You’ve read a patient’s chart, sighed, and reached for your referral pad–again. One of your patients has classic symptoms of hypothyroidism, but the conventional approach of prescribing levothyroxine hasn’t led to any improvements or made things worse. 

Your patient begins to throw out terms for referral requests that include functional medicine endocrinologist, holistic endocrinologist, or functional medicine hormone specialist. You start to search for a provider who can offer a systems-focused pathway that complements the care you provide. 

Functional Medicine Endocrinologist vs. Standard Endocrinologist: What’s the Difference?

The current state of thyroid management in the U.S. sometimes feels like a game of telephone where the patient always loses. Many endocrinologists, despite their brilliance in their fields, are trained to follow a disease-centric approach to thyroid management, focusing overly on diabetes while neglecting the thyroid, and failing to recognize the organ as a major player in the body. 

The goal is typically to normalize TSH with levothyroxine, full stop. The problem is that TSH levels can be restored to normal levels with medication while a patient continues to feel terrible. In some cases, levothyroxine works as intended but causes significant side effects like anxiety or a rapid heartbeat. 

That’s the core difference between a conventional endocrinologist and a holistic endocrinologist. The former typically manages disease markers, while the latter seeks to understand the cause of the dysfunction. 

A functional medicine hormone specialist understands that the endocrine system is only one of many interconnected systems in the body and explores potential causes such as nutrient status, lifestyle factors, and environmental triggers. 

Think of the two different approaches to thyroid health management as the difference between simply adding oil to a squeaky wheel (levothyroxine) versus figuring out why the axle is misaligned and fixing it to stop the squeaking. The former provides a temporary solution at best, while the latter permanently addresses the problem. 

The Levothyroxine Conundrum: When the "Solution" Is the Problem

You’ve probably had patients with normal T4 levels but elevated TSH due to things as simple as excessive iodine consumption, without excess iodine being recognized as the root cause, based on the frequency of this situation, as outlined in the research. 

The standard pathway for many endocrinologists is to prescribe synthetic T4. However, adding synthetic T4 when levels are already normal is akin to trying to fix a leak in a container by pouring more water into it, even to the point where there is now a leak and the container is overflowing with excess water, creating a bigger mess. This approach may not make much sense, yet it has become a standard practice. 

Many patients are left dealing with horrible side effects such as temporary hyperthyroidism, rapid heartbeat, and fatigue. Some end up returning to their primary care physicians feeling worse than they did before starting treatment. 

The U.S. healthcare system is fractured, in large part, due to physicians' hyperspecialization. This refers to the U.S. medical education approach, where medical school graduates often leave medical school unable to practice medicine. In contrast, many other countries graduate all students as broadly trained generalists. 

In the U.S., many medical school graduates initially specialize without a generalist foundation in their residency and then further specialize in their fellowship. This creates heavily isolated knowledge focuses without a strong understanding of the ties that bind these areas all together in how bodily systems interconnect. 

Even primary care physicians (PCPs) must technically specialize in a related residency, and this vital area of care is often undervalued despite the heavy workload. This situation usually leaves you, the PCP, researching the gaps and managing the fallout. 

How a Functional Endocrinology Clinic Operates Differently

A functional endocrinologist for women or men begins care with a thorough assessment of the patient’s current health. They look beyond standard panels, often assessing reverse T3, thyroid antibodies, nutrient levels, and inflammation markers. They look to learn why a patient’s thyroid is struggling, rather than just trying to mask symptoms. 

This approach of working with patients to better understand the whole picture of their health is standard in many Latin American countries, where specialists are required to first graduate as generalists with training ranging from fields like nutrition to podiatry to gynecology to pediatrics to gain a solid footing in each even though cases will be referred up to specialists if needed (and all specialists will once have been generalists). This fosters a natural appreciation for how each system in the body affects others, promoting collaboration with specialists like dietitians. It’s a stark contrast to the siloed approach that often limits the options U.S. PCPs have to explore when treating patients. 

Your New Referral Strategy: How to Find a Functional Endocrinologist

Understanding that you need a different type of endocrinologist to give your patients the highest level of care available is one thing; finding one is another. Your search for the best functional endocrinologist near you doesn't have to be a shot in the dark. Here are some ways to simplify your search:

• Leverage telemedicine: Don’t limit your search to a specific geographic area. Your patients can work with functional endocrinologist telemedicine services from anywhere in the world. 
• Decode the terminology: Look for key phrases like functional endocrinologist, integrative endocrinologist, and functional medicine dietitian. These are signs that indicate a specialist practices a root-cause approach. Ensure that the doctors are physicians with MDs or DOs, who have undergone rigorous allopathic training and have opted to learn how to leverage non-pharmaceutical options. Be cautious about naturopathic doctors who might not have had as extensive training. For dietitians, ensure that these are registered dietitians with a strong scientific foundation, such as an RD with a Master’s degree in Science, rather than a nutritionist, as the term “nutritionist” can be used more loosely.    
• Vet their focus: Read reviews left by past patients of functional or integrative endocrinologists and/or functional medicine dietitians and check out their website. Do they explicitly discuss root cause medicine for thyroid, adrenal, and hormonal issues? A functional endocrinologist specializing in thyroid care should discuss far more than just TSH levels, with a strong understanding of T4 levels, the Wolff-Chaikoff Effect, the Jod-Basedow Phenomenon, the U-curve of benefit for iodine, and other relevant topics.
• Ask questions: Don’t shy away from asking about the functional endocrinologist's cost and what their typical care team looks like when evaluating a functional endocrinology clinic. Do they have an RD on staff? That’s a sign of a specialist who values a holistic approach to thyroid management. 

Beyond the Referral: Building Your Own Knowledge Base

Finding a great functional endocrinologist is a massive win for PCPs, but you should also work on building your capacity to manage these cases so that you can better manage cases and vet potential specialists for patient referrals. 

Understanding the underlying causes of your patient’s problems enables you to deliver high-quality care. Take the case of iodine-induced thyroid dysfunction. Some patients with iodine-induced hypothyroidism could be incapacitated by as little as a single 25 mcg dose of levothyroxine, potentially swinging into hyperthyroidism and being hospitalized, as some patient anecdotes show. This can be avoided if you first understand the root issue at play before trying to medicate the visible part of the problem, especially if the problem is presenting in a way that does not indicate immediate need for intervention, such as a slightly elevated TSH and a normal or high-normal free T4 level.  

Stop Managing the Fallout and Start Understanding the Root Cause

Ready to deepen your understanding of the root causes of endocrine dysfunction? Order our on-demand course today: Are You Consuming Too Much Iodine? Excess Intake & Thyroid Disorders. You’ll learn how to identify and manage complex thyroid cases by the time you’re done reading it. 

You can also sign up for our newsletter for more insights from our patient experience consultancy team as they collect insights from general medicine physicians, dietitians, and specialists across Latin America on how they leverage the variety of resources and navigate limitations in public healthcare systems to build rapport with patients, run risk-benefits analyses, and practice a lifestyle-first approach (including dietary advice) to avoid unnecessarily prescribing medications that could be harmful to patients.