Secrets to Healing Thyroid Disorders - What Doctors Don't Tell You

Well, Amy, I am excited that you are, uh, coming on board with us. We have so many questions from our audience about thyroid, and I want you to really help people understand because many people don't know that testosterone is important nor do they know that T2 is important to evaluate. So tell us more about thyroid and thyroid function in general. We'd like to really kind of understand it from a different perspective because so many women are on thyroid medication.

So many, so many. And it's one of those conditions that really goes undiagnosed and kind of mistreated. So those who are diagnosed, I always challenge my listeners, your listeners, I always challenge my audience to with this question, how do you feel? So let's say you are on that standard of care Synthroid, or maybe you're given a little bit of T3, or maybe you're on NDT. And the question is, how do you feel? Because when you are being treated for hypothyroidism or Hashimoto's, it's important that you feel good. That's the ultimate goal when we're working with women and with patients, with anybody that has hypothyroidism, is getting them to the level of being optimized where all of their symptoms or most of their symptoms are completely gone and they feel like how they did prior to that diagnosis. And then there's the group that are totally undiagnosed and they know that something is wrong, but no one is telling them what's wrong. And that was really me when I first started this journey 20-some-odd years ago. I was misdiagnosed 6 times. And I knew my body and I knew something wasn't right. I had put on 25+ pounds. I say plus because I stopped getting on the scale after the 25-pound mark. And I was in a competition diet mode, so I was eating, I mean, perfectly, absolutely pristine. I was going to the gym twice a day. It didn't make sense that the scale was going up. And I had went to all of these doctors and they all told me, "You're normal. Everything's fine. You're just getting older. Eat less, exercise more. I heard the whole medical gaslighting thing. I, I heard the whole spiel. And finally, when I was diagnosed, then I was mistreated. So that's the biggest thing with thyroid is there's so many people out there that are misdiagnosed, undiagnosed, and then mistreated. And we have to remember that the thyroid is the master gland. It runs the show. It controls your hormone balance. It controls your insulin balance. It controls every single cell and organ in your body. Every single cell has a receptor site on it for thyroid hormone. And yet it's overlooked in conventional medicine. And these women are going misdiagnosed. It blows my mind. So the biggest take-home with the thyroid is it's the master gland, and many different symptoms can be tied back to the thyroid.

So let's talk a little bit about that. So when we're seeing people in practice and we do a TSH on them, thyroid stimulating hormone, and it's normal, and we do a, a T4 or a free T4 and it's normal, then we let people kind of go on their way. And we're not even looking at antibodies anymore because now it's said that if you have antibodies and they're up, it doesn't really matter because if your TSH is normal, your thyroid's working properly. So can we dig a little deeper into helping people understand and also talk a little bit about borderline hypothyroidism as well.

Yep, definitely. So standard of care, as you know, is just like you said, Marcelle, it's going in, you get the TSH, maybe free T4, and if those are within normal limits on that standard lab value range panel, then you're sent on your way. There are so many other tests that we have to do. So the most important test that I look at, free T3 and reverse T3. Those are my top 2. And then we'll talk about the antibodies. So free T3, Like I said earlier, every single cell has a receptor site on it for thyroid hormone. It has a receptor site on it for T3, not T4. So here we are testing the free T4. T4 is just your storage. It's totally unusable by your body unless it is converted to the active thyroid hormone, T3. So that's why we want to look at free T3, that unbound thyroid hormone that is ready to attach to the receptor site on your cell. And if that is low and like you mentioned, borderline, so that's a term that we use for those people that they have all the symptoms, the TSH is even below a 2, it might even be optimal for functional range, but those thyroid hormones, the free T3, the free T4, they're really on that low end of the standard lab value range. Now, for functional medicine, for optimal, Free T3, I want you out of that basement. I want you in the upper quadrant of that standard lab value range, or maybe even over. Even if you were getting flagged high, that might be your optimal. So free T3, upper quadrant of the range or over, that's optimal. If you're in the bottom of the barrel of that range, but you're still coming in as normal, air quotes, then you will be dismissed. You will be told that you are normal when in fact you are borderline hypothyroid or just flat out low thyroid function. Then we move on to reverse T3. Reverse T3 is the antithyroid hormone. I always use the analogy of a bouncer at a club. So if you picture this bouncer outside of your cell, you know, here's your cell with a little receptor site on it for T3, and it's happy when it gets the T3 attached to it. But reverse T3 stands outside that cell and tells the T3 molecule, you can't get in. You can't— you, you're not allowed in today. And so that T3 is just, it's unbound and it can't get to the receptor site because there's too much reverse T3. The reason why this is a test that is often not done by conventional medicine, and many of you may have heard this if you asked for it, we only do that in clinical setting, meaning if you're in the ICU or the ER. Well, if we think about the mechanism of action of reverse T3, it's a survival mechanism that's in our body. So that is going to go up when you are injured, when you're sick, when you're laying in a hospital bed. Obviously, your reverse T3 is going to be high because our bodies are so smart. Our bodies know that you don't need to burn fat, you don't need to grow hair, you don't really even need to have a lot of energy when you're trying to recover from a trauma or an injury or an illness. But we don't want reverse T3 high when you're trying to live life day to day. So we need to test that to know how well are you converting your T4 over to T3. And is your body in this weird survival mode where it thinks that you're dying in a hospital bed, but you're not? So I want to know what that reverse T3 is. Then we have to go on to the antibodies. There's two antibodies, thyroglobulin and thyroperoxidase. Oftentimes I'll see one tested, not both. And like you said earlier, Marcelle, it's important to know the antibody number. Because any antibody is a marker for Hashimoto's. I don't care if it's less than 9 or less than 40 or it's coming in within range. That tells us that something's going on with your immune system, that there's an autoimmune condition kind of brewing underneath the surface that we need to look at. And my argument to not looking at those antibodies and not paying attention or blowing them off like conventional does You're going to wait until that poor woman is 40 pounds heavier on the couch, lost her job, losing relationships, doesn't feel like herself anymore, and then you're going to go, oh, okay, now you have Hashimoto's. That doesn't make sense. Let's catch it early. Let's test and catch it early so we can start a protocol of possibly putting Hashimoto's into remission, or at least treating this poor person and eliminating their symptoms.

Absolutely. So the other thing that's interesting is because I teach for IFM, and one of the things we always talk about is, you know, adrenals first. Than thyroid, you know, adrenals also trump hormones. And what we know is if we have high cortisol levels, there's an enzyme that actually blocks active T3 and increases reverse T3. So it's a huge association between fight-flight. And those women that spend all their time dieting or in the gym and the yo-yo thing, that also contributes to that as well. Especially now, so many women are going on semi-glutide. For weight loss. And, you know, that's going to cascade that problem. Number one, most people gain the weight back. But the other thing is that it also is going to create problems because they're eating so little with the thyroid as well. So it's interesting.

Definitely.

So tell, tell me a little bit more. So if somebody's coming in and they think they have a thyroid problem, you're going to recommend a TSH. T— what about T2? Let's kind of talk a little bit about T2 because we've not talked about that, nor testosterone, and that's a part of this puzzle as well. So what are the things you're going to recommend they ask for their doctor to tested or perhaps even work with you?

Okay, so we're getting the full thyroid panel done, and I'll do testosterone first because that is testable. T2 is not. There's no assay for T2, so we'll get to that. We will absolutely 100% do a full hormone panel as well because I want to know where's your total estrogen, estradiol, estrone, estriol, progesterone, DHEA, free and total testosterone, SHBG, LH, FSH, all the fun stuff. Testosterone, we tend to, you know, with women, we tend to really focus on the estrogen, the progesterone, right? We really focus there. And testosterone doesn't get enough love. Testosterone is the most abundant hormone in a woman's body, although it's just not as high as a man. So we have lower levels of testosterone, but it is the most abundant hormone. And especially when we go into menopause, it almost kind of takes over because if you're not on any kind of hormone replacement therapy, estrogen and progesterone will drop and testosterone kind of almost gets the dominant, becomes the dominant hormone. With testosterone, there is an optimal range, and the optimal range, or my optimal range rather, and I've kind of developed this over the years. I don't even know if this aligns with IFM or not, but I had my total testosterone optimal above a 40 until I interviewed Dr. Anthony Jay. And he wrote the book S-Regeneration, and he's on my podcast. He's talking. He's like, you know, I don't like to see my women under 50 total. I'm like, hmm, all right, maybe I need to raise my, my bar a little bit because you're right, even 40 doesn't quite cut it. Once you get them over that 50 mark for total testosterone and the free testosterone is at least halfway, if not above halfway on the standard lab value range, the women aren't feeling that well. And once you get them above— and the one thing to keep in mind, too, is that your standard lab value range for total testosterone for a woman, 9 times out of 10 gets cut off at 48. So meaning, like, you're going to get flagged high when you're actually optimal. But that testosterone is very, very protective against autoimmune. So this is why we see more Hashimoto's in women than in men, because men have, you know, test levels of 800, 900, 1,000.. And that's very protective from Hashimoto's. It protects them against autoimmune. Women, we have those lower lab values. We have— if you're optimal, you're going to be around 50. You're probably hanging out more around 20, 30, 40 for total. And that makes you more susceptible to Hashimoto's. Now, if you're one of the really unlucky women, which I have seen in my practice with the testosterone that is undetectable, I have seen 3, I have seen 6, I have seen 9 for total testosterone, virtually nothing in their body is working, no testosterone whatsoever, they are usually this ball of autoimmune. They have all the symptoms. Hashi is flaring, it's going into rheumatoid arthritis, maybe some celiac on top of that, and they just become these walking balls of autoimmune. So when we do both, when we treat thyroid and do testosterone hormone replacement in addition to any of the other hormones that are necessary as well, we see that inflammatory autoimmune attack go down. And that helps along with using LDN, going gluten-free, dairy-free, all those lifestyle things that helps to push down the thyroid antibodies. So there are a lot of different things that we can do to help a woman, A, feel better and just get rid of those symptoms that are really ruining her quality of life. And B, literally protect her, her, her body from that autoimmune attack. And then it's also obviously helping with motivation, sex drive, fat loss, muscle retention. So as you age, you don't experience that sarcopenia, you have better protection of your bones, cardiac protection, brain protection. I mean, all the other benefits of testosterone as well. But when we're really honing in on the thyroid, that can be a game changer for patients with Hashimoto's.

So let's talk about dosage. You know, for women that are coming in and we see that their total testosterone is low and their free is even, you know, not detectable, how much do you start them on and what kind of testosterone? Because as you know, you know, in the world of the conventional world, it's pretty controversial that we put women on testosterone at all.

Right, right, right. So first we have to start with what the woman's comfortable with. I really like cream or injectable because it's, it's just a little bit more controlled than pellets. So, and that's just, that's just my take. I, you and I haven't even talked about what you—

I completely agree with you. I've seen some disasters with pellets because it's, you know, it's a roller coaster. Yeah, it's a roller coaster and people can get really, really angry and feel like totally out of control. And it's not a pretty picture if you if the dosage is incorrect.

I have seen females post pellet go up to a 900 in their total testosterone. I'm like, I know a guy down the street that would kill for your testosterone level, but you're not a dude, so we need to do something about this. Yeah, pellets, no. I like cream or injectable. So really whatever they're comfortable with when they're that low, I really like to do the injectable. That's kind of more up and coming and becoming more mainstream in, in our world, we'll say in the functional world, it's becoming way more mainstream to use testipionate for women. I use that. It gets my number up. I get to keep it nice and steady and then I can adjust it. So if I do feel like I'm getting any kind of androgenic properties like acne or excessive facial hair, I can back it off. I can do a half a dose every week. I can do— I can space it out, maybe go every 2 weeks. I really stay in tune with my body and kind of adjust my dose based on that. And then some women with the cream, they just prefer the cream, and that's fine. The most important thing that I can tell ladies that go on test cream is rub it in for 2 minutes. Set a timer for 2 minutes. It's going to feel like you're rubbing it in forever and that your skin is dry. Rub it in for 2 minutes. That's going to ensure that that all gets absorbed. Because a lot of times my ladies that come to me on the cream, they're still in the basement with their total testosterone. And I go, how are you applying it? I mean, you see this much. How are you applying it? They go, well, I just put it on and rub like this. And then I go, did you do for 2 minutes? They go, well, no, I just, I rub it on like face cream and it's just done and I move on with my day. I'm like, yeah, that's why your testosterone is still at 5. You know, it's just not working. So we can do either treatment path. It doesn't matter. It really kind of is up to the woman and what she's comfortable with. But even with the injectable, we're doing it sub-q, we're doing it with a teeny tiny insulin needle. I always tell my ladies, it's nothing. You won't even feel it goes right into your fat. So it's super easy to do. But the bottom line is just getting that level up and keeping it nice and steady.

Absolutely. And the testosterone cream can be very effective. But one of the things that I've seen for some women is that they start the cream, they're really low, or they use testosterone. And I see them after they've had this experience and they, they immediately get agitated and angry. Even with the first couple of dosages. How do you manage those people?

It's very few and far between, but I have seen that as well. So number one, we really have to check, are they— that's where I like to pull in a Dutch test. So are they pushing down that 5-alpha reductase pathway? I mean, it's rare that we would see it, see a woman respond that quickly on like day 2 or 3, but it could happen if she very much aromatizes the DHT, then yeah, it's— it could be an issue. I mean, that's where you're going to get the androgenic effects and you're going to get the mood aggressive, irritable effects of it. Or maybe the compounding pharmacy— and I have seen this as well— completely messed up the dose. So the woman was getting this astronomical amount of testosterone that her body just wasn't even ready for and couldn't handle. And we didn't start low and slow enough like we had planned to. On the dose, and she didn't really get to experience that low and slow benefit. It was just kind of a big punch in the face. So then that ends up freaking the poor woman out. She never wants to touch testosterone again.

Right.

I'm never doing this again. But the good news is that if you are one of those women that push down that 5-alpha reductase pathway, we can use— I don't know if you use this, Marcelle, but we can use saw palmetto. So we can actually use some prostate formulas for guys that help block that pathway so that you're not getting that high DHT level, you're not getting the acne, the breakouts, the aggression, even on the proper low dose that we're starting you on.

Right, right. Absolutely. So let's talk about products because, as you know, controversial. And I mean, I was in practice for many, many, many years and many back when we started our practice in '85, we were already using alternative forms of thyroid replacement. So Synthroid is considered the, the God's gift to humanity, or levothyroxine, or any of the kind of standard. When people wanted then to go on, you know, natural thyroid, you know, combination of T4 and T3, they were oftentimes told, absolutely not, doesn't work as well, it's just ridiculous to even ask for it. And let's talk a little bit about that because I think people are confused because they hear so many people say, no, no, no, no, no, you know, all you need is T4.

Right, exactly. So this is where we can pull in the T2, right? So there are 4 different thyroid hormones. There's T1, T2, T3, T4. We have tests for T3 and T4. That's what we talked about earlier. There's no current public test for T1 and T2. T1 inactive. We just put that on the side. We push that over here. T2 is a very powerful— I call it the forgotten thyroid hormone. There's no assay for it to the general public, but we can test for it in studies. So that's how we figured out that, hey, this T2 hormone drops really low in pregnancy, which is really interesting because it's almost like the body knows to go into a protective, lower metabolism kind of mode., and then we see T2 go up in individuals with a really, really healthy thyroid, with a healthy fast metabolism, with abundant energy. So we can measure it in studies and see that this has a direct effect on the metabolism and the mitochondria. When we're looking at T4, again, totally inactive. T3 is active. T2 can tag on an extra iodine atom and become T3, or it can just stay as T2 itself, which is not a bad thing, and have no thyromimetic effects, meaning it's not going to alter your thyroid labs to where your doctor's going to look at them and go, "Oh my God, you're hyperthyroid now." It's not going to alter your thyroid labs. It's not going to cause heart racing or heart palpitations that T3 can, although that's a little bit overblown in conventional medicine too, but it can. So it just has a direct effect on the basal metabolic rate, increasing that, and on ATP production at the mitochondrial level. So it's increasing your energy and increasing the amount of fat that you burn just sitting around your basal metabolic rate. That is just supplemental. So T2, it is found in natural desiccated thyroid. So when we look at Armor or NP Thyroid, that is a natural desiccated, meaning a dried porcine thyroid gland, and there is a little bit of T2 in it. However, it's a very small amount. So it does exist in medication, in thyroid hormone replacement, but we don't just give you T2 as a hormone replacement like we can give you T4, like we can give you T3. It's in the NDT, but we can take T2 supplementally. So that's a bonus. When it comes to thyroid hormone replacement, the medications that you were talking about, T4 only just I mean, I hate to say the word never, but it rarely, rarely, rarely works. Maybe 1 in 100 people, they'll say, you know what, I'm on Synthroid only and I feel fantastic. Well, those people aren't coming to you and I, so they're out there in the world somewhere and good for them. But most of the time, people are feeling really kind of crappy on T4 only. And that's because, A, you're giving them the inactive thyroid hormone. B, you are expecting that thyroid hormone to convert properly. So let's talk about all the things that hinder conversion, because I always say T4 to T3 conversion is like running 10 Tough Mudders. There's a lot that can get in the way. You had mentioned high cortisol earlier, estrogen dominance, insulin resistance, high insulin. There are, well, it can be low iodine, low zinc, low magnesium, low vitamin D. That all contributes to it. There's 2 genetic SNPs, DIO1 and DIO2, that can make a person a non-converter. Lot that can get in the way. So why would we give someone the inactive form of thyroid hormone and then cross our fingers and wish on a rainbow that it converts properly? It doesn't even make sense. Why not give a little bit of T3? Why not use NDT that contains T4 and T3? Or let's add in some liothyronine or cytomel, which is just straight up synthetic— I'll come back to that— synthetic T3. Now, I've changed the word synthetic. I now use biosynth. It's a made-up word, but I just don't like how people negatively pair up the word synthetic with something bad. So the synthetic thyroid hormones are really made to mimic your own thyroid hormone, and there's nothing wrong with them. If they work for you, they work for you. We find the right combination, you're optimized, you're feeling great. That's what we want. So I love adding in a little bit, a little bit or a lot of it, whatever a person needs of T3 to get them optimized.

Yeah, absolutely. I used to do that in practice all the time, no question about it. And it makes a world of difference. For me, it was very unusual to see somebody on Synthroid and they felt great, or Levothyroxine, they felt great. They didn't, you know. And so many women are struggling with this. So let's talk a little bit about the weight gain issue, because one of the things that people come to me in my practice with is I've gained weight. I know it's my thyroid. I know it's my thyroid. And, you know, at the time I was doing testing through Genova Diagnostics that really gave me much more information about the thyroid. And oftentimes it was thyroid, but then there were times that it wasn't as well because oftentimes people are like, I hope it is, I hope it is. And it's like, it's not. So let's look at some other options here for us.

Right?

Absolutely. Talk about the weight gain issue because it is certainly a problem for people, especially people that are doing everything right. Everything right to a T and nothing changes.

Doing all the things. I know the frustration. I know that feeling. I know the frustration. So when we're looking at the weight component and we set aside the diet, the exercise, let's just assume that all those are on point. You're doing all the things. You're doing all the things. Then it comes down to if it's not thyroid, or even if it is, we still have to look at these other components.

Insulin.

So insulin resistance is huge, especially in today's society with how we eat the standard American diet. And I like to see a fasting insulin below a 6. So your A1C, that's a marker, a 3-month snapshot of what your glucose, your blood sugar has been doing over 3 months. I like to see that between a 4.8 and a 5.1. I like to see insulin below a 6. If it's above those markers, then there is insulin resistance, and that will absolutely hinder any kind of weight loss and possibly spur on some more weight gain. The other thing I look at is leptin, which is very much tied into your T3 being optimized and insulin resistance, and then thyroid or testosterone. Like we talked about. So, if a woman's testosterone is low, that is 100% going to impair fat metabolism because you don't have the building blocks, you don't have the fire to have a proper metabolism. And then the triple whammy to weight would be to have all 3, which I see quite often. There's a thyroid problem, there's insulin resistance, there's low testosterone. And it's like, for those ladies, I just have to tell them, we are literally rebuilding your body from the ground up. We are reigniting the fire. We are rebuilding your metabolism because right now you have none. So don't beat yourself up. Don't blame yourself. Don't get it in your head that you should have done this or should have done that diet or taken this supplement or whatever. You have no metabolism whatsoever. So once we rebuild it, Then all of that great eating that you're doing and the lifestyle changes and the sleep and the exercise and the lifting heavy, that's all going to come together and work now. And you're going to get rewarded for your efforts because we gave you the metabolism back.

Absolutely. I completely agree. The other thing that I sometimes did also, Amy, is I sometimes did a 2-hour postprandial insulin because they gave me additional information. I was surprised how often the fasting was relatively good. And then the 2-hour postprandial was like, oh my God, oh my God. So that was the other thing. And I would just suggest that people consider— well, let's talk about iodine. It is somewhat controversial because we have some people that truly, truly believe absolutely that we have too much iodine now. And it's been my experience when I tested people that more people than not were actually deficient in iodine because they went over to the Celtic salts and they stop using iodized salts and things like that. So what are your thoughts about all this from your perspective?

So I refer back to the work of Dr. David Brownstein, who's kind of the guru in iodine and kind of boosting iodine's use, especially in thyroid conditions. So if you listen to his story, he's a practitioner in Michigan, and he was seeing all of these hypothyroid cases coming to his office. And he even says, he's like, listen, it's fine. I mean, I have no problem giving thyroid hormone replacement and the proper ones, the NDT, the T4 and T3 combined. But he said, I wanted to know why. Like, why was this occurring so often? And he started testing and treating with iodine and people were getting better. They were lowering their dose. They were coming off their medication, off their thyroid medication. When you look at Basic biology. Every single cell in your body also needs iodine. So if we think about that and we think about the thyroid needing iodine for proper function as well as conversion of T4 to T3, we know that reverse T3, one of the causes of elevated reverse T3 is an iodine deficiency. It just doesn't even make sense to withhold iodine. Now, there are those certain cases, and I always talk about you always have a few that ruin it for the whole. There are certain cases where some functional docs were using very, very high doses of iodine right off the bat, and they were sending people into this hyperthyroid state. Some of them had a thyroid storm. And just like we see even with hormones, right? You have one bad report, and then it's like, stop everything. Let's just pull hormones from everyone. Let's pull iodine from everyone. And it doesn't even make sense. It's like, well, wait a minute. Let's look at the individual scenarios. And yeah, maybe that was just too much for that person and they didn't do well with it. But we have these 100 people over here that are thriving and they're lowering their dose of thyroid medication, their energy is better and they're losing weight and their hair is growing back and their breasts are no longer fibrocystic and on and on and on with all of these fantastic reports from using iodine. I have a hard time withholding it. I would like to be in— I am in this camp over here that says, let's use it in small amounts. We'll gradually increase. We're not going to go crazy, but let's just have it in your system every single day and you will notice an improvement.

Right. And how much do you have people on, Amy?

12.5 to 25 milligrams. I know Brownstein kind of goes up to— he sometimes goes up to 50, sometimes 100, and it depends on what case he's doing. He had one case where he had a woman with breast cancer and she was so bromide toxic. So that's the other thing with iodine is that it will compete with the toxic halides. So you have bromide, you have chlorine, you have fluoride, like in our water and our toothpaste, the fluoride treatment you got as a kid. All of those are very toxic to the thyroid. So iodine comes in and it kind of pushes those out. So what he was seeing with this one particular patient was that she did have breast cancer and she was so bromide toxic that her breast literally started pushing out bromide, and she had yellow stains on her nightgown, and she brought the nightgown into him, and he tested it.

It was bromide.

So her body was literally pushing out all these toxic halides, and it was because of the iodine detoxing her body from those halides. So that's another benefit, especially if you're soaking in a hot tub, if you're using fluoride toothpaste, which you should probably stop. But yeah, it's fantastic for detoxing and for the immune system as well.

Exactly. And how do you test for iodine levels? I used to do some urine testing back in the day. How do you test for iodine? Do you do a challenge with them first, or you just do iodine testing?

I still haven't landed on really good data as to what is the best test for iodine. I mean, the jury is really out on that. Totally. I was interviewing Barton Scott, and I was interviewing him on my podcast, and I asked him, when he does the hair tissue mineral analysis, do you guys include iodine? And he said something that has stuck with me to this day. He said, well, every single cell in the body needs iodine, so why don't you just take it? Why you need to test for it? That's really good. So I will test. I will do a blood test for iodine if the person isn't on it. But if you retest once you start taking it, it's going to be flagged high. Right. So it's nice to see, like, are you at the bottom of the barrel? When I tested myself, my iodine level was a 6. Like, it was really flat. It was nonexistent. So again, it's like, well, why don't we just take it and kind of go by symptoms and not necessarily need a test for it? That's my two cents.

Got it. I love it. And in terms of thyroid replacement, we're still— we're talking about using Armour Thyroid. We're talking about, you know, using Synthroid in combination with T3? And also, what about compounded thyroid? I used to do a lot of compounding of the thyroid replacement as well.

It all depends on the pharmacy. So what I have found is if you aren't working with a compounding pharmacy that you know, love, and trust, and you know what they're putting in, you know, what I find is that my patients all go hypo when they go on compounded. And I can't figure out if it's the fillers they're putting in. I know they don't use a lot of fillers, which is why we do compounded. I don't know if it's the— if it's the base that they're using. I can't figure that out at all. But I like to try to stay away from compounded unless someone is very, very sensitive to all fillers. If they're reacting to— even when we're changing the manufacturer, like we can, we can swap out the manufacturer of T3. Because the generic T3 has less fillers than the brand T3, ironically. So with the generic, we can change manufacturers— Greenstone, Sun Pharmaceuticals, Sigma Pharm— and maybe you do better with a different manufacturer than you do with the other one. I like to play with that first before we move on to compounded.

So you would do a combination of Synthroid or levothyroxine and T3 with that in combination, or do, um, something else in combination?

We can go all the way up to Tirosint, which has— or Tirosint-Sol, which has no fillers whatsoever. That's a T4. And then we can combine that with lyothyronine. And that's the beauty of thyroid treatment. That's why it's so nuanced. But we have so many different options when you get outside of that Synthroid box. Conventional medicine thing is we can pair up Armor with some T3 to change that ratio. We can, we can do anything to fit your body. You know, we can pull it, push the T3 ratio higher than T4. I have one patient right now, she's not tolerating even 50 micrograms of T4. So we're going to take her down to 12.5, and we're going to move to Tirosint. We have the T3 in at 20 micrograms twice a day. She might be T3 only. I'm T3 only. If you give me the smallest amount of T4, I will be 10 pounds heavier and depressed by the end of the week. So I do not convert at all. So this woman might be T3 only, but we have to try different things and monitor and monitor the symptoms and monitor the labs till we find what is your optimal combination.

So kind of to sum this up, what I love about the conversation is we're talking about looking at it from a real holistic functional medicine perspective. We're looking at lifestyle, we're looking at sleep, we're looking at all these pieces. But there's a foundational piece that I hear you say that has to do with hormones, has to do with adrenals, and has to do with thyroid and really testing the thyroid in a different way so women feel heard instead of pushed aside to there's nothing wrong with you.

Right.

Awesome.

Exactly.

So if people want to learn more about you, they want to find out how to work with you, any of these kinds of things, can you tell us how they can do that? Absolutely.

So to just listen to me go on and on and on and educate about thyroid, you can listen to the Thyroid Fixer podcast on all the podcast platforms. And then you can go to my website at dramyhorneman.com. If you are interested, you can submit an application, you can do an application call. We wanna make sure that you're a good fit for us. We're a good fit for you. And we'll go through your health history and go over the different options and programs that we have and see which one works best for you. And then of course, I'm on all major social media platforms, so you can find me there under Dr. Amy Horneman.

Awesome. Well, thank you so very much. I think this is a very powerful conversation that women really need to hear. So thank you. I appreciate it.

Thanks, Marcelle. My pleasure.