39: What Your Thyroid Labs Aren’t Telling You – The Root Cause Fix with Dr. Cassie Smith

Today's episode is honestly super special for me and I'm recording the intro after and it was probably my favorite episode I've ever made. So I am so excited to share it with you. We are chatting with Dr. Cassie Smith, who is a dual board certified physician in endocrinology, diabetes, metabolism and internal medicine. She founded a sister from another Mr. Company called Modern Endocrine after years of struggling with autoimmune thyroid disease herself. And she is also the clinical director of Modern Thyroid Clinic. So we get to pull back the curtain today and ask some really hard questions to an endocrinologist, y' all, who practiced for years in the conventional sector and now practices functional based endocrinology. And I am delighted to share this episode with you. Let's tune in. 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. So I am really excited about this podcast. I am here with Dr. Cassie Smith of Modern Endocrine. That is the sign you see behind her. She is my thyroid sister from another mister Is what I call her. And through pure synchronicity and synergy and life bringing us together, we now get to work together. So I am incredibly grateful to be able to share with you all. Dr. Cassie Smith is a part of our team now. She's our clinical director and I just wanted you all to have the opportunity to get to know her a little bit. So Cassie, Dr. Smith, welcome.

Thanks for having me. Super excited to be here. So excited to be a part of Modern Thyroid Clinic now. So yeah, thanks for having me.

Absolutely. So you are a formally trained endocrinologist who has certainly evolved her practice of medicine over the last several years. I would love for you to share with our people your journey of evolution and what kind of led you to where you are in founding Modern Endocrine.

Yeah, so I'm a recovering traditional medicine doctor. I tell people I did primary care. So I went into medicine, went through residency, fellowship, had a lot of struggles myself with thyroid, with Hashimoto's. Well, I had Graves and then I had Hashimoto's pcos. Just tons of issues, endocrine issues. And then when I got out of training, did primary care for a year. Hated it. Hats off to all the primary care doctors. But like nobody got better. Everyone's just super sick and you're just like a pill mill, like giving People pills, and they come back and you give them more pills, and they're just sicker. So I was like, I'm gonna go to fellowship because I hated primary care, and I wanted to learn how to actually help people. And so I was like, well, I want to be an endocrinologist because I want to be able to help people like myself, people with thyroid issues, people with pcos, hormone issues, things like that. So I blindly go into fellowship thinking I'm going to have all these amazing answers when I get out. And. And unfortunately, after two years of training just in endocrinology, I got out, and the answer was still the same. Write people more prescriptions so that they shut up and leave your office, and nobody got any better. And so I did that for a few years and was just very unhappy. My patients weren't getting better, they were getting sicker. I didn't really know how to help them. And so I kind of just. In 2020, I had this moment where I was like, I'm either going to quit medicine and do something completely different. Like, you, like, build houses, right? Or I'm going to figure out a way to make medicine work and find out how to practice it. The reason I went into medicine, like, I want to regain that love of, like, how do I actually help people feel better and give them their life back? How do I be the doctor I wanted somebody to be to me 10 years ago? And so that's kind of how I started this journey. I quit. I worked for a big hospital group called Mercy Hospital. I quit, and I was like, I don't really know what I'm going to do, but I'm not going to do that. And so I started a practice, and I just kind of started learning. Like, how do you treat people without giving them prescriptions? Like, how do you actually listen to people and then correlate their symptoms with, like, how they feel and their labs and figure out how to make them better? So that's kind of how my journey got started. And I just got into the functional medicine space. I just got online and started going to conferences and learning things. I found people like you online who I followed and just learned. And then my practice has changed so much, and it's so rewarding now. I mean, people get better every single day. I was just talking to my nurse practitioner, Summer, yesterday, and she said something to me that kind of like, she's like, cassie, you forget how many people's lives you actually touched and changed. Like, people still tell me every day how you saved their Life and how so it's rewarding, right? Whenever not only I know that, but other people know that. And so that's kind of how I ended up here. Was just being frustrated as a patient, being frustrated with what I was doing to patients, and then just being like, this is not why I did this. Kind of going back to the. Your North Star, like, I'm very passionate about, like, my North Star, which is to improve people's quality of life and make them feel better and make them be able to do what they were put on this earth to do.

So, yeah, that's how I love it. And it's interesting. So a couple things come to mind when you share that. One is the fact that regular medicine is amazing. Like if we need surgery, if we have an acute issue, but it doesn't really make people healthy and well. Right. Like band aiding problems that get people back to where they should be, but not ever optimized, not ever thriving. And the fact that you were able to create that shift in your practice of medicine is so powerful. And I think what patients or regular people don't quite understand is they feel this sense of frustration with their clinician. The clinicians also feel this sense of frustration that these people aren't getting well. This isn't what they came into medicine for. And in fact, like I read a statistic from a physician's group not that long ago, that is 50% of female doctors exit being practice the practice of medicine within five years of practicing medicine, which is crazy. And instead of doing that, myself included, like you mentioned, people don't know, but I wanted to leave medicine and become a contractor like flip houses. Instead of doing that, we've both been able to find ways that are rewarding and fulfilling to help these people and not just this endless road of frustration for both parties. So, so incredible. I would love for you to tell people a little bit about modern endocrine, because what you've built is really, really unique and special. And I know there's the telemedicine part too, but I want you to share with people the physical aspect of what you've built in Oklahoma, because it's. It's incredible.

Yeah. Well, thank you. So modern endocrine, like, I've had this dream, right, of I want this beautiful place that I can go that just makes people feel warm welcome and then helps people heal. Right. And so when I first started my own practice, that definitely, you can't do that. It's very difficult to run a business, especially in medicine. But for the last four Years I just had this goal in mind of, like, I want this very modern building where I can give my patients everything they need to heal. Where we have things like red light therapy and cold plunge therapy and IV therapy, ozone therapy, nutritionists, practitioners that really understand you can spend the time to dive in and just understand and learn everything about you. And so I think that's what we built at Modern Endocrine is I have this space where hopefully people feel very welcomed when they come in. Everyone that works there actually wants to be there, which is very different than medicine. So everywhere I've worked in medicine, when you go to a doctor's office, typically people are rude, they're angry, you can just tell they're. They're just doing their job. And I can honestly say that everyone that works at Modern Endocrine wants to work there, chooses to work there, and is in a good mood about it, which is just great. And then I have this space where you can come and you can be heard, right? We'll listen to what you have to say, we'll validate what you have to say, we'll do extensive testing, and then we'll help you figure out a way to get better. And so I think that's what is really unique about us, is we'll look at everything. So we look at your sleep and we look at your relationships and your movement and your nutrition and how well are. How is your stress and what does your mitochondrial health look like? And so we just have this system in place where we try to look at 10 different, you know, things about you to really help you holistically heal yourself. And so I'm really proud of that, that we, that we've created that. And we do it in a very, just holistic, natural way. And we also do it with a lot of different people. Initially in my mind I was like, oh, I'm just going to take care of women like me in their 30s. And now we take care of their husbands and their parents. And. And now I have a nurse practitioner starting next week who's going to do adolescence because gut health is so important in kids. And these kids are on medications, Adderall and things like that for behavior when sometime need somebody to fix their gut and actually listen to them. And so we're really just trying to create this space where you can come and learn how to heal and not need, like you said, traditional medicine. It's like sick care model and really my, like North Star too. And I know yours is as well. I tell people this all the time. It's a really bad business model. But my goal is to, like, put chronic healthcare out of business. Like, how cool would it be if nobody needed chronic health care? Right? Like, we didn't need all these primary care doctors, we didn't need all these hospitals, we didn't need all these ers. We need a few for acute care. Like you said, my dad had surgery last week. He had an acute issue. We need an ER for that. We need a surgeon for that. We don't need a doctor's office that he goes to every month where they just write pills and pills and pills and he never gets better. So that was my goal with modern endocrine, is to create this space that helps you truly know how to heal. And then maybe you come once a year, you know, and you just make sure everything is in check.

And like, I mean, Cassie and I have many conversations. She's a colleague, but she's also now a very dear friend of mine. And it's like, anytime I'm talking about this idea of a progressive new thing to help people get more optimized, more healthy, she's like, oh, yeah, we have that. So, like, not only do you guys have these things where people can come in and get a workup, but you also have all these modalities, honestly, in an area of the country that doesn't have a lot of access to those sorts of things where people can come and get. Get truly optimized. Which is hats off to you for building a place like that. I know that's a very big undertaking. I kind of want to switch the conversation a little bit to the practice of endocrinology. And obviously there are. You're a believer in the practice of endocrinology, you're an endocrinologist. Right. But I also think there's. There's strengths and weaknesses in every aspect of medicine. And just the way that our medical system is built as a whole, it's built. Built in silos where or like systems of health and organs aren't really integrating with one another. Everything is kept very separate. If you have a cardiology problem, you get sent to a cardiologist that never really thinks about your GI problem, that never really thinks about your thyroid problem that's driving your cardiology problem. So I want you to talk to me a little bit about where you feel like the field of endocrinology is now compared to maybe five years ago, 10 years ago, and what do you think the trajectory is? And I want you to specifically hone in on thyroid so I want you to give me your input on it.

Well, unfortunately, I think that where we are now is the same place we were five years ago, 10 years ago, and probably even 20 years ago. I just don't think that endocrinology, although it's supposed to be this field of thyroid medicine and we're supposed to be the experts, we aren't taught anything differently than you are in med school, than you are in PA school, than you are in nurse practitioner school. We may get a little bit more experience on different types of medications to use different disease processes. Thyroid cancer, for sure, but it's the same. I was in fellowship now almost 10 years ago. It has been 10 years ago. And what they're teaching them in fellowship today is the same that I learned 10 years ago, because I have people that come to my clinic and rotate, and they don't teach them anything that makes you successful in actually treating thyroid disease and actually making people feel better. So, unfortunately, from an endocrinology standpoint, and I think it's any specialist, like you pointed out, we are taught. Like, what I was taught in fellowship was you go in, you see the patient, you deal with their thyroid and their diabetes, and then you let everyone else deal with everything else. Like, this is your field. Like, you don't, God forbid, you spend another five minutes validating the fact that they have GI symptoms or cardiac symptoms. And we try to put it all together. It's just very compartmentalized. And I think that that causes just. It's terrible to be a patient, right? Because it's like, how do you coordinate that care as a person? Like, you have 10 doctors, and none of those doctors are talking to each other because we don't have time and our ehrs don't talk to each other, and nobody's actually looking at you as a whole person. It's like they're looking at you in little pieces. And that is not conducive for making someone well. And it took me a long time to figure that out, too, because when I got out of school, I was like, nope, it's not my problem. Not my problem. Your kidneys aren't my problem. Your heart's not my problem. It is my problem because my patient. And unless we look at it as a whole, it doesn't get better. And so I don't. Unfortunately, I don't think that we're anywhere in a better place than we were 20 years ago. And I don't know that the trajectory is going to change, Nicole, unless we as providers and we as patients demand it. Now with rfk, I'm more excited, but unfortunately, I just think in school we don't teach people how to actually make people well because healthcare is about big, big, big industry makes. Yeah, sick care makes this country a lot of money. And until people are really demanding differently or doctors are demanding differently, it's not going to change, I don't think. Unfortunately.

I feel like I want to bring up the conversation that we had last week which was I was curious, so I was doing a little book research for my book and I pinged Dr. Smith and I was like, this is my education as a PA and specifically in thyroid. And I'll say it now, it is do not use T4 based medications. I mean, excuse me, T3 based medications. Those are active medications like armor, NP, Cytomel, lyothyrene, only use T4 based medications. Levothyroxine, Synthroid, T or Unithroid, Levoxal. If you use T3 based medications with your patients, you're going to give them a heart attack or a stroke. And that is literally verbatim. I mean, it is like a light bulb memory in my mind sitting there in class 20 years ago listening to that. And I still remember it to this day. And so I went to you and I was like, I'm really curious what your education is on thyroid. Do you learn about how thyroid hormones convert and activate, what T3 is about, T3 meds? Because my training leads to a couple things. It leads to one, being very afraid of T3 based medication and two, not knowing how to effectively use them, which even creates more fear. Right. Of the unknown. So there's those dynamics that go into play. And I've heard from many other physicians, clinicians, nurse practitioners, PAs, they have the same type of education. Your education is the highest. It is the top tier that we are going to get in thyroid. And I would love for you to tell listeners what that looked like for you.

Yeah, unfortunately, like I told you, which I hope you put in the book, my top tier education. And, and I went to a fairly reputable good endocrinology training program, especially for, for diabetes care. And my training in thyroid was the exact same as yours in PA school. It was. You check TSH, we would check a T4, but there was no emphasis on T3.0. There was no emphasis on the need to check it to understand why it mattered to use desiccated thyroid hormones. So the same as you, we were told if you give people T3 containing thyroid medication, you will increase the risk of afib which is a fluttering of your heart, which can lead to strokes and heart attacks. We were told it causes bone loss, it causes anxiety. All of these things that just are not true. And I don't know whether it is just pure ignorance, if it's trying to scare you if it's dictated by pharmaceuticals, but I was taught the exact same thing you were taught. And when I took endocrinology boards, the highest board you can take in internal medicine, like, for endocrinology care, right? So the standard of how we train doctors and how we are supposed to treat patients in the United States, I passed those boards. They are all tsh and like, that's it. Like, you look at the tsh, you determine what's going on with the patient, and you treat them with T4 based medications. And especially in elderly people, Right. If you picked a T3 containing medication, an elderly person. Good God. You get these terrible.

That's like a board question.

Oh, yeah. No, no, no. And so it's just not. It's not right. And the sad thing is what they're training you is not what you do in the real world, right? Like, I did that for two years. So I was the biggest rule follower you will ever meet. Like, my dad will tell you, I never got in trouble as a kid. Like, if I did something bad, it was once, never did it again. I was the rule follower. I was. Everything fits in a box, very black and white. I did exactly what I was taught in fellowship. I'm gonna do that. I'm gonna do it to the best of my ability. And let me tell y' all something. For two and a half years, nobody got better. None of my thyroid patients liked me. Nobody could poop. Nobody's hair grew. Everyone got fatter. I mean, it just. It doesn't work. And I did exactly what I was told to do. And that's what I did myself for years, too. And then once I was like, what? Like, started going outside the outside the box and learning functional medicine and understanding how important T3 is and how T4 converts to T3. And I actually started practicing how you should, not how we're taught. Lo and behold, everyone's life was different. Everyone's life changed. And so, unfortunately, in this country, still the highest standard of education is that TSH and T4 matter and T3 doesn't, and you shouldn't use T3. And it's. It's not right.

Yeah, it's crazy. It's crazy. I. I shared this study on social media a couple weeks ago. You Might have seen, I don't remember, but I need to send it to you anyway. Which showed it was a study looking at outcomes of people with T3 levels within normal range. But higher normal and T4 and higher normal levels of T3 led to less mortality, less cardiovascular risk, less likelihood to have a heart attack, stroke, higher socioeconomic stat status, lower unemployment rates, lower death rates, higher, lower risk for osteoporosis, osteopenia. Higher levels of T4, which everyone tells us is so safe is levothyroxine. It's the opposite of everything we've ever been trained in. Medicine was associated with higher mortality, higher cardiovascular risk, higher osteoporosis, high osteopenia, higher unemployment, higher early retirement. Yeah, crazy.

And yeah, all cause mortality. I've seen studies in critical care center in Arkansas where when people came in and any sort of ACs so like whether they had heart attack, stroke, anything like that, they immediately give them T3, sometimes in an IV form and their risk of dying decreased astronomically. Their risk of mortality, morbidity. And they also left the ICU much quicker because you need T3 when you're ill. And so yeah, I've seen a lot of those studies. It's crazy, but yet we go back to Dr. Jeff Garber, the guy who wrote the hypothyroidism guidelines, who's probably paid by pharmaceutical companies. I don't know, you can look. But he, he wrote guidelines for hypothyroidism and saying that TSH and T4 are the end all be all. But then he also published a paper the next year talking about how TSH was a great lab value except in and he listed a ton of reasons you shouldn't use tsh. Aging. It has a diurnal pattern, meaning depending on the time of the day. You shouldn't use that whenever people are on metformin or birth control or statins. I mean that's like 80% of the population. So it just, it doesn't make sense. Like the guidelines were based on this precedents that then nobody actually fits into. Right. So it's like, well, who are you writing the guidelines for? Like animals? I don't know. It just doesn't make sense. None of it makes sense. And that's what we teach people. And I used to get really, really, really mad at doctors. I was just like, I would get so angry when people came in and told me these stories. I would just be so frustrated with doctors. And now I'm just really sad for them and sad for the state that sick Care is in this country because they don't know any better, right? Like they're literally doing what they were told. And to your point, they like terrify you into thinking that these medicines actually hurt people. Just like hormones are terrifying everyone to think hormones hurt people. And so I think that doctors and providers generally want to do what's best for people. That's why you go into medicine. But they just are uneducated and oblivious as to what's really happening. The sad part is that doctors haven't done what you and I did, which was pull their head up and say, none of my patients in the last fill in the blank years have. I've actually gotten better with what I'm doing. So why do I keep doing the same thing? Right? It can't be that 100% of your patients are just not doing what you say. Like that can't be the answer. So if you're a provider listening to this and you're thinking like, well, maybe it's my patients, maybe it cause I did that too, right? Like I'm human, maybe it's the patients. It cannot be that every single patient that you treat is not doing what you say. So there's. That's not it. Like there's something else.

There's something else. And when the opposite happens, when like you have a 95% success rate to give people back their lives, when you do it a different way, that's not happenstance either, right? Those are data points. Tell me why you think in your opinion, so many people fall through the cracks and are told that their thyroid labs are normal, but they feel terrible. Give me some ideas of what you feel like that comes from.

Well, I think it comes from in sick care medicine, doctors have 10 minutes to spend with you. So what they're going to do is they're going to spend that 10 minutes is most effective way they know. And what we're taught in school is you review lab, you make sure nobody's dying and then you move on. Right? And we're not even really taught preventative medicine, which is, which is really sad. So I think that a lot of times you go in and you know, I'm a 39 year old woman and I come in and I say, nicole, I'm so tired and if you're busy and you have 10 minutes with me, you're going to go, okay, 39, what does she need? Has she had her injection? Does she need a mammogram? Like in your mind you're thinking, what are all the things I Need to check off my box since she's 39. And then you're like, well, you're tired. So is the rest of the world. The doctor that's taking care of you is probably tired. Because most traditional medicine doctors don't take care of themselves very well, right? They don't even know how. They're not taught to. In medical school, we're taught to be terrible to ourselves. So they're thinking, well, I'm tired too. Who cares? They're going to run through your labs, they're going to say, oh, nothing is crazy. That's going to kill you. And they're going to hand it back to you and be like, see you later. You know, I mean, I just think that they don't know what to do, right? They literally have no idea. They are pressed for time and they feel the exact same way, most of them. I would almost guarantee you that 95% of physicians who practice traditional medicine are themselves insulin resistant, overweight, don't feel, well, tired, you know, I mean, because they don't take care of themselves either. And so I just feel like it's a combination of physicians don't know what to do or providers. They don't know what to do with that. And they're doing what they think is correct because your labs are normal, but that's what you've been taught in school, and that's not normal labs and optimal labs are not the same. And the other thing that I really struck me was when I started thinking about it, it. Patients aren't going to come back to you over and over and over and lie to you and waste your time, right? Like I used to think when I first got out of fellowship, maybe these people are just lying or maybe they're just bored, or maybe they just want to come and complain to somebody, right? Because, like, everything looks perfect and they're 30 years old. Like, how could they really be that tired? But when they come to you month after month after month and nothing has changed except for their labs maybe are getting a little worse. And when I say labs, their liver enzymes, their insulin, their weight, like, everything's going in the wrong direction. People don't do that to themselves on purpose, right? Like, you don't gain ten pounds on purpose. You don't not go to your kid's soccer game because you're exhausted on purpose. Like, none of this is done on purpose. And so when I really started thinking, like, Cassie, people aren't just saying this to make your life more difficult. It's like they really don't feel well, then you have to start listening. You have to figure out why don't they feel well. And I was guilty of this too, because when I didn't feel well, when I had thyroid issues, just like you, you, and people are like, oh, you're fine. I'm like, okay, maybe I'm fine. I don't know. Suck it up. Like, I'm fine. You just do it. And my hair is falling out, my nails suck, and I, I'm cold all the time, but you just do it. And so I think that that's a lot of the problem too, Nicole, is like, we don't know what to do with those people. We weren't trained. And then we just sometimes get a little maybe skeptical in the fact that like, oh, well, I'm tired too, so just deal with it. So if you're, I say this to people all the time too, and I know you, you kind of agree with this. If you're going to a doctor, if I'm going to a doctor, if that doctor isn't the epitome of health and how I want to be, I'm probably not going to take a lot of advice from that doctor. And I can get all the hate in the world for that. But it's just factual. Do you go to somebody who's broke and give them your money and say, make me money. Do you go to a personal trainer that weighs 300 pounds and say, make me muscular? I mean, it's the same thing with a doctor. If you go to a doctor and they don't look, feel and act how you want to, then they're probably not the best to get health advice from.

So true.

My opinion.

So true. So I think too there's this, this concept almost a couple, couple things to reply to that one is clinicians, physicians want to be able to fix people like they, they want to. And so it's almost this source of frustration and justification as to, well, why can't I fix this person? It's not my fault.

Fault.

I don't want to take responsibility. It's got to be their fault. These symptoms are very general. They're non specific. They could be a million other things other than their thyroid. And so they develop this list of excuses as to why these people feel still feel this way that is not responsible to them. And then the other question, kind of thing that I want to pick your brain on is I feel like thyroid. The area of thyroid with, with physicians is something, or clinicians is something, but mostly physicians is something they Are very defensive about, like, I get hate, hate online from physicians because of the way that I practice thyroid medicine, what I speak about online, and they get volatile about it. And I'm so curious what you feel like the source of that reaction is, because it is a strong reaction.

Well, I think it's a couple things. Number one, I think it's probably because you actually make people feel well, and they are probably just jealous. I remember what it was like to be an endocrinologist working at Mercy Hospital and never having patients that felt well. I have always been a very charismatic, just individual who wants to know how you feel, despite what school taught me. And so even my patients will tell you this, too. You could call any patient I have and say, what is the one question Dr. Smith always asks you? And the first question I ask any patient when I walk in the room, how are you feeling today? Because I want to know, like, do you feel amazing? Do you feel like crap? Do you? And I have always done that because I think it's very important. And when I worked at Mercy Hospital, the answer to that question 99% of the time was like, crap, Tired. Just. There weren't good answers. And now the answers that I get are amazing. Like, I get that all the time. Amazing, wonderful. I have my life back. Like, it's just such a. It's so validating in what we do. And I think that when doctors don't get that, when it's always like when you're getting beat down all the time, when you see in traditional medicine, you're seeing 20, 25 people a day, right? When 20 to 25 people a day are telling you, I'm tired, I don't feel good. And looking at you for answers, it just gets almost overwhelming and exhausting, right? And then it makes you think, well, why am I doing this? And obviously, when people don't feel well, they're not going to make you feel well as the doctor. And so I just think that the physicians just, it's. I think that they hate you because you actually make people feel better, and they don't know or understand how you're doing it. And so they're as human nature, a lot of people, unfortunately, their reaction is going to be to be negative to you instead of being like, oh, my gosh, how is she doing that? How can I help my patients? And I don't know if some of it is fear, some of it is ego. Ego. Some of it is a combination. I know a lot of doctors who have really big egos and it's just, it's not needed, right? Like, I have no ego. I mess stuff up. I'll tell you all the time, if I don't know the answer, I'll tell you that, but I bet I know somebody who does. And I'm going to reach out to them and be like, hey, Nicole, help me with this. What's the answer? You know, because my goal in being a doctor is making you feel better, not putting down somebody who's doing something that is making you feel better. So I think that's why you get a lot of hate. I will also say, though, from a provider's perspective, that I think sometimes people get a lot of hate like you, because there are people out there who have no clue what the hell they're doing and they are hurting people, right? And so sometimes doctors will get those people and they'll have to deal with those consequences. Now, that's not you and that's not modern thyroid clinic. But there are people who just go rogue. Some of them who don't even have medical licenses and just treat people with crazy amounts of thyroid medicine and they have no idea what they're doing, right? And so I think that there's like a combination. And then obviously some of those people are just not happy. Humans, right? Like, they're just not happy with themselves and you can't make everyone happy. But I think that's probably a combination of fear, ego. They've seen other bad things in the past. But in general, I would hope that most doctors are going to show you love, just like I did when I found you. I was like, oh my gosh, who is this wonderful human being who's like giving people their lives back and actually knows what the hell she's talking about? Like, I must reach out to her and figure out about, you know, all the things about her because that's what we're meant to do, is help each other as humans and, and help each other grow and help each other learn. And that's like one of the things I love about modern thyroid clinic and you so much is you're just so willing to stop and help anyone with anything as long as it's benefiting that person in humanity. And if everyone was like that, the world would be such a different place.

It really would if everyone was just a little more open minded. But I do, I think that you're valid in the idea that the concept this person's doing things different, they're doing things against what I was taught and it must be dangerous and they can't accept the concept that what we're doing isn't dangerous, even though it could be. Like there are people that can make it dangerous. Right. But the presumption that we are. I mean, I've been called to the medical board twice. Never by a patient, only by a physician that I know. I have never met her, but she's in Austin and will rally other physicians to call against me or did in the past. And it's literally because she's assuming that I'm doing something that I'm not doing at all. Both times I went before the medical board, both times that they're like, yeah, no, everything's good here. You're not doing anything crazy. Goodbye. But still, it's stress. It's. It's ludicrous.

So.

No, I do think that's right. I want to ask you one more question then. I kind of want to get into some myth debunking with you if you have the time. But I want to know what your take is on when people go to the doctor and they say, hey, can I have a full thyroid panel? Will you run this list of labs here? Because that was once me, many, many years ago. Why do you think doctors say no, in your opinion?

Well, again, education. So, like, some of them may just not even know how to order, right? Like, how do you even order that? Like, I don't even know how to order it my ehr. So some of them might not know how to order it. They don't know how to interpret it. I think a lot of them are scared with what am I going to do with the results? And then some of them just truly don't believe. Believe, unfortunately, that they're needed. Right. Because of what they were taught. So again, it goes back to like this brainwashing that happens in school where they're like, terrified. And I think a lot of them think, well, if. If the lab comes back, if the T3 does come back low or the reverse T3 comes back high or whatever, I can't give them T3 anyways. I'm not gonna be able to do anything about that. So I don't want to run it. I think that's a lot of it. Now. Some of it. I'm going to be completely honest with you. I think it's just pure lazy because doctors are sometimes overworked and they just don't have a lot of time with you that's going to require them to put in an extra order, figure out how to put it in, and then figure out how to Interpret it. And some people are just scared, like they don't want to learn new things, like you said. And so I think that that's a lot of the pushback that you get. There are still some doctors out there and providers who just have these God complex egos, like, this is how I want to do it, this is how we're going to do it, and if you don't like it, go somewhere else. And if that's the case, you definitely need to go somewhere else. But I think those are the main reasons. Like when I first got into functional medicine and I was like, reverse T3, what is this? TPO antibody. Oh, like, you have to learn about it. And so I remember the first time I was trying to figure out how to order reverse T3 and I'm like, how do you find this in quest, like typing all these things in. So it's probably just a combination of all those things. But I've always tried to have a very open mind in general. So.

Said by the endocrinologist, y' all. It's so crazy.

And that's true. I get the same hate that you do. So I have people who message me who are like, that you're a disgrace to endocrinology. You shouldn't be allowed to be an endocrinologist. Yada, yada, yada. I get it too. And I'm just like, okay, well, thank you for your opinion. I mean, I don't know. I don't know what to tell you. Like, my patients are happy and they, they do well. So the day that, the day that more people come into my office and say I'm feeling terrible and say are feeling well will be the day. I know I need to reevaluate things. But that's definitely not the case.

Or everyone magically starts going into afib, which doesn't. Doesn't happen.

Or that one which is never happened.

Which is never.

Yeah, well, yeah. Or I'll tell you this. So to be fair, sometimes my patients, like I had a lady who, who called last week and she's like, oh my gosh, I'm having palpitations, I'm really hot, yada yada. She was somebody who had really bad hashis and we've been working on cleaning out her gut and we've been working on her insulin resistance. We micro dose to her GLP ones. I mean, we've been doing all these things to lower her inflammation. But to be fair, I told her three months ago this might happen and if it doesn't mean you're healing, and that's wonderful. Let me know as soon as it happens, we'll cut your thyroid medicine back. And that's exactly what we did. She messaged me, I cut her thyroid medicine back. I checked on her every day. Three days later, she's like, it's not happening. We redid her labs. They were a little high. We've got her adjusted. She's taking a third of the medicine that she was taking, and her labs are great. So these are, are good things. Like, it's not something to be upset about. Like, maybe she'll get off her thyroid medicine. You know, so it's just like you have to work with the patient and you have to explain that. God forbid you explain things to them and then follow up with them and like, help them through this journey in their health. It's not like it just, oh, here, I did this. Let's set you over here for three months and then you can come back in three months and ask questions. That's not how it. That's not how it works.

And that's the beauty of creating an informed, empowered experience for patients, right? That they know this isn't normal. She told me to call her. I know what to do. We're going to navigate this together, right? And that's an extremely different experience than 99.9% of patients actually get to have, which is sad. It is sad. It is sad. Okay, I want you to tell me too, your thoughts on a lower TSH with normal T3, T4, reverse T3, that's totally fine.

So I don't really care about the TSH ever, to be honest with you. The only time I care about a TSH is with thyroid cancer. Totally different topic. Just to have to decrease the risk of recurrent cancer. And in that case, I want it really low. But if you are a patient with. I don't care if your TSH is undetected. If you're free T3 and you're free T4 in a normal range and you are not having severe symptoms, you're not having palpitations, you're not hot, you're not sweaty. When people are hyperthyroid, they know they're hyperthyroid. Coming from somebody who had grace.

Okay?

Right. There's no denying when you're like, no denying that you have hyperthyroidism. So if they do not have symptoms of hyperthyroidism and their TSH is undetectable, I don't get give a shit at all. Doesn't bother me at all. As a matter of Fact, I don't even care if we check a TSH. Like, I need your T4, I need your T3, and I need your clinical situation, period. That's it.

And so is it tsh, low tsh, that drives increased risk for osteoporosis, atrial fibrillation, heart attack, stroke, or is it output hormones?

No, it's not the tsh, it's the output hormones. So I don't care about the TSH again. And to be honest with you, there actually was a study that showed if you're endogenously, meaning your body is making too much T3 and T4, can it increase your risk of afib and osteoporosis? Yes, but actually, when they looked at studies with exogenous, meaning we're giving people medicine, it doesn't do that. So, I mean, if you got somebody's T3 to 30 for months, you know. Yes, but like, like giving someone reasonable amounts of thyroid hormone to get their T3 and T4 where they need to be reasonably not being crazy. Right? It's not going to. No. And actually it lowers your risk of afib, it lowers your risk of arrhythmias, it lowers your risk of osteoporosis. And here's why Your, your heart actually needs T3. It's. It's very important for your heart. When you start to get older and your heart function starts to slow down. What does your heart need? It needs energy in order to pump blood through it so that it needs oxyge. It needs all T3 is what gives your heart energy and oxygen. Like, it's what gives it the energy to move. So actually it's the reverse. You're more likely to end up with heart failure, afib, things like that, when you have a low T3, because then your heart's like trying to pump, but it can't. Right. And so it's trying to get stagnant. Blood get stagnant, you're more likely to get clots, you're more likely getting rhythmias. And same thing with your bones. If you have no energy, you can't get up, you have no energy to walk, to exercise. I mean, you're more likely to get osteoporosis. So all of that, that is so incorrect and so wrong. And actually, I mean, I have thousands of patients and I have very few with osteoporosis as an endocrinologist. And I don't have people that have arrhythmias either with thyroid disease. Just.

We don't Y. Amen, sister. Preach. Okay, I want you to compare and contrast Hashimoto's traditional endocrinology education to how you practice. Now.

Hashimoto's was kind of like, oh, that's a disease that you can have that causes hypothyroidism. It's one of the many causes. You can either have your thyroid removed, you can have Hashimoto's, which is inflammation of the thyroid, or you just are born and develop hypothyroidism. You don't treat it any differently. It doesn't really matter. People will ask about it. You just tell them they have it and you move on.

How often do you check antibody labs?

Oh, you can check them once and you never have to check them again. This is traditional endocrinology fellowship. And maybe if you were lucky and had somebody that was, like, out there, they were like, oh, check your antibodies once a year just so you can see if it's changing. But it doesn't really matter if it changes because you're not gonna do anything different. Yep.

And can you influence it traditionally in endocrinology?

Doesn't matter. It doesn't matter. What you eat. Doesn't matter. Like, you have it. You were born with it, you're stuck with it. Too bad. Yep.

And then tell me how you practice now.

Yeah, well, totally different. Different. So if you have Hashimoto's, that tells me that you obviously have an environmental issue in your body. You've got a lot of inflammation, your body is. Something's going on. Now, are you born genetically with a pre. Predisposition to this? Yes. I believe that you are. So I'm not saying it's 100% your fault. You were born with a predisposition. You have all these environmental triggers, unfortunately, some of which we cannot. We can't deal with or we can't change. And then what you can deal with, though, and change is how you. What you're doing. Right. So the stress that you put on your body. Body. So what I know now is that Hashimoto's is a. When you have a inhospitable environment, just like cancer, when your body has a bad environment, it is going to do things that it shouldn't do, and your body's going to attack your thyroid gland. So the way I deal with it now is I tell people, we've got an inhospitable environment we need to work on, and we need to make this better. We need to focus on our sleep and our nutrition and our sunlight and our movement and our thoughts, our negative thoughts, our Gut our hormones because it all works together. And so what I tell people now is like the, some of the easy things you can do. Stop eating crap. So we've got to get rid of. I mean, I tell people with Hashimoto's, you can't, you shouldn't eat gluten. Not in this country, if you live in Europe maybe, but in this country, as of right now, unless RFK does some amazing things like all of our gluten is crap. It's sprayed with herbicides and pesticides and it, it causes a lot of issues with your gut. So I talk to people about dietary modifications for Hashimoto's. I talk to them about stress and sleep. I definitely give them T3. Like I want to give them thyroid hormone so that their thyroid stop working so hard because it's almost like your thyroid has tennis elbow. That's what I tell people when you have Hashimoto's. It's like you have tennis elbow. Your thyroid has just been trying to make thyroid hormones so hard, so hard, so hard. And it's trying to push out these hormones through like this tangled cobweb of just like crap. And so it has to push 10 times harder to get your thyroid hormone out of the thyroid. And it's just swollen and inflamed and mad. So let's give you some thyroid medicine so that your thyroid doesn't have to work so hard. Let's give it to you in an active T3 form because, oh, by the way, when you have Hashimoto's, if I give you T4, T4, your body's not going to convert that crap to T3 because you're inflamed and your body thinks you're dying anyways. So let's give you some T3. Let's give you some things like LDN to kind of calm your nervous system, calm your body. We do a lot of adrenal support like you do and then we talk about sleep, nutrition. So I just treat it so differently. Now I look at all your other hormones, like what's going on with your insulin? Do we need to give you something anti inflammatory like microdose GLP ones? What's going on with your hormones? What's going on with your gut? What's going on in your head? And so we, I just, I treat it so differently and yes, you can reverse it. We've reversed it in hundreds of people. I reversed it in myself twice. I have no antibodies currently and so it's just so different than what they teach you. And it is very powerful to follow that antibody level because if it starts to change, then, you know you're doing something the correct way or you're doing something the incorrect way. And those things are all so powerful. And you. Yes, you can, as somebody listening to this with Hashimoto's, you can 100% take control of that, retake control of your life and fix it. If you find the right provider, it's all in your hands. It's just you have to know how to do it and have somebody who's cheering you on and coaching you in the right direction instead of trying to stop your forward progress. I would say yeah.

And the data is powerful. Like, checking the antibodies is incredibly, incredibly powerful. And with that, it. It's going to be really hard to navigate that. I just thought of another thing. I could do this literally with you all day. It's so fun. But you should do it by a pool. We should. We should do it in Mexico by a pool. Florida.

Yeah.

Let's put that on our radar.

Somebody to just record that for us.

Yes, exactly. So I don't think what people really don't know is almost 10 years ago, there was a hard right turn in the world of thyroid, and we started to work very hard at removing people from being eligible for treatment. So expanding the window of let's not treat people when they're in these parameters. For a little while, we were narrowing the parameters and then we started widening them again. And what I'm referring to is what's called subclinical hypothyroidism. And now a lot of guidelines say we shouldn't really treat people with subclinical hypothyroidism, which means an elevated TSH with normal, normal T4 until their TSH is over 10 or 20. Tell me your thoughts on that. That's so stupid.

Yeah. So those are our guidelines, Endocrine Society guidelines. I think that's the dumbest thing I've ever heard. Right, Right. So why are you going to just let your thyroid continue to get worse and worse and worse before you treat it? Right. That would almost be like you shouldn't treat anyone with heart failure until their heart just completely stops and then give them a transplant like that is insane. So I think it's so insane. Not to mention just how people feel when their TSH is high in your thyroid. You say this all the time. Your thyroid is so interconnected to everything in your body. Right. So if your thyroid's not working well, like if your thyroid. If your TSH is going up, and you have subclinical hypothyroidism, and you're performing at a C plus from a thyroid perspective, right? Then your hormones are going to start suffering, your gut's going to start suffering, your insulin is going to start suffering. Everything starts suffering. And so although the rest of your body may be optimal, that C plus thyroid is going to pull everything down to a C plus. So why is it fair to say, oh, we've got to wait till you're a complete F before we start treating you? In the meantime, everything else starts sucking like, no, none of that makes sense? And again, I think it goes back to nowhere in the guidelines. It does mention in the guidelines to look at symptoms. It does say that. To be fair, it says, like, when you're looking at subclinical hypothyroidism, it says their TSH should be 10 to treat, but if their TSH is 5 or above and they have a TPO that's elevated, you could consider looking at symptoms. Like, what kind of garbage is that, too?

Well, they just tell everyone the symptoms are nonspecific anyway, right?

They're so nonspecific. Yeah, but again, our. Our body was made to. To function and to be well. And so you tell my patients all the time when you're not well, like, you can tell me a beret of symptoms and I can look at your labs, but you know what it's like to feel well, and you know what it's like to not feel well. And so. So I don't know a single human woman who feels well when their TSH is above. Two. Two and a half men, not one. Like, I'm not like, hey, girl, how you feeling? Oh, I'm killing it. I'm pooping every day. My skin's good. No, when they're ts2, they're like, man, I do not feel.

Surviving. Barely.

Yeah, like, barely surviving. Don't know what's going on. But not feeling well. Well, I know what's going on. You're thinking, thyroid is pissed. Like, this is what's going on. Like, you're not taking care of yourself. So I think that that's stupid, and I don't think that's how you should practice medicine. It's almost like a dictatorship, McCall. Like, it's almost like, oh, well, this. These are the rules, and this is what we're going to do. So this. I'm going to dictate how your healthcare goes and how you feel, because your thyroid hasn't gotten to a Marker that I consider abnormal. And that's just really crappy, in my opinion.

It is. And the cost is heavy. Like, I mean, I would be on disability if my TSH was 9. And I'll tell you that the starting point of that dialogue happened with a study that looked at how people felt on thyroid medication, AKA levothyroxine. And they found that people didn't feel well with treatment until their TSH was over 10. So instead of looking at, hey, maybe this Leo thyroxine itself itself isn't working, and maybe we need to re look at options for treating thyroid dysfunction. They said we're going to operate on the assumption that levothyroxine works all the time. It's just these people, they're not severe enough to need treatment, so that's why they're not better. So from that study, hundreds of studies have been cited based on that one study. And now we are gone. We have gone completely the wrong direction. So I'm sorry, so grateful that you were able to speak to that too, because I think it's ruining millions of people's lives. Honestly.

It is. And again, it goes back to what we talked about. Like, people are not going to come to you and waste their time, money, resources, unless they don't feel well, right?

Women have better shit to do than good.

So much stuff to do. Like, promise 43 other things to do. We are not coming to your office to ask you for anything unless we are in need and, like, need some help. So why would we not just give them what they need? And worst case scenario, you give it to them, they don't feel better. Okay, let's look for something else. But, like, to your point, you're not going to hurt them, you're not going to harm them. So, like, let's try. And that's what a lot of medicine is. Kind of like cooking. I tell people this all the time. It's like baking. Like, I sort of. I pretty much know what I need to do to take care of everyone that comes in based on what they're telling me. But not everyone's going to fit into that exact mold. So that's why I have people come back. I'm like, come back in four weeks, Tell me how you feel. We may have to, like, take out some of the walnuts and put in some more chocolate chips. Like, everyone's different. But I promise you, I've never met a person, a woman or a man who I feel like comes to my office to waste my time and tell me they feel like crap.

Amen.

Doesn't.

Other things to do, Other things to do. Okay, I want to close with this one because I think you're uniquely able to speak to it. I want you to, because I know you've done research on GLPs early on in this process, and obviously you're an endocrinologist. I would love for you to speak to GLPs causing thyroid cancer.

Yes. So I love this question because they don't. Okay. So there's been a lot of studies. So leader, the leader trial, which was liraglutide, one of the first GLPs, they followed that trial after the fact. There's no increased risk in thyroid cancer in humans. Huge trial. Okay. And then sustain was the trial that we did for semaglutide. And same thing. Semaglutide. No increased risk in thyroid cancer. And these are huge trials. Hundreds of thousands of people. None. Right. There's been other trials where they've looked at GLP1s in general. Just weight loss medication. No increased risk. The C cells where all this came from where? C cells on your thyroid. It's a certain type of cell in your thyroid. Thyroid. And when they did these studies in rats, they had an increased risk of thyroid cancer. But rat C cells have tons of GLP1 receptors. Humans don't. Like. We don't have the same receptors on our C cells and our thyroid as rats. Obviously, we're not rats. So this whole. This could cause thyroid cancer came because they did this. They gave this medication to a rat who has a different receptor on their thyroid gland than we do. We don't have massive GLP1 receptors in our thyroid like rats do. So it doesn't make sense. Physiologically, it cannot cause cancer. Just like estrogen and breast cancer. It's the exact same thing. So it does not make sense. It has not been shown. I have put thousands of people on GLP1. Thousands. I have zero thought that any of them have developed thyroid cancer from insurance. GLP1. Like, none. And so it is not true. And it's like this scare tactic again. I don't know why people do this, but we're not rats. We don't have GLP1 receptors in our thyroid. We do have them in our heart and our kidney and our fat cells and our brain and lots of places where we need GLP1s.

But we're all seeing benefits in all of those places, by the way.

Oh, my God. But we don't have an overabundance of GLP1 in our thyroid. At all, period. Like full stop, none. So I have zero thought that it's causing battery cancer. Now, I will go out on a limb and say this as a patient myself, if. And I've taken microdose GLP1s. I felt so bad in my life before when I had Graves and Hashimoto's that if somebody said to me, oh, you take this microdose GLP1, you'll feel better. And I know how they make me feel, and they do. Even if it did possibly cause thyroid cancer, I would still take it. And let me tell you why. Because thyroid cancer is not that terrible. In general, 99 of thyroid cancers are very easily treated with, with surgery and you don't even have radiation. But that's a whole side note. They do not cause thyroid cancer because we don't have the same cells as rats. So that is all baloney. And I hate that there's this fear tactic behind GLP1s because they're so magical for so many people and it just is really infuriating. Same thing like they do with doctors. T3 causes osteoporosis and afib. GLP1s cause thyroid cancer. Answer. No, they don't. Right? They do not. Period.

Amen.

Do not.

So I want you to tell people listening a little bit about where we can find you. I also know that in the not too distant future you're having a book coming out. So tell us about what's new and exciting, how can we find you, how can we learn more about Dr. Cassie Smith and modern indocrine, I think, etc.

Thanks. Yeah, so I do have a book coming out later this year and I kind of wrote it just because I wanted to teach people how important your gut was. Because you were talking about. I like to look at people as a whole, not compartments. And so I think it's really important for people to understand that our hormones all work together very intricately and there's a dance and if they are not working together, it affects a lot of your body and a lot of that begins in your gut. So I just wanted to teach people what you can do to make your gut as healthy and as resilient as possible so that then all your hormones kind of fall in line. And so I just talk in my book about what how different hormones play together and how all that is affected by your gut. So that should be out in the next 90ish days. I have a website, it's just www.modern-endocrine.com. we have a lot of really Cool. I have put a lot of really cool free resources on there. That's been my thing this year, is really, really just empowering people with education. So I write blogs and I have just a lot of really free stuff. I have a lab review guide like you do. I'm on social media. Not as active as I have been in the past, but I am on social media. I have a podcast that I also love. I've had McCall on several times called Hormones, Metabolism, and you. And then just hoping to collaborate more with you guys at Modern Thyroid Clinic and help continue to give people their lives back. Because I know you. You guys have so many amazing. I've had the privilege of meeting a lot of your providers, too, at Modern Thyroid Clinic. They're all wonderful. They're all so smart. They have wonderful questions. They send me amazing questions about patients. They really care, and they really want to give people their lives back. And so that's why I love what you do, and I'm so happy to help you be a part of it.

Well, we are so grateful that you're on our team, and I am just so grateful for all that you do for patients, but also for just people, like regular people who get to learn from you and get empowered from the information that you freely share. So please tune in to her podcast, please track her down on social media, and I'm sure we'll do this again soon. Thank you so much for. For being.