Is Your Doctor Telling You the Truth About Your Thyroid Treatment?

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Is your doctor telling you the truth about your thyroid treatment?. istockphoto

Here's the situation: You've just been diagnosed with a thyroid condition, and the doctor says that he or she will write you a prescription, schedule Radioactive Iodine RAI) treatment, or refer you to a surgeon. If you ask if there are other options to the recommended treatment, the doctor brushes you off. The implication is that the doctor is telling you what you need to do and there are no options.

The subtle message? "Who's the doctor here?" Sometimes, the doctor even says it. Is your doctor telling you the truth about your treatment options?

It's a question thyroid patients need to ask, because some physicians, including endocrinologists, either aren't aware of options, are biased toward particular options, or feel that patients simply should not have a choice.

Take a look at some of these situations, and make sure you do your homework to know your options!

You're Hypothyroid, and the Doctor is Prescribing a Levothyroxine Drug

If you're hypothyroid -- have an underactive thyroid, or a thyroid that has been surgically removed, or ablated after RAI -- you will be prescribed a thyroid hormone replacement medication.

Conventional medical guidelines dictate that doctors treat hypothyroidism with the synthetic form of the T4 hormone -- known as levothyroxine (i.e., Synthroid, Levoxyl, etc.) What you should know, however, is that there are other options, including:

  • The addition of a T3 drug -- either liothyronine (synthetic T3) like Cytomel, or a time-released T3 from a compounded pharmacy
  • Natural desiccated thyroid drugs, the prescription drugs derived from the dried gland of pigs - also known as porcine thyroid. Brands include Nature-Throid, Armour, and WP Thyroid.

    Some patients do better with the addition of T3 or a natural desiccated thyroid drug, and while some doctors are not comfortable prescribing natural thyroid, research has shown that natural thyroid is as safe and effective as levothyroxine.

    You Have Graves, or are Hyperthyroid, and the Doctor is Recommending Radioactive Iodine (RAI) Immediately

    If you have been diagnosed with Graves' disease or hyperthyroidism, some doctors will tell you that the only treatment option is Radioactive Iodine ablation, known as RAI.

    Ablation of the thyroid gland with Radioactive Iodine (RAI) is almost always a permanent treatment that deactivates the thyroid gland's ability to produce thyroid hormone, and leaves you hypothyroid for life. While RAI is necessary in some cases, it's important to know that there are some key considerations.

    • Patients with Hashimoto's disease, an autoimmune condition, can sometimes have temporary periods of hyperthyroidism, even though the thyroid typically slows down and becomes hypothyroid eventually. Unfortunately, I have heard from many patients who did not have enough tests to determine if their hyperthyroidism was a "phase" of Hashimoto's disease, and were rushed into RAI unnecessarily. Make sure that your doctor has done a Thyroid Peroxidase Antibodies (TPO) test, Thyroid Stimulating Immunoglobulins (TSI), as well as an uptake test, to firmly establish hyperthyroidism.
    • In some cases, antithyroid drugs can be used to treat hyperthyroidism, and some patients will experience a remission from hyperthyroidism. In some cases, they may even be able to go off their antithyroid drugs, and continue in remission from hyperthyroidism.
    • If you are a woman of childbearing age, you should not get pregnant until a year after RAI. If you are interested in becoming pregnant more quickly, thyroid surgery may be a better option.
    • RAI carries some longer-term risks of radiation-induced cancers.

    You Have an Indeterminate or Inconclusive Fine Needle Aspiration (FNA) Biopsy, and Your Doctor is Recommending Surgery

    If you have a suspicious thyroid nodule, doctors typically order a Fine Needle Aspiration (FNA) biopsy of your thyroid nodule(s). While some nodules will come back as conclusively benign, and a small percentage are cancerous, some nodules are deemed "indeterminate" or "inconclusive." The pathology is not clearly cancerous or clearly benign.

    In this situation, some doctors immediately recommend thyroid surgery, known as thyroidectomy, to remove the thyroid gland. At that point, further pathological analysis is done to determine if you have thyroid cancer. Unfortunately, a substantial number of patients who have indeterminate nodules who go on to have thyroid surgery discover after further analysis that their nodules were in fact benign. At that point, however, they have no thyroid gland, and are permanently hypothyroid, and need to be on thyroid hormone replacement for life.

    Many doctors are still not aware of a test, called the Veracyte Afirma Thyroid Analysis. This test virtually eliminates inconclusive or indeterminate results from FNA biopsies, and prevents unnecessary thyroid surgery.

    You Have Thyroid Cancer and the Doctor Has Ordered Radioactive Iodine Treatment

    When a patient has diagnosed thyroid cancer, treatment typically involves thyroid surgery to remove the gland. In many cases, after surgery, doctors recommend patients receive RAI to ablate any remaining remnants of thyroid gland that may be left behind by the surgery. As noted, RAI carries some risks of radiation-induced cancers.

    The latest research shows, however, that many patients with papillary thyroid microcarcinomas -- very small instances of papillary thyroid cancer -- don't benefit from RAI.

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