Note: PlushCare does not have endocrinologists at this point in time, but our team of primary care physicians may be able to help with your thyroid concerns. Our doctors can order necessary lab tests, make diagnoses and prescribe medications for thyroid disorders online. In some cases, specialized or in-person treatment may be recommended.
The thyroid gland is part of the endocrine system, a collection of glands which play a major role in growth, development, sexual function, reproduction, sleep, mood and more.
Major glands in the endocrine system:
- Hypothalamus (part of the brain that links to the endocrine system)
- Ovaries and Testes
All of these glands produce hormones to regulate various processes in the body. When a hormonal imbalance occurs, many symptoms can occur. A hormonal imbalance can be caused by genetics or exposure to pesticides, lead, phthalates (a component of plastic), or other chemicals.
The thyroid gland in particular, plays a vital role in regulating metabolism. If not for thyroid hormones, your cells wouldn’t be able to turn oxygen and food into energy.
So what happens when you have a problem with your thyroid? Some people don’t have a thyroid (or it is removed), what then? Fortunately, there are ways to treat common thyroid conditions and it is possible to live without a thyroid gland.
Endocrinologists are doctors who specialize in the endocrine system, including the thyroid gland. Because endocrine glands and the hormones they produce relate to a variety of functions in the body, an endocrinologist’s job is relatively broad.
Many of the issues are caused by over-secretion or under-secretion of a particular hormone and relate to a specific gland.
The body doesn’t produce iodine on its own, but iodine is an important substance for metabolism. Have you ever looked closely at a salt container? You may have read on the label “this salt supplies iodine, a necessary nutrient.” We get iodine from many foods like seafood, grains, dairy, and vegetables; or as an additive in salt.
The thyroid’s job is to take iodine we get from our diet and produce two hormones that regulate metabolism. These are thyroxine (T4) and triiodothyronine (T3).
Production of T4 and T3 is controlled by the pituitary gland, which releases a hormone called the thyroid stimulating hormone (TSH). When the body is low on thyroid hormones, the pituitary gland senses it and releases more TSH. The release of TSH causes the thyroid gland to increase its hormone output. The pituitary gland then senses the surplus of T3 and T4 in the blood, so it cuts back on releasing TSH thus reducing T3 and T4 secretion. This cycle is repeated continually to maintain proper levels of thyroid hormone in the blood.
For the thyroid gland, over-secretion of hormones causes hyperthyroidism (also called overactive thyroid).
Under-secretion of hormones causes hypothyroidism (also called underactive thyroid).
Hypothyroidism and hyperthyroidism are the two most common thyroid disorders. Thyroid cancer occurs, but it is rare.
Hyperthyroidism | Overactive Thyroid
If your thyroid gland is stuck producing too much T4 hormone, this is known as hyperthyroidism. Most frequently hyperthyroidism is caused by Graves’ disease, but it can also be caused by Plummer’s disease and thyroiditis.
Symptoms of Hyperthyroidism:
- Increased appetite
- Weight loss
- Rapid or irregular heartbeat as well as palpitations
- Changes in menstruation
- Heat sensitivity
- Goiter (enlarged thyroid)
- Sleep issues
- Thin skin
- Brittle hair
- Muscle weakness
- More frequent bowel movements
Hypothyroidism | Underactive Thyroid
The most common cause of hypothyroidism is an autoimmune disease called Hashimoto’s thyroiditis, but hypothyroidism can also be caused by thyroid surgery, radiation therapy, certain medications, and over-treatment of hyperthyroidism.
Symptoms of hypothyroidism generally develop slowly and worsen over time. Because of this, hypothyroidism may go unnoticed.
Symptoms of Hypothyroidism:
- Weight gain
- Sensitivity to cold
- Dry skin
- Hoarse voice
- Muscle aches
- Joint stiffness
- Heavy or irregular periods
- Thinning hair
- Depression and other mental health issues
- Slow heart rate
- Impaired memory
- Lump on your neck under the Adam’s apple
- Voice changes, particularly hoarseness
- Difficulty swallowing
- Pain in the neck and throat
- Swollen lymph nodes in the neck
A thyroid doctor might perform some tests depending on what they think you might have. They will usually begin with a physical exam; taking a look at skin, eyes, reflexes, legs, and heart rate. After a physical exam they may draw blood to analyze concentrations of hormones, antibodies, or particular proteins associated with the thyroid.
Hormone Blood Tests
These are the most common thyroid tests. Doctors draw blood and analyze it for concentrations of TSH, T4, and T3 hormones. Measuring the concentrations of TSH is considered the most reliable and generally TSH tests are done first. The results from these tests give the doctor an idea of whether or not the thyroid is overactive or underactive.
There is a particular type of test which measures T4 that is not connected to other molecules. This is called a Free-T4 test and it is a better estimate of thyroid activity compared to measurements of total-T4 testing.
Thyroid Antibody Blood Tests
Sometimes the thyroid is overactive or underactive due to a problem with the body’s immune system producing antibodies that attack the thyroid. The thyroid antibody test measures concentrations of such antibodies in the patient’s blood. Thyroid antibody tests are usually done to investigate whether or not a patient has Hashimoto’s disease or Graves’ disease. These tests might also be done if a patient has a goiter or some other autoimmune disease.
Radioactive Iodine Uptake
Doctors can estimate the overactivity or underactivity of a thyroid gland by giving a patient slightly radioactive iodine. The doctor can then measure the radioactivity and observe how much iodine is taken up by the thyroid.
While this test may sound supernatural, all iodine is radioactive, yes even your table salt, so don’t worry. In these dosages, it’s totally safe and allows the doctor to accurately scale your thyroid’s ability.
Imaging of thyroids using radioactive iodine can help a doctor measure the size, shape, and position of the thyroid. This can help an endocrinologist diagnose hyperthyroidism, hypothyroidism, as well as thyroid cancer.
Thyroid Cancer Tests
There are several thyroid tests specifically for patients with thyroid cancer, or who are suspected to have thyroid cancer.
- Ultrasounds. Used to inspect thyroid nodules.
- Thyroid needle biopsy. A dependable test for identifying cancerous nodules.
- Thyroglobulin test. After thyroid surgery, thyroglobulin blood tests are done to monitor whether or not cancer cells are still present or have returned.
- Thyroid scans. Can measure lumps and nodules in the thyroid.
While PlushCare does not have online endocrinologists, our primary care physicians may be able to diagnose and treat your thyroid condition, or refer you to in-person specialized care.
If you have already been diagnosed, then it’s a good idea (and perhaps necessary) to follow up with a thyroid specialist. If you need thyroid medication refilled, you can book an online appointment with a primary care physician here.
How to Set Up an Online Appointment
At PlushCare, setting up an online appointment is easy. All you have to do is book an appointment on our app or website! You can also call (888) 608-5845. Appointments are frequently available within the hour and you can select your doctor of choice. If you have not booked an appointment with us before you will need to create a profile, set up payment options, and provide health insurance information.
If you do not have health insurance that’s ok too, we have a flat-rate fee of $99 an appointment.
Our membership program is just 14.99/mo for unlimited access to top online doctors.
How Does Testing Work With Online Appointments?
If the online doctor determines you may benefit from thyroid testing they will refer you to the nearest lab to undergo blood tests. The doctor can electronically send these lab orders and will reach out to you when your results are in. They will then diagnose and treat your condition.
In some cases in-person or specialized treatment may be recommend.
When to See a Thyroid Doctor
You may consider setting up an appointment if you are experiencing symptoms of hyperthyroidism or hypothyroidism such as:
- Weight-loss or weight-gain
- Changes to your heartbeat
- Swelling around the base of your neck
- Increased sensitivity hot or cold
- Changes in menstruation
- Feeling tired for no reason
- Dry skin
Keep in mind that it can be difficult to notice some of these symptoms, particularly for hypothyroidism due to its slow onset. If you experience any or some of these symptoms, book an online appointment to determine if your symptoms may be caused by a thyroid condition.
Anybody can suffer from thyroid disorders, but some people are at a higher risk of hypothyroidism and hyperthyroidism:
- Pregnant within the last 6 months
- Older than 60
- Family history of thyroid disease
- Have type-1 diabetes, celiac disease, or other autoimmune disorder
- Have undergone thyroid surgery
- Have had radiation therapy, radioactive iodine, or anti-thyroid medication
If you have been diagnosed with a thyroid issue, then you will need to see a doctor on a recurring basis. Hypothyroidism is usually treated for life and conditions of hypothyroidism, hyperthyroidism, and thyroid cancer may need to be regularly monitored.
For the rare cases of thyroid cancer, you will need to see and talk to a doctor in person for biopsy and treatment. For overactive (hyperthyroidism) and underactive thyroids (hypothyroidism), you may be able to receive treatment online.
Hypothyroidism Treatment Options
Treating hypothyroidism is typically done with a synthetic hormone called levothyroxine, which provides the body with T4 hormone (the T3 your body needs is derived from the T4). Common brand names of levothyroxine include Synthroid, Levoxyl, L Thyroxine, Levo T, Levothroid, Levothyroxine T4, Levoxine, Tirosint, and Unithroid.
Finding the proper dosage for levothyroxine requires some time, trial and experimentation. Initial stages of taking levothyroxine require blood tests every 6 to 8 weeks to fine-tune the dosage. After the proper dosage is found, patients will still need to monitor their hormone levels, because dosages may change over time. This can be done less frequently, every 6 to 12 months is sufficient.
Once the proper dosage is determined, levothyroxine has very few side effects, but during the initial stages a patient may experience some. If the dosage of levothyroxine is too small, then you will remain feeling symptoms of hypothyroidism. If you are taking too much levothyroxine you might experience:
- Increased appetite
- Heart palpitations
An endocrinologist might start off conservatively with very small doses, particularly if you have coronary artery disease or severe hypothyroidism. This is because hormone therapy can drastically change metabolic rates and your heart might need to get used to it gradually.
If the sound of a synthetic hormone does not sit well with you, there is an option for “natural” hormone replacement therapy using extracts from pig thyroids. This option is also prescription only.
Levothyroxine prescriptions can be obtained through an endocrinologist online appointment. Check out our review of Synthroid (a major levothyroxine brand) for patient reviews and more information on the side effects and warnings of levothyroxine.
A few foods and dietary supplements can cause the body to not absorb levothyroxine. If you are taking levothyroxine you should be aware that soy and coffee products can reduce absorption. Dietary supplements can also inhibit levothyroxine absorption. Avoid taking iron, aluminum hydroxide, calcium, or any multivitamin containing any of those. If hypothyroidism occurs due to an iodine insufficiency, iodine supplements could be helpful.
Hyperthyroidism Treatment Options
There are more treatment options for hyperthyroidism compared to hypothyroidism. With hyperthyroidism your thyroid gland is overactive and too many hormones are produced. The goal of treating hyperthyroidism is usually to reduce secretions of thyroid hormones.
Ways to Treat Hyperthyroidism:
- Shrink the thyroid by radioactive iodine. In severe cases surgery is done to remove most of or all of the thyroid.
- Antithyroid medications can help prevent the thyroid from releasing as many hormones.
- Beta blockers can help with heart-related symptoms such as rapid heart rate, palpitations, and tremors.
If you think you have a thyroid condition, set up an online appointment to discuss your symptoms and get treated. Getting diagnosed will be the first step toward feeling better and living a healthier life.