Questions to Ask When Interviewing a New Thyroid Doctor

Testing

Do you test Free T3 and Reverse T3 along with TSH and Free T4?
Most desired answer: Yes. I understand the importance. http://www.downsyndrometreatment.net/thyroid.html

Do you look at the ratio between Free T3 and Reverse T3?
Most desired answer: Yes. I want to know how much active T3 is available.

Do you look within the ranges, or do you take symptoms and placement within the ranges into consideration when interpreting labs and making treatment recommendations?
Most desired answer: Yes. I like to see the Free T4 at midrange and the Free T3 in the upper part of the range.

Do you take into consideration the American Academy of Clinical Endocrinologist’s recommendation that the upper level of the TSH range should be lowered to 3?
Most desired answer: Well, of course.

Do you always consider a low TSH as being hyperthyroid or do take pituitary function into consideration?
Most desired answer: I always look to see if the Free T3 is elevated when determining if a
patient is hyperthyroid.

Do you test for all antibodies? TgAb (Hashimoto’s), TPO (Hashimoto’s), and TSI (Graves’.)
Most desired answer: Of course.

Do you perform saliva cortisol?
Most desired answer: Yes. I understand that it provides the measurement of cortisol that is free floating and available for use. I also like to know where the levels are throughout the day.

Do you test iron by checking ferritin as well?
Most desired answer: Yes. I also realize the vast range and prefer to see a ferritin more around 60-80 rather than a low normal.

Most often, you will know by this point how well you will be able to work with a prospective doctor. If it looks promising, you can follow with these questions about treatment:

Treatment

How do you treat hypothyroidism? Using synthetic T4 only, T3/T4 mix, desiccated thyroid, or straight T3?
Most desired answer: I prefer desiccated thyroid and will make adjustments with T3 depending on the balance of the levels and reverse T3 status.

How do you treat low iron?
Most desired answer: Natural iron.

How do you treat a high reverse T3?
Most desired answer: By testing saliva cortisol and tending to iron deficiency.

Do you adjust thyroid treatment dose according to Free T3 levels or TSH? If the TSH goes low and the free T3 is below midrange, will you increase dose?
Most desired answer: I adjust dose according to Free T3 level.

Do you titrate dosing?
Most desired answer: Yes. I start out in 15 mg increments for children and increase every two weeks until the target dose (according to the prescribing instructions) is achieved and hold there for six weeks and retest.

Antibodies

Do you use desiccated thyroid for treatment of antibodies?
Most desired answer: Yes. I will dose to where the Free T3 is in the upper quarter of the range to suppress the thyroid to calm the antibodies.

Do you have dietary recommendations for antibodies?
Most desired answer: Yes. I believe gluten free can help decrease thyroid antibodies.

What other treatments do you use for treating antibodies?
Most desired answer: (Other antibody treatments include diet, IVIG, others).

Do you prescribe LDN for antibodies?
Most desired answer: Yes, if desiccated thyroid and diet have not been able to get antibodies down.

Don’t be too discouraged if your doctor does not answer verbatim to the most desired answer. These are answers we would get in a dream world. The main place to start with any doctor is the appropriate tests. Things can be pieced together after that.

Hope this is handy when it comes to interviewing a prospective doctor.