Balancing Hormones and Thyroid Health with Dr. Amie Hornaman

We're still not testing properly. I still see people coming into the clinic with just a TSH.

Many women are told your labs look fine, labs are normal, labs are fine.

That's what they hear every single day because they are just like you said, they're looking at the TSH, thyroid stimulating hormone. TSH is a brain hormone, it's not a thyroid hormone. So why aren't we looking at the actual thyroid hormones that your thyroid produces that actually have to get to your cells to give you a metabolism and to light up your brain and grow your hair?

The standard of care is It sucks. It's horrible. So please, you don't want the standard of care.

No. It's very, very common for doctors to just say, oh yeah, well, nothing to see here. It's in the normal range. Meanwhile, the woman could be walking around with a reverse T3 of, let's say, an 18. Her body literally thinks she's lying in the ICU or the ER.

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Thank you, JJ, so much for having me on.

I'm so glad you're here. You've helped thousands of women now who were told their labs were normal fix their thyroid. So I'm excited to unpack all of this, cuz I know it's such a major missing piece for so many women. So what I'd love to dig into, start with first, is Thyropause. Why has no one heard of this? What is it?

I know. And we need a spotlight on this.

We so much— I think you're doing it.

And you know, I mean, there, there's been great talk about menopause and perimenopause lately. I think we're, we're getting a spotlight on women's health more and more, but Thyropause. That's really what needs some love and attention. So I define it as when your thyroid gland craps the bed after the age of 40 due to fluctuating hormones. Basically what that breaks down to is when we're talking about the thyroid, the master gland, from head to toe it runs the show. We have to look at how thyroid dysfunction occurs, and we know that 95% of all hypothyroidism is Hashimoto's. Hashimoto's is autoimmune. We also know that that autoimmune switch can stay in the off position for a long time, sometimes decades. Then a woman goes through hormonal fluctuations like pregnancy or perimenopause, menopause, and boom, turns on. So that switch turns to the on position. Now a woman has Hashimoto's, but she's in her 40s, she's in her 50s. Everyone's telling her, well, it's just part of growing older. It's, it's menopause, you know, just get used to it. Meanwhile, she's walking around with a thyroid problem, i.e., thyropause, and doesn't even know it.

Well, I was always taught that you couldn't balance your hormones. Like if you're going into perimenopause, if you're going on hormone replacement therapy, if your thyroid's not right, you're not gonna be able to balance your hormones anyway. But why is it that women are walking around with this undiagnosed thyroid issue? Why is this getting missed?

Because we're not testing thoroughly enough. It really starts with testing. And honestly, I can't believe that we haven't come further than, than what the needle has moved since I was misdiagnosed. We're still not testing properly. I still see people coming into the clinic, women coming into the clinic with just a TSH. Now we know thyroid stimulating hormone, TSH, is a brain hormone. It's not a thyroid hormone. So why aren't we looking at the actual thyroid hormones that your thyroid produces that actually have to get to your cells to give you a metabolism and to light up your brain and grow your hair. We're not testing thoroughly enough to see what's actually inside this person, what's going on with their hormonal profile and, and the whole balance of the thyroid hormones inside. And it starts with testing, starts with thorough testing.

So you, you hinted to your own struggle, which I'd love to go through. How long were you struggling with this before you figured it out and what was your story?

Yeah, so, you know, so many of us in this space go through pain of some kind. So this is way, way back in my 20s. I was competing, I was doing figure competitions, bodybuilding figure competitions, and I had done plenty of them, worked with a coach, you know, had the whole diet laid out, hitting the gym twice a day, which is craziness now that I think about it. But it's just insanity, a little bit of insanity. But I knew how my body was supposed to respond, right? And we know just basic biochemistry, calories in, calories out. I was eating chicken, broccoli, and asparagus and doing cardio twice a day. The weight should come off, the scale should come down. And this one particular show I was getting ready for, it didn't. It was going the other way. I mean, every single time I got on the scale, it was up like 2 to 5 pounds. So my coach thinks I'm cheating. Everyone at the gym is like, oh, she's eating too many donuts. I'm wearing big sweatshirts, just covering up. I mean, it was frustrating. It was depressing. I, I absolutely fell into a depression because I knew my body was rebelling against me, but nobody could give me an answer. I went to 6 different doctors who all told me, oh, you're normal, everything is fine. One of them actually told me to eat less and exercise more, which I laughed in his face. I'm like, this is my diet, right? This is what I would hand them paper. This is what I'm eating. And they still wouldn't believe me. Finally, the 7th doctor, she touches my neck. First one to touch my neck. She goes, I want you to swallow. Okay. I'm feeling some nodules on your thyroid. We have some labs over here that look like you have hypothyroidism, so here's a pill. And I left her office, I was like, yes, I have a diagnosis, I have a pill, this is gonna fix everything, I'm gonna lose the weight finally. Nothing. 5 months later, nothing. Well, turns out, I found out later through doing my own research, she gave me T4. She gave me Synthroid. She gave me the inactive thyroid hormone, T4. And it did not work. And now I know, I mean, from working with our patients, It doesn't work. T4 only doesn't work. We need some of that active thyroid hormone in the mix. We need to personalize the treatment for every single woman going through this. But yeah, I was misdiagnosed 6 different times.

Is this more common for women? 'Cause that started with you young, probably 'cause you were overtraining, stressed out, et cetera. Mm-hmm. But it feels like this is so common in women 40 plus. What's happening? 40-plus, is there some magic that's happening? Is it perimenopause? And how common is this?

So the current stats are 1 in 8 women, but we have to remember these are the diagnosed ones.

Are they diagnosed based on traditional labs? Exactly.

Yeah, exactly. So what is it really? 1 in 4, 1 in 2? We don't know. We don't know the real stats. But what I can say is I, I truly believe that Thyroid disorders are on the rise, kind of going back to what I just said about Hashimoto's. So if 95% of all hypothyroidism is autoimmune, and we know that autoimmune comes on with a trigger of some sort, so we can use that, that three-legged stool analogy that Alessio Fasano said years ago, where you have that genetic predisposition, your mom, your sister, your aunt, your grandma has some kind of autoimmune. We have leaky gut, which pretty much all of us have leaky gut at this point. And then we have that trigger. So is it perimenopause, menopause, and fluctuating hormones? Is it overexercising and undereating like I did? Or is it that toxic load that we are being bombarded with these days in modern times with, with environmental toxins, extra stress? We're under more pressure nowadays, even just with social media, that extra, extra stress, extra cortisol production. That can turn on an autoimmune condition. So I think it's a multitude of things that are all happening at the same time. And then you add on more awareness. So now these women are going, oh, wait a minute. Um, I don't have to be fat, foggy, and fatigued after I turn 41. There's actually something going on inside of me and there's something I can do about it. So I think women's awareness too is heightened now, and that's why we're seeing more and more thyroid conditions.

Well, and then they go to their doctor and they typically run maybe a TSH and a T4, and their TSH is in range. Mm-hmm. And so what's going on here? Like, because it's, it feels like so many women are told your labs look fine.

Labs are normal. Labs are fine. That's what they hear every single day because they are just like you said, they're looking at the TSH. So TSH, thyroid stimulating hormone, it's a brain hormone. So it's released by our brain. It's our sensor in our body. It's our brain saying, you know, is there enough thyroid hormone in this body to run it properly? If there's not, TSH is going to go up. It's one of the only markers where high means low. So the higher the TSH goes, the lower and slower your thyroid is functioning. But if we only look at that, and like you said, somebody comes back in range, well, that's a problem in and of itself because we're only looking at one marker and we're looking at a brain hormone, not a thyroid hormone. Then layer on top of that the fact that that standard lab value range for TSH has been changed through the decades. It used to go to a 10. Now it's— oh yeah, there was one point in time you could roll in with a TSH of 8 and your doctor's like, yeah, you're fine, nothing to see here. Then it dropped to a 6. Now it's at a 4.5. But in functional medicine, we want it less than 2.

Mine always sat around 1, and when I went to a little above 2, I was a disaster. Yep.

I hear that all the time.

A disaster. A disaster. Thankfully, I was working with Alan Christianson and he was like, "Oh," you know? Yeah. So, you know, is it also, is there a normal range that's good for someone? Like someone might feel great at 2.5, but I didn't. Right. I felt horrible.

I would say most people do feel, they feel it when they go above a 2. You might have that random person that's like, "Yeah, I can float at like a 2.5 or a 3." As long as my free T3, one of the most important markers, as long as that is optimal, not just in range, optimal. And as long as my reverse T3, the other important marker, is below a 12. Reverse T3 is your anti-thyroid hormone, so it will put your body into lockdown, hibernation, survival mode if it goes up too high. Now, again, the standard lab value range for reverse T3 goes up to a 24. I just said we want it less than 12. So it's so easy. First of all, if you even get the reverse T3 tested, it's very, very common for doctors to just say, oh yeah, well, nothing to see here, it's in the normal range. Meanwhile, the woman could be walking around with a reverse T3 of, let's say, an 18. Her body literally thinks she's lying in the ICU or the ER. And this is the beautiful thing about our bodies. Our bodies are so smart. Our bodies know that if we are in an accident and we're lying there fighting for our life, we don't need to burn fat, we don't need to make major decisions, have sex, we don't even need to poop every day. We just need to lie there and survive. So reverse T3 will go up in order to basically tell the body, okay, stop all these unnecessary metabolic processes. Let's just shuttle all the energy to healing, healing that wound, healing that person, keeping the heartbeat. But if you're walking around trying to live life and your body thinks you're in the ICU, that's a problem. So that's why we always wanna check reverse T3.

So when someone's getting thyroid labs, is that then part of what should always be? Because I've heard other doctors only do that if the other things look off. Could everything else look normal and your reverse T3 was high?

Yes, yes, yes, yes. I like checking it every single time. And here's the other piece.

What are you, what's the number you're looking for there? Like, where would you ideally want it to be?

Just less than 12. As long as it's less than 12, I don't have a problem if it's low. I get that question asked all the time. I don't care if it's flagged low, because that tells us how well you are converting your inactive thyroid hormone to the active thyroid hormone. So reverse T3 is especially important if someone is on thyroid hormone replacement. If they're on even natural desiccated thyroid, if they're on T4 or NDT, we have to see that T4 that you're taking, is your body actually converting it to the active thyroid hormone? That's the information that reverse T3 gives us.

Okay, so someone going into their doctor, what are the labs they should ask for specifically?

Yep, so go ahead and throw in the TSH because they're going to test that anyways, that's fine. Free T4, which is the inactive thyroid hormone, but it's free, unbound, it's ready to be converted to T3. So let's toss that in. 2 most important ones, free T3. We wanna know how much unbound active thyroid hormone you have. Reverse T3 that we just talked about, the survival hormone. And then we wanna look at TPO and TGA antibodies. Those are the 2 markers for Hashimoto's. So that tells us whether or not you have an autoimmune condition.

And where do you want your TPO, your antibodies to be?

Zero. Yeah. Zero. Yes. I know you've seen this too. How many times a person will say, well, I don't have Hashimoto's. And we look at their labs, like, TPO is a 20. Okay, yeah, it's not over 30. I don't know who came up with 34 as a random marker for TPO antibodies, but it's like, okay, so I don't have Hashimoto's unless I have 35 antibodies, but I have 20 right now that are going out on a daily basis and destroying my thyroid. Oh, but, but, but I don't actually have Hashimoto's yet, doctor. You'll tell me I have Hashimoto's when I'm 10 pounds heavier and can't get off the couch. Then you'll give me that diagnosis of Hashi.

So antibodies, you want those at zero, is super important. And then with the free T3, where do you want that to be?

Upper quadrant of the range. So this makes it easy for anybody in a different country, or you're going to a, a random lab that has different standard lab value ranges. Just take that standard lab value range for free T3, cut it into four. I want you in that upper fourth, that upper quadrant.

And it's usually in the lower fourth. It's like, you just see it all the time. All the time. All the time. Yep. And most thyroid medications, are most of them out there either a combo or just T4? I mean, generally what I see is people do better when they actually add some T3 alongside it to get to the right level.

Exactly. So there was actually a stat given out at an A4M conference, and I love this woman who said it, and I use this all the time. Only 2% of those with hypothyroidism— and she used the term do well on, which I— okay, we can argue what does do well on mean. 2% do well on T4 only. 98% need T4 and T3, or sometimes even T3 only.

Yeah, well, what I would assume is you'd actually probably use less overall if you're targeting. So then the next question is, why is your body having struggling to convert T4 to T3?

You know, there's so many things that get in the way. And I equate it to running 10 Tough Mudders in a row, 'cause it's hard for your body to do. Conventional medicine assumes that our body just converts easily. But when you think about it, estrogen dominance, insulin resistance, what are we at, like 97% of Americans are insulin resistant now? It's a crazy high number. There are genetic SNPs that can get in the way of T4 to T3 conversion, nutrient deficiencies like low mag, low selenium, low iodine. There's so many things that get in the way. It's like, no, we should start off with the assumption that someone isn't going to convert well and work backwards from there.

And now the iodine question, because I've heard both. Mm-hmm. You know, if you're low in iodine, it's problematic, but then iodine can cause thyroid problems. What is it?

It's all about the dose. It's all about the dose. Yeah. Right? I love a little bit of iodine, and I really think it got a bad reputation from practitioners overdosing it.

Oh my God, that crazy, remember the iodine test?

Yes.

There was a time in the integrative space when iodine was— it's like creatine now. Iodine had its moment and people were like slathering iodine on and it was like, 'cause they were doing the test and they—

See how fast it absorbed. Yes. Yes. Not an accurate test, by the way. Don't do that. But no, it really, too many practitioners were overdoing it and people were going into hyperthyroidism. Some people slipped back to hypo. I did that. I did that to myself years ago when I was experimenting with iodine. I'm like, "Ooh, well, more is better, right?" No, I started gaining weight, so I reversed. It's all, what is that, the saying, the cure versus the poison is in the dose? It's all about the dose.

Well, especially with minerals. Yeah, exactly. Fat-soluble vitamins and minerals, they don't go places, they store, so be careful. So what about fat loss? Why does fat loss seem just impossible when your thyroid's off? Like, what's— when your thyroid's low, what are all the horrible things that are happening?

So when we start with the premise that your metabolism literally starts with a thyroid, I mean, yes, there are many factors to metabolism. We have to look at your insulin, we have to look at your cortisol and your stress level and your, your hormonal balance. Do you have enough testosterone? What about your estrogen? All that's going to contribute to fat gain or weight loss resistance. But the thyroid, that's the master, that's the master regulator. So we have to make sure that you have enough of that active thyroid hormone T3 in your body. So when we look at the cells, every single cell in the body, it has a little receptor site on it for T3. So if you think about it like a lock and key, the T3 is coming in, turning that lock, and that's what's activating— that's what's activating thermogenesis, activating your metabolism. And when you think, okay, hypothyroid, low and slow, everything is slowed down. So yeah, metabolism is slowed down, cell turnover rate, circulation, your body temperature, your heart rate, everything is low and slow. So how can your body possibly look at your fat stores and say, hey, we're going to go over here and burn this for fuel when it can't even beat your heart properly? It can't even regulate your body temperature properly. And again, it comes back to our bodies are so smart. Our bodies will do what it has to do to stay alive first. And the way you look doesn't— your body doesn't really care, and, and that's not really going to factor into staying alive. I mean, yeah, we could argue, okay, well, if you're overweight, then type 2 diabetes and all the diseases of, of obesity. But at the bottom, at the end of the day, your body does not care if you fit into the dress that you want to fit into. It's going to hold on to that body fat if your thyroid is low and slow, so it can just do the basic functions of survival.

So beyond the body fat gain, what are some other symptoms? Because I think one of the key things here is recognizing some of these symptoms so you go in and get tested.

Yeah, exactly. You know, obviously as women we focus on weight because we hate it when our clothes are tight. But hair loss is another big one. Hair loss, hair thinning, hair breaking, brain fog, uh, memory issues, focus, concentration, anxiety, depression. Like we already talked about, heart rate, low heart rate your variability is off, your body temperature is down, you're constipated, you're bloated all the time. I mean, literally, if you go from the top of your head, starting with your hair, all the way down to cracked heels on your feet, dry skin, dry elbows, dry heels, it affects everything.

How on earth does someone kind of parse out perimenopause versus thyroid, and how do they interact?

Yeah, well, first test, don't guess. Just test. I mean, let's test your hormones.

Plus we can do functional health now. Like, it's so dirt cheap, thank you, Mark. That like, come on, it's under $500. I think it's now under $400 a year to do all those labs.

So easy.

And I'm pretty sure they have TSH. I don't know if they have reverse, but I'm sure you could add it.

Yeah, you can add it now. Yeah, yeah, yeah. No, we do have to message Mark and tell him, just add in that reverse T3.

I will message him. I was at another lecture, a BHRT cruise, and they're like, will you please tell Mark I'm into add progesterone? I'm like, okay, okay.

Okay, I'll do it.

Anyway, apparently that's in the works, so like. They're actively putting things together. But I also know you can add things to the test.

So you totally can. So you, you can get an inside look at your own body. And again, that's what we talk about in the book is here's the optimal lab value ranges. So get your own labs and then actually look at them from that optimal perspective and see if you're in that range. Now, when it comes to that overlap, like you asked about perimenopause and thyroid, again, it is about testing. So there's going to be some overlap.

Yeah, just brain fog.

Come on. It's like, you know, but here's— progesterone actually plays a role in T4 to T3 conversion. So let's say a woman's heading toward 40, progesterone's tanking, her cycles are heavy, she's not sleeping, and now she's gaining weight. Okay, well, that low progesterone definitely affecting her sleep, definitely affecting her mood and brain function, but it's also affecting that T4 to T3 conversion. So now, does this person have perimenopause and a thyroid problem at the same time? We have to test in order to get all that.

Well, how would you know then if they just need some progesterone that would fix their thyroid problem, or if they need the thyroid as well? And if they started on the thyroid and it really was a progesterone problem and the progesterone started to help it, can they then roll off the thyroid?

Yeah, you totally can. Yeah. I think really deciphering whether, okay, is it thyroid, is it perimenopause, or both. Again, you look at that testing. Now let's say that person had low progesterone, but they also had free T3, like we always see it, like 2.6, really low, like still in the optimal or still in the standard lab value range, but not optimal. And then we're seeing, oh, they also have a few antibodies here. So Hashimoto's is present. Susie, how long have you had those symptoms? Oh, you've had them for like 10 years. Oh, you're over 20 pounds overweight and the weight just keeps coming on no matter what what do we do? In that case, I'd be like, let's do both. Let's treat thyroid and hormones at the same time. And yeah, we can revisit that conversation of you coming off of or lowering your thyroid medication if we need. But also, if you're living your best life, then you might be like, you know what, you're gonna have to pry this thyroid medication out of my face.

Like, you're not taking my estrogen, you're not taking my thyroid. But I mean, then it comes down to— because there's such a, like, everyone's talking about perimenopause now. Yeah. The question then is, with perimenopause and menopause, if someone didn't look at thyroid and they just went and started optimizing their sex hormones, could they really do that if their thyroid wasn't optimized?

You're not gonna hit that 100% mark. You're not gonna dial in your hormones perfectly while you're ignoring the thyroid. And that person isn't going to get total symptom relief either. We actually— now, I know this isn't hormonally related, but I'm going to use a GLP story to just show the impact of how powerful the thyroid is. We had a patient come in, she was about 150 pounds overweight. She had Hashimoto's, so she was on T4 only for 15 years. She was also on a prescribed GLP because she was a type 2 diabetic. Her A1C was 11.9. Oh wow. Wasn't working. She was on that GLP for a year and a half. Well, her reverse T3 was a 22. She was on T4 only. Her free T3 was like a 2.3.

This makes me honestly wanna cry. Like it's, and how long had she been suffering? Yeah. Oh, beating herself up.

Like that's just decades.

It's just ridiculous.

Decades. We fix her thyroid. Now the GLP is working. Her A1C went to a 5.4. She lost 150 pounds.

Wow. I mean, it is the case. And so I was very fortunate early in my career to work with this Dr. Diana Schwartzbein, she was a thyroid fellow who then went into sex hormones. She was Suzanne Somers' doctor. And her whole thing was like, if your thyroid isn't working well, none of this other stuff will balance. Like you have to balance this first. So it's always just stuck with me that you just, and you know, and that so many of these people are walking around and taking Synthroid and thinking, calling it a day.

I know. Well, and that's the message they're getting from their doctor, from their provider. It's like, well, this is all you need. This is standard of care. And it is, it is standard of care.

But the standard of care, it sucks. It's horrible. So please, the standard of— you don't want the standard of care.

No. My sister is a geriatric doctor and I reached out to her for a quote for the book because I wanted to know how much thyroid education do you really get in med school? And she's a DO. So supposedly doctors are osteopathic. A little bit more outside of the box thinking. She wouldn't gimme a quote for the book. She goes, "No." Really? "I don't wanna be quoted on how much thyroid education, 'cause it's bad." Wow.

Okay, well, let's talk about how to fix this then, and kind of the, you know, is this something that you could do alone with supplements? What if someone's got low thyroid? I know you're gonna hear, "But I wanna do it naturally." I know, you're gonna, like, I had someone come to me with that, with going through perimenopause, menopause, and they wanted to do it naturally. I'm like, your hormones are dropping.

Yeah.

Those are natural. Anyway, so let's talk about, you know, I wanna do it naturally. What can you do and what, what can you do? Do you have to take hormone replacement therapy for thyroid? And you know, yeah, let's go. Let's start there.

Let's start there.

You have to do that.

Different buckets. Okay. So the first bucket is the people who can maybe do it naturally. These are your people that, maybe they're just showing signs of Hashimoto's, a few antibodies are showing up. They're going to be the ones where they're like, well, not gaining a ton of weight, maybe an extra 5 pounds that I'd like to take off. Sure, I'm a little bit tired. I'm not like crushing fatigue, nothing like— they're in the beginning stages. So for those ladies, yeah, we can add in some black cumin seed oil. Let's go low-dose iodine, magnesium, selenium. Let's make sure your vitamin D is good. Make sure you're going gluten-free because that's going to increase an antibody attack and increase your antibody markers. Let's do all of those things naturally. And, and let's see where we take you. But the women that I mean, you and I see, especially once they get to our practice, they've been suffering. They've been through the 5 to 7 doctors. They've put on more than 10, 20, 30 pounds. So at that point in time, it's like, let's bring in hormones. And I really try to reshape the way that they think about thyroid medication. We have to put it in that same category as bioidentical hormones. So I say to them, I'm like, okay, and I always like using kids too because that hits kids and pets, right? It's the heartstrings. Said, if your child was diagnosed with type 1 diabetes and the doctor comes in and says pancreas isn't working anymore, your child's going to need to go on the hormone insulin. In order to live, in order to stay alive. You wouldn't at that point go, you know, I really— I'd like to do this naturally with my kid. Like, the doctor would be like, your child's gonna die. Like, no, you can't. You cannot do it. Yes, that is a hormone that's needed for survival. We need thyroid hormone for survival, but our bodies can really go through a lot of suffering with minimal thyroid hormone before it really impacts us. But when you get that right blend when you get that right hormonal blend, that's where you're going to be, where you and I are, and that you're gonna have to pry it out of our dead cold hands because it changes your life. And you, when you think about it as a hormone that you are replacing, that your body is just simply no longer making properly, that, that shifts it in your mind. Because people don't like that little orange pill, pill bottle, you know, they feel like Grandma, like, I don't want that orange pill bottle on my counter, it's a medication. I go, well, no, the medications you want to avoid are the Band-Aids that they're going to give you, like your lady that got the Prozac or the statin or the blood pressure. Those are the medications that we want to avoid, that we can avoid when we treat the root cause.

Well, and I think it's important for people to understand what happens when you have chronically low thyroid. And I'll give you the example. I have a non-blood cousin because I'm adopted. She never goes to the doctor. Never goes to the doctor. And come to find out she breaks her hip. This was the first sign of her low thyroid function, 'cause she never went to the doctor. Her TSH was like insanity. It was like up in the 20-plus something. And I just was like, how the heck were you walking around like this? You know, so what are the damage that can happen when you're walking around with low thyroid? 'Cause I think people don't understand that too.

I'm so happy you asked that because I am guilty, and I have admitted it on my show too, that I tend to focus on the aesthetics and we forget about the longevity. We forget about the, the internal damage that goes on if you're walking around with low thyroid function or non-optimized thyroid function. So cancer is one, you know, a lot of people are online right now saying Synthroid causes cancer. It's not that it's a carcinogenic medication, it's not that it's causing cancer directly, but it's lowering your immune system because when your thyroid isn't functioning optimally, your little surveillance guys, your, your soldiers that go out and they look for those mutated cancer cells, they're not on high alert. They're not working properly. Your circulation is down. Everything is down. Your glucose regulation, insulin regulation, that's down. Okay, so there's type 2 diabetes, heart disease. That's the biggest killer of women. We are at an increased rate when our thyroid is in the toilet. So yes, there are these diseases of aging that we can't forget about that directly are—

Oh, and just muscle. Muscle and bone.

Bone turnover, muscle loss.

The last thing you wanna do is like try to get those back.

Exactly. And once they're gone, it's super hard to get back. Like you said, yeah.

What does a true, beyond just taking a thyroid hormone, and ideally I'm assuming most people probably will do better with with taking some T3 alongside what they're taking. What does a total thyroid optimization program look like?

Test, don't guess, number one. We, we have to have the data. If we don't have the data, we know nothing.

And then how often, once someone does that first test and starts to modify things, how often should they be testing?

I like retesting at about the 2 to 3 month mark just to see, are we moving in the right direction? Now, those numbers might not be optimal yet, But we're still going to see the trajectory and make sure that we're moving in the right direction and then course correct if we need to. Then after we get you optimized, then really once every 4 to 6 months. I mean, I get tested like once a year.

So upper quartile for T3, where do you want TSH to be?

TSH below 2. And then free T4. This is where I kind of throw people off because there's a lot of people that will have, you know, free download of the optimal lab ranges. And I always see free T4 usually like at a 1.5. I go, mm-mm, no, I want free T4 actually lower. I want it like a 0.8 to a 1.2. Because if someone comes in with a free T4, the inactive thyroid hormone, of a 1.5, the reverse T3 is probably gonna be high. That usually tells me like they're being overmedicated on T4. They're with a doctor that just is like, here's 88 micrograms, let's go to 112, let's go to 125, and just keep increasing the dose.

I will tell you that we had a doctor when I lived in Palm Desert We had a kind of crazy weight loss doctor who put everyone who walked in the door, man, woman, kid, on progesterone and thyroid. Everybody. Okay. And his goal was to drive your TSH— you're gonna fall outta your chair, so stay. Yes. Hold on. Gripping. His, his goal was to drive people's TSH to as close to zero as possible. What happens when someone does that? So what's the, the reverse of this when someone is overmedicated?

So we have to kind of look at each situation. On its own. If someone has a low TSH, like a 0 or less than 0, and it's because they're on—

can they have a less than 0?

Well, like a 0.00. Well, I guess I was like, how do you have a less— all right, 0.000. Yeah, really, really low, non-existent.

Like, I've never seen a negative one. That's true, that's true.

I wasn't, I wasn't great at math, just science. So we have to look at, are they taking T3. So even people on natural desiccated thyroid medication, in fact, even people on a boatload of T4, we can push that TSH to zero. It doesn't mean that you're gonna feel your best, but we can. So if TSH is naturally a zero, like mine is, mine's 0.0007, that's because I've been on T3 only for the past 25 years. So it's naturally going to be low. But in my case, that's okay because the other numbers fall into place. Then you ask that person, how do you feel? So ask me how I feel. I feel great, I'm living my best life. Like, I feel energized, I don't gain weight looking sideways at a brownie, I'm not losing my hair, I'm not constipated. So you have to look at each situation. Now, the flip side is if someone does have a TSH of a zero and a free T3 and a free T4 that are elevated and maybe even flagged high, and they're like, oh my gosh, you guys, these heart palpitations, I'm really anxious all the time, and I'm kind of sweating, I'm not sleeping at all, like, I'm not saying then you're overmedicated. Then we do look at it and go, okay, yeah, you're on too much of something here and we need to adjust.

And so the big things that would happen if someone was overmedicated is just poor sleep, anxiety. Yeah.

Those types of things. Hyper. So if you think of everything, you feel hyper, amped, jacked up, like you drank 10 Red Bulls.

And beyond the medication, what are the other things? So you talked about some of the supplements that could be helpful and of course fixing leaky gut. Assuming that's Hashimoto's, but most of the time it is. What are some of the other things that could be helpful here?

So balancing magnesium, selenium, vitamin D, your B vitamins, and then a little bit of iodine. Those are what I call like the no duh supplements. Like, of course, the duh, we're gonna keep 'em in every day.

How would someone know how much iodine to have?

Yeah, I know that's a tough, that's a, that's a big, that's a big question. 'Cause we know, already talked about the, the patch test on your skin.

Don't do that.

A lot of practitioners will argue what the best test is. I remember talking to Barton Scott years ago about the hair tissue mineral analysis. I'm like, do you have iodine on here? And he goes, no, every cell in the body needs it, so why don't you just take it?

I was like, that's a good point. Okay, well, if you take too much, then you have a problem.

If you take too much, you have a problem. So I just love starting people nice and low and slow with a drop. I like liquid iodine so we can go up drop by drop.

One drop per day. But how do you know how much to go up?

Well, you just go one drop per day. So this is what I tell people. One drop per day and a little bit of water. And then maybe, or maybe you're going up one drop every other day or every third day if you're sensitive. Pay attention to how you feel. So that day that you go 5 drops or 10 drops, you go one drop too much, you're gonna feel amped up. You're gonna feel like, you're like kind of, I call it icky and sticky.

So it's like anxious amped. It's not good amped.

It's not a good amp. It's an anxious amp. And then I go, that's okay, interesting, you're gonna be okay. Take some vitamin C, take some salt. Tomorrow, don't do that dose, go back to the one that you were at the day before where you felt great. So really listening to your body, I think, is the better way. Now, you could get a blood test, but what I've seen with the blood test for iodine is if someone isn't taking it, it's going to be flagged low. As soon as they start taking it, it's literally going to be flagged high. Hmm.

So, I mean, would it be— it sounds like taking a blood test for magnesium, but if you did an RBC, you'd be okay. Can you do a blood— red blood cell iodine, or does it not It doesn't exist.

You can do the provocation test where you take 50 milligrams of iodine, which that's kind of a whopping dose too, so be careful. You take 50 milligrams of iodine and then you collect your urine for 24 hours and we're literally seeing how much are you peeing out and how much are you retaining. And then that gives us an idea of your iodine status.

So it sounds like based on all this, just take a little bit and see how you feel. Okay.

Just a little bit. Little bit.

That makes sense.

Iodine is in prenatal vitamins. It's like we give it to pregnant women without testing them necessarily for iodine, 'cause there's just a little bit of iodine in prenatal, so yeah.

All right. That totally makes sense. How long does it typically take to take someone from like thyroid whacked to thyroid optimized? And, you know, once they're thyroid optimized, what do they notice?

They just coast, yeah. Usually about 3 to 6 months. You know, all thyroid patients want better yesterday, you know, but I always tell them, and, and the progress is not linear either. When we're doing thyroid optimization, yeah, you might get better, and then you're like, oh wait, it's a few symptoms are coming. Oh wait, I'm better now. Oh wait, now I'm worse.

Why is that?

It's just the body adapting, you know, because the thyroid is the master gland. It's also affecting your blood sugar. So is your blood sugar dropping? Are you going hypoglycemic? Do you maybe need to eat a little bit more? Are you looking at your hormones at the same time as looking at your thyroid. So about 3 to 6 months to get optimized. And then really, it's— I talk about being in optimization land all the time. Like, it's a great place to live. Like I said, you don't gain weight looking sideways at a brownie, you get to poop every day, it's beautiful. But you really just kind of coast. And then as life happens, we might need to turn the dials a little bit, but we're not going all the way back to the beginning and reinventing the wheel with your thyroid health. We know what basically works, so we might have to just tweak a little bit here and there.

So it could be that as you go through it, might need a little bit more.

Yeah, more or less. Um, estrogen, estrogen replacement. Estrogen will increase thyroid binding globulin. Now, especially oral estrogen, which we don't use.

Although I just heard someone was recommending oral estrogen. I was like, I thought that was a big no-no.

Seriously. Yeah, I can't believe that people still do too, but I hear that as well. Oral estrogen will increase thyroid binding globulin, which will bind to your thyroid hormone.

Another reason to not use oral estrogen.

Correct, exactly. And then you'll need more thyroid hormone. But even, even topical in the patch, a little bit of an increase of TBG. And so, okay, when you start on estrogen replacement because you're in menopause, that's fantastic, do it. The hormones give you life. But just know that we might have to move over here and tweak your thyroid med a little bit.

So the easiest thing is once you get through all of that and everything's just probably coasting, what about the intersection between GLP-1s and thyroid. Is there, 'cause you mentioned that one woman who walked in who was using, I guess, Synthroid plus a GLP-1 and nothing was working. Yeah. If your thyroid's off, is your GLP-1 not gonna work well? I would assume that it probably wouldn't.

Right, so thyroid's off, GLP-1 won't work well. I have a chapter in the book on GLPs as a biohack tool for the thyroid. So what I have found when it's, done properly. And that's the big talk around GLPs right now is not the PharmaPen. We're not the PharmaPen. And, and a true microdose, not the microdose that an IG influencer is talking about when it's really just a regular dose, right?

Yeah, that's, that's an important thing. Yes, the starting dose for a GLP-1 is not a microdose. Correct. That's a low dose for most people because they're going to go up, but that's not a microdose.

It's not a microdose. If we do a true microdose with someone where you do not lose your appetite, you're, you're not experiencing the acid reflux and the fatigue that comes alongside of a standard dose. What we can see over time, and this takes about 6 months to a year, but what we'll see is the need for less thyroid hormone, a little bit less T3.

So why is that, do you think?

Inflammation reduction.

Mm-hmm.

So we reduce inflammation, thyroid gland can work better even, even when it's been attacked for decades with Hashimoto's. You lower that inflammation and, and what is left of your thyroid gland actually does work better. We don't know yet, and it'll be interesting to see as more research comes out about receptor site activity. I'm also wondering if there isn't almost like a, for lack of a better description, like a scrubbing or a cleaning. Like when you reduce the inflammation, do your receptor sites on your cells get more sensitive? Or yeah, get more sensitive. Because I was on— I, I've been on T3 only now for decades. I was taking 75 micrograms twice a day, which is kind of a hefty dose, but for me, I always need higher doses of hormones and anything. But with the microdosing of a GLP, I'm able to lower that to 50 twice a day. So now I'm down to 100. So I dropped it by 50.

Wow.

People go, what's the big deal? You said that, you know, thyroid hormone isn't a problem, it's a hormone. Yes, that's true, but We know that T3 will burn fat and muscle. We do know we get some muscle loss with T3, just like we have to admit with GLP, it's like we're seeing some lean muscle loss, right?

Even if you were doing everything right, would T3 push muscle loss?

You're gonna get a little bit, a little bit. So I can honestly say that I have more muscle now than I did in my 20s when I was competing. So I think that, well, I mean, in addition to excessive cardio, which I was doing back in my 20s.

Look at the dumb stuff we did in our 20s.

Just dumb.

Vegan cardio.

Oh gosh. Just, and the protein. Yeah.

Let's have a moment. We'll have a moment and forgive ourselves. Forgive ourselves. We did not know.

But no, I do believe that backing off on my T3 has actually allowed my body to put on a little bit more muscle.

That is interesting stuff. If you just looked at it purely from, if a microdose of a GLP-1 could lower inflammation, Which is what I do, a tiny dose too, because I have all these joint problems from when I was dumb in my teens. And then I did this interview and I was finding out how that could actually lead to heart problems. And I'm like, oh yeah, no, okay. I didn't ever connect the dots that osteoarthritic inflammation was systemic inflammation, duh. Like once you look, they go, oh, of course. Yeah. So what do we need to do to knock that down? All right, ready for some rapid fire? Love it. Okay, here we go. Top 3 signs your thyroid is off.

Weight gain, fatigue, hair loss.

One lab everyone should test?

Free T3.

Most overrated thyroid advice?

Oh goodness, avoid cruciferous vegetables.

Is that still out there? The goitrogen thing?

Yeah, the goitrogen thing. I mean, you know, there's some science to it, but you just cook them really well. Like, don't, don't be a rabbit and eat them raw.

Well, I mean, raw broccoli is one of the phalluses.

Yeah.

Okay, I thought that was an excuse not to eat broccoli. One thing to stop doing immediately?

Staying up past 10:00 PM.

Most underrated thing for energy?

Underrated? Vitamin D. Hmm, yeah.

What do you like to optimize it to?

80 to 100.

Okay, and here's a couple more thoughtful ones. What belief do you hold about thyroid health that most people get wrong?

Testing, when to test. I test the thyroid 18 to 24 hours after your last dose of thyroid medication. Now, if you're on T4 only, it doesn't work, but if you're on NDT or any kind of T3, or even if you're taking a thyroid glandular supplement, you want to test 18 to 24 hours after you take it. So we were testing in the trough, not the peak, because the peak will show—

I was just thinking, did I— do I hit it? I hit about 20 Probably 25, 26 hours. I'll just push it a little bit.

Just a little bit. Yeah. Yeah. Just to get in that like sweet spot window.

18 to 24. That's interesting. Never knew that. Wow. What question should every woman over 40 be asking but isn't?

Will you test my thyroid, doctor?

Correctly.

Uh, correctly. And here's, here's all the, the labs that I want you to test in a bulleted list. And here's my symptoms. Yeah. It really is about getting properly tested.

Yeah. Yeah. If someone does one thing after this episode, what should it be?

Buy the book. Buy the book.

And then let's, let's shamelessly plug this book that's sitting right here. Your new book baby that's on sale May 12th.

Yes. My book baby.

Your book baby.

You have inspired me through the years. I have to plug you because it was you that taught me that, you know, a book matters. A book is your voice. It's a way to help the masses because not everybody can afford functional medicine and we know that. I would love to be able to fix all thyroids everywhere, but the bottom line is people need a guide.

All right, well, thank you so much for all of that. You have your book here, and we are going to put all of this information at jjvirgin.com/thyroidfix. Um, someone buying the book, do you have any special things you're doing? Tell, tell us about it.

What are you doing? Do we do— we do. So if you go to thyroidfixbook.com, you're going to see all the bonuses. We're doing everything from a chance to win a year's supply of Thyroid Fixer. We have podcast episodes that have never been released, but the big thing is on May 16th, you get a ticket. We're doing an all-day live launch event, kind of like Alex Hormozy style. But on this event, I love answering questions. I love reading people's labs and literally giving them feedback as to what's going on. So the people that buy the book get a ticket to the Zoom room so they can do the interaction. They can ask their questions live. They can have a chance to get their labs read on screen. Everybody else, yeah, you can watch it on YouTube. That's fine, but you can't interact. When you buy the book, you get a ticket to the Zoom room. Nice.

Yeah. Nice. You can get in the room. In the room. You always wanna be in the room. Right. Okay. So again, we'll put all that at jjvirgin.com/thyroidfix. Easy enough to remember. And thank you so much for coming by.

Thank you so much for having me.

So if you feel like your body is turned against you, I want you to hear this. You're not broken, you're not lazy, and this is not what it has to be. For aging. Test, don't guess. As, as Dr. Amy said, thyroid could be a big part of why you're not feeling quite like yourself. So get it checked out. And if you've got a friend who's struggling, make sure you share this with them as well. And be sure to check out Dr. Amy Horniman's new book and all of her cool stuff, including her podcast, at jjvirgin.com/thyroidfix. One thing people forget about on their fat loss journey is digestion. When you're changing what you're eating, how much you're eating, and when you're eating, your digestion changes too. You may be feeling any of these things. You feel backed up, a little bloated after your meals, maybe some cramping or just overall ugh. One of the foundational things that I recommend during this time to support your gut is sodium butyrate. So what is sodium butyrate? So butyrate is a short-chain fatty acid that's produced by your beneficial gut bacteria. And it's actually one of the primary nutrients for all the cells that line your gut. And when those gut cells are supported, digestion, comfort, regularity, it all works better. And that is why I added BodyBio Butyrate to my daily routine. If you're in the process of upgrading what you're eating, how you're eating, when you're eating, head over to bodybio.com/jjvirgin to start supporting your gut today.