Note: Originally published in September 2015, this article has been revised and updated for accuracy and thoroughness.
One of the common questions I receive from readers is whether they should see an endocrinologist once they have been diagnosed with Hashimoto’s.
Often times, patients think that endocrinologists will have access to the latest and greatest advances in medicine, but this is not necessarily the case with Hashimoto’s.
While I have the utmost respect for the profession of endocrinology and believe that every person who has been diagnosed with Hashimoto’s should see an endocrinologist at least once for a full evaluation and a thyroid ultrasound, many patients with Hashimoto’s end up disappointed with the care they receive from their endocrinologists and conventional doctors.
This is because the conventional medical approach to treating thyroid disease focuses on replenishing thyroid hormone levels with the use of synthetic thyroid medications once the “thyroid has burned itself out” and can no longer produce its own thyroid hormones.
Appropriate Medication Management
When your TSH is elevated to the point of needing medications, most conventional doctors will prescribe Synthroid (generic name: levothyroxine), a synthetic thyroid medication, which was the #1 prescribed medication in the US in 2014, accounting for 23 million prescriptions (Medscape)!
While levothyroxine may work well for some people with Hashimoto’s and hypothyroidism, there are many people who continue to have symptoms of hypothyroidism on this medication. This is because levothyroxine (chemical name tetraiodothyronine or T4) is a prohormone that needs to be converted to the more physiologically active liothyronine (chemical name triiodothyronine or T3) in the body to fully activate thyroid receptors.
“On paper” this simple conversion should happen just fine, but it doesn’t always happen that way in the body. This is because the conversion requires a lot of different pieces to be in place, including having enough nutrients (that act as cofactors in the chemical process), having proper gut and liver function, and the body needs to be on a low-stress setting, as chemical messengers related to stress may block or alter the conversion, resulting in the person not having enough of the T3 on board.
However, most conventional practitioners are not going to be comfortable with medications other than synthetic T4 medications… Most clinical guidelines and pharmacology textbooks recommend only using synthetic T4 medications and avoiding the use of Natural Desiccated Thyroid Medications (NDT), [brand names include: Nature-Throid, WP Thyroid, and Armour] and even Cytomel, a T3 medication, for most people with hypothyroidism. This is because, in prior years, the NDT medications were not manufactured precisely, and this resulted in inconsistent dosing between batches.
Additionally, T3 medications were misused and given to people without thyroid disease in high doses to induce hyperthyroidism and try to achieve weight loss—a very dangerous scenario!
Today, the manufacturing process of NDT medications has been completely revamped, and now the medications are safe and effective when used correctly for people who are supposed to receive them (i.e. people with hypothyroidism). But I digress…
If you’re seeing a conventional doctor and taking a synthetic thyroid medication, you can cry, plead and beg for NDT or a T3 containing medication, but most of them are not going to give you a medication they have learned is inferior and potentially dangerous.
If you are struggling with thyroid symptoms despite being on thyroid medications, you should see a doctor that is trained and familiar with the use of a variety of thyroid medication options, including T4 only medications (Synthroid, Levoxyl, Tirosint, levothyroxine, Euthyrox), T3 medications (Cytomel, liothyronine), Natural Desiccated Thyroid Medications (Armour*, Nature-Throid, WP Thyroid) and compounded thyroid medications (hypoallergenic blends of T4 and T3 in compounded, physiological ratios).
It will be much safer (and effective) for you to work with a doctor familiar with these medications than it will be to work with a doctor who has only used synthetic medications! I urge you to seek a doctor that is knowledgeable in thyroid pharmacology 🙂
*Note: While Armour Thyroid does not have any gluten-containing ingredients, it is not tested for gluten content, and cannot be certified as gluten-free. Armour does contain sodium starch glycolate, which can be derived from wheat or corn.
Getting to the Root Cause
Most conventional doctors have not been trained in the root cause approach. When asked what to do about the immune imbalance, they, unfortunately, don’t have any answers.
If you’ve been diagnosed with Hashimoto’s with elevated thyroid antibodies (indicating an immune attack on your thyroid gland), but a “normal” TSH, you’re likely going to be told that there is nothing you can do, other than wait until the thyroid is destroyed to the point that you will need thyroid medications.
Of course, many people still experience symptoms with just elevated thyroid antibodies, even when the TSH is “normal,” such as anxiety, depression, fatigue, hair loss, irritable bowel syndrome, and weight gain.
Many have gone to conventional doctors to seek help, with the doctors, unfortunately, having very limited recommendations, such as “Maybe you should take an antidepressant,” “Perhaps you’re just getting older” or the often hurtful “Exercise more and eat less,” (which of course can make things worse if you have impaired thyroid and adrenal function).
Often times, conventional doctors will kindly offer to test you for other autoimmune conditions as the underlying immune imbalance can translate into the development of new autoimmune conditions if not addressed, but they will NOT test you for underlying root causes of the autoimmune condition.
Simply, because this is not something they have been trained in- much of their training is focused on identifying a condition, and using medications and/or surgery to treat the condition.
My training in pharmacy school was very much the same. “If someone has ‘X’ disease, you recommend ‘Y’ drug!” I learned about helpful lifestyle changes for a few of the conditions as well, but to be perfectly honest, the lifestyle recommendations were severely lacking in my training.
Furthermore, most conventionally trained doctors, pharmacists, and nurses are not trained in root cause resolution. I was never told that adrenals, food sensitivities, toxins, nutrient deficiencies, digestive issues, and infections could create chronic autoimmune illness within the body and that addressing these issues can help a person feel better and even result in remission.
In contrast, the root cause approach focuses on why your immune system may be out of balance in the first place.
The root cause approach focuses on figuring out what triggered your condition, what can exacerbate your condition, as well as the interventions that can make you feel better, reduce the attack on the thyroid gland, prevent you from getting another autoimmune condition, and get your condition into remission.
There is a whole, growing field of medicine dedicated to this approach, known as functional medicine.
Functional medicine practitioners can have a variety of backgrounds, including Medical Doctors, Doctors of Osteopathy, Physician Assistants, Nurse Practitioners, Chiropractors, Pharmacists, Naturopathic Doctors, Acupuncturists, Nutritionists as well as other professionals.
While all of the above-listed practitioners can help you with addressing the root cause of the condition, in most states, only medical doctors, osteopathic doctors, physician assistants and nurse practitioners will be able to prescribe thyroid hormones (look for ones that are trained in functional or integrative medicine).
The biggest challenge with seeing these types of practitioners is that they are often not going to be covered by insurance. This is because the recommendations, interventions, and tests recommended by these types of practitioners are often considered “experimental,” and insurance companies are going to be very resistant in reimbursing them for their services.
However, these are the professionals working with the latest research, and the practitioners that are coming back with unmatched outcomes and numerous success stories! (Sometimes with just the recommendation of lifestyle!!)
During my career as a pharmacist, I always worked with underserved populations, and once I figured out my triggers and recovered my health, I wanted to give people a way that they could support and help themselves, this is why I wrote the book Hashimoto’s Thyroiditis: The Root Cause and my new book Hashimoto’s Protocol.
I didn’t write the books for notoriety or so that people would come to my concierge clinic. I was a very private person until I decided to share my story with Hashimoto’s, and I didn’t even have a clinic at the time of writing. Rather my goal was to empower you with the knowledge you need to get better and thus, I put all of the information that I thought would be helpful for you to get better in the book.
Hashimoto’s Protocol will teach you the reasons behind why you developed an autoimmune condition, as well as the lifestyle changes you can implement on your own to feel significantly better, reduce, and sometimes eliminate the attack on your thyroid!
Hashimoto’s Protocol will also teach you advanced protocols for infections, toxins and hormone balancing that are used with a doctor. My goal is to give you the tools and strategies you need to take back your health, as well as reduce your dependency on the medical system!
You can do many things on your own, or with a conventional practitioner, like get the right diagnosis, eliminate inflammatory foods (and inflammatory people, too, stress is a huge trigger!), address your nutrient deficiencies, and take helpful supplements.
But for other interventions, like getting on the right medication, or testing for infections, or doing an advanced detoxification protocol, you will need a specially trained practitioner…
I pride myself on being a solution focused forward thinker and my goal is to change how thyroid disease is treated. This is why I write, create documentaries and educational programs for patients and practitioners.
Please note that this is not something that will happen overnight, and please know that it starts with you. You are the one that’s making a choice to educate yourself and to take charge of your own health, seek out a practitioner that is familiar with the root cause approach, and in some cases, take things into your own hands!
One day, I hope that every single practitioner will be well versed in diagnosing and reversing Hashimoto’s! In the meantime, over the past few years, I’ve been collecting names and contact information for practitioners that can help from other thyroid patients.
If you’re looking for practitioners who believe in the root cause approach to treating thyroid issues, sign up to get my free list of clinicians in your area!
I’ve also included a little excerpt from my book, Hashimoto’s Protocol, on “Finding Dr. Right” to help you ask the right questions so that you can get the help you need.
I hope that this information helps you take charge of your own health!