Wouldn’t it be amazing if we could find the one doctor who could give us a magic pill to make all of our problems go away? We would lose weight, grow our hair back, have energy again…
While there may not be one magic pill out there, finding the doctor who is right for you, can change the course of your health journey and put you on the path toward healing.
I recommend that everyone with Hashimoto’s consult with a healthcare professional. Even if you are extremely knowledgeable about Hashimoto’s, it helps to have an objective individual to bounce ideas off of, help you identify potential triggers of your condition, and resolve them.
That said, one of the questions I hear the most from my readers is: “What type of doctor should I see for Hashimoto’s?”
The sad reality is that many patients are often disappointed after meeting with conventional doctors, who tell them that there is nothing that can be done about the autoimmune attack on the thyroid. Such doctors only prescribe one type of thyroid hormone, don’t dose the thyroid hormones correctly, and leave their patients feeling miserable!
In this article, I’d like to offer some information about the conventional approach to thyroid care, versus a Root Cause approach, and how to find a doctor who can help you meet your wellness goals.
Read on to learn:
- The conventional approach to thyroid treatment
- The Root Cause approach to treating Hashimoto’s
- Different approaches to medication management
- Questions to ask your practitioner
- Insurance concerns
The Conventional Approach
The conventional approach to treating Hashimoto’s focuses on looking at one particular organ or function (the thyroid), versus looking at the body as an integrated whole.
Here are the typical recommendations made for those with Hashimoto’s:
1. The standard of care approach to Hashimoto’s, practiced by most conventional doctors and endocrinologists, is focused on testing for low levels of TSH (thyroid-stimulating hormone) if a patient presents with a series of known thyroid symptoms.
The issue with this for someone with Hashimoto’s is that it is not a “preventative” test, and a person with Hashimoto’s may appear to have normal TSH levels and be told they are fine… for years.
TSH often tests as abnormal only after a lot of damage to the thyroid has already been done. There are five stages of disease progression in developing Hashimoto’s, and TSH doesn’t usually test as abnormal until stage 4!
If your thyroid labs appear “normal,” 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.
2. If thyroid levels are deemed “abnormal,” levothyroxine (T4) is the thyroid hormone of choice prescribed to most people with Hashimoto’s.
However, patients are frequently not dosed on medication appropriately because outdated and cookie-cutter lab reference ranges are used. These measure the levels of thyroid hormone in the pituitary gland, but not in the rest of the body. (Furthermore, I’ve found that many clients respond better to non-T4-centric hormone medications. This is because some people’s bodies don’t adequately convert T4 to T3, so they may need a combination T4/T3 medication for optimal support. (As a pharmacist, I take appropriate medication use seriously. Please check out my article on thyroid medication options to learn more.)
3. Thyroid medications are expected to address a patient’s symptoms, and patients are often told that they should begin feeling better in a few weeks. Once on this prescription-only path, a patient will likely have limited follow-ups that are focused primarily on the medication’s effectiveness at improving their TSH levels. TSH levels may improve, but the patient’s condition can worsen, as Hashimoto’s is progressive and their immune system will likely continue to attack the thyroid (if the underlying root cause of the condition is left unaddressed).
Many have gone to conventional doctors to seek help for specific symptoms like brain fog and weight gain, only to be given limited recommendations such as “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).
Patients who continue to be symptomatic are often referred to other specialists for additional medications to target symptoms, such as dermatologists for hair loss, or psychiatrists for depression. These symptoms are not recognized as being related to the autoimmune thyroid condition or its root causes.
4. The conventional approach is about managing the “disease” rather than offering the support and tools needed to help patients fully recover. There are usually no lifestyle recommendations or attempts to find triggers for the autoimmune response against the thyroid, and one’s thyroid antibodies are rarely even tracked. (However, the progression, or regression, of Hashimoto’s can often be tracked by monitoring fluctuations in one’s thyroid antibody levels, as higher antibody counts are usually correlated to a greater autoimmune attack on the thyroid. Read more about that here.)
5. The conventional approach limits its focus to the particular follow up appointment and labs, monitoring the medication’s effects at each visit, instead of having a practitioner truly partnering with the patient to figure out why their bucket is leaking in the first place (and what they can do about it).
There is never a focus on making the autoimmune issue better! Instead, the condition is seen as “irreversible”, but patients are told that medication will at least supply the body with the hormone (which the thyroid is no longer able to produce on its own) that it needs.
So, Should I See an Endocrinologist?
One of the common questions I receive from readers is whether they should see an endocrinologist once they have been diagnosed with Hashimoto’s.
Oftentimes, 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.
While there is a time and place to see an endocrinologist, I recommend that most people with Hashimoto’s find a functional medicine-minded practitioner who can help dig for root causes and take an individualized approach to treating the condition.
The Root Cause Approach
Most conventional doctors have not been trained in the root cause approach. When asked what to do about the immune imbalance that triggered the autoimmune disease in the first place, they, unfortunately, don’t have any answers.
Oftentimes, 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.
This approach to Hashimoto’s is patient-centered and looks at the underlying issues and the person’s individuality.
The Root Cause Approach to Hashimoto’s involves:
- Utilizing comprehensive thyroid tests to determine diagnosis and the need for thyroid hormone therapy.
- Using optimal and functional ranges of thyroid hormones instead of outdated reference ranges.
- Optimizing thyroid hormones, utilizing the T1,T2, T3, and T4 hormones when necessary (all are produced by the thyroid gland, but only T4 is present in levothyroxine, the most commonly prescribed thyroid drug).
- Optimizing nutrition through eliminating reactive foods as well as addressing deficiencies and digestion.
- Addressing the stress response.
- Addressing the health of the detoxification system.
- Addressing the state of the gut.
- Identifying the person’s unique triggers such as chronic infections, toxins, or traumas.
- Tracking thyroid antibodies every three months to see if the interventions are making the condition less aggressive.
- Appreciation of the person’s experience and always utilizing the person’s symptoms as a guide for adjusting treatment.
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. Some may be medical doctors, doctors of osteopathy, physician assistants, nurse practitioners, chiropractors, (compounding) pharmacists, naturopathic doctors, doctors of integrative medicine, acupuncturists, and nutritionists. This list may also extend to other professions as well.
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). Some may also be limited in the ability to prescribe other helpful medications like LDN, which has been found to be helpful for improving thyroid symptoms and antibodies.
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 coming back with unmatched outcomes and numerous success stories! (Sometimes, amazing success stories result after a few simple lifestyle changes that they recommend!)
Approaches to Medication
When the TSH is elevated to the point of needing medications, most conventional doctors will prescribe Synthroid (generic name: levothyroxine), a synthetic T4-containing thyroid medication, which was the number one prescribed medication in the U.S. in 2019, accounting for 114 million prescriptions!
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. One reason 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 co-factors in the chemical process), having proper gut and liver function, and being on a low-stress setting (as chemical messengers related to stress may block or alter the conversion, resulting in the person not having enough T3 on board).
Some people who do not have enough T3 on board may benefit from T3-containing thyroid medications or natural desiccated thyroid medications (NDT), which are derived from the thyroid glands of animals and don’t require a person to convert T4 to T3 (a process that is impaired in many people with Hashimoto’s).
However, most conventional practitioners are not going to be comfortable with medications other than synthetic T4 medications… In fact, most clinical guidelines and pharmacology textbooks recommend only using synthetic T4 medications.
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 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) — unless, of course, there’s a recall! More on that in a minute.
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 are not experienced in prescribing. And this is actually a good thing — you don’t want to be someone’s very first patient on a medication they don’t know how to use. Instead, you want to work with a practitioner that is well versed in using the various thyroid medications.
Another reason why a person may not feel well while taking levothyroxine could be due to issues related to absorption. For those needing to take multiple medications or those that have issues with malabsorption such as low stomach acid, H. pylori, acid reflux or SIBO, taking a medication like Tirosint may aid with proper absorption.
If you are struggling with thyroid symptoms despite being on thyroid medications, it may be helpful to 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 (NDT) medications (Armour*, Nature-Throid, WP Thyroid), and compounded thyroid medications (hypoallergenic blends of T4 and T3 in compounded, physiological ratios). This type of a practitioner will be able to help you find the type of thyroid medication that will work most effectively for you.
As such, I urge you to seek an expert that is knowledgeable in thyroid pharmacology. 🙂 (You’ll find resources to help you find such a practitioner in your area, further on in this article!)
Note: I wanted to give you a heads up that there has been a recent recall on all current lots of Nature-Throid and WP Thyroid (manufactured by RLC Labs, Inc), due to certain lots being found to be sub-potent. This means that the affected medications may have too little thyroid hormone in them. A person who is stable on their current dose of thyroid hormone, who then receives these affected lots, may become hypothyroid!
As such, there may be a current backorder of Nature-Throid and WP Thyroid medications in your area. Please contact RLC Labs and your local pharmacist directly if you have any questions or concerns.
*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.
Questions to Ask Your Practitioner
So, how do you find the right doctor?
If you’re looking for a practitioner who can help you address Hashimoto’s, it’s important to know what you are looking for in a healthcare partner.
For example, if you are getting started on your thyroid journey and want to get some baseline labs and a thyroid ultrasound, you might want to start with an endocrinologist. If you’re looking for a more comprehensive approach that involves addressing your root causes, a functional or integrative practitioner is going to be your best bet. If you are looking for someone to help personalize your thyroid medications, compounding pharmacists are an excellent resource.
Here are some questions to ask your practitioner to see if they are a good fit for you:
- Do they prescribe hypoallergenic thyroid hormones like Tirosint, compounded thyroid medications, or natural desiccated thyroid medications (NDTs like Armour Thyroid, Nature-Throid, WP Thyroid, NP Thyroid and others)?
- Do they have experience with prescribing low-dose naltrexone (LDN)?
- Do they order a full thyroid panel that includes TSH, Free T4, Free T3, TPO/Tg antibodies, or just the TSH test?
- Do they have accounts with functional medicine lab companies like Ulta Labs, Direct Labs (GI-MAP test for gut infections), My Med Labs (food sensitivity testing), or ZRT Laboratory (Adrenal Stress Profile) so they can help you dig for hidden root causes?
- Can they order food sensitivity tests?
- Optional: Do they offer telemedicine (virtual appointment via video conferencing) options?
I encourage you to write out a list of these and other questions you have for your healthcare provider, and look for a like-minded practitioner who can offer you the level of care that you need on your individual journey.
Finding Dr. Right in Your Area
To help you locate a practitioner in your area, I have compiled a database of recommended clinicians and practitioners. The list of names in this database represent practitioners who have shown an interest in my Root Cause approach to Hashimoto’s. However, you will still need to be your own advocate in asking the right questions to find someone who will be a good fit for you. Unfortunately, I’m unable to evaluate each of them individually at this point, but I hope this list provides a starting place for you.
You can also check my list of compounding pharmacies to find a pharmacist who will compound your thyroid medications for you.
I also recommend searching the Institute of Functional Medicine’s practitioner database, where you can search world-wide for healthcare advocates who are experienced in functional medicine. ZRT Laboratory offers a practitioner database as well.
Booking Virtual Appointments
While 2020 has been a crazy year, these days, there is something that may help even if you live in a place with very few experienced practitioners. Something to consider is telemedicine, which allows you to work with a functional doctor remotely, via Skype, Zoom, Google Meet, or other video conferencing applications. With telemedicine, you can work with a practitioner who is a good fit for you, but may not be located in your area.
More and more, medicine is using these remote options, and many doctors are embracing technology to expand their services. In the current climate that we are living in, this might be particularly beneficial! When looking for Dr. Right, be sure to ask if they offer virtual appointments.
Remember, you are your best health advocate!
Will Insurance Cover My Practitioner?
If you are working with a practitioner who accepts insurance, keep in mind that they may not be able to spend as much time with you as necessary due to reimbursement guidelines, and they may not be able to order functional medicine labs.
While these labs can be extremely important in getting to the root cause, they are outside the standard of care and considered experimental, so most endocrinologists, primary care doctors, and internal medicine doctors will not run those tests.
Many insurance companies refuse to reimburse doctors who use “non-approved labs” or order what they deem as too many tests for a patient. Unfortunately, the insurance companies have too much control over the practice of medicine.
Oftentimes, you will need to find a practitioner outside of insurance to get the care, attention, and testing you deserve. In some cases, you may be able to submit the claims to your insurance company for reimbursement. However, some insurance companies may not reimburse for these labs, so be prepared to pay out of pocket if needed.
I think of these tests as a health investment. Many of us will go out and spend money on a purse or a pair of shoes that makes us feel better in the short term, but spending money out of pocket for a lab test could dramatically improve our health in the long term.
In the event that you cannot find a doctor who will be able to prescribe medications and order the functional medicine labs, you may want to work with your medical doctor on monitoring your medications while you work with a functional medicine practitioner (who may not have prescriptive authority) to order the tests for you.
If you cannot find a practitioner to order the tests for you or if you have a high deductible, you can also order the same tests on your own through direct-to-consumer lab companies. (I’ve set up a few tests that you can order through them at a discounted price! Find them here, in the “Labs” section.)
I believe that everyone needs to find a practitioner who will let them be a part of their healthcare team. You want someone who can guide you and also listen to you and your concerns. You want someone who is open to thinking outside the box and who understands that you may not fit in with the standard of care.
It’s also important that you don’t expect your doctor to change for you. Instead, find a doctor that fits your situation and understands your needs. There is a time and a place for an endocrinologist, a functional medicine practitioner, and a compounding pharmacist. It is up to you to ask the right questions and find the healthcare partner who will help you achieve your healthcare goals.
For more information on being your own healthcare advocate and finding your root cause, I encourage you to pick up a copy of my books Hashimoto’s: The Root Cause and Hashimoto’s Protocol. I wrote these books after struggling to find the help I needed from my doctors, learning to dig for my own root causes, and discovering the world of functional medicine. My goal is to empower you with the knowledge you need to get better and give you the tools and strategies you need to take back your health, as well as reduce your dependency on the medical system!
There are many strategies (that you’ll find in my books) that you can implement on your own, such as eliminating inflammatory foods (and inflammatory people, too, as stress is a huge trigger!), addressing your nutrient deficiencies, and taking helpful supplements.
But for other interventions, like getting on the right medication, testing for infections, or doing an advanced detoxification protocol, it is helpful to have a specially trained practitioner on your side.
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, check out my list of like-minded practitioners!
I hope that this information helps you take charge of your own health!
P.S. You can download a free Thyroid Diet Guide, 10 thyroid-friendly recipes, and the Nutrient Depletions and Digestion chapter for free by signing up for my newsletter. You will also receive occasional updates about new research, resources, giveaways and helpful information.
- Lewis S. The Top 50 Drugs Prescribed in the United States. Healthgrades website. https://www.healthgrades.com/right-care/patient-advocate/the-top-50-drugs-prescribed-in-the-united-states. Published September 5, 2019. Accessed August 13, 2020.
Note: Originally published in September 2015, this article has been revised and updated for accuracy and thoroughness.