7 Questions About Thyroid Disease You Need to Ask

The Answers Could Change Your Health and Life


Many thyroid patients are up on the latest information about research, medications, supplements, and nutrition. But even the savviest patient may not know to ask some of these key questions about thyroid disease that can finally help us feel well and live a better life.

1. Are You On the Right Medication for You?

Most thyroid patients—whether you have had your thyroid irradiated (RAI) for hyperthyroidism, surgically removed for thyroid cancer or nodules, or it's slowed down due to autoimmune disease—end up hypothyroid. That means you'll need to take thyroid hormone replacement drugs. Commonly, most doctors prescribe a levothyroxine drug, a synthetic form of thyroxine, the T4 hormone. (Common brand names include Synthroid, Levoxyl, and Unithroid and Tirosint.)

Research has shown that the majority of hypothyroid patients actually prefer a combination therapy of T4 and T3, the active thyroid hormone. This can be achieved through the addition of a synthetic form of T4/T3 drug treatment. The generic term for the T3 drug is liothyronine, and the brand is Cytomel. T3 is also available by prescription from compounding pharmacies in time-released form. Another option is natural desiccated thyroid (NDT), the dried thyroid gland of pigs, also known as porcine thyroid. The most common brands are Nature-Throid, Thyroid WP, and Armour Thyroid. There is also a generic NDT made by Acella.

There is no one right medication for everyone. The best thyroid hormone replacement medication for you is the one that safely and best resolves your symptoms. But you should consider whether or not you might benefit from the addition of T3 or natural desiccated thyroid.

2. Are You on the Right Dosage of Medication for You?

Not only do you need to be on the right medication for you, but it's important that you are not only medicated to levels that fall in the normal/reference range, but instead, that your levels are "optimal." Broadly, optimal thyroid levels tend to be:

  • A TSH below 2.5
  • A free T4 in the top half of the reference range (can be lower if you're on a T4/T3 combination drug treatment)
  • A free T3 in the top half, or even the top 25th percentile, of the reference range

If you have elevated TSH levels, or low free T4 and/or free T3 levels while on treatment, and are still experiencing hypothyroidism symptoms, you may have room for improvement in terms of dosage of your medications.

3. Should You Change Your Diet?

Some thyroid patients find it difficult to stay regulated on their dosage of thyroid hormone replacement medication. Others can't lose weight. Some people have joint and muscle aches and pains that continue despite treatment. And still, others experience constant bloating and skin irritations. Even if your treatment is optimized, if you continue to have these kinds of symptoms, your diet may be to blame.

For example:

4. Are You Getting Enough Sleep?

You may find, even with optimal thyroid treatment, that you still feel fatigued. The most common cause is the most obvious one: lack of sufficient, good quality sleep. If you are experiencing fatigue, make sure you work with your practitioner, and practice good sleep hygiene, to get at least seven to eight hours of sleep per night.

This is even more essential if you are trying to lose weight, or are have been diagnosed with adrenal imbalances.

In addition to getting more sleep, here are some other fatigue-fighting secrets.

5. Are Your Ferritin and Vitamin D Levels Too Low?

Ferritin—the stored form of iron—is crucial to proper thyroid function. On a reference range of 20 to 100, many integrative doctors recommend that ferritin levels be at least 50 for proper hormonal function. If you are experiencing hair loss, the recommendation is that the level is at least 80. You can have a blood test for ferritin performed, and discuss iron supplementation with your physician if necessary. Remember, though, that if you supplement with iron, you should take it at least three to four hours apart from your thyroid hormone replacement medication.

Vitamin D is now known to be more than just a vitamin, it's a prohormone. And it has an important role in immune health and weight loss. On a reference range of 20-100, many integrative doctors recommend that Vitamin D levels be at least 50 or higher.

6. Are Your Adrenals Imbalanced?

Did you start on thyroid treatment, feel better, and then a few weeks later, find that you've regressed or even crashed, symptom-wise? Do you find that you can't tolerate even small increases in thyroid medication without feeling jittery and anxious? You may have some sort of imbalance in your adrenal glands - the glands that produce stress hormones and help the body manage stress. Imbalances or insufficiency in the adrenals can cause a backslide in thyroid symptoms after you've started treatment, or make you intolerant to thyroid medication.

Integrative physicians typically recommend that you have adrenals tested with the 24-hour saliva cortisol/DHEA test, and imbalances can sometimes be corrected with supplements along with nutritional and lifestyle changes. Substantial adrenal insufficiency may sometimes be treated with prescription hydrocortisone medication.

7. Are You Being Treated by the Right Doctor?

Endocrinologists are physicians whose specialization is in diseases of the endocrine system, including diabetes, infertility, polycystic ovary syndrome (PCOs), and thyroid disease.

Endocrinologists are, however, in extremely short supply in the US and worldwide, and many of them focus their practice primarily on diabetes diagnosis and treatment. For suspected or confirmed thyroid cancer, Graves' disease, nodules, and goiter, it's important to see an endocrinologist who specializes in thyroid issues.

But for diagnosing and treating Hashimoto's disease, or diagnosing and managing sex hormone, thyroid, or adrenal imbalances, an endocrinologist may not be the best choice. Many patients find they are better served by an integrative physician (a physician who combines conventional as well as holistic medicine). Other physicians that specialize in managing hormone imbalances can include primary care doctors, GPs, internists, gynecologists, osteopathic physicians, naturopathic physicians, and nurse practitioners who specialize in women's health issues.

A Word From Verywell

Keep in mind that even when you're frustrated, you shouldn't give up on your effort to improve your health and resolve your symptoms. 


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