Ten Questions to Ask About Your Thyroid Health

A Look at the AACE 2015 Thyroid Awareness Campaign Flyer

Mary Shomon

As part of the January 2015 Thyroid Awareness Month campaign, the American Association of Clinical Endocrinologists (AACE) has released a PDF flyer, titled Ten Questions to Ask About Your Thyroid Health. The "Ten Questions" effort is a companion to AACE's utterly inexplicable "Same, Same, Same" awareness campaign initiative.

It's always surprising to see how tone deaf and disconnected the AACE seems when they roll out their awareness campaigns each year.

And this year's "Ten Questions" list is no different.

I've taken a look at their ten questions, along with my comments and thoughts.

AACE'S Ten Questions to Ask About Your Thyroid Health

What to ask your Physician (according to the AACE):

AACE: 1) Where is the thyroid located, and what does it do?

This is a basic question. But given that most patients have about 7 minutes during an appointment, is this really the best use of a patient's limited time?

AACE: 2) What are the differences between hypothyroid and hyperthyroid patients and what are the symptoms of each?

Assuming that the doctor suspects that the patient is hypothyroid OR hyperthyroid, what is the point of explaining the differences between two opposite conditions? Better that the doctor spend valuable and limited time explaining the actual condition being diagnosed.

AACE: 3) What is Thyroid Stimulating Hormone (TSH), how is it measured, and what should my target number be?

A reasonable question, except that many doctors don't even agree on the target number. Conventional endocrinologists believe that any number within the normal "reference range" for TSH -- typically, from about .5 to 5.0 -- is normal, and doesn't warrant treatment. Integrative physicians believe that levels above 3.0 may be indicative of hypothyroidism.

Some doctors also test for thyroid antibodies, and consider elevated thyroid peroxidase (TPO) antibodies, even when TSH is within the normal reference range, to be evidence of Hashimoto's disease, warranting treatment. Most endocrinologists do not feel that testing for TPO antibodies is useful or necessary.

AACE: 4) What else besides TSH levels are important for making sure my thyroid condition is under control?

A good question. Unfortunately, most endocrinologist will say that nothing else is important.

AACE: 5) Why are more people than ever being diagnosed with thyroid cancer and should I be checked for it?

Given that only about 60,000 people were diagnosed with thyroid cancer in the US in 2014, this question would be relevant for patients who have thyroid nodules that the physician deems suspicious. Otherwise, it seems to be raising a needless concern.

What to ask your Pharmacist: (according to the AACE):

AACE: 1) What is the difference between a generic thyroid hormone pill and a brand name thyroid hormone pill?

This question appears to be obvious pandering to the big drug companies that make brand name thyroid pills -- the same companies that fund the AACE. Because the answer is that generic thyroid hormone pills are considered equivalent to brand names.

There is a few differences -- differences that pharmacists aren't likely to mention. They include:

  • Synthroid brand levothyroxine contains acacia and lactose, which cause sensitivities in some patients
  • The Tirosint brand of levothyroxine is a liquid capsule, and is hypoallergenic, and is designed for people who are sensitive to dyes and fillers, or who have digestive/absorption issues

The only concern with using generics is that different generic levothyroxine drugs may have different potency levels. With generics, you can get a refill from any manufacturer whose product is in stock. So each refill can vary in potency.

If your pharmacist can give you drugs from the same generic maker each time, there is no concern.

AACE: 2) Will you notify me in advance if you switch my thyroid medicine from the brand name I normally use to a generic?

Ideally, they would, but many pharmacists don't. And some pharmacies, such as the big mail-order pharmacies operated by insurance companies, make it nearly impossible to get brand name drugs, or to request a specific generic manufacturer.

AACE: 3) What time of day is best to take my thyroid hormone pill?

A good question. Typically, it's recommended that you take your thyroid medication in the morning, at least an hour before eating or drinking coffee, and at least three to four hours apart from taking medications or supplements that contain iron or calcium. Some patients have found that they do better, however, when taking their thyroid medication at night, or splitting doses during the day - something few pharmacists will mention.

AACE: 4) May I take my thyroid medication with food, other medications, vitamins or supplements?

Again, a good question. See 3) above.

AACE: 5) Can any of my other medications affect my thyroid?

Pharmacists should be able to provide a detailed list of any interactions with current prescription medications, and outline any thyroid-related effects of your prescriptions.


Mary Shomon's Ten Questions to Ask About Your Thyroid Health

As a patient advocate, here are the ten questions I believe patients should ask about their thyroid health.

1) What do you feel is the top cutoff point for the TSH reference range?

2) What do you consider to be an optimal TSH for relief of my symptoms?

3) Do you run Free T4, Free T3, and thyroid antibodies tests as part of your diagnosis and follow-up treatment?

4) If I have TSH levels in the normal reference range, but elevated thyroid peroxidase (TPO) antibodies, will you treat me?

5) Do you consider optimization of the Free T3 level to be part of your treatment approach?

6) Do you prescribe only levothyroxine for thyroid hormone replacement, or are you willing to add T3 drugs, or prescribe natural desiccated thyroid drugs, for my hypothyroidism?

7) Will you order an ultrasound of my thyroid, to evaluate it for enlargement, atrophy, or nodules?

8) If I require a fine needle aspiration biopsy of a suspicious thyroid nodule, will you use the Afirma Thyroid Analysis test to minimize the chance of an indeterminate or inconclusive test result?

9) If I am diagnosed with Graves' disease, will you offer me a trial of antithyroid drugs before you recommend Radioactive Iodine (RAI) treatment to permanently ablate my thyroid and make me hypothyroid?

10) If I still have symptoms after you've prescribed treatment, will you work with me to optimize my treatment, or recommend I see a psychiatrist?