroid test is 'normal.'"
"You don't need Free T3 and Free T4 tests."
"Thyroid antibody tests don't matter."
"Everyone with hypothyroidism should be treated with levothyroxine."

Have you heard any of these statements before? Sadly, many doctors and healthcare practitioners who diagnose and treat hypothyroidism don't take a comprehensive approach. Things like time, education, protocols, or insurance may limit them.   

Many doctors offer the bare-bones basics of hypothyroidism treatment. After ordering a Thyroid Stimulating Hormone (TSH) test, if the lab results come back as "high," they diagnose hypothyroidism, write a prescription for synthetic thyroid medication, and send you on your way. Too often, it's a cookie-cutter, one-size-fits-all approach to diagnosis and treatment.

But, is that enough?

Speaking from the thyroid trenches – hypothyroid myself, and supporting others with thyroid challenges for two decades – I can offer an unequivocal no! As patients, we want to feel well – not just have "normal" results on a lab test.

When it comes to your underactive thyroid condition, does your healthcare practitioner "get it?" Here are a few questions to help you decide.

Is your healthcare practitioner aiming for the "normal range" or the "optimal range?"

Labs evaluate thyroid test results using a reference range based on the general population. Levels within that range are considered normal, so it's often called the "normal range." The problem? Even if your test results fall within that broad normal range, your levels may still not be normal… for you. You need to find out where within that range you feel best. This narrower window of test results is what some healthcare providers and patients call the "optimal range." An optimal range is individual to each patient and allowing them to have the best and safest relief of symptoms. Thyroid-savvy practitioners focus on finding – and safely getting you to -- your optimal levels.

Is your healthcare practitioner relying only on your TSH test results?

Many endocrinologists call Thyroid Stimulating Hormone (TSH) the "gold standard thyroid test." That's a bit misleading because it doesn't measure actual thyroid hormones. Instead, this test measures TSH, a pituitary messenger hormone. When your TSH level rises, it's a message to the thyroid saying "make more thyroid hormones." When your TSH drops, it says, "make fewer hormones." The problem? The TSH test doesn't measure your actual circulating thyroid hormones. And those hormones do all the heavy lifting -- ensuring that oxygen and energy get to your cells, tissues, glands, and organs.  The TSH test offers a broad picture, but Free Thyroxine (Free T4) and Free Triiodothyronine (Free T3) tests show the actual levels of available thyroid hormones in your bloodstream. That's why thyroid-savvy practitioners test Free T4 and Free T3 levels, to fully optimize your hypothyroidism treatment.

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Is your healthcare practitioner a "levothyroxine-only" diehard?

As mentioned, a healthy thyroid gland produces two hormones: thyroxine (T4) and triiodothyronine (T3). The body converts the inactive T4 hormone into the active T3 hormone the body needs.  Similarly, thyroid hormone replacement medication also comes in T4 and T3 formulations.  Traditionally, thyroid replacement treatment starts with levothyroxine, the synthetic version of the T4 thyroid hormone. (You may know this medication by the brand names Synthroid, Levoxyl, Unithroid, or Tirosint.)

While levothyroxine works well for some people, it leaves others struggling with symptoms and sub-optimal treatment.  There are many treatment options, including adding synthetic T3 (like liothyronine or Cytomel), and adding or switching to natural desiccated thyroid, which is a combination T4/T3 drug (brand names include Nature-throid, WP Thyroid, Armour Thyroid, NP Thyroid). 

Innovative thyroid practitioners consider all your treatment options based on your symptoms, lifestyle, medical history, and lab results. The best treatment for you may be a customized combination of medications and dosages that safely relieves your symptoms.

Does your healthcare provider think that thyroid antibody tests don't matter?

For most people who are hypothyroid in the United States, the underlying cause of hypothyroidism is Hashimoto's thyroiditis, an autoimmune disease.  In Hashimoto's, the body produces antibodies that attack – and can eventually destroy – your gland's ability to produce thyroid hormone, eventually causing hypothyroidism. There's a lot we still don't know about autoimmune disease, but some things we do know:

  • Autoimmune diseases can run in families – Hashimoto's, in particular
  • Thyroid antibody levels can be elevated and cause symptoms long before hypothyroidism is detectable in TSH, Free T4, or Free T3 blood tests
  • Early treatment of people with thyroid autoimmunity (shown by elevated thyroid antibodies) may prevent progression to overt hypothyroidism, and worsening symptoms

The challenge is that when it comes to autoimmune disease, many healthcare practitioners still aren't entirely sure why the immune system turn against the body's healthy tissues. Many scientists suspect that autoimmunity is a complex outcome of many contributing factors, including exposure to viruses and bacteria, environmental toxins, heredity, and gender. 

What we do know for sure is that Hashimoto's can cause hypothyroidism. It's critical to evaluate your family history of autoimmunity, and include thyroid antibody testing when diagnosing hypothyroidism and monitoring your treatment. Early treatment may prevent full hypothyroidism, stop autoimmune inflammation in its tracks, and prevent a long list of debilitating symptoms. Thyroid-savvy healthcare practitioners make it a point to include thyroid antibody test results in their diagnosis and treatment approaches. And that makes for healthier patients with fewer symptoms and complications.

Your Next Steps?

It's important to be in partnership with your thyroid doctor. You should feel heard, unrushed, and cared for, and simultaneously be able to have honest conversations about your care. If this isn't the case for you, it may be time to consider alternatives. 

Paloma Health offers end-to-end care for hypothyroidism -- all from the comfort of your home. The at-home thyroid test kit measures not only TSH, but also Free T4, Free T3, and Thyroid Peroxidase (TPO) antibodies. This wealth of information helps to guide your diagnosis and treatment. 

You can then schedule a video consultation with a Paloma Health thyroid doctor and be confident that you're working with a compassionate, comprehensive thyroid practitioner who gets it right from the start!

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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