First Visit To An Endocrinologist/consultant/GP
The generally accepted approach to diagnosing hypothyroidism is to start with a careful history and physical examination. Any medical practitioner who does not do such an examination should be asked to do so. Your doctor should take your complete medical history and ask you whether there are any members of your family who have a thyroid disorder or other autoimmune disease.
S/he should check your heart, eyes, hair, and skin and take your BP (preferably sitting down and immediately on standing) to see if you drop some points. This could indicate you have low adrenal reserve. S/he should also test your reflexes, especially your Achilles reflex. If he taps on your Achilles tendon (at the back of your ankle) and it has a very slow reflex time, this is SPECIFIC to sufferers o://tpauk.com hypothyroidismp.
You should make a note of all your sympthoms and signs and you can check yours against those here in our website. Give each symptom and sign a score from 1 to 5. 1 being the worst 5 being the least.
The doctor should check for the presence of a goitre (an enlarged thyroid), especially a rubbery, painless one, as this may be an indication of Hashimoto’s disease. If the thyroid is tender and enlarged but not necessarily symmetrical, the doctor may suspect sub acute thyroiditis. A diffusely enlarged gland may occur in hereditary hypothyroidism, in postpartum patients, or from the use of iodides or lithium. Goitres may also develop in people with iodide deficiency.
Blood Tests should be done and these should include Thyroid Stimulating Hormone (TSH) free Thyroxine (FT4), free Triiodothyronine (FT3). If TSH levels suggest hypothyroidism or sub clinical hypothyroidism, or there is autoimmune disease within the family, the doctor may choose to perform a blood test for specific antithyroid antibodies that act against a factor called thyroperoxidase (TPO). Tests can also check for antibodies to thyroglobulin. Sadly, many patients who exhibit some of the symptoms and have some of the signs of hypothyroidism ~ but who have normal blood results are refused a diagnosis, but you should be watched and retested at a later date.
Although some doctors request the T4 and FT3 tests, some laboratorys fail to carry these out. If this is the case, and you have not yet registered as a member of our TPA Online Support Forum, please register at www.tpauk.com/forum to find out where you can get these tested privately.
Take your basal temperature before you eat or drink anything and before you get out of bed in the morning. Keep a record of these and take the results to your doctor. Normal temperature is 98.4. If yours is 97.8 (and it could be much less) this is an indication that your thermostat isnt working as it should and could be an indication of hypothyroidism.
The following is a list of what you can do to help your endocrinologist reach a diagnosis.
List all your symptoms in order with the worst at the top, least at the bottom.
List all your medication including any supplements you are taking.
List one week of your basal temperature.
Write down any questions you might want to ask your endocrinologist (take a pad and pencil with you so you can jot down the answers).
The following questions were compiled by Health Centers Online and from Mary Shomon’s article What thyroid hormone replacement drug are you going to prescribe for me?
1. Is it possible to have hypothyroidism if I don’t have any external symptoms?
2. If I don’t have hypothyroidism now, is it possible I could develop it in the future?
3. Do I have any of the risk factors associated with hypothyroidism? Which ones?
4. Do you know what likely caused my hypothyroidism condition to develop?
5. Can my condition be expected to worsen with time?
6. How often will I need blood testing to monitor my hormone levels?
7. Will I need to undergo periodic thyroid scans? If so, how often?
8. What types of therapy are available to me?
9. Is there another, more effective combination of hormone therapy that I can use?
10. Are there are lifestyle and dietary changes I can make to help my condition?
11. Are there any habits that can aggravate my condition?
12. Does this raise my chances of contracting other diseases, such as cancer and heart disease?
13. Is my son or daughter likely to develop this condition if I have it? Should they be screened?
14. Should I talk to other relatives (siblings, parents, aunts, uncles) about getting screened for thyroid disorders? Should they see a specialist?
15. Do I need to take any added precautions if I am travelling to a developing country?
16. Are there activities that I should or should not engage in?
17. What is the normal thyroid-stimulating hormone (TSH) range at your lab?
18. What TSH level will you use as a target for me?
19. What thyroid hormone replacement drug are you going to prescribe for me?
20. How quickly can we expect my TSH to return to normal, given the dosage prescribed?
21. How often will you test my TSH until we get it back into the normal range?
22. After I’m in the normal range, how often do you suggest I come back for a TSH test to make sure my dosage needs haven’t changed?
23. If I have questions between appointments, how can I get in touch with you? Do you return calls yourself, or do your nurses return calls for you? Do you have an email address for corresponding with patients?
If you have been previously diagnosed with Fibromyalgia, you could ask your endocrinologist if you might have a trial of Liothyronine (synthetic T3) as you have heard on numerous websites that the symptoms of this disease can, in fact, be undiagnosed hypothyroidism, where there is a deficiency in T3 reaching the cells.