Hypothyroidism is a condition in which the thyroid glands are unable to produce adequate amount of thyroid hormones. These hormones are important in maintaining the metabolic rate and energy levels of a person. In some cases, the person may go to a general practitioner for first visit who will then refer to an endocrinologist, a doctor who specializes in diagnosing and treating diseases of endocrine (hormone-secreting) glands of the body.
If you have been recommended to an endocrinologist, the chances are that your case is not run of the mill and may be unusual or complicated.
Usually, your first visit to an endocrinologist will help you get a better understanding of your condition and involves a discussion of the next steps to address the concerns. It generally involves a lot of questions from both the doctor and you, and in some cases few tests. It is important to make the most of the visit by going prepared.
What are the preparations for an appointment with the doctor for hypothyroidism?
- Before any doctor visit, ensure to write/note down the symptoms that you are experiencing. Do include even those, which you think are unrelated to the reason for which you are seeking an appointment.Nothing is too insignificant to be mentioned. Notes ensure that you discuss every concern and don’t forget key symptoms so do it diligently.
- Note down personal information including any major changes in life like trauma or stress.Often stress related abnormalities could mimic disease related symptoms so it is important to rule it out.
- Keep a copy of the prescription or note down the medications that you are currently taking.Also include vitamins and supplements you may be taking. It may be a good idea to share any previous medical history.
- Make a note of all the queries that you have regarding the condition or the visit.Ensure you include all your concerns even minor ones.
What happens during the visit?
It is common for the doctor to start the appointment by going through your medical history to get a better understanding of your affliction.
The doctor will take a complete medical history based on responses to questions. This includes questions like
- Family history of thyroid diseases
- History of thyroid surgery
- History of radiation treatment for cancer
- Other medications used
- Other medical conditions
The doctor will do a thorough physical examination of the thyroid glands to check the thyroid gland and for presence of symptoms. The doctor may feel your throat or neck to check for enlargement of glands. Doctor will check heart, eyes, hair, skin, and blood pressure. They may also test Achilles reflex by tapping at the back of the ankle. Slow reflex time in Achilles reflex test is specific to patients with hypothyroidism.
Blood tests are also recommended to check for the levels of thyroid hormone in the blood. Tests include
- Thyroid stimulating hormone (TSH)
- Free thyroxine (FT4)
- Free triiodothyronine (FT3)
Further tests for anti-thyroid antibodies (Thyroperoxidase or TPO) are suggested if the blood test suggests hypothyroidism or subclinical hypothyroidism. TPO is also recommended if there is a family history of autoimmune disease. A test for antibodies for thyroglobulin is also suggested for some. In some patients the blood levels of hormones may not suggest hypothyroidism, and these patients may be asked to go for a retest at a later date.
It is important that you partner your doctor and not just take instructions. You are the one going through the problem so it is only fair that you understand it thoroughly. Don’t evade the subject and hope it will disappear with medication. More often than not, it is noticed that when the patient is also involved in the process of determining the best solution, the treatment tends to work better.
Some questions that you can ask the doctor during the visit
- Risk factors of hypothyroidism
- Possible causes of the condition
- Chances of the condition worsening over time
- Time line for blood tests or other screening tests
- Available treatment methods
- Lifestyle changes needed
- Possibility of other medical conditions
- Chances of children getting the disease
- Time line to check for dosage change
- Activities that should be limited or altogether avoided
- Alternative therapies that could help
- Any precautions to be taken
Ensure you make the most of your appointment with the doctor. Be honest and do not hold back from discussing every single concern you have. The concern may seem silly but if it has been nagging you it is worth discussing. The first visit is the best time to share all your worries and get a clearer picture of the illness that is ailing you. In most cases, doctors understand your anxiety and are very patient. They don’t mind discussing your concerns in great detail if they feel it can help. Capitalize on the opportunity.
What are the next steps after first visit?
In some patients the actual cause of the disease may be difficult to determine. In such cases, follow-up visits may be required to check for other diseases that may affect the production of thyroid hormones. Other tests including ultrasound scan, magnetic resonance imaging (MRI), or CT scan may be recommended.
It is imperative that all tests are duly conducted before deciding on a way forward. Nothing is worse than a misdiagnosis.
In most of the cases, thyroid medications are recommended only after the second blood tests which show a drop in the level of thyroid hormone. Treatment program may be initiated only after identifying the cause and confirmation of the diagnosis. One should remember to ask about the different options available in the treatment of hypothyroidism.
After your doctor and you have decided on a course of action and treatment is initiated, it is generally found that symptoms subside and you feel much better. It has been seen that supplementing treatment with additional vitamins and dietary changes can help speed recovery. It also helps if you support your body during the healing process with regular exercise and a healthy lifestyle.