Thyroid Care

Thyroid care is the testing and treatment of disorders of the thyroid gland — a small butterfly-shaped gland in your neck that produces hormones controlling metabolism, energy, body temperature, weight, and mood.

At Good Health NC in Knightdale, our team manages the most common thyroid conditions in primary care:

1. Hypothyroidism — underactive thyroid, typically treated with daily levothyroxine.
2. Hashimoto disease — autoimmune hypothyroidism, the most common cause of low thyroid in the U.S.
3. Hyperthyroidism — overactive thyroid, including Graves disease.
4. Thyroid nodules — usually benign, but require imaging and sometimes biopsy.
5. Subclinical thyroid disease — mildly abnormal TSH with normal free T4. Treatment depends on age, symptoms, and other factors.

Most thyroid disease is managed beautifully in primary care. Complex cases — uncontrolled Graves, thyroid cancer, large or growing nodules — get referred to endocrinology while we stay in the loop.

Our scope covers:

• Hypothyroidism — newly diagnosed and long-standing. Treatment with levothyroxine, with TSH retested every 6 to 8 weeks until stable, then every 6 to 12 months.
• Hashimoto thyroiditis — autoimmune destruction of the thyroid. Most patients eventually need lifelong levothyroxine.
• Hyperthyroidism — including Graves disease, toxic multinodular goiter, and thyroiditis. We initiate workup and refer to endocrinology for definitive treatment when needed.
• Thyroid nodules — incidentally found on imaging or palpable in the neck. We arrange ultrasound and refer for biopsy when criteria are met.
• Postpartum thyroiditis — common, often missed, and usually self-limited.
• Subclinical hypothyroidism — TSH 4.5–10 with normal free T4. We follow guidelines for when to treat vs. Monitor.
• Iodine and selenium considerations — for select patients.

Thyroid disease often travels with diabetes, high cholesterol, and depression — all of which we manage in the same medical home.

Your first thyroid visit at Good Health NC runs about 30 minutes. Here's how it goes:

1. History — symptoms (fatigue, weight changes, hair changes, cold or heat intolerance, mood, menstrual changes), family history of thyroid or autoimmune disease, current medications, prior thyroid testing.
2. Physical exam — including neck exam to palpate the thyroid gland and check for nodules or enlargement.
3. Labs — TSH and free T4 as the standard initial panel. We add thyroid antibodies (TPO, thyroglobulin antibodies, TSI) when autoimmune disease is suspected. Labs are drawn on-site.
4. Imaging if indicated — thyroid ultrasound for nodules or asymmetry.
5. Treatment plan — clearly written, with the next testing interval.

Most lab results are back the same day or next morning. We message you through the portal as soon as they're in.

Treatment depends on the specific condition:

• Levothyroxine (Synthroid, generic) — first-line for hypothyroidism. We titrate the dose based on TSH every 6 to 8 weeks until stable.
• Liothyronine (T3) or combination therapy — for select patients who don't respond fully to levothyroxine alone. Evidence is limited but real for a subset of patients.
• Antithyroid medications (methimazole, propylthiouracil) — for hyperthyroidism. We typically co-manage with endocrinology.
• Beta-blockers — for symptom control in hyperthyroidism.
• Endocrinology referral — for radioactive iodine, surgical evaluation, suspected thyroid cancer, complex nodules, pregnancy with thyroid disease, or persistent treatment failure. See specialist referrals.

We handle the prior authorizations and refills ourselves. See medication management for how that workflow runs.

Make an appointment if you're noticing any of these:

• Persistent fatigue, especially with weight gain, cold intolerance, dry skin, or constipation (possible hypothyroidism)
• Unexplained weight loss, racing heart, heat intolerance, anxiety, or hand tremor (possible hyperthyroidism)
• A lump, fullness, or asymmetry in your neck
• A family history of thyroid disease and never been screened
• Postpartum mood or energy changes that aren't resolving
• Difficulty getting pregnant or recurrent miscarriage
• New atrial fibrillation or unexplained high cholesterol
• High TSH or abnormal thyroid result on a screening lab elsewhere

Thyroid testing is part of routine preventive care when symptoms or risk factors are present.

Good Health NC was founded by our experienced PA-C clinical lead with 22 years of practice — to deliver thoughtful, evidence-based care for the most common chronic conditions. For thyroid patients, that means:

• Same-day labs — TSH and free T4 results back the same day or next morning
• Real titration time — we adjust your dose based on labs, not guesses, every 6 to 8 weeks early on
• Symptom-aware care — TSH within range doesn't always mean symptoms are gone. We listen.
• Endocrinology partnerships — strong referral relationships across the Triangle for the cases that need them
• Coordinated chronic disease management — your thyroid plan stays connected to your other conditions

Most major commercial insurance, Medicare, and Medicare Advantage plans are expected to be accepted at opening.