Be prepared to discuss things with your doctor in a calm and polite manner. If you can, take someone with you so that they can either remember everything that was said or make notes for you.
Take a notepad with you. Make sure that you write down any questions that you want to ask in the notepad. Leave enough space for the answers. Ask if the doctor minds you making notes – say you want to do this as you are likely to forget what has been said after the appointment.
Get more information from the NHS on the questions you can ask your doctor. If you don’t understand what your doctor has said, ask for things to be repeated to you.
During the discussion:
- Give your doctor a copy of your diary and list of symptoms and explain some of them if necessary.
- Go through any notes you have made. Explain exactly how your symptoms are affecting your quality of life, your family life and your work life. Explain the things you used to be able to do but can’t now. “Before” and “after” photos sometimes help too.
- If this is your first appointment to discuss your symptoms, ask if you can have all the thyroid tests done, i.e. TSH (thyroid-stimulating hormone); Free T4 (FT4 – your level of thyroxine in the blood); Free T3 (FT3 – your level of triiodothyronine in the blood) – to check for non-conversion of thyroxine; and thyroid antibody tests TPO (thyroid peroxidase) and TgAb (thyroglobulin) – to check for Hashimoto’s disease or Graves’ disease.
- If you have only had some of the thyroid tests done previously, ask your doctor if they can all be done this time.
- Be aware, though, that your GP may say that an FT3 test can’t be done, or they may ask for FT3 to be done but the lab that does the test may refuse to do it. You could try asking if your GP will add something to the test form to say “Thyroid function test including FT3 and FT4, regardless of the TSH reading” as this may help.
- If your doctor can’t do the FT3 test and others, ask if they would take a look at any private testing that you may have done in the future.
- Inform your doctor if any family members have been diagnosed with thyroid disease.
- Ask your doctor if they would also check your vitamin B12, folate, iron, ferritin, selenium, zinc, magnesium and vitamin D levels as deficiencies of any one of these could be a reason for your ill health.
- If you are giving your doctor any evidence, i.e. copies of private test results, ask that these are placed in your medical file.
- If your doctor suggests seeing a consultant in a different field to endocrinology, perhaps a rheumatologist or psychiatrist, it might be a good idea to do this. It will either show up another health problem or it will rule it out completely. This often happens when patients are referred to psychiatrists.
- If your doctor offers a referral to an endocrinologist, make sure it is a thyroid specialist and not a diabetes specialist.
- If you are not sure about anything you should go back to the surgery to talk to the practice nurse or the GP.
If you have had all the thyroid tests done previously:
Discuss with your doctor the possibility that you may have a thyroid condition because your tests show one of the following:
- Borderline hypothyroidism – one or more of your results are near the bottom or top of the range
- Subclinical hypothyroidism – you have a high TSH and a normal FT4
- Subclinical hyperthyroidism – you have a low TSH and normal FT4. Often doctors do not inform their patients of this
- Hashimoto’s disease – (the autoimmune form of hypothyroidism) – you have high thyroid antibodies
- Graves’ disease – (the autoimmune form of hyperthyroidism) – you have high thyroid antibodies
- Central hypothyroidism – (low levels of TSH, FT4 and FT3) – this is caused by a pituitary problem
If you have had all the vitamin and mineral tests done:
Check your results. If you are deficient or have low levels, discuss with your doctor the possibility that you may need to take some supplements because all of the following can impact on your thyroid health or cause similar symptoms to hypothyroidism:
- Vitamin B12 – the symptoms of vitamin B12 deficiency are very similar to hypothyroidism. The range for vitamin B12 is very wide and you may find improvement with supplements 1
- Vitamin D – there is a link between vitamin D deficiency and autoimmune thyroid disease and thyroid cancer 2
- Selenium – low selenium can impact on your thyroid health by causing non-conversion of thyroxine (T4 to triiodothyronine (T3) 3
- Folate – deficiency in folate causes similar symptoms to hypothyroidism 4
- Iron – iron deficiency anaemia is found in patients with hypothyroidism. The symptoms are very similar to those of hypothyroidism 5
- Ferritin – links have been found with ferritin deficiency and hypothyroidism 6
- Zinc – zinc and other trace elements such as copper and selenium are required for the synthesis of thyroid hormones 7
- Magnesium – low serum magnesium is associated with increased risks of positive anti-thyroglobulin antibodies and hypothyroidism 8
- Cholesterol – high cholesterol is often a sign of hypothyroidism 9
If the discussion with your doctor concludes with a diagnosis of hypothyroidism, hyperthyroidism or a vitamin or mineral deficiency, discuss treatment options including the benefits and harms of any medication offered. Make sure you ask about medications that may help but which are not usually prescribed, i.e. liothyronine for hypothyroidism or PTU (Propylthiouracil) for hyperthyroidism.
If you really feel that you would like a second opinion regarding thyroid disease, it might be a good idea to:
- Think about changing your GP
- Ask for a referral to an endocrinologist who specialises in thyroid disease
- Visit a private doctor or practitioner
If your thyroid test results show that you have thyroid disease, you can get more information here:
- If you are diagnosed with an underactive thyroid (hypothyroidism)
- If you are diagnosed with an overactive thyroid (hyperthyroidism)
- If you are diagnosed with Hashimoto’s disease
- Vitamin B12
Symptoms – Vitamin B12 or folate deficiency anaemia
- The Role of Vitamin D in Thyroid Diseases
International journal of molecular sciences vol. 18,9 1949. 12 Sep. 2017
- Selenium and Thyroid Disease: From Pathophysiology to Treatment
Ventura, M., Melo, M., & Carrilho, F.
International journal of endocrinology, 2017
- Vitamin B12
Symptoms – Vitamin B12 or folate deficiency anaemia
- Characteristics of anemia in subclinical and overt hypothyroid patients
Erdogan, M., Kosenli, A., Ganidagli, S., Kulaksizoglu, M.
Endocrine Journal 2012;59(3):213-20. Epub 2011 Dec 27
- The relationship between iron status and thyroid hormone concentration in iron-deficient adolescent Iranian girls
Eftekhari MH1, Keshavarz SA, Jalali M, Elguero E, Eshraghian MR, Simondon KB.
Asia Pac J Clin Nutr. 2006;15(1):50-5
- Zinc Deficiency Associated with Hypothyroidism: An Overlooked Cause of Severe Alopecia
Ambooken Betsy, MP Binitha, and S Sarita
International journal of trichology, 2013, Jan-Mar, 5(1), 40–42
- Severely low serum magnesium is associated with increased risks of positive anti-thyroglobulin antibody and hypothyroidism: A cross-sectional study
Wang K, Wei H, Zhang W, et al
Scientific Reports vol. 8,1 9904. 2 Jul. 2018
- Effects of Thyroid Dysfunction on Lipid Profile
C.V Rizos, M.S Elisaf, and E.N Liberopoulos
The Open Cardiovascular Medicine Journal vol. 5 (2011): 76-84
Date updated: 24/02/20 (V1.3)
Review date: 14/04/21