How do you know if you are receiving the best advice and support from your doctor? Here are 5 questions you can (and should) ask your doctor if you are struggling with the symptoms of an underactive thyroid.
If you don’t have time to read the post, don’t worry! Then simply watch the video! You will learn more about the questions to ask your thyroid doctor.
Have you too experienced this scenario? You were diagnosed with an underactive thyroid, and your doctor gave you a script for thyroid medication (which is usually the synthetic T4 medication) and sent you on your way.
But you are still not feeling better. You are still struggling with symptoms such as fatigue, brain fog, weight gain, or struggling to lose weight.
Then, you go back to your doctor and mention how you feel to him or her. The doctor sends you for new lab tests (which are often just TSH and T4 tests) and your doctor tells you that you are within the range and that it is all normal.
“It is in your head. You are normal. There is nothing more to do.”
5 Questions for your doctor
The scenario above is what happened to me more times than I care to remember. Over the years I educated myself on my thyroid and the options available. Consequently, I fired many doctors and finally, in 2019 I found a functional medicine doctor who is working with me and REALLY helping me, not just treating me on a set of lab results.
So, if you are feeling that you are not getting the best support and advice from your doctor, here are 5 questions you can ask your doctor. These questions are very specific – you will get a good and clear understanding of exactly what your doctor’s approach is with regard to thyroid health.
You can then also make a decision on whether your doctor is the right doctor for you.
Question 1: Why is my thyroid underactive?
The first question to ask your thyroid doctor is this: why is my thyroid underactive?
This question is designed to prompt your doctor to take the next steps in identifying the ROOT CAUSE of your underactive thyroid, and not just treating the result – which is the thyroid being underactive.
There are many reasons why your thyroid gland is underactive. By understanding why your thyroid gland is underactive, you can take the best action to treat the underlying root cause.
So the ideal answer by your doctor should be this:
“There are many causes of an underactive thyroid. We’ll need to do some additional tests to see what the possible causes could be”.
If your doctor is answering “It doesn’t matter” or “We don’t know, it just happens”, you may not be receiving the best support and advice.
READ MORE: Why is my thyroid underactive
Question 2: Do you do the full thyroid panel tests, including thyroid antibodies?
The full thyroid panel blood tests include the following:
- Total T4 and Free T4
- Free T3
- TPO antibodies
- TG antibodies
- Reverse T3 (not always, but sometimes valuable)
The most common reason for an underactive thyroid is the autoimmune condition Hashimoto’s Thyroiditis. This is when your immune system is attacking and destroying your thyroid gland, leading to an underactive thyroid over time.
Hashimoto’s Thyroiditis is an immune system problem, not a thyroid problem. The underactive thyroid is the symptom, while the immune system is the root cause.
So by testing for the thyroid antibodies, you will know if your immune system is the reason for your underactive thyroid.
But many doctors do not want to test for it, because the only treatment option they have in their arsenal is to replace the thyroid hormones with T4 medication. (On a side note, it’s not their fault – it is what they were taught during their medical training. And, they cannot prescribe lifestyle changes and diet as a treatment).
Question 3: Do you use the standard lab reference ranges?
When you look at your blood test results, you will note that the laboratory has a reference range. Most doctors are using these clinical reference ranges to check if your labs are normal, or if there is a reason to be worried.
Therefore, I want to pause here for a moment and ask you this question:
How are those reference ranges determined?
Think about it for a moment. From what I understand, these lab ranges are determined by a large population of people, and often those are actually getting the tests done. This large population is what should represent “normal”, and often the information on lifestyle, medications, stage of life, and hormones used is not taken into account. Then, let’s not even start with genetic heredity, dietary habits, and other issues (such as alcohol, smoking, drug abuse, etc).
As Dr. Serle, who focuses on personalized medicine, stated: “the lab Clinical ranges used today are very broad and typically are determined by averaging only sick people’s scores.” But here is the crux: NORMAL DOES NOT MEAN HEALTHY.
Therefore, I don’t want to be checked against the normal population. I want to be checked against those who are healthy. Those ranges, based on healthy people, are the functional medicine ranges.
You can even add this question to your list of questions to ask your thyroid doctor: do you use functional medicine ranges when you look at lab results?
Question 4: Do you prescribe T3 and NDT?
Of all the questions to ask your thyroid doctor, this one is very important: do you prescribe T3 and NDT?
The standard and recommended treatment for an underactive thyroid are to prescribe synthetic T4 medication. That’s it.
This is what is recommended by the American Thyroid Association, and taken directly from their website: “Thyroid hormone is available as levothyroxine, which is biologically equivalent to your own thyroid hormone, thyroxine (T4)” and “there is no indication for the use of T3 alone for the treatment of hypothyroidism.“
And the British Thyroid Foundation also only recommends T4 medication: “Your doctor will prescribe levothyroxine, a synthetic version of the thyroxine produced by the thyroid gland” and “So taking all the factors together, T4 alone remains the recommended treatment for thyroid hormone replacement.”
When I consulted with two endocrinologists, they refused to prescribe T3 medication. I was still experiencing the symptoms of my underactive thyroid and Hashis.
Yet, the moment I saw a functional medicine doctor, she immediately added T3 to my regime. I started feeling better.
I don’t know why so many doctors are scared of T3 – but it has a long history and a story to it, I’ll write more about it in a future post. And because they have been taught that T4 is the best way to treat hypothyroidism, they don’t understand the benefit of T3.
NDT is another treatment option
Then, NDT stands for natural desiccated thyroid hormone, which is made from dried pig or bovine thyroid glands. Also, a long story as to why many doctors do not prescribe it. I’ll leave that for another day. NDT is a combination of T4 and T3 hormones.
The thing is, so many patients feel so much better when T3 is added to their regime, or when they switch to NDT, or even if they go on T3 only regime.
Working with a functional medicine doctor is the key. Your lab results will be different when you are on T3 medication or NDT, and a functional medicine doctor knows how to interpret the labs when you are taking T3 medication or are on NDT.
Question 5: Do you prescribe LDN?
LDN stands for low-dose naltrexone.
This drug has been shown to benefit some patients who have an immune system that is on the attack, as it helps to modulate the immune system.
For Hashimoto’s Thyroiditis patients, it may help to lower thyroid antibodies as it modulates the immune system. Unfortunately, it works well for some patients, and for others, it doesn’t work at all.
My functional medicine doctor suggested that I try it, but unfortunately it didn’t work me. So, the only way you will know if it works for you is if you work with your doctor and try it.
It may just change your life!
I believe your doctor should be a partner in your health journey, helping you to understand what is going on in your body, working with you to determine the root cause of your underactive thyroid, and be open to treating you on how you are feeling, and not just see you as a set of lab results.
Here I have given you 5 questions to ask your thyroid doctor.
These questions above will help you to understand how willing your doctor is to work with you and try different things.
- Functional range vs clinical range. Dr A Serle. https://www.personalizingyourhealth.com/functional-medicine/functionalrange-vs-clinicalrange
- Thyroid Hormone Treatment. American Thyroid Association. https://www.thyroid.org/thyroid-hormone-treatment/ , accessed 14 June 2022.
- Your Guide to Hypothyroidism. British Thyroid Foundation. https://www.btf-thyroid.org/hypothyroidism-leaflet , accessed 14 jUne 2022.
- Q&As to accompany to the 2015 BTA Statement on the
Management of Hypothyroidism. British Thyroid Association. https://www.btf-thyroid.org/Handlers/Download.ashx?IDMF=f148a6f7-565e-4324-8e7d-5a449a75180c/ Accessed 14 June 2022.
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