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QUESTION

What type of tests should I have to see if I have hypothyroidism, and do I need to see a special doctor, or can I see my general practitioner?

DRS. RICHARD AND KARILEE SHAMES ANSWER

Let us answer the second part of this question first. Thyroid tests can be ordered and interpreted by several different kinds of doctors. Almost any GP, internist, or family physician would be an appropriate choice for initiating a thyroid evaluation. Some people seek out or are referred to an endocrinology specialist if their situation seems more complex or more difficult than simple low thyroid.

Keep in mind that endocrinology specialists are among the most conservative, often less than enthusiastic about trying something new and different. They are also often overburdened with life-threatening diabetes cases, and may not have the time to give thyroid the attention you would like.

We believe that having an open-minded, curious, and thyroid-friendly MD or nurse practitioner, or physician assistant, or any other practitioner allowed to order tests and prescribe medicine, can work fine as long as you become activated and articulate in directing your own care.

As for tests, a standard thyroid panel of TSH and Free T4 should be augmented with additional tests of Free T3 and thyroid antibodies. If you are already on medicine, and are doing the tests to determine the optimal dosage, you can drop the Free T4 and the antibodies and simply ask for a TSH and a Total T3 (the Free T3 is best used for making a diagnosis rather than for determining treatment).

Also regarding treatment, if you are taking just thyroxine alone (Synthroid, Levoxyl, Levothroid, or Unithroid) as a single medicine by itself, and you are not doing as well as you'd like, you might consider also running a Reverse T3 to see if your T4 to T3 conversion process has gone awry. (August, 2002)

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Dr. Richard Shames has practiced for over 30 years, written and lectured widely on thyroid-related topics, and is considered an expert in the field. He practices in San Rafael, CA. Karilee Shames has been an assistant professor of nursing, and has led thyroid support groups for many years. In addition to writing their popular book, Thyroid Power, they are regular contributors to Thyroid-Info.com, and provide a service offering thyroid coaching education sessions to consumers nationwide by telephone. For more information, see their site, www.Thyroidpower.com.

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