Testing, diagnosis, changing medications, prescription renewals and digging deeper for the root cause are just some of the services offered. A physical exam of the thyroid gland will be performed for in-office appointments along with an explanation of findings regarding texture, size and presence of nodules. The 6-marker advanced thyroid panel is the test of choice to start with, results come back in about 10 days. To learn more about thyroid consultations, click here.
After testing, what happens next?
Depending on results, if a prescription or change to prescription is required, a combination of T4 and T3 medications will usually be prescribed. Most people with hypothyroidism feel their best with a combination therapy. This can be achieved by prescribing both Synthroid and Cytomel, compounded versions of levothyroxine (T4) and liothyronine (T3) or desiccated thyroid (ERFA). A thorough discussion regarding the options will always involve an informed choice by the patient. Once the new prescription has been picked up, the patient can simply switch over the next day. Each change to prescription dose warrants reminders to watch for in case the dose is not quite balanced in the body.
Many people with hypothyroidism and on Synthroid do not know that they have Hashimoto’s. It is estimated that over 50% of hypothyroid patients have the auto-immune disorder Hashimoto’s Thyroiditis. The advanced thyroid panel will confirm the presence of antibodies and the next steps of treatment can begin. Auto-immune comes from genetics and a trigger(s) (read about triggers here) which can be narrowed down by a good history taking and lab testing. Digestion, infections, toxic metals and hormonal imbalances cover the main root causes and it is important to start uncovering the layers. Since the digestive system is how all nutrition from food enters the body, it is logically the best place to start.
An innovative off-label use of the prescription drug naltrexone has helped to stabilize many people with Hashimoto’s thyroiditis. It can also be prescribed for multiple conditions that involve inflammation such as IBS, anxiety, auto-immune, PCOS and psoriasis. The Low Dose Naltrexone Research Society Trust out of the UK has a wealth of information on this topic and many top prescribers contribute to this organization. LDN therapy is commonly prescribed at the Vancouver Thyroid Health Clinic.
Other than prescriptions?
Not everyone requires (or wants) prescriptive thyroid medication, and not everyone needs it. Some Hashimoto’s patients have a thyroid capable of making enough thyroid hormone to control the correct rate of metabolism and no hormones are needed. It is important to look at the nutrients involved in hormone synthesis, conversion, transport and utilization. A 2019 study looked at exactly this (The Journal of Thyroid Research, PubMed 35140907) and correlated B Vitamins (2,9 and 12), Vitamin D, calcium, choline, copper, iron and zinc to be tied to levels of T3 and TSH. Dietary consumption and supplementation is determined based on gut health and micronutrient testing. Some herbs can also greatly support thyroid health such as Guggul, Boswellia, Bacopa and Turmeric. Individualized treatment plans are developed based on symptoms and lab results.
Want more details?
For a complete look at how Dr. Luis views and treats Hashimoto’s and hypothyroidism, read this checklist.