What is a Thyroidologist . . .and why do I want to consult with one?

For 31 years I have been seeing patients with thyroid conditions. For 5 years I have been answering 30-50 E-mail questions a day from patients who visit my web site, www.thyroid.com. The thing that struck me was very few patients have ever seen a thyroidologist and most do not know they exist. Most thyroid cases are handled by primary care physicians, internists, endocrinologists, surgeons, nuclear medicine physicians, E.N.T., and, in the case of thyroid cancer, oncologists. The above physicians rarely consider sending you to an expert thyroidologist.

Thyroid disease is rarely an emergency, and therefore referral to someone out of town or state is feasible. The diagnosis rendered by a thyroidologist is rarely changed for the rest of the patient's life. The first encounter will label you for life, render a proper thyroid diagnosis, and ensure you proper care.

Here are the signs it is time to see an expert:

1. When you are told there is an abnormal thyroid blood result. When your physician wants to treat you for hypo- or hyperthyroidism, request a consultation first. If he or she feels it is not necessary, it is even more reason to seek an outside thyroid opinion. The most common mistake is failure to get a consultation when the TSH test is abnormal. Both hypothyroidism and hyperthyroidism have abnormal TSH testing, but this is not enough reason for treatment until the cause is known. Treatment by your family physician is a risky thing without a thyroid consultation and a complete thyroid evaluation including ultrasound.

2. When you are told there is a mass in the thyroid. It is best to stop there and get a referral to a thyroid expert before you allow a biopsy, or any further studies.

3. If you fail to see a specialist and get a biopsy by other physicians and are told you need surgery, you still have time to get an expert opinion. A complete thyroid evaluation may turn up reasons for the biopsy results, or after review of the biopsy, render a different diagnosis. The adequacy of the biopsy can be determined and if inadequate for proper diagnosis, a repeat can be performed. Ultrasound-guided biopsy should be the standard in thyroid needle biopsy.  The surgery may not be needed.

4. It is still not too late to see the expert, even when the surgery is set. The thyroidologist will frankly tell you if he thinks the surgery is needed, and if so, if the surgeon is qualified to offer low risk care. He will recommend a thyroid surgeon. Remember thyroid surgery for nodules is not an emergency.  It is elective surgery, and you have plenty of time to be sure it is necessary, and if so, to have the best qualified thyroid surgeon.

5. When you are told you have thyroid cancer. Most people think an oncologist is the right physician to see. Well, that is wrong. The thyroidologist would not think of treating breast cancer with chemotherapy he does not use regularly, but an oncologist thinks nothing of treating thyroid cancer when she is not the best physician, and truly is not an expert with endocrine cancer, (which is treated without chemotherapy drugs oncologists routinely use for other cancers). Thyroid cancer is a thyroid hormone cancer and is best treated by a thyroidologist.  None of the drugs used by oncologists have any use in treating thyroid cancer. Also external radiation therapy is not useful in most cases. The nuclear medicine physician, unless he or she has special training in thyroidology, which is rare these days, is not the best physician to captain your thyroid cancer team. He may recommend excessive radioiodine studies and treatment when it is not always necessary with other modern methods of cancer diagnosis and therapy such as thyroglobulin and high frequency ultrasound. There are newer and better methods that are not related to the use of radioiodine. They make it seem that radioiodine will save your life, but there is little evidence to back that up. It doesn't cure the disease, and may cause leukemia. It has a useful purpose, but thyroidologists weigh the risk/benefit of the use, rather than shotgun use in all cases, which has been the unproven standard until recently.

6. You are told to withdraw from thyroid hormone in order to have radioiodine testing and treatment for your cancer, for up to 6 weeks. You know you were sick the last time, but feel you have no choice. Well, you do have a choice today. Request a second opinion. The thyroidologist will decide if you really need to have the treatment or study. Then, if it is needed, there are modern methods that DO NOT make you sick from hypothyroidism, and allow you to stay on thyroid medication during the testing and treatment.

7. You have thyroid antibodies in your blood, but your physician tells you other thyroid tests are normal. She wants you to do nothing and return in a year. These are great markers for autoimmune thyroid disease, and a consult should not be put off for a year. Request a consultation now, and get one anyway if he refuses to refer you.

8. Pregnancy and post pregnancy are dangerous times for thyroid patients. This is when you need to see a thyroidologist, even if the OB/GYN thinks it isn't necessary.  Some of the problems include: child I.Q. losses due to early pregnancy hypothyroidism in the mother, fetal hyperthyroidism passed to the baby by a mother treated for Graves' disease in the past, changing thyroid hormone dose during pregnancy, improper instructions on neonatal vitamin use with thyroid hormone resulting in hypothyroidism, and hyper- or hypothyroidism occurring postpartum.

9. Modern ultrasound can find the cause of elevated cancer marker, in the face of negative I-131 body scans, MRIs, PET scans and CT scans.[PR1]  Demand to see a thyroidologist with this capability.

10. Demand to have a pre-surgery lymph node check with high frequency ultrasound.  A node can be biopsied and, if positive, cause a change in the surgery plan.

There are many more examples of the value of early consultations with the thyroidologist, but anytime is better than never, as the thyroid gland diseases are long term and intervention at any stage can be very helpful.

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