23: Revolutionizing Thyroid Care: The Story of Modern Thyroid Clinic

Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness and thyroid, unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. Today we are going to have a very just casual, authentic conversation about trying to determine if Modern Thyroid Clinic is right for you. I get questions about this all the time. I was holding weekly webinars for a little while to take you guys through this information and then I figured maybe I just need to share this on a more permanent platform so that you guys can be empowered to be able to make a decision if you feel like the next step for you on your thyroid hormone journey is Modern Thyroid Clinic. So let's dig in. Let's talk first about how Modern Thyroid Clinic came to be. And I apologize. I was sick like a week ago. I had a cold and my voice has not completely come back. So Modern Thyroid Clinic was really born out of my own personal pain to purpose story. And what I mean by that is I was 27 when I was in my most recent severe thyroid crisis. I was already a practicing pa, already had my medical license, was already on Synthroid, was just kind of beginning my journey. My first few years into practicing medicine and y', all, I was going to bed at 3:30 in the afternoon every day. So I would finish work. I actually worked in neurosurgery. I thought that was my dream job in PA school. I always wanted to be a nerd as a kid. So naturally I was like, this is what I need to do. It was not my dream job. I don't know if you guys have heard my ted talk, but TEDx talk talk. But I discuss it a little bit there as well. But I finished the OR every day around 3. I would come home and I would literally immediately go to bed at 3:30 and I would be in bed until I had to go back to work the next day. Weekends were spent in the exact same way. I was literally recovering enough on the weekends to recover from the week before and try and rest enough to prepare for the week ahead. And that was my life, y'. All. Not kidding. I really did not do anything. I was bedbound and I was about 15 pounds overweight. I was really just flat and depressed and my hair was shedding and my skin was so incredibly dry. I had absolutely no libido and I couldn't function in my life and my relationships barely could function in my job. Just trying to survive. And I went to My doctor and I begged him for help. And he said, okay, let's run labs. He only checked tsh. He came back and said, your TSH is too low. We need to reduce your medication. And I broke down in tears and I begged him. I had done some research back then. There was not a lot of information about more progressive approaches to thyroid care. I mean, you could say the same thing about now, but there's quite a bit more now than there was back then. Begged him to run a full thyroid panel, gave him a list of labs on a post it, and he took it and was like, well, I'll research it and I'll come back and I'll let you know. He came back, back and said, no, I'm not running these labs. They're useless. We need to reduce your medication. And I was like, if you take anything else away from me, I will lose everything in my life. I will not be able to function at work, I will not be able to function in my marriage, and my entire life is going to fall apart. And his solution, to be honest with you, was to reduce my thyroid medication and put me on Lipitor because as a 27 year old, my cholesterol was high and my cholesterol was high because of my thyroid problem. So I left, obviously in tears like so many of the people that come to see us at the doctors before clinicians before they come to see us, and dug in, used every ounce of my brain power to try to find someone else to help me. And I know how devastating and disheartening that feeling is and how overwhelming and impossible that task seems. But I got on the waitlist for someone, waited three months to see them, and I would never get better on Synthroid that I wasn't able to activate it, that it was simply increasing my inhibitory hormone and not converting to my active hormone or my T3. He changed my medication. He actually put me on armor. And within a few months, I was on the way to getting my life back. And from that moment, I was like, I am not going to let you. What happened to me happened to any of my patients. So I learned absolutely everything I could from that man. He became a mentor to me. I digested every piece of information I could possibly get my hands on for thyroid, and then I just started implementing it in my practice. By several years later, strangely, I was actually practicing functional and integrative psychiatry. That's what I spent the bulk of my time doing before entering this niche and loved it. Ended up treating so many people with treatment resistant Depression that actually just had treatment resistant depression because of their thyroid condition. Loved every second of it. Those people actually took my information and they spread it all over the Internet on thyroid advocacy platforms. And I noticed a shift in my new patients. Now all of a sudden, 85 to 90% of the people showing up in my integrative and functional psychiatry practice were coming to see me for thyroid. And I had never once, not ever, marketed myself as a thyroid person. So once my first patient flew in from out of state to see me for thyroid, I had like a light bulb moment and I was like, think I'm doing the wrong thing? I love it. Every time I see a patient coming in for thyroid, it makes me so happy. I do this so well. I get to change these people's lives. I want to create a place that's safe for them, where they know they can come to get only the best care for thyroid. And I want to expand access because this is such a big problem. And from that modern thyroid clinic was born. And we have changed thousands and thousands of lives since. And we have been on this sacred journey as a practice, as clinicians, as partners in our patients health. And it's just so life giving for us. For patients, it's an interesting, mutually incredible journey. So for those of you listening who are our patients, thank you for allowing us to participate in your journey. And for those of you listening trying to figure out if it would be, we might be the right partners for you on your journey. I'm excited you're here. So I'll do a brief kind of overview of what we're going to talk about today. So I want to touch on what we do and why we're different. I want to touch on who is the right fit for us and who really probably isn't. Logistics, pricing, all of that. Let's dig in. So what makes modern thyroid clinic different? Let's talk about it. The first thing I would say is we have very, very unique optimal lab ranges. We do not go by what is normal and we do not go by what even functional medicine dictates as optimal. In fact, no one uses our lab ranges, or rather I should say we are not using anyone else's lab ranges. They are unique to us. And the reason for that is because when we first started modern thyroid clinic almost a decade ago, we started by using kind of general functional medicine ranges where hey, we trim a little bit off the upper end of the margins of labs and a little bit off of the bottom and then everything in between is optimal. And that was fine. But what I, what we did along the years and over the course of time is about every 12 to 18 months, we would analyze our data with our own patients and try and understand where these people, where their labs are when they are not having thyroid symptoms versus where they are when they're not having thyroid symptoms and when they feel healthy and vibrant and at their highest form of health and well being. And slowly, about every 12 to 18 months, we would narrow our margins a little bit more, we would reanalyze that data. Twelve to 18 months later, we would narrow those margins. And after we've done that over the course of almost a decade now, we're left with margins that are this wide. But we find if we can get people into our optimal ranges and an extremely tightly controlled manner, that these people get their lives back, that their symptoms dissipate and they feel better. And so we really feel like we have found significant data points that allow people or that facilitate people with hypothyroidism to no longer be symptomatic. Okay, so again, we do a full thyroid panel. So not only we're not just checking TSH, we run TSH free T4, free T3, reverse T3 every single time we check labs, we run Hashimoto's and or Graves antibodies every single time we run labs because those pieces of data are so incredibly important to monitor over time. The other thing that we do that's different and unique, especially from like a traditional approach, is we use medications with active thyroid hormones in them ubiquitously. I don't think we have a single patient on inactive thyroid medications alone. Those are medications like levothyroxine, synthroid, tyrosine, unithroid. We, at least for people that come to see us, we see people who do not activate either A, those medications well enough to get their lives back and not have symptoms, or B, they don't activate enough of their own endogenous T4 or inactive hormone to get their lives back and thrive and feel great. So because of that, the people that come to see us are largely what I would describe as poor converters. They don't convert and activate those hormones well, so we use active thyroid hormones. The other thing that we do differently that really kind of sets us apart is if you're listening and you have a thyroid condition, you've probably experienced this. You go to your clinician or your doctor and they say, oh my gosh, you have a thyroid problem, we need to put you on thyroid medication, come back in like three to six months and we'll see what happens. You let time pass, you get labs, you go back and they say, well, you're not, your labs aren't where they need to be. So we're going to increase your dose and they increase your dose to the next dose up and again, it's, we'll see what happens. And so what ends up happening is patients simply increase one dose up or down at each medication change. And it's the we'll see what happens approach that is absolutely the not how we practice medicine at Modern Thyroid Clinic. And because this is literally what we do all day, every day, we're not guessing. So we are not, let's wait and see what happens, people. We actually, if we start with stable, good data, we can predict within a very narrow margin what your labs will look like at your next appointment, almost to a T. So what does that mean? It means we're not guessing, we're not waiting and seeing. It means because we have more predictability and control, we are able to move the needle better, faster. And so instead of changing people's medication simply one dose at a time, every time they come to see us, we actually do slow controlled medication titration. And what that looks like is it's like, okay, well these are your labs. Let's talk about medication options. We decide what we feel like is the right plan. And then when you leave, you actually get a long list of instructions from your clinician at MTC that says something like, days one through five, you're going to do this. And days six through 15, you're going to add a little bit in the afternoon. Days 16 to 24, circle back and add a little more in the morning. So we are slowly increasing your dose in microscopic doses, allowing your biochemistry to adapt between doses until you arrive at your final dose, from which you'll stabilize for around two months before we repeat that cycle again. So long story short, what ends up happening is we accomplish about 9 to 12 months of work every time you see us in 2 to 3 months. So that translates to people get better faster. 90 plus percent of people, when they come to see us, feel improvement after their first appointment with their clinician. So after the very first round of medication changes, people feel better almost every single time. And it's because of that to a large degree. Right. Another aspect of care at Modern Thyroid Clinic is that we value above everything the safety of our patients. So we are not in this to overdose people on T3, to over medicate them, to be medically irresponsible. No. In fact, every single Detail is accounted for in our practice to protect people from over medication of T3. And what that means is we check labs at their peak. We have a very in depth understanding of what that means, what that looks like and we use appropriate levels of medication. And honestly, for the first time ever in my career, we are getting people transferring to our practice almost on a weekly basis in a life threatening state of being over medicated. And that is very hard to do. So that is not casual, that is not one dose too much. That is gross medical negligence. That is can be in significant cases life threatening. And we have seen those cases more than I've ever seen them in my career lately. And, and sadly it is. There are quite a few practices advocating for this and patients don't know better, guys. And I need you to know better because five years ago I would have said look, it's really, really difficult to get patients to the degree of over medication at recovery requires to have a heart attack and a stroke. And now I see it reasonably often. So it is a real fear. And that is something that we do not do so full stop. Nor do people need to be over medicated to get their lives back from their thyroid condition. Like that's just not necessary and it's frankly dangerous. Lastly, the other thing that I wanted to bring up is we take a holistic or a functional medicine approach to thyroid, right? So we of course value greatly the balancing of your hormones because it is the way that you're able to get your life back, your symptoms resolved, your quality of life improved as quickly as humanly possible and the prevention of heart disease and diabetes and all these other factors that come into play when your thyroid is not appropriately balanced. But the other thing that we do is we work to reduce the severity of Hashimoto's or Graves disease, autoimmune thyroid issues. So we want to reduce those antibodies as much as humanly possible and ideally even get them into remission, which is very much a real possibility. I am a perfect example of someone who had severe severe Hashimoto's. I had an enormous goiter. I have been in remission for my Hashimoto's for over a decade now. And we see that occur all the time in our practice. Sadly, medicine has not quite caught up with the idea that you can influence autoimmune diseases, at least not Hashimoto's other ones. They have, they are coming to that realization. But that is something that we work on as well. And I want you guys to understand that there are some nuances to this right, There are practices that are functional medicine that work on root cause, but they cannot give you medication. Sometimes they even make it seem like they can give you medication but that you don't need it, so they're not going to. And that's kind of a red flag, right? People with true hypothyroidism need medication. Doesn't matter if their Hashimoto's goes into remission, they still have lost thyroid function and they have to replace that loss of thyroid function with hormone supplementation. Okay, so you don't want functional medicine without medication management and you really don't want medication management without a functional medicine perspective. And this is where modern thyroid clinic bridges that gap and meets both needs. Some other kind of topics, some other systems, some other aspects of your physiology that we feel and have found are clinically relevant in the ability for someone to get their life back after years and years of having hypothyroidism, we try to address as well. So of course we address thyroid, but essentially almost every one of our thyroid patients, or most of them have some form of hormone dysfunction. And we want to fix that. Hormones are incredibly powerful things in our physiology that impact so much of our health, our lifespan, our health span, but also our day to day quality of life. So we absolutely address hormones. As I mentioned before, we address Hashimoto's graves, we address adrenal dysfunction. This is something that almost again ubiquitously is present in our patients. They have some level of adrenal dysfunction that will keep them from feeling their best inflammatory issues, metabolic issues, weight related struggles. Like we want to fix all of these things so that by the time we get you where you deserve to be and where you work so hard to be, we've addressed all of the major underlying things, things that would keep you from getting to your highest form of health. Let's talk about the training of our clinicians at mtc. So I can't tell you how many times during the expansion process of MTC we were approached and told, listen, you guys just need to contract out a telemedicine platform and you can be open in all 50 states tomorrow. Like you can just teach them what you're doing. Teach the physicians, they're sort of working from home and you'll just get random ones. Whoever the patient signs up for in each state, they'll be selected with a certain physician and you'll be open like tomorrow. And y', all, we have never done that, we have never sold out because we care deeply about maintaining the integrity and the complexity of Our thyroid treatment paradigm. Okay. So our clinicians go through, except extensive training under what we call modern, the Modern Thyroid method. They learn all about it for weeks and weeks and weeks. And then they shadow us, and then we shadow them. And then we have ongoing twice a week clinician round table meetings where we present cases, we share ideas, we talk through plans, we become our we. We basically work on their skills more and more in a nuanced level so that they can continue to grow and build and become more and more and more of an expert. Right? That we have people that still show up for our twice a week meetings that have worked with us for two years, like every week. They're still there, still learning, still committed. Because I really do think, I don't think, I know. Our clinicians are incredibly dedicated to you all. They are at Modern Thyroid Clinic because they desperately wanted to be. We have actually never hired anyone off the streets or like off, indeed, that didn't come to us. Already invested in our mission. Like people who have been following my work, the work of Modern Thyroid Clinic for years. Those are the people that we end up hiring when it's time to hire. And because of that, they are so invested in the mission of our company, but also in your health, all of them directly. Their lives have been touched additionally by a thyroid condition. So they have a high, high level of empathy and understanding. And our team is unmatched, y'. All. It is, it is so good. I am so incredibly proud of our clinicians. But honestly, everyone from the clinicians to the healthcare coaches to the medical assistants, to the administrative staff, to the leadership team, just so, so grateful because they show up every day dedicated to helping you get your life back and almost reverse the trauma that you've experienced in medicine after being dismissed for so long. So anyway, they are rigorously, rigorously trained. We still have monthly collaborating physician meetings where we, we learn even more and it's just, it's this never ending format. So no matter who you see at Modern Thyroid Clinic, the goal has always been and will always be, you get the same level of care and you get a true partnership with a clinician who is invested in your ability to get to your highest form of health. So I want to briefly touch on who this is for and who this isn't for. So we are in the business of delivering care, thyroid care, but different. Right? So if you are looking for the standard approach, if you are wanting levothyroxine based on TSH alone, like we are not for you. And I know that sounds weird, That I would say that. But this last year, I think we've had two patients where they come to see us, we talk through the whole plan together, we develop it, and then they take it back to their primary care doctor or their endocrinologist and they're like, I would never do that. You need to just be on levothyroxine. And these people are like, well, why didn't you just put me on levothyroxine? And it's like, well, that's not what we do here at all. Like, if you can be on levothyroxine and feel good, you don't need us. Like, absolutely. I always encourage people, look, start with your primary care doctor and endocrinologist. See if you are able to get your life back with plain old levothyroxine with the standard medicine approach. If so, go on with your bad self. You don't need us, you don't need to pay for us. You don't need the whole thing. Like, just stick with what works and what's simple. We are practices built for people that will never get well based in that system. And those people deserve to have somewhere to go where they can actually get their lives back and not be repeatedly dismissed and just basically told, this is not your thyroid that's causing all of these symptoms when. When in fact it is. So we are in the business of thyroid care, but different. So if you, if you want different, if that's what you need, we are your people. Lastly, I want to talk about logistics and pricing. So obviously I get this question so incredibly often. Do you take insurance? And when my answer is no, people say, why? And you guys deserve to know why. And there's a few dynamics that I want to share with you to be clear on. So, number one, we are. We work for you. We want you to be our boss. We are your facilitator to get your life health to the point that you want it to be right. We do not care to work for your insurance company, full stop. Because what happens if we work for your insurance company is we end up having to deliver the exact same level of care that you've gotten everywhere before you came to see us, which is what's called eight minute medicine. So in medicine, as a clinician, I was trained. Clinicians are trained to see patients in eight minutes. Can you solve complex medical problems in eight minutes? You can't. And so can you listen to your patients and actually hear them and understand their journey and where they're coming from in eight minutes? You cannot can you educate, inform and empower your patients so that they can make informed and empowered effective decisions about their health now and long into the future in eight minutes? No, you cannot. So I don't care to deliver that level of care in a complex setting. Thyroid issues are very complex. They're extremely simplified in medicine, but they are not simple. And that is why our current treatment paradigm is failing so many people. This is a very nuanced and complex thing where patients also deserve the right to understand what's going on with them, to be able to make effective decisions, to be educated about their options, all of which cannot take place in eight minutes. So I want to give you an example. At Modern Thyroid Clinic, your first appointment with a clinician is an hour. Okay? If we took insurance for that hour long appointment with our patients, we would get paid between about 38 and 65, maybe 68. Okay? We would not. Our doors would not be open. That's not possible. It's not possible for us to see eight patients a day for on average $50 and keep our doors open. So again, we work for you. We don't care to work for your insurance. And the last piece of this that I really want to convey to you guys, and I'm sure most of you have had this experience, you go to your doctor and you say, hey, will you run a full thyroid panel? And you know what the response is? 9 times out of 10, no, your insurance won't cover that. And what's interesting is we run a full thyroid panel every three months. We run so many labs, it's crazy. Every three months. And who pays for it every time? Your insurance company. You know what happens if I took insurance and I was running a full thyroid panel every three months on my patients Very, very quickly, your insurance company would reach out to us and they would say, hey, listen, you're charging us too much money. You're over ordering labs. If you don't stop doing this right away, we're going to drop you from our policy. And so in that way, they have control over what labs clinicians order. They do not have that control over us. We get to order whatever labs we want because there is no veiled threat that we will no longer be able to participate in their plan. So again, we are freely able to work for you. Your insurance still pays for the labs. Your insurance still pays for medication when applicable. But the only thing they don't pay for is our time. Because we can't work for $50 an hour and keep our doors open and help people and Serve them. So we essentially are happy to provide you with a super bill for reimbursement for out of network reimbursement of our time. We also accept HSA and FSA and all of that. We bill your insurance every time for labs we run, any medications we send in that aren't compounded the ones that insurance will cover, we try to get them covered by your insurance. The only thing that we don't accept payment for from your insurance company is for our time for your visits. So that is a little insight as to why and it's confusing for you. All I know because it seems really unfair to pay a lot of money every month for insurance and then not have them cover things like this. And here's what I'll tell you our right now in medicine, our insurance system, our medical system is built to treat sickness. It is not built to, to make you well. And I want for you to be well, I want for you to thrive. I want for you to be at your highest form of health. And that is not done in an insurance based model yet, unfortunately. I wanted to also in closing kind of share with you a little bit. I get this question a lot on social well, how do you know how often one do you see patients? And we see patients about every three and a half months. And until they get their lives back, right, till everything's good and people say, well, how do you know when everything's good? And here are our goals that we set at Modern Thyroid Clinic so that we can know when we achieve what we've set out to do. So when you first come in, we ask you if we could wave a magic wand and we could get rid of three symptoms, what would they be in order of importance to you? So you tell us those, those stay with you, your entire plan with us. Like we hack away at those three things. So when those top three symptoms are improved, when your labs, your hormones are perfect, when we've addressed adrenal dysfunction, Hashimoto's Graves, we've improved that great. And then on an energy, vitality, sense of well being scale, we like to think about this as objective and measurable so that objectively we can know if we're doing our job. We think about that on a scale of 1 to 10, 10's impossibly perfect. You have to basically live in a lifestyle bubble and do everything right all the time. And I don't want you to have to do that to feel good in life. So our goal is that you get to about an 8 or an 8.5 out of 10, if 10 is perfect. And that's honestly where my patients have told me historically, like, hey, lady, I'm good, we can stop here. We don't need to keep going. And that also creates room for you to live life in a balanced, realistic way and not try and achieve this impossible thing and maintain this impossible, perfect lifestyle all the time. So when people get to that point, we start drawing out their appointments more and more until ultimately we see them about every six to 12 months. And then the interesting thing that happens is when you hit optimal, when you know what you are supposed to feel like, you're then able to differentiate if you deviate from that even 10%, when you don't know what optimal is. And people that come to see us, it's been a very long time since they felt like the optimal versions of themselves. You don't know the water's too muddy. You don't know if you're good, you're bad, you're better, you're worse because you're just living in this land of confusion of what you're supposed to feel like. But once we can put a pin in, this is what you are supposed to feel like, this is you thriving. When you decrease 10%, guess what? And if it's before your next appointment to get labs to come back, we'll reconvene, we'll pivot, we'll finesse things. But you'll never need that overhaul again that you need at first because you will never let yourself drop function to that level again because you'll know better. So I hope this was very, very insightful. I'll of course put links in the show notes where you can find out more about Modern Thyroid Clinic and becoming a patient always. You can find us@modernthyroidclinic.com if you've enjoyed this, please give us a review on your favorite podcast episode, share this episode with a friend or any episode. And then of course, follow us on social. Ben and I hope to see you there.