Balancing Hormones and Thyroid Health with Dr. Amie Hornaman

So good, so good, so good.

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Only 2% of those with hypothyroidism, and she used the term do well on, which I, okay, we can argue what is 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, 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 tests?

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 then—

See how fast it absorbed. Yes. Yep. 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 energy 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 we 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 gonna 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 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 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 function 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.

Okay. 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 Hyman to 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 I 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 gonna 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 data.

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 you 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 throat.

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 want to cry. Like, it's— and how long has she been suffering? Yeah, beating herself up.

Like, that's just decades.

It's just ridiculous.

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

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, I'm 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.