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Choosing Your Thyroid Physician
Choosing a physician for any medical problem is not easy, and finding one who is skilled in thyroid disorders can be particularly difficult. Because thyroid diseases are usually lifelong, thyroid patients require not only an experienced physician, but one who is able to develop a respectful and long-term relationship with their patients.
For medical thyroid problems (such as an under- or overactive thyroid), that is, those that do not require operation, a patient should choose a medical doctor (as opposed to a surgeon). Your choice may include an internist, a family practice physician, or a medical endocrinologist, a specialist who is trained in a variety of endocrine diseases (hormone disorders) such as thyroid and parathyroid disease as well as diabetes and other hormonal ailments.
If you require radioactive iodine to treat thyroid cancer you will be referred to a radiologist who specializes in nuclear medicine.
If your thyroid disease requires an operation you will have to choose a surgeon. Many different types of surgeons perform thyroid operations, including general surgeons, head and neck surgeons (also sometimes called ENT surgeons for ear, nose, and throat, or otorhinolaryngolosists), or even plastic surgeons. All of these surgeons may be trained to perform thyroid surgery, but the real difference lies in their experience with this type of operation. For example, although an ENT surgeon is very comfortable doing operations of the throat, he may not perform many thyroid operations in the course of a year. This may mean that he has little experience with thyroid disease and be unfamiliar recognizingthyroid abnormalities during an operation. Don't be afraid to ask how many thyroid operations your surgeon performs every year (see below).
If you need a special test such as an ultrasound, computerized tomography scan (CT scan), or nuclear scan, a radiologist will read and interpret the test.
Regardless of what type of thyroid ailment you have, it is still critical to thoroughly screen your physician to make sure that you are getting the best care. Below are some important questions for you to consider.
How well trained is your thyroid doctor?
Where did your doctor go to medical school and where did he do his residency or training after medical school? If your doctor trained outside the country, has he been certified to practice this specialty in the United States?
Has your doctor done specialized training in thyroid disease? For example, a qualified internist may have done an additional fellowship in medical endocrinology, which includes thyroid disease. An appropriate surgeon may have trained in thyroid and parathyroid surgery by doing an additional fellow ship in endocrine surgery in addition to his or her previous training.
Is your physician board certified in his or her field? Has your doctor passed strict written and/or oral examinations in his or her area of expertise?
Does your doctor have experience treating patients with thyroid disease?
It is important to ask your doctor what percentage of his or her practice is devoted to thyroid disease. For medical physicians and radiologists the answer to this question should be at least 25 percent. There are some medical endocrinologists, for example, who although originally trained to treat patients with thyroid disease, rarely in fact see patients with thyroid disorders. Obviously, these would not be the ideal doctors for you.
For a thyroid surgeon, ask what part of his practice involves thyroid/parathyroid surgery. Remember that there are risks to thyroid surgery (see chapter 7) and although these complications can never be eliminated entirely, they can be minimized in the hands of an experienced thyroid surgeon. Your surgeon should perform at least twenty-five thyroid and/or parathyroid operations per year. If your surgeon performs less than that number, look for a different surgeon.
Again, remember that just because someone is trained in head and neck surgery doesn't necessarily mean that he or she is skilled in performing thyroid operations. Because much of the decision-making process regarding the extent of thyroid surgery and the type of operation performed depends on your physician's judgment during your operation, it is important to have a surgeon with a lot of thyroid experience, You should also ask your thyroid surgeon how many of the thyroid operations that he performs are for cancer. This number is important, because, as we discuss in the section on thyroid lumps or nodules, there are many instances where a thyroid operation is the only way to tell if a patient has thyroid cancer or not. The preoperative tests to diagnose thyroid cancer are limited, but still effective. At least 25 percent of the patients undergoing thyroid surgery should have either precancer or cancer. A figure lower than this one, means that your thyroid surgeon is not screening patients preoperatively and may be performing unnecessary operations. Some hospitals have a rate as low as 10 percent, while other major thyroid centers may have a figure as high as 50 percent.
It's a good idea to find a doctor who is affiliated with a thyroid center--a multidisciplinary group of physicians and practitioners designed to diagnose, treat, and educate patients with thyroid disease. A thyroid center has radiologists, pathologists, ophthalmologists, medical endocrinologists, endocrine surgeons, and other practitioners who focus their practice on the treatment of thyroid disease.
Additionally, you should ask if your practitioner has any affiliations with national academic societies specifically concerning thyroid disease, such as the American Thyroid Association, the Endocrine Society, the American Association of Clinical Endocrinologists (for medical doctors), the American Association of Endocrine Surgeons, the Society of Head and Neck Surgeons (for surgeons).
Remember to ask questions about academic activities does your thyroid surgeon do any thyroid research-either clinical or basic science? If the answer is yes, you know that your doctor has a significant career interest in thyroid disorders.
Never be afraid to ask these questions in order to provide yourself with the physician who is best for your particular problem. Remember that...