When You Need an Endocrinologist for Your Thyroid ... and When You Don't
Endocrinologists are physicians who specialize in diseases of the endocrine system. Your endocrine system includes glands such as the thyroid, pancreas, adrenals, and ovaries. Endocrinologists treat diseases that originate in those glands, including thyroid disease, diabetes, and infertility, among others.
When to consult an endocrinologist
There are several situations when you absolutely should consult with an endocrinologist who treats thyroid disease.
When you have suspicious thyroid nodules: If you have thyroid nodules that are growing, affecting your ability to swallow, or impairing your breathing, an endocrinologist should evaluate you. The doctor can then recommend, order, and interpret the appropriate imaging tests, blood tests, and a thyroid biopsy, if necessary, to determine a course of treatment and assess if the nodules are cancerous.
When you have thyroid cancer: If you have been diagnosed with thyroid cancer, it is important to work with an endocrinologist who specializes in thyroid cancer to manage your treatment and follow-up monitoring. Note that general practice physicians, ear/nose/throat (ENT) doctors, and even oncologists often end up diagnosing thyroid cancer. Thyroid cancer is still relatively uncommon, however, and you are likely to have the best outcome if you work with a physician with a depth of experiencing managing thyroid cancer patients.
When you have Graves’ disease: Pinpointing Graves’ disease as a cause of hyperthyroidism requires specialized knowledge of thyroid blood and imaging tests and how to interpret them. Typically, this type of knowledge is unique to endocrinologists. When you have Graves’ disease and/or hyperthyroidism, it’s wise to consider consulting a thyroid-savvy endocrinologist for in-depth evaluation and treatment options.
When you have a symptomatic goiter: Many people with thyroid — both hypothyroid and hyperthyroid — have a small goiter (enlarged thyroid) that is not visible and doesn't impair swallowing or breathing. If you have a large goiter, if it's externally visible or cosmetically unsightly, or if your goiter is affecting your swallowing or breathing, it’s time to consult an endocrinologist.
When your newborn or child has a thyroid condition: If your child is born with thyroid disease — for example, with conditions such as congenital hypothyroidism or transient hyperthyroidism — or if your child is diagnosed with a thyroid condition, it’s wise to consult a pediatric endocrinologist.
Challenges in finding an endocrinologist
There are a number of challenges you may face in finding an endocrinologist.
A severe shortage: According to the American Board of Internal Medicine, as of 2010, there were only 5,811 board-certified endocrinologists in the U.S., and only around 1,000 of them were in active practice, serving more than 6,000 hospitals in the United States. Moreover, the number of new endocrinologists drops each year, leaving the specialty unable to keep up with the increased need around the nation. Even as the number of endocrinologists drops, more are choosing to specialize even further, focusing on infertility/reproductive endocrinology, obesity, or diabetes. Given this shortage, you may find it difficult to get a referral to an endocrinologist, much less find one who is taking new patients.
Long waits: Even when endocrinologists are taking new patients, you can often expect long waits before visiting one. Some people report waiting up to six months or more to get an appointment. Given that there are almost 30 million Americans with diabetes and an estimated 27 million people with thyroid disease, there is stiff competition for a limited number of endocrinologists and appointments.
Where to find endocrinologists
If you have thyroid cancer, a good resource for finding expert physicians is the Thyroid Cancer Survivors’ Association.
Another helpful resource for finding endocrinologists is the American Thyroid Association "Find a Specialist" directory.
The American Association of Clinical Endocrinologists (AACE) also has an online “Find an Endocrinologist” database. Be sure to select “Thyroid Dysfunction” under the category “Endocrine Focus” when conducting your search.
When you may not need an endocrinologist
The majority of people with thyroid disease in the U.S. are hypothyroid, usually due to Hashimoto’s thyroiditis, an autoimmune condition. Most are diagnosed and treated by primary care physicians, general practice doctors, gynecologists, internists, nurse practitioners, physician assistants, or other practitioners.
For straightforward hypothyroidism, most practitioners should be knowledgeable enough to order a thyroid stimulating hormone (TSH) blood test, interpret the results, make a diagnosis, and prescribe the conventional treatment: a levothyroxine drug such as Synthroid or Levoxyl.
There are three situations when you should consider seeking out a practitioner with a more broad-minded approach to thyroid diagnosis and treatment:
- If you have thyroid symptoms and/or risk factors, or a personal or family history of autoimmune disease, but your TSH test result falls within the normal reference range, and your current physician will not consider further testing (antibodies, Free T4, or Free T3).
If you have thyroid symptoms and/or risk factors, and your TSH, antibody levels, Free T4, and/or Free T3 are within the range but not optimal, and your physician will not consider making a diagnosis or trying a thyroid treatment.
If you’re being treated with levothyroxine for your hypothyroidism but still don’t feel well, and your doctor says there are no further testing or treatment options beyond levothyroxine.
You can usually find more broad-minded thyroid care from among a variety of different types of health care practitioners, including:
- physicians who practice functional medicine
- holistic and integrative physicians, including medical doctors (MDs) and osteopaths (DOs)
- licensed naturopathic physicians (NDs)
- gynecologists and practitioners who specialize in hormone replacement treatment (HRT)
- menopause and bioidentical hormone experts
You may also find it beneficial to explore whether available internists, primary care doctors, nurse practitioners, and physician assistants have a personal interest in thyroid diagnosis and treatment.
In addition, here are some other sources to help you in your search for a more broad-minded practitioner:
- American College for Advancement in Medicine - Integrative Physician Finder
- The American Association of Naturopathic Physicians (AANP) "Find a Naturopath" Database
- Lifescript's Doctor Finder: Doctors Who Treat or Diagnose Hormonal Imbalance
- American Osteopathic Association Database
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