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Do You Need an Endocrinologist for Hypothyroidism?

Endocrinology is a specialty that offers advanced training in the endocrine system, which includes various glands and organs that secrete hormones such as the thyroid, pancreas (diabetes), testes, and adrenal glands, among others.  Endocrinologists also commonly treat osteoporosis.  In this article, the first in a series, we will discuss the thyroid gland and more specifically hypothyroidism (an underactive thyroid).

The thyroid gland is a butterfly-shaped organ located in the base of your neck.  It releases hormones that control metabolism, the way your body uses energy.  The thyroid's hormones regulate vital body functions, including your heart rate, body weight, temperature, nervous system, menstrual cycles in women and even has an effect on your cholesterol.

Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough thyroid hormone.  About 5% of the general population in the United States has hypothyroidism, although this number has varied widely in studies and within certain groups of people.  Women, especially those older than age 60, are more likely to have hypothyroidism.  Some studies have shown rates as high as 25% in the older population.  Common symptoms in adults are fatigue, feeling cold all the time, weight gain, constipation, change in voice and dry skin, but clinical presentation can differ with age, sex and other factors.

Most people with hypothyroidism take synthetic thyroid hormone medication to replace what the body is unable to produce.  Frequently, a primary care doctor can manage this condition.

One of the most common questions I get from the public and even sometimes other physicians is, when should a patient be referred to an endocrinologist for hypothyroidism?  Your primary care doctor should be able to help you monitor your condition most of the time.  However, there may be situations when you need the care of a thyroid specialist.  Even within the community of endocrinologists there are doctors that obtain additional training in the study of the thyroid.  We often refer to ourselves as thyroidologists.  Thyroidologists are endocrinologists who specifically study, diagnose, manage and treat the thyroid gland.

So when should you see an endocrinologist or even a thyroidologist?

When you are first diagnosed:  Some experts recommend, and some patients prefer, seeing an endocrinologist at least once when you’re first diagnosed with hypothyroidism to review your condition, your test results and your treatment plan.  In this setting, after a few visits you may not need to keep seeing an endocrinologist regularly and your primary care doctor may resume the care of your condition.

You have an enlarged thyroid gland, or goiter:  A goiter is an enlargement of part or all of your thyroid gland.  If you have one, it is a good idea to see an endocrinologist to help you figure out why it has developed and what if anything needs to be done about it.  Sometimes the entire thyroid gland is enlarged and there are no masses or tumors.  This is referred to as a simple goiter

If you have a thyroid nodule:  Sometimes a goiter contains thyroid nodules.  If you have a nodule, or other growth on your thyroid, an endocrinologist should evaluate it.  Also, sometimes a thyroid nodule may be found on a radiology scan (or by your thyroidologist if they do their own ultrasounds.  More about thyroid ultrasounds in the next article).  Most thyroid nodules are harmless (benign), but once in a while a more serious condition exists.  Thyroid nodules can actually be a cause of an overactive thyroid (hyperthyroidism) or can rarely be cancer.  Any given thyroid nodule carries a roughly five to ten percent chance of being malignant (cancer).  Ultrasounds and thyroid nodules will be covered in the next article, but are treated by a thyroidologist.  Anyone with a thyroid nodule or lump regardless of whether or not they have hypothyroidism should see a thyroidologist.

You are pregnant or are trying to conceive:  If you have an underactive thyroid, your medical care can become complicated during pregnancy or even before conception.  Pregnancy changes your hormone levels in a dramatic way.  If you want to get pregnant or you become pregnant, you should see an endocrinologist to monitor your thyroid hormone medication treatment closely and be sure you are on the correct dose.  Some women require an increase between 20 to 30 percent more thyroid hormone while pregnant.  The proper timing of a change in your dose may be required before the patient even knows she is pregnant.  Untreated or undertreated hypothyroidism increases the risk of miscarriage and other pregnancy complications. 

If you have fluctuating blood levels:  Sometimes patients who have hypothyroidism will have blood levels that seem to change all the time despite regularly taking their medication.   There are other health problems and medications that can influence the absorption and action of thyroid medications or even interfere with the blood tests used to evaluate hypothyroidism.  A specialist may be able to sort through your medical history and develop a treatment plan that stabilizes your blood testing and dosage of medication.

If you have hypothyroidism and your symptoms have not gotten better with treatment:  If you've been taking medication to replace your thyroid hormone for an extended period of time but your symptoms persist, it may be reasonable to see an endocrinologist for a second opinion.  Some people with hypothyroidism have a more difficult time finding the dose or type of thyroid hormone medication that works best for them.  In these situations, a thyroidologist may be able to help.   

A pituitary gland disorder is causing hypothyroidism:  It’s very unusual, but in some people, the brain does not secrete TRH or TSH like it is supposed to and the thyroid is not being instructed to make thyroid hormone as it should.  In other words, the thyroid gland itself is fine but it does not make thyroid hormone if it is not told by the hypothalamus via the pituitary to do so.  This is a complicated condition and an endocrinologist is essential to evaluate and manage this condition.

September is Thyroid Cancer Awareness Month and next month’s feature article will be about thyroid cancer.

By Ian J. Orozco, MD of Carteret Medical Group. Dr. Orozco specializes in Endocrinology and has a particular interest in thyroid disease, parathryoid disease, thyroid cancer and endocrine tumors. He is one of the select few physicians in the nation who holds ECNU - Endocrine Certification in Neck Ultrasound.  Dr. Orozco see patients at Carteret Medical Group in Morehead City and Cedar Point, 252-247-2013, www.carteretmedical.com.

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