Finding the Right Medical Team
A common theme expressed by those with thyroid disease is a sense of frustration with their initial health care providers. Often symptoms go on for too long before thyroid disease is diagnosed. Even after diagnosis, treatments fail to alleviate many of the symptoms.
In the survey I mentioned in Chapter 1, another question they asked was: “how satisfied are you with the treatment you receive?” The possible responses were numbers from 1-10 with one being ‘not satisfied’ and 10 being ‘very satisfied.’ The majority of the respondents gave scores between 1 and 4.
When the same group was asked “how many times have you changed doctors because you were not satisfied with your thyroid treatment?” the results were pretty disheartening:
39% of respondents changed doctors 2-4 times
12% of respondents changed doctors 5–9 times
3% of respondents changed doctors over 10 times
After treating thyroid disease for 20 years, these results were not at all surprising. Nearly everyone who came to see me did so because they had been trying to get help for years with no luck. Usually, there would be some simple part of their care that had been overlooked. I always had such conflicting feelings when I realized a solution was readily available. Part of it was a joy that they could soon be feeling better and another part was frustration that it took them as long as it did to come to a solution.
Everyone who came in had some level of hope that was sufficient for them to try something different. Yet many had become disenfranchised with the medical profession in general.
Sometimes the most important things are the hardest. Unraveling the symptoms of thyroid disease often does take an orchestrated effort between yourself and a doctor. You should never surrender your common sense and go along with approaches that seem unscientific or unsafe. You should also never ignore apparent side effects of treatment or abnormal blood levels just because a doctor says these are ‘healing crisis’ or that ‘it is ok to ignore blood test.’
Please know that your best recovery will come from having a healthy relationship with a professional. Ideally, it will be a person or a team of people who understand three things: 1. the power of diet to correct thyroid disease, 2. the importance of gently bringing your thyroid levels back to the optimal range for you, and 3. how to identify and treat the other conditions that often exist alongside thyroid disease.
The best providers will be good communicators, you will feel that their top concern is not their pet theory or their income, but your well being. The best providers are those who connect with you and encourage you to settle for a level of health as good as, if not better than you had before the thyroid diagnosis.
Of course, your recovery is in your hands, and sorting out diet and lifestyle are essential but those are parts of the equation that you have more control over.
There are lots of reasons that it helps to have a good team on your side. Those who are on thyroid medication need a prescribing physician. You also need a doctor to do a physical exam of your thyroid and to order your ultrasound. In most states, you may not need a doctor to order your blood tests, but a good one can interpret them all in context.
People without a good medical team often struggle to figure it out on their own, and then they try to tell their doctor things like which tests to order and which medications they want. In fact, one of the most common questions people ask online is ‘what thyroid tests should I have my doctor order?’
If you find yourself asking this question, it means you don’t have the right kind of relationship with a doctor. This approach never works well because most doctors fall into one of two categories. The majority are already committed to rigid protocols that often don’t help. Typically they will only prescribe generic Synthroid, test just TSH, and do not order an ultrasound.
The other type of doctor is almost too willing to take requests. They are happy to order any labs you ask for and prescribe whatever you think is best. Their willingness to help may sound noble, but it misguided at best and apathetic at worst. They are more afraid of upsetting you than they are in jeopardizing your health.
Too often they give the impression that you are able to find the right thyroid treatment solely by watching symptoms. Think of symptoms as data, but not directions.
The symptom-led approach seems to make sense but there are two main problems. First is that you can feel bad from too much thyroid medication, too little, or the wrong type. The symptoms alone can be the same in any of these scenarios. They are what matter but they are not specific enough to know what changes will help. The second issue is that the majority of people with thyroid disease have other medical issues. If these conditions are not identified and treated, thyroid treatment alone will not take you all the way back to health.
Finding the right team is not easy. Each time you visit a doctor you have to invest substantial amounts of time and money just to see how things work out. It is not practical to just try large numbers of them in hopes of getting it right.
What Type of Doctor is Best?
When seeking a thyroid doctor, there are many types of physicians to choose from. Here is an overview of the types that are available and some insights on their training and practices.
Chiropractors’ core training pertains to the alignment of the spine. Some also have education in nutrition and possibly facets of natural medicine. Chiropractors are an option for the treatment of uncomplicated back pain or for general wellness. At this time Chiropractors are not licensed to prescribe medication, therefore they cannot manage thyroid medicines. That may change in years to come.
Functional Medicine Doctor
A doctor of functional medicine is a Chiropractor or a conventional doctor who has attended seminars on functional medicine. These seminars teach doctors about the interconnectedness of the body’s systems and how diet and lifestyle can affect them. Functional medicine doctors are a good option for general wellness or nutritional guidance. If a functional medicine doctor is a prescriber, they may be able to help manage thyroid medication.
Naturopathic physicians attend specialized medical schools that cover conventional medical training from the perspective of the body as part of the natural world. Illness is addressed by lifestyle changes that help the body regain its resilience. Naturopathic physicians are a good option for general wellness and guidance on lifestyle. They can manage thyroid medication in states in which they have a license to prescribe.
A conventional doctor (MD or DO) who has undergone specialty training and board certification in the treatment of hormonal conditions such as thyroid disease, diabetes, or infertility. Endocrinologists are good options for the diagnosis and management of thyroid disease with medication. Most focus primarily on diabetes in their practices. Some focus on fertility. A subset of them has done more detailed training in thyroid disease. They make it their top focus and are called thyroidologists.
A Naturopathic Physician who has undergone specialty training and board certification in the treatment of hormonal conditions such as thyroid disease, diabetes, or infertility. Naturopathic Endocrinologists are good options for the diagnosis and treatment of thyroid disease through lifestyle and medications if needed. Like conventional endocrinologists, most have a practice focus.
Too many people with thyroid disease are frustrated with their doctors. Many try to stay with a doctor who is local and on their insurance. They often hope that they can learn enough online to manage their own lifestyle and give suggestions to their doctors. They assume that this approach would cost less than working directly with a thyroid specialist. Those who come to see us often report spending hundreds each month on new supplements or devices without seeing much benefit.
I think nothing is more expensive than discount advice. We all want to be our best for our loved ones. Yet if our health is not at its best, we can’t be there for them as fully. Moms can be especially guilty of putting their own needs last.
Screening For a Thyroid Doctor
You can’t meet with every potential thyroid doctor. Thankfully there are some easy ways you can do pre-screening beforehand and narrow your list down. Here are some of the most important considerations and how you might find out about them.
Do They Focus on Thyroid Disease?
Many functional doctors advertise that they treat thyroid disease. Yet this is less of a draw when they also treat everything else.
To make the point I just did a google search for ‘local doctor thyroid disease’. The top result also offers services related to Mental Health, Autoimmunity, Medical Aesthetics, Type 2 Diabetes, Nutrition, Weight loss, Back pain, Biohacking, ADHD, Hormone Replacement, Leaky Gut, and Insomnia.”
Doctors are people who have limits on their time just like you do. To treat a condition well, it takes experience, activity in a community of peers, and ongoing training.
Are They Board-certified in Endocrinology?
A thyroid specialist who does ongoing training will likely be a member of organizations that train in endocrinology and thyroid care. The doctor may list their affiliation on his or her website or you can search the membership lists of the organization directly.
Relevant organizations include:
American Academy of Clinical Endocrinologists
American Thyroid Association
Endocrine Association of Naturopathic Physicians
Are They Trained in Lifestyle Medicine?
The evidence is clear that diet, sleep, exercise, time in nature, social connections, and mindset are among the most powerful parts of your recovery. Your thyroid doctor should also feel the same way and should be able to Integrate it as a central part of your Health care.
Doctors with training in lifestyle medicine may mention it directly or they may have affiliation with groups such as:
American Association of Naturopathic Physicians
American College of Lifestyle Medicine
American College of Preventive Medicine
Do They Offer Telemedicine?
This consideration is not essential, but most people prefer it.
The telemedicine revolution has arrived. Many people may not happen to have the ideal thyroid doctor in their neighborhood. With telemedicine, you can work with doctors who may not practice in your city.
Thyroid care lends itself well to telemedicine because it is focused on communicating about your symptoms and progress, reviewing your lab findings, and making recommendations for changes in lifestyle, supplements, and medications. All of these steps work fine over the distance. The newer telemedicine systems allow real-time face to face communication with your doctor. You no longer have to worry about traveling to and from a doctor’s office or the wait times involved.
Do They Take Insurance?
This point may not be what you expect. If a doctor you are considering does take insurance, they may have fewer options for you. Insurance companies have strict guidelines about the types of care a doctor can offer. More and more doctors are opting out of insurance and working directly with patients directly.
Are They Part of a Team?
There is nothing more frustrating than getting good momentum with a doctor and then not being able to find time to see them. Perhaps they get booked up too far in advance or maybe they are on vacation when you need them. Ideally, your doctor would be part of a team that shares the same training and approach to thyroid care. If your main doctor is not available, one of the others can step right in.
Questions to Find the Right Team
Once you have narrowed down your search, you may still have a few candidates. Many doctors will offer a brief visit at which you can learn more about their approach. Those who have a more thorough online presence may also answer these questions on their website. The other option is that the doctor’s team might be able to answer some of these questions as well.
If you’d like to bring this list with you to a medical visit, there is a printable version on your resources page: www.thyroidresetdiet.com/resources.
Do You Think Can I Get Better?
Often doctors assume that thyroid disease cannot improve. It can. You can feel as well as you did before it started. Never buy into lower expectations.
Do You Ever Use Natural Medication?
The best doctors are willing to use any safe medication that can help you feel better. Natural thyroid medication contains T4, T3, T2, and thyroid proteins, it can help metabolism more than synthetic thyroid and also reverse autoimmunity.
Should I be screened for thyroid cancer?
Thyroid cancer is the fastest-growing cancer type among women in North America. The best thyroid doctors screen all patients routinely and know how to adjust their care if they have nodules, calcifications, or other risk factors.
When should I do my blood tests?
If you have your blood taken at the wrong time of day, the results can be meaningless. The best doctors advise their patients on how to time their tests correctly and consider the time of day, fasting, thyroid medication, certain supplements, and the menstrual cycle. They also can suspect timing factors as a reason when blood levels are unusual.
How many supplements do your patients normally take?
The best doctors discourage their patients from taking long lists of pills. They recognize that you may need a few foundational nutrients long term, but most everything else should be avoided or used for a set period for a specific goal. They understand that symptoms are the result of some missed cause, not from the lack of supplements.
What range is best for my blood tests?
The best doctors understand the distinction between normal ranges and optimal levels. They also know how to personalize optimal levels for a given individual.
How would I know if I were taking too much medicine?
The best thyroid doctors know that thyroid medicine can be dangerous when overdosed. Their goal is to help your symptoms and they use blood tests to make sure they do so safely.
How to be Your Best Advocate
Much of this chapter will help you understand how to find the right team and work well with them. Yet it is important to realize that you are part of the team. Your efforts are at least as significant as those of your providers.
Are you sleeping, exercising, and being thoughtful with your diet? Do you feel good about your weight, your social connections, and your overall situation in life? If not, any of these factors could cause symptoms that could seem to be from your thyroid. They could even make it harder for your thyroid to work or for your body to respond to treatment.
If there are any steps you can make to make your lifestyle more thyroid-friendly, please do them before you feel a need to find a new doctor. If there are things to correct in this area but you do not know how to, your doctor may not have all the answers but could likely still be a good place to start.
What percent of the time do you follow the guidelines in the Maintenance chapter? What percent of the time do you take any recommended medications or supplements? Believe it or not, the majority of people do not follow treatments as recommended for more than a few weeks. If you miss several doses per month of thyroid medication, you may not feel well even if your blood levels seem to be OK
The most effective patients write out their concerns and send them in prior to their visit. Check with your team and find whether email or snail mail is best. Any good doctor will appreciate this. Most business people won’t go into a meeting that doesn’t have an agenda. Your doctors’ visits are no less important. This will give you time to gather your thoughts and make them clear. Without an agenda, you run the risk of leaving out important points or not explaining them well. You also can risk going back on your plans at the moment and not saying what you planned to say in hopes of not being difficult.
If you are not feeling well or if treatment is not working for you – tell your doctor and do so right away. It made me sad to have someone talk about a new symptom that started months ago. I wished I could have helped sooner. It was also common that a patient might not think to mention a symptom unless I asked about it specifically.
Please keep a journal of your health. Make notes on the day to day symptoms. Keep a special section to write down things you’d like to remember to talk to your doctor about and bring it with you to your visit.
It can be tough to ask for help. Especially with symptoms that are not visible or obvious like a broken bone. If a doctor cannot find an explanation or an effective solution, it is easy to feel upset and second guess. Are they a good fit for you? Are they knowledgeable? Do they even care? Are you just a number to them? These are normal feelings. If you have had to work with multiple doctors, it can be even easier to lose faith.
API means Assume Positive Intent. I’ve had private conversations with hundreds of doctors of all types. From my experience, the odds are pretty high that your doctor does want to help. Give them the benefit of the doubt.
When do you move on? There is no simple formula. It is possible to stay in the wrong medical relationship too long and it is possible to leave one too early that could turn out to be helpful.
In the world of thyroid treatment, a good doctor may still require many steps to get your thyroid levels just right. It is safer to take several small steps than fewer steps which could be too aggressive.
If you are not making progress, your doctor should have a plausible explanation of why and a plan for a new course of action that makes sense to you. Your doctor should also take the time to answer your questions and explain themselves clearly. If these conditions are not present, it may be time to offer up your gratitude and move on.
P.S. Whenever you are ready, here is how I can help you now:
1. Download and use my Favorite Recipes Cookbook Here
2. Check out my podcast Medical Myths, Legends, and Fairytales Here
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet and The Metabolism Reset Diet.
Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, diabetes, and regain energy. Learn more about the surprising story that started his quest.