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Originally published on 24th October 2017 Last updated on 8th July 2019
As a thyroid patient, there are a few different types of medical and healthcare professionals you may see for your condition.
Some can be more useful in addressing different areas of the condition than others and different patients find different success with different types of doctors. You may have tried a few of these already, but I’m going to sum up what each one is, how they look at hypothyroidism and why they may be helpful to you.
First of all, let’s begin with an explanation on:
Conventional Medicine VS Functional Medicine
There are two approaches to medicine, conventional and functional, the former being what it says on the tin – conventional ways to treat a patient e.g. they come in with a symptom so they’re given a drug to help with that – but functional medicine looks at getting to the actual issue, the root cause of the symptoms, and fixing that, before jumping to treating just the symptoms with drugs.
Endocrinologists and GP’s generally fall into conventional medicine, as well as some private doctors. However, I see a private GP who combines conventional and integrative medicine practises.
Whereas Conventional medicine looks at each symptom and health condition as a separate issue to treat, functional medicine is holistic and looks at the whole body, considering how one issue can have a knock-on effect and cause other things to go wrong, too.
Whilst also considering some drugs, functional medicine places importance on lifestyle factors such as diet – what we eat and drink – stress levels, chemicals, toxins and much more. For some people, conventional medicine does them just fine and they return to good health on thyroid medication alone for their underactive thyroid, but for many others, they never quite feel right again, post-hypothyroidism diagnosis and conventional doctors prescribe multiple medicines for multiple symptoms that we are told, are separate issues.
A lot of thyroid patients therefore feel a functional medicine approach is better suited to them because it not only deals with their thyroid condition, but also looks at other parts of the endocrine system which may have also gone awry, such as those pesky adrenal glands and sex hormones, and it works to bring them back into balance, also addressing any other issues from the root, avoiding the need for a growing list of prescription medications.
Functional practitioners also consider whether your hypothyroidism is autoimmune (it is for around 90% of us) as being very important and crucial in your recovery. Conventional medicine feel that treatment will always remain the same, whether you have autoimmune thyroid disease or not. Due to cost restraints, conventional doctors are rarely allowed to use innovative tests and treatments and often can’t spend enough time to help identify, run tests or treat complex autoimmune diseases and hormonal imbalances. So, when you need more personalised thyroid treatment, conventional medicine can feel inadequate.
GP stands for general practitioner, and they are just that. They’re not specialists in a particular area or field and as such, tend to know a standard amount about all aspects of the body, rather than being focused on one area or system.
GP’s are generally the ones who diagnose hypothyroidism in most cases and many thyroid patients only see their GP for thyroid medication prescriptions, dosage adjustments and any on-going issues. However, they can refer you to a thyroid specialist if you have on-going complaints of symptoms and conventional T4-only medication (Levothyroxine or Synthroid for example) not working as well as you’d hoped. Some thyroid patients do just fine on the standard medication and simple dosage adjustments their GP can make, but for those who are still not feeling optimised for their condition, a referral to an endocrinologist can be made and may be useful. GP’s tend to follow a conventional medicine approach and in the UK especially, can only prescribe T4-only medication.
An endocrinologist (often called an endo for short) specialises in the endocrine system, a system that includes the thyroid gland as well as the hypothalamus, pituitary, parathyroid, adrenal glands, pineal gland, and the reproductive organs (ovaries and testes). The pancreas is also a part of this system; it has a role in hormone production as well as in digestion. The endocrine system is made up of glands that produce and secrete hormones. These hormones regulate the body’s growth, metabolism and sexual function and an endocrinologist specialises in knowing all the ins and outs of these systems and hormone balances (or, imbalances, as many of us have!).
As mentioned above, a referral to an endo can be made by your GP, but patients are often waiting for months or even years to finally see one. In the UK, you can see an endo on the NHS. Endo’s are somewhat a controversial topic among thyroid patients and others who live with adrenal and reproductive hormone issues, too. Whereas some patients find a good level of success with an endocrinologist, others feel that they follow conventional medicine too closely and thus, are not much more help than their GP.
Sticking to the ‘importance’ of the TSH test, although paying a bit more attention to other thyroid tests such as Free T4 and Free T3, endo’s can offer a bit more of a detailed insight in to your thyroid condition and management, including a few more tests (which, to be honest, we should all be having done anyway) but they generally stick to very stiff, outdated ranges and place the most importance on TSH levels.
Depending on where you are in the world, endo’s can offer more than T4-only medication but often only prefer to prescribe conventional T4 synthetics. This means getting them to prescribe you T3 and NDT medications, which help many thyroid patients get their good quality of life back, can be difficult. But it is possible. More so in the US than other countries – it is pretty uncommon in the UK for example. Some thyroid patients feel let down after waiting to see an endo and realising that they’re not much more help than their GP, but they can be useful. In my opinion, it’s always worth trying and seeing an endo at least once.
Private GP/Private Doctor
Private doctors or private GPs here in the UK especially tend to fall mostly into conventional medicine practises but often offer more than mainstream doctors, such as that on the NHS. For example, the NHS only offer the thyroid medication Levothyroxine for the most part, but private doctors or GPs can offer more types of thyroid medications. They are often keen to do more in depth and comprehensive testing (such as the full thyroid panel) too, but all of this can cost a lot out of pocket.
I see a private GP doctor who prescribes me my NDT medication, and he combines both mainstream and integrative medical practises and information, and sees himself as a holistic doctor.
Functional Doctor or Functional Medicine Practitioner
Functional doctors or functional medicine practitioners tend to do more comprehensive testing than conventional ones, look at changing other aspects of your life including diet, routines for sleeping and stress coping and prefer to treat you looking at the whole body as a system that needs to work in harmony together, rather than focusing on the thyroid gland alone, as conventional medicine does.
Functional doctors/medicine practitioners generally cost more than conventional and in the UK, they’re not covered on the NHS. Seeing a functional doctor qualifies as paying to see a private doctor and costs can be quite high, but there are functional doctors out there offering services for different kinds of budgets. It’s always worth having an online search and emailing for quotes on prices.
Many thyroid patients turn to functional doctors/practitioners after years of feeling let down by conventional medicine, and there’s loads of info online singing their praises. With an approach that looks at the whole body as opposed to just the thyroid and supporting good overall health, it’s a more personalised approach to your specific situation. In my experience, a functional doctor or medicine practitioner was the way to go to address my health as a whole.
A naturopath applies natural therapies to health conditions, often to compliment what you’re receiving from a conventional or functional doctor. It includes natural healing practices (homeopathy, acupuncture, and herbal medicine).
They provide personalised care to each patient, and, similar to a functional doctor, they see the body as a holistic unity of body, mind, and spirit, aiming to address the body as one. They usually practice in a freelance environment, but have the option to work in hospitals, spas and healthcare, too. Not all naturopaths have medical degrees, so whilst some are Naturopathic Doctors, others are simply Naturopaths. Only those with medical degrees can write prescriptions.
You can come across a naturopath in a nutritional and family consultancy as well as in a beauty clinic for example, as some specialise in areas such as thyroid issues, infertility and skin complaints. Like functional medicine doctors or practitioners, you would usually pay to see a naturopath and costs can range to suit various budgets.
Obstetricians and Gynaecologists
Obstetricians and gynaecologists can also help to manage thyroid conditions. These specialists are generally concerned with the care of a pregnant woman, her unborn child and the management of diseases specific to women, such as thyroid issues, which can come to light during pregnancy, be triggered by pregnancy or get better or worse during pregnancy.
Managing hypothyroidism in pregnancy is of paramount importance to reduce risks of complications and miscarriage. Many practitioners in this field have a special interest in one particular area, such as high-risk obstetrics, fertility care or minimal access surgery. In gynaecology, patients range from those who have chronic disorders which are not life threatening but interfere significantly with quality of life, such as thyroid disease, to those where an acute emergency presentation is the first indication of a gynaecological problem.
Gynaecology is concerned with the well-being and health of the female reproductive organs and the ability to reproduce, which involves a lot of the endocrine system I mentioned above. When one part of this system goes awry, so can others, so sex hormone imbalances and adrenal issues for example are pretty common with thyroid problems. You will usually be referred to an obstetrician when pregnant or a gynaecologist for reproductive system related symptoms or issues – both are included on the NHS in the UK. Many thyroid patients find that they get more comprehensive thyroid testing done compared to an endo or GP, from an obstetrician or gynaecologist. If you fall pregnant as a thyroid patient, you may be referred to see an obstetrician or gynaecologist to help manage you through pregnancy.
Ears, Nose and Throat specialists can be involved with thyroid conditions due to the location of the gland being in the neck. Thyroid patients who are referred to an ENT (can be done on the NHS) are often done so due to complications of their thyroid disease such as goitres, inflammation or enlargement of the thyroid gland. They recognise autoimmune hypothyroidism (Hashimoto’s) and how it can affect the thyroid gland in terms of inflammation. ENT specialists may conduct further testing that an endo and GP cannot, such as:
- More in-depth blood tests of thyroid function
- An ultrasound examination of your neck and thyroid
- A radioactive thyroid scan
- A fine needle aspiration biopsy
They will pick up on any abnormalities such as thyroid cancer and create a treatment plan going forward for any issues they may diagnose or find.
So, who is the best doctor to treat your thyroid condition? I wish I could tell you! I hope this article has at least educated you on your options and encouraged you to be your own advocate, helping you figure out which direction to go to find the best doctor for you and improve your overall health and wellbeing. At the end of the day, all thyroid patients deserve to feel good and live a full life.
You can click on the hyperlinks in the above post to learn more and see references to information given.
Written by Rachel, The Invisible Hypothyroidism
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Rachel Hill is the highly ranked and award-winning thyroid patient advocate, writer, blogger, speaker and author behind The Invisible Hypothyroidism. She has two books: ‘Be Your Own Thyroid Advocate‘ and ‘You, Me and Hypothyroidism‘. Her thyroid advocacy work includes writing, speaking on podcasts and co-creating Thoughtful Thyroid courses. Rachel has worked with The National Academy of Hypothyroidism, BBC, The Mighty, Yahoo, MSN, ThyroidChange and more. She is well-recognised as a useful contributor to the thyroid community and has received eight 2019 WEGO Health Award Nominations.