2. Thyroid Series - Getting the Right Treatment

So one of the biggest challenges once you are pretty sure you have a thyroid problem, and/or you've got lab work to prove it, is finding a good doctor.  Understand that pre-T3 treatment, you're at your lowest ebb, and if you don't think you have the energy to thoroughly research your thyroid specialist, then enlist the help of friends and family. 

The care you need

More on this another day but the key things you need to know are (a) that for all forms of hypothyroidism T4 (synthroid/levothyroixine) only doesn't work, you need someone to prescribe T3 or Armor thyroid (b) most endocrinologists will be useless and (c) if you have Hashimotos, the best immune modulating drug out there is Low Dose Naltrexone, and you need someone who will prescribe it.

In short what you need is someone who is unfortunately going to be expensive, and almost definitely not in network (for the US) or with BUPA (in the UK).  Finding them however can be a real trick, and its worth the effort, because there is nothing more time consuming or expensive than a doctor who doesn't know what they're doing.

This has some very general advice on finding a doctor http://www.stopthethyroidmadness.com/how-to-find-a-good-doc/

How to pick a doctor

But your best bet is to start with http://www.thyroid-info.com/topdrs/index.htm 
If you're in California then see if you can get to a Holtorf clinic http://www.holtorfmed.com/
If you're near one of the Fibro & Fatigue clinics try them http://fibroandfatigue.com/

Then when you've short listed some doctors, phone up and ask (a) do they prescribe T3 and (b) if you have Hashimotos, do they prescribe Low Dose Naltrexone.  If they don't, scratch them off the list and move on.  You may end up having to fly/travel a long way for your care, but once you're a regular patient most doctors will allow you to do some appointments by phone.

I would recommend going in with labs to make sure the first appointment is as efficient as possible - if your primary care won't order the basic panel of FT3, FT4, TSH, RT3, thyroid antibodies, then you can order them directly. Ferritin, B12, D3, free and total cortisol, DHEA, Pregnelone, Serotonin, sex hormones and a basic CBC and metabolic panel are also helpful.

Try here for ordering your tests https://www.mymedlab.com/
STTM also has prearranged panels (see down the bottom of the page) http://www.stopthethyroidmadness.com/recommended-labwork/
Mary Shomon also has some panels you can order https://www.mymedlab.com/mary-shomon-profiles/shomon-thyroid-baseline-br-with-expert-review

Endocrinologists

I'm not totally against endocrinologists for thyroid problems, particularly the old school ones who started training or were trained by someone who predated the switch from treating with dessicated thyroid to T4 only.  I'm a great fan of the endocrinologist I saw in Colorado, who was the first person who prescribed T3 for me, who sympathized with what I was going through, and was interested - could describe to me how I probably got hashimotos without a family history (great for my sanity) and also had some theories on why I had always got better when up in the Colorado Rockies.

However, the majority of endocrinologists are arrogant, careless, and really trained to treat diabetes not thyroid issues.  The only thing diabetes and thyroid issues have in common is that they both relate to endocrine hormones.  In Type 1 diabetes the auto immune attack stops when you lose all the insulin producing cells in your pancreas, in Type 1 Hypothyroidism/Hashimotos, the immune attack never stops, will attack bones, cartilage etc as well as being triggered by your replacement thyroid meds - managing the auto immune piece of Hashimotos is key.  They also tend to be T4 only and they come out with complete nonsense - I heard of one describing T3 as being like speed - T3 would be a hormone your thyroid used to produce and your organs can convert T4 into, there is frankly no good argument for not supplementing with T3.  They also tend to be ovely focussed on TSH, when the key lab result is actually FT3.

Private Primary Care/GP

You're also probably going to need a concierge/private primary care/GP.  The issue being that once your thyroid levels are out of wack, you're likely to pick up knock on problems such as digestive disorders, clotting issues, migraine increases, and joint problems.  Once fully explored you'll probably find out this is down to your thyroid issues, but they'll need to be explored. You'll need someone who is responsive and will co-ordinate all this.