People who have a parent or grandparent with an autoimmune disease also have an increased risk. Learn more about hypothyroidism in our health library.
You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Menu Search. Thyroid Disorders Diagnosis and Treatment. Page Content. The Thyroid Gland The thyroid is a small butterfly-shaped gland located at the base of your neck just below the voice box, or larynx. That being said, the occasional patient does correctly self- diagnose themselves with hypothyroidism based on information obtained on-line or in books.
Q: What is the best advice to give a patient with hypothyroidism when they complain that their T4 agent is not making them feel fully well? A: Again, I'd want to find out more about their sleep, diet and exercise habits. I'd also make sure their TSH was in an optimal therapeutic range and that they were taking their medicine at regular intervals.
Calcium and iron can bind thyroid hormone in the gut so it's important not to take levothyroxine with vitamin supplements, and proton-pump inhibitors can also reduce their absorption. I also like to remind patients that it can take four to six weeks before thyroid hormone levels normalize after starting therapy or changing a thyroid hormone dose.
Patients with Hashimoto's thyroiditis need to be aware that they're at higher risk for other autoimmune disorders like type 1 diabetes, lupus, rheumatoid arthritis or adrenal insufficiency.
Q: When should a primary care physician refer a thyroid patient to an endocrinologist? A: Most patients with thyroid disease can be handled very well by a primary care physician. If the PCP notices that the blood tests are atypical and don't fit a regular pattern, or if a patient is refractory to treatment with thyroid function tests all over the board, or if the PCP finds an anatomic abnormality like an enlarged or lumpy thyroid gland , they should refer the patient to an endocrinologist.
Q: Is there anything that you wish PCPs would do before referring patients to you? A: It's best to have a specific question for the endocrinologist. Also, if thyroid function tests are mildly abnormal, you may wish to repeat them after a short interval to make sure it's not a lab error or a variation due to illness before referring the patient to an endocrinologist.
If the patient has a couple of abnormal TSH levels and a family history of autoimmune thyroid disease, it'd be appropriate to order an anti-thyroid antibody panel TPOAb before referring the patient to the endocrinologist. We also like to see a CBC, Chem 20, and lipid panel because they all can be impacted by hypothyroidism depending on how severe it is.
Q: How do you find the right balance between allowing the PCP to manage the patient versus providing specialty help and input?
A: I think there should be one cook in the kitchen when you're trying to negotiate changes in thyroid function tests and adjust medication dosing. The endocrinologist should communicate to the PCP what the TSH goal is and why they're taking the therapeutic approach they've chosen, and manage the patient during the period of time in which the medication is being adjusted.
Once the TSH is in a good therapeutic window, the endocrinologist may well transfer management back to the PCP until there's a new problem or concern.
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Also from ACP, read new content every week from the most highly cited internal medicine journal. Even if your answer is "yes" to all of the questions above, you may still feel that your healthcare provider doesn't fit your needs. Different people appreciate healthcare providers with different personalities, and it's OK to find a healthcare provider who meshes with yours.
Keep in mind that you are a client and have the right to choose the type of service you want. Above all, remember that you are never "stuck" with a healthcare provider. If you are unhappy with the healthcare provider helping you manage your thyroid disease, you have every right to get a second opinion—or switch altogether. With a chronic condition like thyroid disease, your relationship with your healthcare provider is crucial for the optimization of your thyroid management.
Once you have established care with a thyroid doctor, continue asking questions about your condition and following up with your healthcare provider as advised.
A true partnership with your thyroid doctor takes time to build but is worth it. There is no such thing as a perfect healthcare provider, but by taking the time to figure out what is most important to you in a patient-doctor relationship, you're more likely to find the healthcare provider you want and need. Losing weight with thyroid disease can be a struggle. Our thyroid-friendly meal plan can help. Sign up and get yours free! Management of anaplastic thyroid cancer.
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We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes. Table of Contents View All. Table of Contents. Types of Thyroid Healthcare Providers. Evaluating Your Current Healthcare Provider. You have an enlarged thyroid gland, or goiter: A goiter is an enlargement of part or all of your thyroid gland. If you have one, it is a good idea to see an endocrinologist to help you figure out why it has developed and what if anything needs to be done about it.
Sometimes the entire thyroid gland is enlarged and there are no masses or tumors. This is referred to as a simple goiter. If you have a thyroid nodule: Sometimes a goiter contains thyroid nodules. If you have a nodule, or other growth on your thyroid, an endocrinologist should evaluate it. Also, sometimes a thyroid nodule may be found on a radiology scan or by your thyroidologist if they do their own ultrasounds.
More about thyroid ultrasounds in the next article. Most thyroid nodules are harmless benign , but once in a while a more serious condition exists. Thyroid nodules can actually be a cause of an overactive thyroid hyperthyroidism or can rarely be cancer. Any given thyroid nodule carries a roughly five to ten percent chance of being malignant cancer. Ultrasounds and thyroid nodules will be covered in the next article, but are treated by a thyroidologist.
Anyone with a thyroid nodule or lump regardless of whether or not they have hypothyroidism should see a thyroidologist.
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