#211: Can You Heal Your Thyroid? with McCall McPherson

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Hi.

Hey guys, this week we're going to talk about thyroid and we're going to look at it a little bit differently. I'm really excited about my guest because she takes a hardcore functional medicine approach when it comes to thyroid. And we're going to talk about things that you might not have heard before and we're going to cover everything down to like The differences in medications and when you should get your labs drawn and what happens with the autoimmune component and should you have surgery to have your thyroid removed and when you do, then what? Oh my gosh, we talk about all of it. So I'm really excited for this conversation. It's really important. But let me just sing her praises really quickly. Her name is McCall McPherson and she's the founder of Modern Thyroid Clinic, a thyroid-centered functional medicine practice in Austin, Texas, and she's the owner and chief hope-giver of Thyroid Nation. She's a physician assistant, TEDx speaker, and a thyroid and hormone expert by way of being a patient. Oh my gosh, you guys, McCall and I are so much alike, it's crazy. We have had many of a similar health journey, so it was really cool connecting with her. Her passion for perfecting thyroid treatment stemmed from years of her suffering due to the mismanagement of her own hypothyroidism. Now she lives, breathes, and thrives in understanding the nuances of proper thyroid care. And her philosophy is simple: there is no reason to still have thyroid symptoms. I love that. She spends time with her patients to get the help that they need and help get their lives back, teach them, advocate for them, and the other millions of women who are suffering who aren't her patients. So I love everything she's doing. I hope you find this conversation helpful. Please pass it along to another woman. You have been blessed. Now go out and be a blessing. Let's get started. Welcome, Nicole, to the Gutsy Gynecologist Show.

Thank you so Thank you so much for having me. I'm really, really excited to be here.

I am excited that you are here as well because we need to have this conversation. I see way too much thyroid disease and suffered with it my whole life myself. And I know you have as well, right?

Totally. Yeah. I turned my pain into purpose for sure. So I am a thyroid patient through and through.

What was your diagnosis?

Yeah, so I had Hashimoto's. Pretty severely. Both antibodies were quite elevated along with hypothyroidism. Now, I haven't had Hashimoto's, thankfully, for over a decade, but was really taken to the floor metaphorically, actually just taken to bed when I was 27 and couldn't function while on Synthroid and just really had a hard time navigating, finding someone that could help me. As you know, it's a big kind of gap in medicine still. Slowly over the years, I've really learned to navigate, you know, nuances to thyroid treatment that I think medicine is missing still.

Awesome. I love that. We need to have this conversation because, as you talk about on your Instagram, conventional medicine does not know how to treat the thyroid. They don't know how to even diagnose properly. And, you know, I'll raise my hand and admit that I was one of those doctors. Even though I had thyroid disease myself, I was on Synthroid. Through medical school, I wasn't getting the training or the understanding that I needed. And so I just fell into that trap of, oh, I guess people with thyroid just have to struggle their whole life. I'm just going to feel miserable and have no energy and have gut issues. Like, this is my constellation. And I perpetuated that lie as a doctor, you know? And it breaks my heart looking back now going, oh my gosh, we are just really doing women such a huge disservice.

It breaks my I respect so deeply that you say that. I think medicine is something that's constantly evolving. And to refuse to say that, which a lot of physicians and clinicians do, they outright say, look, we're doing it right. And I think it's such a dynamic thing, and millions and millions of women are suffering needlessly. So something has to change, right? And it is underappreciated in medicine, the devastation that thyroid conditions bring to people's quality of life. I mean, I really believe that. believe it affects women, mothers, marriages, children, generations. I feel like we can impact generationally family dynamics if we can help these women.

Yeah, without a doubt. I mean, my own mom wasn't diagnosed with Hashimoto's until she was 65. And so that's another piece that we should talk about is just because you have been tested for something before and it was negative or you weren't given a diagnosis doesn't mean something isn't going on Or doesn't come about later in life because those are dormant possible genes that can be affected, right?

Absolutely. Dormant genes that can be affected. And then the tragedy of poor screening methods, not checking full labs. In fact, literally 100% of my patients at Modern Thyroid Clinic have been told before they see us, usually 5 to 10 times, hey, these issues you're having, they're not actually your thyroid. And those are the same people that go on to get their lives back, right? I advocate so heavily for navigating this as an informed consumer of your health. Women, people, but mainly women have to push to find their answers, and they can't passively sit back and just say, well, you know, my clinician said I'm fine because there's a good chance maybe you're not.

Right, exactly. And I'll tell you, the idea of even having a well-functioning TSH range in the conventional medical space is so new. Like, that was just a concept when I was in residency. I mean, my kids call me old, but I'm not that old, you know what I mean? So like, I remember the study that came out from the reproductive endocrinologist saying, hey, we are seeing that women struggle with infertility when their TSH is above 2. Like, let's get the TSH down below 2. And that is at the point where I thought, Huh, maybe we don't know everything about thyroid. Maybe there's some missing pieces here. Like, because you know the range when I started medical school, it was like up to six, and then they squeezed it down to five. And and and now the studies are showing like you really need to be on the very lower end to actually feel good. But I just want listeners to understand that you can't even be mad at doctors because yeah it's. Not being researched, it's not being questioned. People are not asking, why does my patient not feel any better with this thyroid medication? So that's where functional medicine comes in. That's where McCall and I come in. Like we have to bridge that gap and help you understand that there's so much more. It is not a black and white easy situation. It's very complex, right?

And then there is no true like standardized range. When you talk about, you know, there were a few years I thought, oh my gosh, this thyroid issue, it's it's trending in the right direction, like we're making real headway. And then I'm sure you heard of the study that came out a few years ago that said actually people aren't getting better on thyroid medication if their TSH is less than ten. So we need to not treat people if their TSH is less than ten because they're not getting better instead of flip that whole thing upside down and say. Maybe the medicine we're giving them isn't working, and that's why people aren't getting better.

Right?

That's right. Should have been in the analysis somewhere. It wasn't. And so sadly, now a lot of clinicians are accepting up to 10 as a normal TSH, which most people walking around with a TSH of 8 are headed for disability.

Right. They're like pooping once a week.

They have diabetes.

Brain fog is terrible. They're obese. They're, you know, struggling to get through their job during the day. Like, that's not—

Show up for their families. Right.

And it's a really important point because just because a study came out and gave us a result does not mean that study has any validity. It does not mean that study should be paid attention to. There are so many poorly done studies. The variables are not evaluated appropriately. Nobody's asking, why did I get that result? Is it actually because of the hypothesis? That was said? It's usually not. Like, we have to really get our critical thinking hats on and stop just regurgitating the lies that are being perpetuated, honestly.

Yeah. Oh my gosh, I couldn't agree more.

So let's dive in because my listeners want to know, why do people get thyroid disease? And like, we got to answer all the questions. How do they actually know they have a thyroid problem? What do they do about it? Can they get their life back? Is Hashimoto's reversible? All the things. So let's start at the beginning. Yeah.

Most important thing is absolutely you can get your life back. Like, my whole motto at Modern Thyroid Clinic is there's no reason to still have thyroid symptoms. You know, people, we are taught to believe, oh, you're condemned to a life of struggle and misery. No, these people can thrive. I'm one of them. My patients are them. So I want people to accept that as truth, and the time it takes to get your life back when you land in the hands of the right clinician is very short. So it seems hopeless; it's not hopeless. There is so much hope to be had. So that's the most important thing. You know, I kind of look at thyroid conditions in two big sectors, like Hashimoto's, which is an autoimmune condition associated with hypothyroidism or low-functioning thyroid. And that autoimmune condition is not treated with medication. And I'll kind of circle back to that. And then the second class is like your plain old hypothyroidism where you don't have Hashimoto's. And this can be caused by, you know, a few varying things. It can be nutrient deficiencies, but it can also be what I see in my practice is a slow decrease in function over time, which I think is becoming more and more common in women. And I My suspicion is a lot of it is environmental. Absolutely right.

We just have such environmental toxic burden.

Yeah. And just like all of our hormones, slowly we lose them over time. More and more environmental pollutants, more and more issues harming our body kind of move up that timeline little by little. I'm sure you can speak to the hormonal aspects of that as well, right? Absolutely. Yeah, research shows like 80% of people with hypothyroidism have Hashimoto's. I actually don't see that in my practice. I'm seeing more and more women that are just losing function of their thyroid gland slowly as we age. But, you know, research shows, you know, where, you know, medicine thrives in the world of thyroid is, hey, let's balance your hormones, which is a huge piece of this. People need to have balanced thyroid hormones to have a metabolism, to have energy, to be able to think, to be able to have the capacity to live a healthy lifestyle. And that is a lot of it is is by a balanced approach to medication. But that actually doesn't help the Hashimoto's piece at all. That's where really the functional medicine right comes.

That's why I never felt better all through medical school at residency because my Hashimoto's was out of control, but nobody addressed that, and I didn't know because I was. You know, in my conventional training.

I can't imagine going through residency in like a severe Hashimoto's flare.

Yeah. And a surgical residency at that. It was rough. It was very, very rough. And I went into severe adrenal fatigue eventually. Now I burnt myself out over it.

Oh, I bet. Yeah. I don't— your body has no other choice, right?

No, exactly. Exactly.

Yeah. And with the Hashimoto's piece, you know, there's so many things regular medicine says, look, you've got an autoimmune condition. You've got this Hashimoto's. There's nothing we can do about it. We actually never even need to check these antibodies again. Just forget about it.

Yes, I actually read that in UpToDate, which, for people listening, that is like one of the main resources that, you know, Western medicine uses to quickly look up anything medical. So a doctor needs to look up, you know, how to treat something, they go to UpToDate. I remember one day being on UpToDate and it said, They suspect 80% of people have an autoimmune thyroid condition, but it's not recommended to test the antibodies because there is nothing that can be done about it. And this was during my functional medicine training, and I just, I wanted to cry. Like, oh my gosh, there is so much we can do about it. This is such a lie.

Such a lie. And I think at this point, like, I just run across studies here and they're not necessarily specifically for Hashi, but But medicine is beginning to recognize that we are able to influence autoimmune diseases.

Yeah.

It's becoming undeniable at this point. And I think we're not that far away from accepting that as truth. Now, how long that will take to end up in standard practice is another issue, but I think we're getting there. I think it's becoming undeniable. And the beautiful thing about functional medicine and finding a functional medicine clinician is we view autoimmune diseases As modifiable, they can be reduced. They can be put into remission. I'm a classic example of that. I I tell even my followers sometimes I've posted a video of me with a giant goiter. I mean, just huge, so inflamed, just in the peak of my Hashimoto's, living my life in Italy as like a 20-year-old celiac person eating gluten all the time.

You know? Oh my gosh! Oh my gosh!

I wasn't well. But yeah, I mean, eventually I can— my antibodies are completely negative, don't even show up in my blood. I have no goiter anymore. So many of my patients have the same story. And in fact, I— the way that we do things in my practice is we measure antibodies, we make an intervention, we remeasure antibodies 90 days later. We see how that intervention impacted antibodies because this is a measurable, objective thing that you can monitor to make headway with your long-term health.

Absolutely. Oh my gosh, I love hearing that. We do that the same in our practice. And I will say, like, my numbers were just written out as over 900 back in the day when I first got them checked because that's how high the lab would go. And so I just knew they were really high. And now I'm like single digits, you know, 4, 7. I had a huge goiter as well. It is gone. I've had biopsies. I don't know how many ultrasounds. All of those things, that life is behind me. It's not even existent anymore because I've cracked the code. So let's talk about how you reversed your Hashi's and what you do with your patients.

Yeah. Couple issues for me. Number one is I am definitely hardwired for inflammation. Like, my physiology—

Oh my gosh, me too.

Are we twins? Yeah. There's like a lot of parallels here.

Once my inflammation turns on, can't turn it off. It's crazy.

It's so difficult. Yeah. And I, unbeknownst to me, was celiac. I knew, like, as I grew older, I could recognize more and more what foods kind of made me feel bad. But celiac's a very complex thing. That wasn't known about then. I mean, even when I went to B.A. school, people really didn't know much about it. So massive gut issues as well. So those two things combined really put me into an inflammatory crisis that I did not know how to get out of, and I had to move through the process of you know really living in this tiny little box and controlling literally every aspect of my life because I was navigating it alone. And that's where finding a functional medicine clinician. is so valuable. That's the exact thing I don't want for my patients. I want us to make informed, educated decisions so they don't have to restrict, overly restrict. They don't have to live in this tiny little box. But gut is a huge one. I mean, absolutely huge. 100% of our patients with Hashi get gut workups with food inflammation testing and stool analysis and all of that. I'm sure it's the same for you.

Yeah, I love hearing that. It's just so important. It's the absolute gateway, the root cause of all of it. And you can take any medication you want at any dose you want, and if you don't heal your gut, it's not going to matter. It's a temporary bandaid. It's just another drug, you know?

And if you don't do that root cause work, you're just walking around at risk for other autoimmune diseases.

Absolutely.

And the higher those antibodies are, I kind of view them as a direct correlation for risk. If we can reduce antibodies, even if someone's not in remission or not in remission yet, we can use that as a direct reduction in their risk for developing more serious autoimmune diseases.

Exactly. So I don't know if a lot of people know about my story, but, you know, I get diagnosed with Hashi's at 17. They tried to burn my thyroid out with radioactive iodine, and I didn't know any better. I was 17. I said, okay. And it just progressed from there. You know, by the time I was in my early 20s, I had chronic IBS, chronic depression. Then I got into undergrad and medical school, and I had GERD and reflux and eosinophilic esophagitis. And every, you know, it just, it kept multiplying. Then I got Raynaud's syndrome, and it just kept multiplying. Then I got eczema so severe my hands would bleed. Throughout residency because I had to wash them all the time and wear gloves. And everybody would tell me, like, oh, it's just the gloves. It was not the gloves. It was my gut, my gut and my uncontrolled autoimmune condition that I was just, like, fueling, living on gluten and dairy and sugar and caffeine and stress. Like, like you said, I'm thinking, how did I get through that? Holy crap.

I could do so.

And now, like, I would never go through that again, knowing what I know now, like, absolutely would not sign up for it. But when you're in it, you literally think that's life. Like, this is it. I guess I just have to figure out how to live this way. And I love that you're saying, no, we don't actually have to live that way. You and I are proof that you can, like, thrive and feel amazing and do all the things, right?

Yeah.

And have a good, healthy weight and lots of energy and run businesses and Yeah, like all the things.

Versus I would be on disability by now.

Yeah.

You know, had I not gotten help. And so the 2 stories couldn't be farther from the truth. And being equipped to know how to navigate to get to that alternative ending is so important. That's why I like, like, I just share everything that I possibly can openly. Like, I don't keep anything to myself. I don't— on social, on podcasts, I'm just like, here, take everything. So that you can figure out how to get your life back.

I love that. That's so good. I mean, I see women struggling with things like hair loss. You know, that's a super popular topic right now. I get it. The pandemic really triggered a lot of inflammation, but for thyroid patients, like, it's magnified. And for a lot of them, I do think once you turn that inflammation cascade on, you can't turn it off. And I'm here to tell you, like, this is all my own hair. Like, there's a lot of it. And I have thyroid disease, and I'm on thyroid medication because they did burn out my gland. But you don't have to suffer with all those symptoms.

Amen. And yeah, as a person who lost all my hair during COVID this is all my hair too. It's like—

I love that. I love that because there are people out there. I mean, I love the hair extensions. They're gorgeous. But it's giving this false sense of like, oh, well, She must be really healthy and be okay because her hair looks fabulous. And they're not mentioning, like, hey, this is an extension. This isn't really what's going on. And so maybe I'm not as healed as I thought. Just throwing that out there.

Yeah. One other thing I wanted to bring up because of your story specifically that I hear a lot in engagement with my people, my community, social media. And I'd love your opinion on this. Like, I hear so many people, their doctors try to have them remove their thyroid, get rid of their thyroid for things like Hashimoto's.

Yeah.

Or the worst of all is, we can't get your medication right, so let's just take out your thyroid gland and then everything will be so much easier. And I'm like, oh dear God.

Yeah.

These people need to know. That this is not the answer.

I'm so glad you brought that up because honestly, I am the anti-surgeon surgeon. Like, I did a 4-year surgical residency. I absolutely loved being a surgeon. Like, I loved it. But God did not create our bodies to have organs that needed to be removed. Like, that's not how our bodies were created to function. And so this mentality of, well, it's misbehaving, just remove the offending organ. Yeah. Causes so many long-term sequelae and problems for patients that we do not talk to them about. We say we do risks, benefits, and alternatives discussion and sign an informed consent. That does not happen. I promise you, as a surgeon, I didn't give these kind of alternatives because I didn't know they existed. And so this is really important information for anybody listening. Like, if you're being threatened to have your gallbladder removed, your uterus, Your appendix, your ovaries, your thyroid. You have those organs for a reason. They have a job to do until the day you die. And so just removing the offending organ is not going to fix your problem. It might fix that one initial symptom, but I promise you, you're signing up for a whole other set of new problems for the rest of your life. I see it every single day. People get their gallbladder removed and then they can't digest their food. They get their thyroid removed and they never feel the same again. They get their uterus removed and their sexual function's never the same again. Or they, you know, they don't produce testosterone and they don't have orgasms. Like, so many things that we don't talk to people about. So thank you for bringing that up. Please don't run off and have surgery.

I tell people, I'm like, listen, whatever you can do, To not get your thyroid removed, you do it. Now, I think in treatment refractory cases of severe Graves', sure. In thyroid cancer, sure. But all of this casual talk of, for almost any other reason, removing a thyroid gland, these people are never the same.

Right.

They're never the same. It's devastating. So I'm like, please, just unless it's absolutely necessary, don't— just get a second, third, fourth, fifth opinion. Yeah.

And half the time they get their parathyroids removed as well. Nobody tells them. Then their bone health goes to crap. It's like, it's very sad. It breaks my heart.

No, it is. It's so sad. Yeah.

Don't jump under the knife, please. I promise you, like, surgeons love doing surgery. That is their tool to treat you. That is what they're going to offer you. They don't have other tools. They're surgeons. So That's what they're going to tell you to do.

So true. Yes. Find a functional provider.

Yes. Oh my goodness. Okay, so what are the best things to calm inflammation and calm this thyroid attack?

Yeah, so I view inflammation like water in a cup, and I'll use like my little Stanley here as an analogy. So our body is meant to deal with a cup's height of inflammation, and inflammation is inevitable. We are going to get inflammation. Every bit of inflammation we get is a drop of water in that cup. When people are in an inflammatory crisis like I described earlier, like you say you get into, I view their cup as completely full. Any tiny inevitable drop of inflammation that our body should deal with fine creates an eruption of overflow, and when it overflows, it creates symptoms and autoimmune disease. So we don't need to get rid of all the water in the cup. We just need to lower the level enough That we can handle inevitable drops of water into that cup without creating symptoms or autoimmune disease. Right. I love that. So that is—

yeah.

So it's either reducing inflammation going in or improving your ability to detox inflammation. Right. So liver support, glutathione. Glutathione is our body's most potent antioxidant, anti-inflammatory agent. Usually when people have autoimmune disease, especially if it's like genetic, Often they don't have enough glutathione; they don't produce it enough. So supplementing with that, I even have thyroid patients use glutathione cream like right on their thyroid gland to calm it locally. Great, great ways to reduce inflammation. I love LDN. I love LDN. I think it is or low dose naltrexone is is the full name. It is a way that people can take. The water level in their cup and dump out 2/3 of it and get a reset so they don't have to do what I had to do and live in this tiny, tiny little box and control everything to not be debilitated. Right. Right. And then they can build off of that, improve their lifestyle, reduce inflammation going in, reduce toxins, eat better, more micronutrients, improve that gut function. Right.

I love that. And how many people would you say have the side effect of like wild, vivid dreams or headaches on LDN. Are you seeing that very often?

Definitely vivid dreams. Yeah. Like I tell everyone, you know, don't expect them to be bad, but expect to go on an adventure a few nights a week. And it doesn't really go away. It kind of can wax and wane. I don't generally have people stop it for that.

Yeah.

Headaches, I don't have so much of an issue with. A little kind of fatigue in the morning when they first start it, but out of probably Well over 1,000, maybe closer to 2,000 people I've put on LBN. I've probably had like 5 stop it. So I mean, pretty well tolerated.

Yeah, I would agree. Awesome. And where are most people landing on their dose? Like the 4.5 max, or—

I usually, I mean, 99% of my people are at 4.5, which is the dose research is done at. I find people with Graves' often need a higher dose.

Yeah.

And 100% of my Graves' patients are on LDN. It's such a powerful, powerful way to reduce the flares and the roller coaster that Graves' creates. And then other people too, they just need a little more. I think their physiology is wired a little bit differently. So I'll start them, I increase them up to 4.5 slowly, and then I'll increase them in 1.5 milligram increments and kind of test that dose with antibody measurements. Right. Right. Albion's a really powerful way to reduce antibodies or with just how they're feeling. Inflamed people know what inflammation feels like. They are constantly working on it.

Yeah. Yeah. I mean, there's such a difference, you know, just being able to exercise regularly and have a normal feeling recovery and not being wiped out for days after. Like, that was my telltale sign. Like, oh, I want to work out more than twice this week. Awesome. You know, I'm making progress.

Yeah. Yeah. No inflamed people; they deeply have their their recognizable traits that tell them they're inflamed.

Yeah, absolutely.

Okay.

So some people do need to be on thyroid medication. That thyroid just is struggling to function, especially when it's being attacked. Is there a Is there a preferred medication that you like? Do you find everybody's kind of individualized and tolerates things differently? What is your general approach when you're first attacking this situation?

Yeah, so I really hone in on a deep level of understanding for where people's thyroid physiology is functioning versus not functioning. So I don't have like a one-size-fits-all. It's very unique based on their labs. However, the consistent thing really across the board—basically, pretty much 100% of people at my practice are on some form of T3 or active thyroid hormone. Doesn't mean everyone needs to be. I think there are people that do okay on inactive hormones like levothyroxine and Synthroid and Tirosin, Unithroid, and Levoxyl. But those people don't ever need to see us. They see their primary care or they see their endocrinologist, and they feel fine on those medications. They're so lucky they should go buy a lottery ticket, right? Not everyone gets that flight. So a lot of people that medicine does not account for are not able to activate those medications. That was me. That's all of my patients. Those people are left with symptoms despite being on thyroid medication, and they will never actually get well on T four only. And those people deserve. an alternative form of treatment. And that is— yeah, that is layering in T3, whether that's Cytomel in addition to levothyroxine or a form of natural desiccated thyroid, which is a combination of active and inactive thyroid hormones. Those are drugs like Armour or NP. We have to present an option for these people.

I just want to ask you what you're seeing in your practice, because for me, I would say, with my autoimmune thyroid patients, it goes either way with the desiccated thyroid hormones. I have people who feel so much better on it, and then I have people who just feel worse, like their antibodies increase. And I'm only assuming that their body is attacking that thyroid glandular medication as if it's a thyroid tissue. realizing we need to do more calming down, more emptying of the inflammation bucket. What has your experience been with that?

Yeah, I know that that's definitely a dialogue that happens in functional medicine a lot. I actually don't see that very often. There have been a couple of cases, literally less than 5 out of 6,000 or so, where I'm like, you know, I'm a little— I think that this might actually be the desiccated thyroid. Perhaps they don't do well with pork or pig, and that's what these medications are made out of. For the most part, the people I find that do not do well on desiccated thyroid are people who can't handle that ratio of inactive to active thyroid hormone, because desiccated is almost all inactive.

Right.

With a small amount of active. those people convert that inactive hormone to reverse T3 or their inhibitory hormone too much, so they can't outrace that inhibitory hormone blocking their active hormone.

Yeah.

From being usable. And so those— I'm one of those, um, actually just post-COVID. I was on Armour for 15 years and was fine, but stress changes and physiology made it to where I can't handle that ratio anymore, and now I have to be A little Cytomel as well as Armour.

Oh my gosh, I'm so glad you made that point. Like, it does matter what season of your life you're in. You are not always going to be on the same dose and have the same requirements. You are going to change over time. It's the same thing with sex hormones. It's the same thing with your diet and your exercise. Like, what suits you now is not going to suit you probably in 5 years. That's just not how it works. So I think that's a really important point that But even if you've been on the same medication for a few years, you should continue to be monitored and reevaluated and think like, is this optimal? Is this the best scenario for you?

Right. Because we are dynamic, evolving, changing, evolving people. And our physiology, our ability to activate and use thyroid hormones is not static. It is not the same across years, decades. Across stressors, pregnancy, post-pregnancy, all of it. So absolutely, I encourage— at most, people need to get their thyroid checked every year. Absolutely.

I love that. That's so important. And let's talk about how to check thyroid. What's your favorite way? So I watch you on Instagram. I noticed that you love to check it at the peak. And I love this concept because, honestly, I have people do their labs fasting because I'm looking at fasting stuff like insulin and lipid panels and things like that. But in my head, when I'm interpreting the results, I'm going, okay, she's been off her thyroid meds for 12 hours or 24 hours. Her T3 should be looking a little bit different at this point. And so I'm doing some internal interpretation that they're probably not even aware of. And so they're looking at like, what's my optimal level? And they're always like, But it's not this. And so we have to have that conversation. But I like that you're just like, well, let's check it when we need to check it, at the peak. And maybe I'll start doing that and tell them like, okay, get your fasting labs done fasting, get your thyroid labs done at the peak. Because explain why to patients. I think it's super helpful to understand.

I think it is one of the most important things that has to change to evolve thyroid care because the narrative in medicine is that T3 medication Armor, Cytemel. These drugs are not stable. They're not reliable. They're risky because they're inherently unstable. They're actually extremely stable. What isn't stable is when there is no set standard of when we need to be checking them. That creates a lot of volatility because these medications peak and trough anywhere from 3 to 8 hours. So if we are not accounting for that, we are guessing. And, you know, we don't get where we need to be in thyroid if we're guessing. So if the true risk and the fear in medicine is the volatility of these meds, the unpredictability, even though they're predictable, because we are worried about people's T3 getting too high, because that is what the fearmongering dialogue that's happening in medicine is centered on, we need to know what these people's T3 are at the highest level that it gets when they're taking T3 medication. And I'll give a perfect example. Of a patient we had a few weeks ago that came in, 30s young woman, been on NP and Cytemel, checking her labs off meds and perpetually getting them increased. And I saw her previous labs; her T3 was extremely low, 2.2, 2.6. Pajama town is what I call that. Every time she sees the clinician, she gets her labs off her meds. Every time her T3 looks low. Why? Because if you take your T3 on a Monday morning or a Monday morning and afternoon and you get your labs drawn on Tuesday morning without taking your T3, none of your medication is in your system, right?

Because T3 is very short acting. It has a very short half-life. It's gone.

It's gone. It's completely out of your system. So now we are basing what to do with this woman's medication without knowing what her medication is actually doing in her body because it's not even in her body at the time that we're testing or what But a lot of the dialogue in functional medicine and integrative medicine that has been propagated from a single source of Stop the Thyroid Madness is what started this, not to call them out, but is take it way later. You take your labs way later after that medicine has peaked, it's troughed, and then we're checking it. And again, we are not getting real information. So again, people's meds are being constantly increased, constantly increased, constantly increased.

Yeah.

Then they show up to my office, I check them on their peak, and, you know, I think this last woman's was 14. Her T3 was 14, which is wildly not safe. I've had a woman actually transfer to us that had a stroke between the last person she saw and us, literally from her T3. And another 72-year-old woman showed up to my office with a T3 of 17. Like, she's sitting in my office and I'm like, is this person going to have a heart attack right now? Because, and again, she would have seen her previous provider, checked her labs, off of meds. They would have continued to increase her T3.

Yeah.

Which is crazy. So I advocate for peak T3 times. Is there T3 at that peak all day? Of course not. No. But that is the only way you can safely and effectively protect people from overmedication. So for cytomel and lyothyronine, that's about two to three hours after they take their meds. For Armour or NP, it's about three to four hours after they take their meds.

Yeah, I think that's really important for women to understand, and I get so much pushback. They're always like, "But my T3 is low." I'm like, "It's supposed to be low. It wasn't in your system when we checked it." I'm looking at your TSH, and it's point zero zero zero one. You know, it's like. Ridiculously suppressed, you're getting too much. And so I think for patients to understand this, it is complex, and we don't expect you to be able to adjust your doses and understand all the things that you know we've spent decades learning and understanding and experiencing with our patients. But it's just really important for you to know the limitations. And I think that's what's happening is we're not understanding the limitations. And T3 is being treated by the functional space like a sugar pill, like a placebo, like it's no big deal. Anybody can take whatever dose you want and enjoy. And then the conventional space is like freaked out, like, oh my gosh, T3 should be banned. And we're trying to help you guys meet in the middle and understand there is a happy medium, either extreme is not helpful.

And it's not necessary to be grossly overmedicated to feel well. People, let me tell you, as my whole day job is only to treat these people, and my success rate's like over 95% of giving people their lives back, you do not need to overmedicate people for them to feel well.

Yeah.

They need to be treated in narrow margins, tightly controlled, but they do not need to be overmedicated. And I think the reason functional medicine thinks we can just put people on all this T3, it's not a big deal, is because they're not seeing the numbers that they're creating. They're not seeing the free T3 value that's actually happening on these medications.

Right.

Which is dangerous. And we're not going to fix the fear in medicine about giving patients access to these medications until We can get some really solid data around it.

Yeah, absolutely. And I want people to understand, like, these higher-dose T3s, they directly affect your heart. I've, you know, taken care of multiple people who had had to go to the ER. They thought they were having a heart attack, or they go into an arrhythmia where their heart rhythm isn't normal, and that can increase your risk for a blood clot and a stroke, like you mentioned. Like, These are not benign side effects, right?

They are. And these medicines are very safe when they're used appropriately. People do not casually have a heart attack. They don't casually have a stroke. Right. But also, no one should be on 50 or 70 micrograms of Cytomel. There's not a human on the face of the planet that needs to be taking 50 micrograms of Cytomel, not even if you don't have a thyroid gland. So this gross, negligent, overmedicating people is not only hurting the progression of thyroid care in general, it's hurting— I mean, it's killing people, literally.

Well, you and I are both on Cytomel or T3, so I just want that to be out there. It's a low dose. I fluctuate from 10 to 12.5 micrograms and 25 of levothyroxine. That's But I have felt really well since I started my perimenopause transition, probably 3 or 4 years ago. And that's where I've been good. Yeah. My thyroid antibodies are gone, right? So that's the key.

It's so important. And, yeah, it's so vital to clarify, we're not afraid of these meds. In fact, these are the only meds I use. I am out here advocating for people to have access To these medications, but it also needs to be done correctly and safely.

Absolutely. Good. I love that we've cleared so much up today. You're such a wealth of knowledge. This is so good. Oh my goodness. So you help women all over the country with your clinic, right? So if they are struggling and they're like listening to this going, okay, yeah, I know I need to change my dosage or Maybe I have a thyroid problem and nobody's diagnosed me yet. Like, you take care of all of that, right?

So Modern Thyroid Clinic, yes. Our whole mission is to serve women who have not been able to find answers to their symptoms, to their thyroid problem, who are being told, hey, this isn't your thyroid, when actually most of the time it is. By the time they end up at our office, if it looks like a duck, it quacks like a duck, it walks like a duck, it usually is. We are expanding Modern Thyroid Clinic nationwide. Personal goal in my lifetime to reduce the amount of time it takes for women to know that this is likely their problem, that there's another way of getting help and helping them. And then 3, expanding access to these people, because right now there are just— there are truly not a lot of people that are adequately trained in progressive thyroid methodologies, and there's just not enough access. So we're expanding it.

I love that. That's so good. And you have a gift for the listeners, right, for them to check out? What is it?

Yes. So I have my free thyroid lab guide. It will tell you what labs you need and what they mean, the ranges that I use with my patients in Modern Thyroid Clinic all day, every day, what each one of those labs means. You can get it at gift.modernthyroidclinic.com, or obviously I'm sure you'll put it in the show notes.

Yes, I'll have all the links for you in the show notes so people can Find you, follow you, check you out. Thank you so much. This has been an amazing conversation, and I know somebody got something really good out of this one. I know. This was a pleasure.

It was delightful. Thank you for having me.

Woo! So many golden nuggets. Okay, how about the concept of checking your thyroid labs at the peak level of their dosage to get a better understanding of how high those levels are going during the day and to see whether you actually do need to increase your medication or not. I love that. I love that idea. I typically haven't done that in the past because so often I need labs done fasting for women for other labs. And so maybe we'll start doing it 2 times, you know? We'll do the fasting labs when we need to do them and then And we'll do the thyroid labs at your peak medication dose just to see where you truly are. I love that we continue to critique and research and evolve so that we can give you the best outcome and help you feel amazing and thrive. So I hope you enjoyed these conversations. They're really important to have. And I do want to give a little shout-out to Lake McHugh girl who gave me a five-star review. Thank you so much for taking the time to do this. Honestly, it's so important because when women are searching for new podcasts, we look at reviews, right? We want to see what other women say. So thank you for taking the time to do this, Lake McHugh girl. She said, "I learn something new every podcast!" Exclamation point. Thank you for bringing truth and wisdom to women. So many doctors are so sold just offering pharmaceuticals and surgical solutions. I'm so grateful to have your voice out there bringing functional perspectives. God bless your practice! Exclamation point. Keep sharing your messages! Exclamation point. Woo! I love that. I love all the exclamation points, and I love your support, and I love hearing that. You're getting finding value in this. Like that's why I do it. So let me know, please. If you haven't, take thirty seconds. Leave me that review. It's very easy to do. That helps Apple know that you care about this stuff and push it up so that you can find it. You need to use your voice, ladies. We need to use our voice collectively as well. So thank.

Thank you.

Thank you. Thank you. Yeah. And if you're watching on YouTube, I did change my clothes because here's what happened. I recorded the intro and outro for this episode and it got lost in my computer. So lesson for the day, just do it again. Don't fret about it. Don't stress about it. Just do your best. That's all you honestly can do, right? We just have to keep moving forward. Don't let hurdles stop you. You know, that's been the biggest game changer for me is I just don't let all the messes and the mountains and the bombs, whatever they are that go off every day, that get in my way, that happen. Just keep trucking along. Just don't let it faze you, okay? Just keep faithing your way through every Every day. God's got you. All right, have an amazing week. I'll see you soon. Bye.