Finding a Specialist

Which Doctor For Me?

The first thing you should know about finding a thyroid specialist is that you may not need one after all.

If your problem is hypothyroidism that has been diagnosed, your physician may choose to start you on thyroid hormone and observe the results. If your symptoms disappear and you feel well again, periodic rechecking of your serum TSH level to be sure the dose is right may be all that's necessary. On the other hand, most patients with Graves' disease or cancer should see a thyroid specialist. And your physician is likely to be the best person to find a thyroid specialist for you in your area. TFA has the names of thyroid specialists all over the country, chosen for referral because they are members of the American Association of Clinical Endocrinologists, the American Thyroid Association, or The Endocrine Society, which are the three large professional organizations of these specialists in the United States and Canada.

Your physician may refer you to a surgeon for help with a number of thyroid problems. You may have an overactive thyroid that has not responded to medical treatment and there may be reasons for not taking treatment with radioactive iodine. You may have a very large thyroid, or goiter, that is disfiguring or interfering with breathing or swallowing. You may have a nodule, and your physician wants a biopsy to tell if it contains cancer. You may have a thyroid tumor that needs to be removed, or a recurrence of a previous cancer.

Choosing A Thyroid Surgeon

Several types of surgeons operate on the thyroid, including general surgeons, otolaryngologists (ear, nose, and throat specialists), cancer surgeons, thoracic (chest) surgeons, and even surgeons who specialize in operating on patients with endocrine problems. On the other hand, your problem could be Graves' disease and you may need eye surgery. Here an ophthalmologist or plastic surgeon may be the best choice. Any one of these could be right for your problem.

The most important considerations for you and your physician are the type and extent of your problem and the skill and experience of the particular surgeon with that disorder.

Here are some questions to ask. Has the surgeon had good results with your type of problem? Does the doctor have special training in endocrine operations or neck surgery? How often does he or she do this type of operation? Does the surgeon have special credentials such as board certification, or membership in the American Association of Endocrine Surgeons? What is the surgeon's complication rate for problems such as injury to the laryngeal nerve which supplies the vocal cords or to the parathyroid glands?

There is another way to look at this too. In this era of "managed" health care, health insurance companies are taking an increasingly active role in deciding who should perform surgery of many types. But in your special circumstance of thyroid surgery, which can be unexpectedly delicate and complicated, not everyone who does thyroid operations will be right for you. Make sure that the choice of the surgeon is matched to the operation which is to be performed.

To give you a place to begin discussions with your physician and, if necessary, your insurance company, you might consider the following guidelines.

• A general surgeon who does less than ten thyroid operations per year could do a thyroid biopsy, remove small cysts and benign tumors confined to one thyroid lobe.
• A surgeon who does at least 10-15 thyroid operations per year could be right for benign goiter, thyroid cancer consisting of a single nodule less than an inch in diameter confined to one thyroid lobe, and a near total thyroidectomy for uncomplicated hyperthyroidism.
• Only a surgeon who has performed more than 100 thyroid operations (excluding biopsy) should be chosen for a large obstructive goiter under your breastbone (substernal goiter), reoperation for recurrent cancer, thyroid cancers larger than an inch in diameter (these are more likely to have spread locally), any medullary thyroid cancer, and anaplastic (rapidly spreading) cancer.

Remember, these are only guidelines. A particularly gifted surgeon in your area may be right for your problem, even though he or she does not fit into these exact categories. In that case, ask your physician to explain the reasons for choosing that surgeon for you. These ideas are presented to help you understand your particular surgical needs and to provide a starting point for discussion with your physician about your surgeon. Above all, your physician is in the best position to help you with this important decision.

Finding an Eye Doctor

Not every eye doctor has the training and experience needed to manage complicated thyroid eye disease. Many can advise you about minor symptoms such as eye irritation or swelling of your eyes, but you need a specialist to advise if thyroid eye surgery, corticosteroid drug treatment, or radiation of the tissues behind the eye are being considered for a severe eye problem. A specialist in thyroid eye disease will be able to recommend ultrasound tests and other images of your orbits if needed. They will also be able to advise as to which of the treatment alternatives are best for you.

It's critically important to have an experienced eye surgeon if orbital surgery is recommend to relieve pressure behind the eye. These are very complicated operations and only a surgeon who is well trained and experienced in this sort of surgery should be considered. If your physician does not know such an individual in your area and if TFA cannot find one in your area, it's worth making a trip to a major medical center where such surgery is done frequently. There is no substitute for an experienced eye surgeon if you need an orbital decompression procedure.

You can learn more about surgical treatment of eye problems here.