Expert Advice

Acella Pharmaceuticals, LLC., is partnering with Lindy Ford, RD, LDN, to bring greater awareness to the importance of thyroid care and education. This post is sponsored by Acella Pharmaceuticals and should not be construed as medical advice. Please talk to your doctor about your individual medical situation.

Disclaimer: The information provided is for educational purposes only and does not substitute professional medical advice. Consult a medical professional or healthcare provider before beginning any exercise, fitness, diet, or nutrition routine.

Working with a dietitian is an excellent way to help manage hypothyroidism or Hashimoto’s disease symptoms. Helping patients manage hypothyroidism is certainly not rare in my practice. In fact, it's quite common, especially among women.

Before I even see a patient, I know a lot about them. I instruct them to send me comprehensive paperwork that helps me learn more about them before the first visit. Below you will find what I ask for to be able to conduct not only a successful first appointment but also to create a treatment plan that leads to optimal health.

During the first 90-minute appointment, I will go over this paperwork:

Medical History, Personal History & Background

My intake form is 11 pages long. It details present health concerns in order of significance, prior diagnosis, and past and present treatments. This is good for the patient.

I also ask for their present prescription drug usage and dosage, as well as all the vitamin, mineral, herbs and homeopathic remedies they are currently taking. My patients give me an overview of their current health status, including food allergies and sensitivities.

Their personal health history is important as well. I want to know their health habits, how many meals they are consuming a day, exercise status, food preferences and who does the cooking and shopping in their home. I tell them that my nosiness helps them and it certainly does!

Food Journals

Food journals are so important. Many people will tell me, “I eat fairly healthy." When I look at their journals, I find they are not eating optimally for their unique physiology, especially if they present with thyroid issues.

I look for servings of low glycemic vegetables, healthy fats and clean proteins, and the types of carbohydrates they are consuming. If they present with hypothyroidism, I look for iodine- and selenium-rich foods as well as foods that support gut health. The thyroid benefits when the gut is strengthened.

No one comes into my office presenting with just one condition. They could have a thyroid condition, blood sugar problem, gut health issue, heart disease, autoimmune disorder and a myriad of other things. If I strengthen one area, this helps other health conditions. The tricky part is prioritizing which area to target first.

I also assess their hydration status and talk to them about consuming enough purified, not tap, water.

Bloodwork

I ask for a complete battery of bloodwork from their health care provider. They give me what they've had done in the past year, but unfortunately, this is usually less than complete. They don't have to have all my preferred bloodwork done by the first visit, but I have them schedule to get it done.

The bloodwork I ask for should be standard, but because of insurance and other constraints, it isn’t. The lab, vitamin D 25 (OH), is one I usually have to ask to get. This is important for everyone, but especially for hypothyroid patients. Vitamin D is not a vitamin but a prohormone that regulates over 300 genes, including genes that are important for lipid and glucose metabolism.

For hypothyroid patients, I want to see a FULL thyroid panel including TSH, Free T3 and Free T4. Since the majority of those presenting with a dysregulated thyroid also have Hashimoto’s thyroiditis, I like to have thyroid antibody labs. I only ask for these labs if the person has an irregular thyroid panel.

I don’t determine there is a problem with the thyroid by using conventional thyroid lab values. For example, some labs don’t flag thyroid dysfunction until the TSH hits 4 mIU/L or 5 mIU/L. I look at a functional lab value of TSH. That red flags the TSH at over 2 mIU/L.

Hormone Health Profile

I developed a diagnostic tool called a “Hormone Health Profile" that is symptom-driven. This 12-page questionnaire asks the patient to check off their symptoms but only gives them an "A, B, C, etc." The 18 categories include: Inflammation, excess insulin, low serotonin, excess cortisol and low progesterone, but the patient doesn't know it's that condition.

I use an answer key to “grade" the questionnaire. Of course, one of the conditions is “low thyroid." It contains 19 symptoms related to hypothyroidism and it’s uncannily accurate. I’ve administered this over 1,000 times, and if the answer key gives a high probability, that person presents with hypothyroidism. Of course, I use bloodwork to back this up.

First Visit

B The first 90-minute visit with me can be conducted in my office in Wilmington, N.C., or by video conference. I see patients all over the continental U.S.

I ask them diagnostic questions like, "On a scale of 1 to 10, if 0 is not ready and 10 is ready, how ready are you to make changes in your lifestyle choices?" It gives me a good idea of how motivated they are to make changes.

I then ask them on a scale of 0 to 10 what their energy level is on any given day and their mood. I ask them about the frequency of bowel movements, quality of sleep and water intake.

I then go over their intake form, prescription drugs, supplements, hormone health profile and labs. I try to know everything about their health and lifestyle choices.

Many of my patients present with blood sugar issues as well as thyroid problems. I have a graphic presentation about glucose and insulin that I show them.

I already have a folder of handouts I give them to read, depending on their conditions. I give them a goal (homework) sheet and always ask for their waist and abdomen measurements. They have other homework assignments, such as reading the material I gave them and watching certain YouTube videos on my Lindy Ford Nutrition and Wellness channel.

For my hypothyroid patients, I prescribe personalized supplements that will strengthen the thyroid. Of course, vitamin D3 is included, but the dosage depends on their blood levels. I also have them watch, “Foods that Boost Thyroid Health and Metabolism."

I then set up their following week’s 30-minute appointment. They are required to send me a three-day day food journal every week.

The approach I take in treating my hypothyroid patients is comprehensive. There is a high degree of accountability. I don't know how to help people effectively any other way. It may sound corny, but I truly do play "nutrition detective" because I am trying to get to the root of what is going on with my patients physiologically. In doing so, they have the best chance possible of achieving optimal health.

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