Should I Get a New Doctor?

Every day I see posts in Facebook groups from people who are seeking help with their thyroid medication dosing. Usually they have residual symptoms and don’t believe their treatment to be adequate. Often they are told by another group member to get a new doctor. Is it even possible to get a new doctor in their area? Do they have the finances to seek private care? Is getting a new doctor the only solution?

Where I live in BC, Canada, getting a new doctor is an impossibility. We don’t have enough for the population and we take what we can get. So even if I were to get a new doctor, there is no guarantee the thyroid care would be what I’m looking for. I’m fortunate to have a doctor who supports me, despite the fact that he does not regularly prescribe T3 medication as part of his standard of practice, although he does prescribe it to me after being assessed by an endocrinologist. He is a good doctor, who cares about his patients and is willing to refer to a specialist when necessary. He is open to working with me to be as well as I can be.

I agree there are many doctors who don’t understand us, their patients with no thyroids. They don’t know why we don’t respond to levothyroxine on its own. Often TSH is the only lab test run, and occasionally a free T4 to see if we have enough T4 in our serum. Many doctors have been taught that is all that is necessary, and that raising T4 until the TSH is normal is enough. But some of them are open to learning and why shouldn’t we give them the opportunity to work with us and see if they are willing?

So how can we encourage them to help us? Here are some suggestions and examples:

Explain the problem

Your doctor doesn’t live with you in daily life and it’s easy to respond “not bad” or “fine” when he/she asks how you’re doing. If your dose, or your medication isn’t working well for you, you need to state that clearly. “Doctor, despite taking my thyroid medication as prescribed, and my TSH being in the normal range, I’m still experiencing symptoms of hypothyroidism that I would like to talk about.”

Be clear and specific

“I’m cold all time. Despite following a higher fiber diet, I’m constipated. I fatigue easily and can’t get through a day without several rest periods. There is nothing normal about the way I’m living”. I’ve heard that adding T3 in a physiological dose can be helpful for people without a thyroid gland and I would like to try it”.

Take notes with you to help stay on topic

Notes can be helpful to keep you on track. Point form is best if you’re going into a doctor’s appointment.

Offer new information and research to guide the conversation

Bring something to support your case. Be careful about what you choose – anecdotal information from Facebook groups may not be the best thing to support your cause. Choose articles or books that have been medically vetted. If you are internet savvy, you might find research articles on Pub Med to support your position, or you might find other books and publications your doctor could “get behind”. Remember that the understanding of thyroid hormone action has been changing faster than your doctor’s knowledge may be. Your doctor could very well be interested in what you have to show them.

Be organized – you may have little time to present your information

It’s hard to squeeze everything into your time slot. Some medical systems offer more time than others, but I think most doctor visits are fairly brief. Preparing in advance can help you present a lot in a little time. Be organized with your notes and your research. Start with your opening statement of why you’re there, move on to your solution, and give them your back up information, preferably in a handout that’s highlighted with the relevant information. I remember drawing a rough timeline in pen across a piece of paper once that I gave to my doctor to give him a visual representation of my symptoms. It was the most concise, organized way to present it and it was extremely helpful.

What if it Doesn’t Work?

It’s entirely possible that your doctor may not be willing to change your thyroid therapy. Maybe they aren’t comfortable moving into an area they have no expertise in, or they simply don’t understand thyroid hormones well enough. Remember their training was probably focused around T4 therapy and restoring TSH to normal. Many have no knowledge beyond that.

You could ask for a referral to another doctor who might be able to help. An example could be, “Doctor if you aren’t comfortable with adding T3 to my medication, do you know someone who could help me with that”?

It’s also entirely possible that your doctor won’t listen to your concerns or help you navigate the difficulty of thyroid medication issues. That’s a reality. But I think it’s worth a try. It may be cheaper and easier than finding a new doctor, and you might even come out with a better relationship with your medical care provider as a result. There’s also the chance that if they learn something new, they might apply that knowledge to another patient – you could inadvertently be helping someone else in their journey. Good luck!