49: Still Tired on Thyroid Meds? – The Most Overlooked Fixes for Hashimoto’s & Hormone Balance with McCall McPherson

Foreign 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 today we are doing another Ask Me Anything episode, which you guys tend to love. It's going to be a little heavy on the Hashimoto's. Some workout stuff, some GLP stuff, some fertility stuff. We're getting a little random towards the end, but it's going to be a great one. It's going to be fun. There's some great questions you all submitted. If you're wondering how to submit questions for podcasts or ask me anything, you can do that on my Instagram atclemcphersonpa. I ask my Instagram people, especially on stories, all kinds of things, and we go deep. We are close. They know the ins and outs of my whole life, so find more there. Let's dig in. Number one, tell me the top five things you would do first, when you're diagnosed with Hashimoto's. Number one, I would take ldn, especially if my antibodies were significant. Number two, I would measure antibodies, both TPO and thyroglobulin before I start any intervention, whether that's LDN or something else. But for example, diet, I would go either gluten or dairy free, measure antibodies before I go gluten or dairy free, measure them 90 days later and see how they respond. If they don't reduce and I went dairy free, I would go gluten free at that point and measure antibodies 90 days later. If they did improve, I would continue being gluten free and then maybe continue that for another three months and then potentially try to be dairy free. In addition, several months down the line, always measuring antibodies before and after. Number three, I would probably take 200 micrograms of selenium every day. Again, measuring antibodies at Day 0 and Day 90. Part of the thing with Hashimoto's is, y', all, you have to find what works for you and it's not the same for everyone. And the only way that you can know what tools work in your toolbox is with data. And you all have to mine and collect that data, which means you check and recheck TPO and thyroglobulin antibodies every 90 days. If your doctor won't order those, there's, I think I. There's even a link in my profile where you can order your own. In so many states, there's things like any lab test now where you can go and order your own labs. So let that be a resource. Okay. Number four, I would say I would work on my gut health, right? Especially if I'm having gut symptoms, whether that's taking a really good probiotic like just Thrive or Megaspore, whether that's getting tested for Candida antibodies to see if maybe I have Candida doing a stool analysis. Pick something to work on your gut health. And lastly, I would do red light on my thyroid 10 minutes, one to two times a day. You can hold it about six inches away from your thyroid. And that has been shown to reduce antibodies in Hashimoto's or, excuse me, an autoimmune thyroiditis. And that can also help to improve conversion and activation of your hormones. So that was a really great question. Blends also in with how to lower antibodies. Let me read on here. Starting HRT with Hashimoto's. Do you start estrogen, progesterone and testosterone together? It depends. I usually start with the hormone that the person has the most severe symptoms in. If they're not super sensitive. I don't have a problem starting multiple at one time. But I generally go in order of priorities, which I think. And you can work backwards from there. Someone asked about Hashimoto's and hormones. So people with Hashimoto's often have hypothyroidism. People with hypothyroidism have hormone dysfunction. Right. The first hormone that I see decline in people with Hashimoto's and hypothyroidism is progesterone. And I see that in women, I mean, even in their teens, but Certainly in their 20s, 30s, symptoms of low progesterone, anxiety, irritability, agitation, insomnia, worsened leading up to your period, heavy crampy, moody periods, dysregulated cycles. The next hormone that I see fall is testosterone. And that leads to low sex drive, difficulty with physical stamina or endurance. Like you just can't build up your endurance when you're exercising. You can't build muscle mass when you're exercising, even if you're lifting weights and you have slow or poor exercise recovery. I don't see estrogen drop nearly as often, obviously in like post menopause. Close to that. I mean, menopause, perimenopause towards the end of perimenopause. Sure. But that is the pattern, definitely. Your thyroid and your hormones are interconnected. So that means. Also the flip side of that coin is if you start taking hormones, whether that's in perimenopause or just hormone depletion or menopause. You need to be checking your thyroid labs because often medication needs to be adjusted. What can you do if your antibodies won't lower, even if you're. You've removed gluten, dairy, et cetera. So I would consider starting glutathione. So you genetically might not be making enough to combat the effects of inflammation. Okay. Like you might be. I myself am primed for inflammation. That's why I talk about it so much. But a lot of people that struggle with autoimmune diseases are. So you could start something like glutathione, 500 milligrams orally. Glutathione, topically resveratrol, NAD precursor, NAD like NMN NR. I'm gonna have a podcast released on that really soon. That was absolutely enlightening. So I learned so much. Stay tuned for that. It's not all about diet, unfortunately, guys. You can do intermittent fasting, you can do red light. All of those things are outside of diet. Don't just think diet. Think outside of that box as well. How does a thyroid ultrasound look? Normal. No nodules, but it still shows Hashimoto's. So Hashimoto's, on an ultrasound looks a very particular way. It's almost like hypervascularity on your thyroid gland, which is different than nodules, different than cancer. It's actually not something, when I see an ultrasound that I'm concerned about. Like, sure, I'll. I'll watch it, but it's not a very big concern of mine. Let's see. I'm trying to pull in any other questions on Hashi. I have Hashimoto's, but I don't need meds yet. How often should I be checking hormones? I would say if you're symptomatic of hypothyroidism, fatigue, brain fog, weight gain, all the things dry skin, hair loss. Gosh, I'd be checking those labs every three months, and I sure would be doing a full thyroid panel and comparing your labs to optimal, not normal. If you don't know what that is, I have a free thyroid lab guide linked in my profile where you can find our optimal ranges that we use at modern thyroid clinic. You guys can be debilitated. Debilitated. And be in, quote, normal ranges. Okay, so let's deviate a little bit from this conversation, but let me wrap it up with this one. Epstein Barr and Hashimoto's. I'm not convinced. So this is not something that I work with with our patients. It's not something that I believe is actually sound or valid. The person that pushes this idea and concept is, gets it. I mean, in very strange and unique way. If you guys, if you know who I'm talking about, you'll know what I'm referring to. But it's not really a medically valid or sound way at all whatsoever. Also, I myself am in remission for Hashimoto's. I've put so many people into remission. Never once have I influenced Epstein Barr antibodies. And saying that Hashimoto's is due to Epstein Barr because everyone with Hashimoto's has Epstein Barr is like also saying everyone with Hashimoto's has Hashimoto's because we have a pinky. Surely there's a connection here, right? Because anyone that has Hashi has a pinky. Same with Epstein Barr. We are all walking around with Epstein Barr antibodies titers. Like I have seen two people ever not have them. We all have them. So people go into remission all the time without influencing Epstein Barr antibodies. That's the last one I'll talk about on Hashi, I think how to work out with thyroid problems. We're doing rapid fire today, y'. All. The biggest thing here is listen to your body. After you work out later that day, check in. How does your body feel? How does your brain feel? How do you feel the next day if you leave a workout and later that day, you're depleted, you need a nap, you feel sick, you have overdone it, and you will not get stronger. By continuing to do that exercise, you will actually weaken your body substantially, and it's just not a good idea. So pull back. People think, especially, like, really driven, motivated people think, well, I just need to work harder. I just need to do this more, and I'm gonna get stronger. And in fact, you're breaking down your physiology. So some of the only people that I can't fix at modern thyroid clinic are those people that just keep pushing on their workouts and they get worse and worse and worse until they ultimately work out and they're sick for like five or six days. And then ultimately, long term, they're just sick all the time, depleted, laying in bed, can't get out of bed. That's not what we want for you. Okay? So listen to your body. My advice early on in the thyroid journey is walking and slow weight training. What do I mean by slow? In between your sets and reps, you let your heart rate completely come down. You let it recover to completion. And yeah, that's Important. The last thing I want my people doing is CrossFit. The last thing I want my people doing early on is hiit. Just because you can't do that now doesn't mean you won't ever be able to do it, though. There's no one that I really advise to do CrossFit, like, ever. But your body will get stronger, but you have to rest your way out and prepare foundationally for you to get stronger. You won't get stronger by pushing yourself so much. You'll ultimately again make yourself weaker. Let's talk ivf, thyroid and hormones. So there's a deep interconnection here between hormones and thyroid one. I think having a thyroid issue primes you for worse fertility and poorer outcomes. Research certainly shows that. So step one is getting your thyroid optimized to perfection. Okay? Number two is when you go to ivf, make sure your thyroid is optimized so that you make the most out of that journey, because it's expensive, it's costly, emotionally, physically, financially, all of it. And then I would say work with someone that specializes in thyroid throughout that process, because the fertility people don't know y'. All. They just don't. So at every big change, when you're getting hormones, I check thyroid labs before your transfer, I check thyroid labs. After your transfer, I check thyroid labs. So all of these big steps, there needs to be accountability for thyroid. And then lastly, the big piece of advice that I tell people on their fertility journey with IVF is be sure someone is checking your progesterone early on in pregnancy, almost on a weekly basis to make sure you didn't do all that work, all that intensity, and you're at an increased risk for miscarriage because people one with thyroid are at an increased risk for miscarriage. I think people with fertility struggles are also. So be sure, because I've seen so many times that IVF practices aren't, and we're doing that in our practice for people. There's a lot of people that aren't accessing that, and they don't even know that they're missing it. Discuss when and how T3 meds do not work and what patients did instead. That helped hypothyroidism. So this is very, very rare. I can count on one hand. No, I can. Two patients that couldn't tolerate T3. Like, that's all I've got in the history of my career. So that is 0.0000001%. Usually, if the clinician really knows what they're doing, they can make it work. Like there's just various things to do. For people that are really sensitive to T3 work, 99.9% of the time, we can make a workaround. If not, then you can try to improve things that facilitate the activation of your own thyroid hormones or T4 potentially. Those are things like low inflammatory diet, getting enough rest, reducing stress a night, a micronutrient, dense diet, enough calories, protein, low inflammation in general, good gut health. Those are all the things that contribute to poor activation of your hormones. So if we can reverse engineer those, that would be amazing. Another fertility question. Thyroid overactive immune system causing recurrent pregnancy loss. For me, I think my mind immediately goes to ldn, like absolutely low dose naltrexone. Potentially having a patient on a GLP before they're actively attempting pregnancy. Things to reduce inflammation in a massive way would be key. I even know there are practices that put patients on steroids. I think there's a doctor in Chicago, fertility specialist out of Chicago, that I've shared patients with that does that. But I don't even know if that's necessary when you have something like LDN and a GLP that can so potently, so, so potently reduce inflammation. Hypothyroidism and cholesterol. There's an intricate connection here. Your thyroid hormones influence cholesterol transportation to be taken out to the trash, basically. And when you don't have enough thyroid hormones very, very early on in this process, you begin to accumulate cholesterol. That is one of the first signs of hypothyroidism. So often before someone is even diagnosed with hypothyroidism, their cholesterol will elevate. And like in my case, I was already on medication, but the doctor was willing to put me on a statin, but unwilling to address my poorly managed hypothyroidism. So when you fix your thyroid very commonly, especially T3, your cholesterol will begin to drop. People are asking, how can someone in Arkansas get your help, please? I think someone asked also about Massachusetts. There's a couple states, y'. All. We are down to like four or five states that we're not open in. We will be open in them. Like, we're literally everything submitted. We're just sitting here waiting. And it's completely up to how long the medical board and things take for the approval process. We bombard them on a weekly basis trying to hurry and get access for you all. If we're not there yet, there are very few states left. We will be there, I promise. You, you sit tight. We are coming. We have not forgotten about you at all. Okay, a few more T3 monotherapy. So we love T3 monotherapy for people that need it. Those are people with high T4 naturally without taking levothyroxine, Synthroid without taking T4 and low T3 often. They also have an accompanying elevated reverse T3. So that's a T4 that's like 1.2, 1.4, reverse T3. It doesn't have to be elevated. But often when people have an elevated T4, they have an elevated reverse T3 that's like 18, 24, 28. So in those cases we want to facilitate an increase in T3 and a balance of T4. Very different than suppressing someone's T4. Do not see a clinician. That is okay. Suppressing your T4, that is not going to end well for you. It's a horrible, horrible way to treat thyroid dysfunction. You need T4 full stop, period. You guys know how much I love T3. It's amazing. It's absolutely vital. It's the most important thyroid hormone. You cannot do life without T4. T4 is. Think of it as the lowest possible threshold that your thyroid gets every day. Because your T3 that you're taking is volatile and extremely short acting. And there is no way that you can have access to T3 all day with just supplementing T3 because it's short acting, it's going to peak and it's going to trough. Even with multiple times a day dosing, you will not have enough. And when that T3 is gone, you have no T4 to pull from. So any function in your physiology that chronically needs access to thyroid hormones, hormone production, metabolism, hair, libido, digestion, cholesterol, all of these things you are going to have problems with because you do not have access to thyroid hormones throughout the day. Literally, if your T4 is suppressed and you're on T3 only, you will have 00 thyroid hormone access in between doses of your medication, which y' all is crazy town. Like you cannot do that. So we love T3. We give T3 monotherapy to people who only need T3, but we never suppress T4. It's a no. Okay, so the MTHFR gene, Y', all, I'm gonna close with this one. It's back in vogue because someone in the media that has absolutely no medical credentials at all or formal medical training in any field is all hyped up about it. And this happens like the MTHFR hype happens every few years. I started treating MTHFR in 2012. That's 13 years ago. I was an extremely early adopter. Went full in, full in. And you know how many patients got better? Zero. Zero patients got better. And I was even practicing integrative and functional psychiatry, which I think has the highest potential for improvement by addressing MTHFR defects of any specialty of any niche of medicine. Psychiatry would be it. And so it can cause incredibly complex side effects, namely massive agitation, almost like mania rage. And it's not gonna fix your thyroid problem like full stop. It's not gonna change how you feel with your thyroid. It's just, it's not. So it's a in vogue thing to sell you supplements. And when you take them, if you do, you need to be very careful because the side effects of it are, can be obscure and they build over time. They're not immediate. So usually agitation shows up between three, four or five weeks. I personally get large muscle weakness which is kind of terrifying. Like my legs get weak. So I think there's like hype and real and sure methylation is real, like the real process in our body. It is not as simple as taking L, methyl folate, it's just not. So my recommendation is pass over that completely. Work on things that actually can impact your quality of life and your long term health outcomes. And in my opinion, methylation isn't it. So I heart you guys. I love these. Ask me any things, let's do them again soon.