From Primary Care to Endocrinology

Chances are, the first doctor you'll see is your primary care doctor. You might go in complaining of fatigue and weight gain, or you may go in after you've noticed a bump in your neck. Alternatively, you may be on a routine physical exam when your doctor detects an abnormal lump in your thyroid. In any case, your primary care doctor is often your first stop on the way to diagnosing and treating your thyroid troubles.

Some cases of thyroid disease go no further than your primary care doctor, who may be perfectly qualified to detect the source of your thyroid problems. Some primary care doctors are suitably qualified to treat an under- or overactive thyroid. These doctors are often internists, who specialize in internal medicine; family practitioners, physicians who treat families; or general practitioners.

Some people have as their primary care doctor an osteopathic physician (DO). Osteopathic doctors are trained just like medical doctors and are able to prescribe medications and perform routine examinations. What makes Dos different from MDs is that their training emphasizes viewing the body as an integrated whole.

What is a thyroidologist?

It's arguable whether the term thyroidologist is real. There is no board certification to be a thyroidologist, only for endocrinologists. But doctors who call themselves thyroidologists specialize in disorders of the thyroid. Endocrinologists can treat the entire endocrine system but may specialize in one aspect of it. If your primary doctor suspects you have a more serious thyroid problem, she may feel more comfortable sending you to a specialist, usually an endocrinologist.

Meet Your Endocrinologist

Endocrinologists specialize in the treatment and care of hormone disorders, such as thyroid disease, reproductive disorders, and diabetes. For many people with thyroid disease, an endocrinologist is their primary care doctor — the first one they call when something goes wrong with a new drug or when they feel symptoms.

Becoming an endocrinologist requires rigorous medical training. After four years of medical school, an endocrinologist must spend three or four years in an internship and residency program. Beyond that, they focus exclusively on hormonal disorders for another two or three years before becoming board certified in endocrinology.

Many endocrinologists are fellows of the AACE, a membership that is signified by the initials FACE. However, not all endocrinologists are knowledgeable in thyroid disease. Rather, they may specialize in diabetes, lipid disorders, or reproductive endocrinology.

Many academic endocrinologists are members of the Endocrine Society, the professional arm of the Hormone Foundation. This prestigious organization hosts yearly meetings that expose endocrinologists to the latest research.

Certain people with thyroid disease are more apt to need the services of an endocrinologist than others. These include people who have:

  • Mild hypothyroidism

  • Hypothyroidism due to a pituitary disorder

  • Graves' disease

  • Thyroid nodules

  • Thyroid cancer

  • A condition that requires thyroid surgery

Others may simply prefer to see an endocrinologist if they develop thyroid disease. After all, an endocrinologist is generally more familiar with disorders involving the hormones than most other physicians are.

If you want or need to see an endocrinologist, you can probably ask your primary care doctor for a referral. But you may also want to ask friends, family members, and other people with thyroid disease for referrals. You can also look for an endocrinologist on the Internet or in chat rooms about thyroid disease. Many doctors now have their own Web site and frequently communicate with patients by e-mail.

Ideally, you'll find a good doctor you genuinely like, since thyroid problems can last a lifetime and will require lifelong maintenance.

What Makes a Good Endocrinologist?

Not all doctors are created equal. Some may be technically competent but lack the people skills that prompt patients to open up about embarrassing but important symptoms. Others may be great communicators but neglect to stay on top of the latest developments in endocrine research. When it comes to finding the best endocrinologist to treat your thyroid disease, you want one who is both skilled and compassionate, namely, someone you can trust.

Essential

Love your doctor? Nominate him on Mary J. Shomon's About.com site. The site allows you to click on a state and read what other patients have to say about their doctors. It also gives the top docs' addresses, phone numbers, and e-mail addresses.

It isn't always easy to find someone who meets those high standards. Some doctors treat their patients according to the results of their lab tests, while others are more inclined to consider a patient's symptoms only. Ideally, you will find a doctor who considers both factors in making a diagnosis and deciding on treatment.

Doing some research before you start seeing a doctor can help you find a good physician. After all, having a chronic condition means you'll be seeing a lot more of the health-care profession. It will also mean working more closely with your doctors on matters important to your well-being.

So even if the doctor comes to you from your mother, you may find him unsuitable in ways that don't bother your mom.

Some good questions to ask his staff include:

  • Does the physician specialize in the treatment of thyroid disease?

  • Does he already have many patients with thyroid disease?

  • Does he have a long waiting list?

  • What kinds of alliances does the physician have with other health-care professionals? Is she plugged in to a network of other medical professionals or affiliated with a good hospital?

  • Are there other people in her practice who can assist in your care?

  • What kind of health insurance does the doctor accept?

  • Would it upset him if you sought a second opinion?

  • What does he think of alternative therapies?

  • How convenient is the office to your home or workplace?

On your first few encounters, take note of the doctor's communication skills. Does he speak clearly, in words you understand, and answer your questions? Does he make you feel comfortable in his presence? Does he call back when you need assistance or information?

Also, take note of the office support staff. Schedulers, nurses, and assistants who are courteous and respectful can make a big difference in how well you do with your doctor. They can also affect how likely you are to see your doctor when you really need him.

Keep in mind, too, that the best doctor may not be the one who is closest to you. In more complicated cases, you may need to travel quite a distance to find the best doctor.

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