How to Find the Best Doctors for Thyroid Care

Figuring out what type of doctor to see for your thyroid disease care can be confusing since physicians from a wide range of medical specialties—from family physicians to endocrinologists—treat thyroid concerns. Whether you suspect you may have a thyroid condition, are newly diagnosed, or have been living with the condition for some time, there are many factors to consider in choosing a doctor, including the type of thyroid condition you have, your insurance coverage, and personal preferences.

There are two types of physicians who may specialize in any area of medicine—medical doctors (MDs) and osteopathic physicians (DOs). Osteopathic physicians undergo training very similar to that of medical doctors, and the two are considered equal with regard to the ability to care for and treat patients. Some may specialize in endocrine conditions, like thyroid disease, while others may care for patients with these concerns as well as others.

With some thyroid conditions, your family doctor may be your best choice for your care, whereas, with others, you may need to see an endocrinologist or a surgeon who specializes in treating thyroid cancer.

MDs and DOs who may treat thyroid disease include:

Primary care includes specialties such as family medicine and internal medicine. Doctors differ in the scope of their practice, but many primary care doctors are comfortable treating autoimmune hypothyroidism (Hashimoto's thyroiditis).

Among primary care physicians, some are more interested in treating hormonal imbalances and have a passion for treating people with thyroid disease. These physicians may call their practice "holistic" or "integrative" to describe an approach to a disease that includes total well-being, rather than numbers on blood tests alone.

OB/GYN physicians care for women and are often the first to detect thyroid disease. Many are comfortable managing thyroid conditions like thyroid disease and women's hormonal health are closely interconnected.

Endocrinologists are physicians who focus their practice on the endocrine system (such as the thyroid). Endocrinologists first go through a residency in internal medicine (so they are familiar with primary care) followed by a fellowship in endocrinology.

While endocrinology is the field most closely aligned with thyroid disease, endocrinologists differ in the scope of their practice, with some focused more on thyroid disease and others focused more on conditions such as diabetes, infertility, or obesity.

Oncologists specialize in the treatment of cancer with medications and may be needed by people with thyroid cancer that is not managed with surgery alone (such as anaplastic thyroid cancer).

If a thyroidectomy (partial or total removal of the thyroid gland) is being considered, a surgeon will be needed. Different types of surgeons may focus on thyroid surgery, including general surgeons, ear, nose and throat physicians (ENT), head and neck surgeons, endocrine surgeons, oncology surgeons, and more.

If you need an oncologist or a surgeon, you will know it, as either, you will have a diagnosis of thyroid cancer or a thyroidectomy will have already been recommended to you.

When that's not the case, you may assume that an endocrinologist is a better choice for you than your primary care doctor or OB/GYN. Endocrinologists specialize in the endocrine system, but not everyone with a thyroid condition needs to see one of these specialists. This is fortunate as there is currently a significant shortage of endocrinologists in the United States.

With conditions such as autoimmune hypothyroidism, people may actually receive better care from another specialist simply because they are able to see them more regularly; many endocrinologists' appointments are booked far into the future or they are not taking any new patients.

However, in certain circumstances and when particular conditions are already diagnosed (or suspected), seeing an endocrinologist is a good idea:

• Suspected thyroid cancer
• Grave's disease
• Thyroid eye disease
• Hyperthyroidism
• Goiter or thyroid nodules
• Newborns with congenital hypothyroidism and young children who are diagnosed with thyroid disease
• Secondary hypothyroidism (if a pituitary problem is causing hypothyroidism)
• Thyroid storm
• Uncommon types of thyroid disease, such as chemotherapy-induced hyperthyroidism or medication-induced hypothyroidism
• Subclinical/borderline thyroid disease
• Symptoms of hypothyroidism persist despite "normal" lab tests
• TSH fluctuates unpredictably
• Heart disease along with a thyroid problem

An initial evaluation with an endocrinologist may also be helpful for those with new-onset Hashimoto's thyroiditis and for those who are pregnant or trying to become pregnant with thyroid disease (especially those who are experiencing infertility).

If you do see an endocrinologist, it's important to find one who specializes in thyroid disease rather than another endocrine condition such as diabetes.

Sometimes, only a single visit is needed to confirm a diagnosis and establish a treatment plan.

Once you see a doctor for your thyroid condition, it's a good idea to step back and decide whether or not this is the physician you wish to continue seeing.

Having a list of questions to ask yourself can sometimes make this decision a bit more objective. You probably won't be able to get everything you want in one thyroid doctor, so it's helpful to decide what is most important to you, as well as what is realistic.

• Does your doctor seem compassionate and interested in your concerns?
• Does your doctor receive messages and respond to calls or requests for refills promptly?
• Is your doctor open-minded, willing to listen and explore your ideas about treatment?
• Does your doctor carefully review any information you bring her? With medical journal articles available online, as well as access to literature from professional organizations, many people living with chronic conditions are well versed in their conditions and may even know more about certain details. Does your doctor recognize this and respect your input?
• Does your doctor recommend treatments or remedies only available through her? This is not always bad but should lead you to ask more questions.
• Does your doctor focus on how you feel, rather than simply treating you based on your lab test results? Tests (such as your TSH) are only part of the equation in knowing whether your thyroid dosage is too high or too low.
• Does your doctor listen without interrupting? For example, is she looking you in the eye or typing on her keyboard? Does she give you time enough to ask all of your questions? 
• Does your doctor seem to remember you (or at least appear like she has reviewed your chart)?
• Does your doctor look at other aspects of your medical history?
• Does your doctor treat you with respect and include you in decision making or is she patronizing? Does she discuss all options for treatment?
• Is your doctor willing to admit uncertainty when she doesn't have a solid answer?
• Do you feel like your doctor is your partner in living your best life?

You may wish to get a second opinion when you are first diagnosed, or even when you've been living with a thyroid condition for decades. Even if you have a doctor you trust, doctors all have different interests, and sometimes it's simply helpful to have a fresh opinion. While there is a "standard of care" when it comes to treatment, thyroid disease treatment is complex and the guidelines leave room for clinical interpretation.

If your doctor seems upset that you want a second opinion, this is all the more reason to get one. Examples of specific situations in which a second opinion might be a good idea include:

• Radioactive iodine has been recommended for Grave's disease: The United States is the only country where this is recommended as a first-line treatment, and it's important to be aware of the alternatives before you make your decision.
• You have symptoms of a thyroid problem, but have been told your tests are normal
• You have a fine needle biopsy for a thyroid nodule that is indeterminate: This doesn't necessarily mean surgery is necessary, and there are other tests that can be done to diagnose thyroid cancer that not all doctors are familiar with.
• Radioactive iodine is recommended after thyroid cancer: Newer research says this is not always necessary and that it can increase cancer risk.

If you're still questioning whether or not to take that step, listen to what other people with thyroid disease have to say about it; you can likely connect with some via social media or support groups.

There are many ways to find doctors to consider, but personal recommendations are a great place to start. If you have friends or family members with thyroid problems, you can ask about their experiences. Online thyroid communities may also yield suggestions of doctors who treat thyroid disease in your area. People in these forums are often passionate about thyroid conditions and familiar with the physicians who are, too.

To broaden your search even further, consider referencing databases provided by professional organizations, which allow you to search by specialty and location:

• The American Thyroid Association
• The American Association of Clinical Endocrinologists

If you have thyroid cancer, especially an uncommon type such as anaplastic thyroid cancer, you may need to travel to a larger cancer center (such as a National Cancer Institute-designated cancer center) to find a specialist who is considered a thyroid cancer expert.

While online ratings for anything can be helpful, they can also be misleading. It's especially important to keep this in mind when it comes to reviews of doctors.

For example, a good rating may be owed to a receptionist's friendliness rather than the physician's abilities, while a bad rating may stem from a patient projecting frustration with their condition on to the doctor. A doctor may receive a very low rank because it takes a while to get an appointment or they are always late. However, that same doctor may be excellent in terms of the care they provide and may always willing to answer every question you have, even if your appointment time is up.

If you do look at reviews, try to read the comments rather than simply glancing at ranks and scores.

Once you know what type of doctor you wish to see, there are several things to consider before you make your appointment. This is an important decision for several reasons. Not only is thyroid disease something that often requires long-term care, but it isn't always easy to treat—and working to find an effective treatment can make a difference in outcomes.

Everyone is different when it comes to the type of care they wish to receive. Some prefer care that is as close to home as possible, whereas others are willing to drive a significant distance to see someone with a great passion for treating thyroid disease. Some people want a doctor who is always on time, but others might trade an hour in the waiting room for a doctor with an excellent bedside manner.

Taking the time to review your health insurance policy before making an appointment may end up saving you a lot of money. Many insurance companies cover a wide range of providers, but in different tiers, with lower copays and better coverage for first-tier providers. This doesn't mean that you can't see a second tier or out-of-network provider, but the cost of doing so will likely be higher.

Many of the more "open-minded" physicians when it comes to thyroid disease operate on a self-pay only basis. If you can afford it, just a few visits with a truly knowledgeable thyroid doctor could mean returning to wellness sooner than you might under the care of another physician. That said, if you are being treated and feel that the treatment is successfully controlling your symptoms, sticking with your insurance coverage is probably a wise financial decision.

Since the treatment for many thyroid conditions is ongoing, you need a doctor you can trust and talk with. Even if your answer is "yes" to all of the questions above, you may still feel that your doctor doesn't fit your needs. Different people appreciate doctors with different personalities, and it's OK to find a doctor who meshes with yours.

Keep in mind that you are a client and have the right to choose the type of service you want. Above all, remember that you are never "stuck" with a physician. If you are unhappy with the doctor helping you manage your thyroid disease, you have every right to get a second opinion—or switch altogether.

With a chronic condition like thyroid disease, your relationship with your doctor is crucial for the optimization of your thyroid management. Once you have established care with a thyroid doctor, continue asking questions about your condition and following up with your doctor as advised.

A true partnership with your thyroid doctor takes time to build but is worth it. There is no such thing as a perfect doctor, but by taking the time to figure out what is most important to you in a patient-doctor relationship, you're more likely to find the doctor you want and need.