Modern Thyroid Masterclass: Empowering Your Journey - February 6, 2025

Let's see. Hi, guys. I am going to get all of this just set up just right and then we will begin. Hope you guys are having a good day. Okay. Hoping you can see the slides now. I can't see you guys. I don't like that. Let me see. Yeah, I wish. Hi, guys. I wish there was a better way to share this because I think that might be. That's just awkward, right? That's so awkward. Okay, I think we might just have to go with this. Still so very awkward. You can't see my pretty background, but welcome, everyone. I'm so glad you guys are here. So this will probably. So this is a webinar series of three. This will be the shortest session of the three and kind of most simple, I would say, for the most part, pros and cons of that. The pros are it leaves more time for you all to ask me questions at the end, which is kind of nice. So we will go ahead and just kind of recap what we've already done last session. And if you guys haven't seen this, we will be offering a replay on the last session. But last time we talked about empowering your thyroid journey, why you still might have symptoms. Like we discussed labs, you know, full thyroid panels, what labs you need, what optimal is versus normal. And then we discuss different types of medications. Today we're talking about just other parts of your physiology that your thyroid influences and then how other parts of your physiology influence your thyroid. And then the last session is really dedicated solely to thyroid and metabolic health. So that will be the next one. So stay tuned. I think we're planning to do that in March, April at the latest. But yeah, I wish I could tell how many of you all are here, but I can't see anything because of the way that zoom works when I share my screen. So if you don't know who I am, I'm Nicole McPherson. I am the founder of Modern Thyroid Clinic, and I ended up a thyroid expert by way of really being a patient, like probably all of you, where I just could not get out of a life plagued with thyroid symptoms until I was finally able to find someone to partner with and was able to get my life back. And now that's our mission exactly at Modern Thyroid Clinic. So we're going to start with kind of a broad overview of the thyroid and its effects on your body and how it can play a role in evolving into other issues or symptoms, etc, and there's a few things that we'll touch on today. Your thyroid is really Like a master gland, it is foundational for all, almost every, like, organ system not. It is, it is integrated into every organ system, but almost every even biochemical reaction in your body is. So you know, when something begins to go wrong with your thyroid, the trickle down effect is certainly real. Some of the ones that we're going to talk about tonight are your adrenals, your hormones, your metabolism. This is what we'll do a deep dive on at the next discussion. And then energy. A lot of what we're going to focus on today is this because this is the bread and butter of what we see all day, every day at modern thyroid clinic that really, truly impacts people's quality of life in a very, very profound and significant way. So I want to start with adrenals and you all. This is not the first time you all will have heard me discuss adrenals. So your adrenals and your thyro are very much interconnected with one another. And when you have thyroid dysfunction, your adrenals try to compensate. When you have adrenal dysfunction, your thyroid is trying to compensate. So they sort of give and take, back and forth. And pretty quickly, or at least by the time certainly people arrive at modern thyroid clinic, they have had a thyroid issue either for long enough or so profoundly that almost 100%, if not 100% of people's adrenals are affected. And the problem with that is symptoms of adrenal dysfunction, especially later on after years of sort of wear down. It mimics thyroid issues almost to a T. So, you know, symptoms of hypothyroidism. Right, we all know about those, but I'm just trying to see if there's anything in the chat window. Okay, good. You guys are welcome to enter questions into the chat window too, to kind of prime them for when it's Q A time. So feel free to do that. If you think about something too along the way as we're talking, enter them there. If you guys see me, like, glance constantly over to the right. I have my daughter's seizure monitor, like here, and I'm like, watching her while she's asleep. So just, you know, multitasking in true mom form. But symptoms of hypothyroidism we're all very familiar with. It's fatigue, it's brain fog, it's weight gain, it's dry skin, it's brittle nails, brittle hair, hair loss, loss of the outer portions of your eyebrows, constipation, low sex drive, depression, sort of apathy, cold intolerance. And there's more, but those Are a lot of the basics symptoms of adrenal dysfunction are fatigue, brain fog, lower blood pressure. Also happens with hypothyroidism, sleep disruption. Also happens with thyroid disruption. And kind of craving salty, snacky foods, which can be, you know, intriguing. Like it can be related to thyroid. But honestly, that's more when the adrenal piece has already come into play. You know, I would say some differentiators in symptoms between adrenals and thyroid. Adrenals specifically, people tend to crave salty, snacky foods. Our adrenals need salt to function. And so when they're not functioning well, they start looking for that in an exogenous form. And we're looking almost for this energy source to keep us going throughout the day. And a lot of that takes place by craving salt and eating salt. Also, another differentiating factor with adrenal fatigue is a lot of the time people are fatigued. Oh, good. I see Yalls Q A. I got it. Okay, sorry, I just saw Yalls questions. Anonymous attendee. I am not muted. Correct, everyone. Like, I think maybe your volume might be off or down on. On zoom itself. So, um, yeah, so adrenals that are a little bit separate. How good. Adrenals that are a little bit separate in terms of symptoms are fatigue and brain fog, kind of specifically in the late afternoon. You guys know that 3pm Crash? A lot of people think that's thyroid. A lot of times that's because it's already interrelated with adrenals. And the other one is fatigue after stressors. So that can be like emotional or psychological stress. A lot of the ways that this most profoundly manifests whenever I see patients is people that exercise and they get really tired after they exercise, like almost sick, they need a nap. Sometimes they feel flu Y. That is deep, deep adrenal dysfunction. So those are some hallmarks. What I'll really tell you is this right? If. If people that came to see us at modern thyroid clinic, if we fix their thyroid and made it perfect and we did not address their adrenals, they would think they still have thyroid symptoms. So if you want to fully get your life back, you have to address your thyroid. But 100% of our patients at least also need their adrenals addressed. And if you don't, they never really reach their full potential. And it's almost like they can't feel. They can't feel the improvement in their thyroid symptoms until their adrenals are. Are also simultaneously addressed. So it is so important some ways that you can improve your adrenal Function is. And this is like a rebuilding process. Well, let's talk about testing ways too. So ways to test your adrenals. You can do like a four point salivary cortisol test that measures your cortisol pattern throughout the day. A blood cortisol test is almost useless. I don't really do a ton of salivary cortisol lab tests anymore. I did when I first started practicing functional medicine a long, long time ago, but now I can kind of clinically pick up on what's going on with people. If they have a very complicated adrenal picture, then yes, I will run a four point salivary cortisol test. Another way that we kind of just track it over time for improvement is monitoring and watching people's DHEA sulfate. So that's an adrenal hormone. Usually when people come to see us, it starts out quite low, meaning their adrenals are tired, they're worn out. And then slowly, over months, even years, it builds up more and more and more. But there's a couple key things that you can do to speed up that process. You know, lifestyle wise. Obviously stress reduction is big. So stress reduction, meditation, wherever you can, is an opportunity for improvement. With your adrenals, you have to rest them more than you tax them for them to heal you, can't you, that's the deal. You have to out rest adrenal fatigue. So you don't want to tax them, you don't want to over exercise all the time, et cetera. Um, increase your salt. Your body is actually asking you for salt because your adrenals need salt to function. So actually giving them that salt. Sometimes I even tell people to put like a quarter of a teaspoon of a very high quality salt in water and even drink it twice a day. Just flood their adrenals with, with the salt that they need to function, obviously optimize sleep. And then if you guys have followed me for long, you know there are two particular supplements for adrenal support that I am a big, big advocate for. Let me drink some water. I've been talking like all day. I think I've done like three interviews already today. So number one, my favorite, probably favorite supplement of all time is by a brand called Orthomolecular and it's called Adrenal Adrene dash all. And you can see that on the screen. It has micronutrients and minerals that like nourish, help to restore your adrenals. But what it also has is cow adrenal gland in it. And what that does is it's almost like desiccated thyroid gland, like armor and pee that makes your body feel like you don't have an adrenal issue while we're working on fixing your adrenals. So that translates to better energy, clarity, motivation, engagement, resilience to stress. Right. I love adrenal, y'. All. I put a huge percentage of our patients on it. My husband's very often like McCall. Why are you always talking about adrenal on social media or on TikTok lives, et cetera? It's literally because it's life changing. Like, it's absolutely life changing for people. So it's tricky. It's called. The company's called Orthomolecular. I should have written that in the PowerPoint. Orthomolecular. Adrenal. I have my patients. This is not medical advice. It's educational only. Right. But I have my patients increase slowly up in the morning and at lunch because adrenal kicks in in 30 minutes. It lasts for about three to five hours. The good news about it is it really, truly is incredible as far as symptom improvement. The bad news is there's not like one size fits all dosing. However much adrenal function you're missing is how much of the supplement you need. So you have to kind of toy with the dose until you find what makes you feel good. So I have patients take it morning and lunch. Have them start with 1 in the morning, 1 with lunch. Every few days, I'll have them increase 2 in the morning, 1 at lunch, 2, 2. And ultimately the max I usually recommend is like 3 in the morning and 3 with lunch. Most people don't even need that much. Um, but you're looking for clarity, energy, engagement, motivation. And if you end up getting a little too much, people generally feel kind of stimulated, almost stressed, and they back off by one the next day. And that's kind of sweet spot. The one other caveat I do want to add that I always try to tell my patients is adrenal has. Has a B vitamin in it called niacin that if you get enough niacin, it creates a flush. And that kind of looks and feels like hives. It's not an allergic reaction. It's actually really health beneficial. I tell my patients not to change anything based on that. It'll go away in 15 minutes. But it is like red, almost hot, itchy, scratchy patches on your face. Neck goes away in 15, 20 minutes. Totally harmless, really health beneficial. And then lastly, my other favorite supplement is Ashwagandha um, ashwagandha can help nourish, restore and speed up ultimately the recovery process of worn out adrenals. I estimate in my clinical experience, it reduces the recovery time of healing my patient's adrenals by about 50%. And I just have my patients take it at night. I tell them, look, don't expect to feel anything. Like, I'm not actually giving it to you to feel any level of improvement. I'm only giving it to you to speed up the recovery time. If they notice anything, it's usually only that they sleep a little bit better. But that's not why I'm giving it to them. Okay, so now I want to talk a little bit about hormones. And if you guys look closely, I can almost guarantee that you're going to find typos because I did this all today and I, I don't know if you know this about me, but my toxic trait is I refuse to proofread. Like, I just won't do it. I feel like it's a waste of my resources. So, okay, so hormones with thyroid dysfunction, I see sort of patterns of hormones in women and men. So in men, obviously the first hormone to start to decrease over time is testosterone. Right. In women, the first hormone that I generally see that decreases is progesterone. And I'll circle back to the testosterone piece because it applied. The symptoms apply to both men and women, but low progesterone symptoms are part of a facet of what's called estrogen dominance, which, the symptoms of estrogen dominance, whether it's from low progesterone or too much estrogen, are the same. Mostly it's anxiety, irritability, agitation, insomnia usually worsened leading up to a period. Heavy crampy, moody periods, dysregulated cycles, pms, pmdd, that kind of thing. Um, I see this all day, every day. Even with teenagers like it is, it shows up and manifests so incredibly early. And the world of thyroid dysfunction, a lot of young girls end up getting put on birth control for this. When it's like totally an extremely fixable problem, usually very, very quickly, almost from one cycle to the next, it can improve. So anyway, hormones start to dissipate with loss of thyroid function and progesterone tends to go first, testosterone tends to go next. In women, symptoms of low testosterone are fatigue, kind of loss of overall sense of well being, low sex drive, difficulty with physical stamina. Like you're exercising, you're working out, you're not building up endurance, you're not building up Muscle poor recovery. And then kind of apathy, especially for men. Apathy, depression, kind of just a flat mood. Super, super also easy to fix, at least with hormone supplementation. And then finally for women much later, honestly usually later in perimenopause or menopause, postmenopausally or the other time that I see this in kind of young women is post thyroidectomy. Sometimes I'll have women that have a thyroidectomy that are very much not in, not close to menopause, that will never have a period again. Their estrogen just kind of drops and falls off the radar. And symptoms of low estrogen are hot flashes, vaginal dryness, decreased skin elasticity, osteoporosis, osteopenia, that kind of thing. So we, we think about the thyroid impacting hormones across an entire lifespan of women and men as well. But when women arrive into menopause, there's the reversal that can happen too, where that loss of hormones can actually increase the incidence and risk for, for hypothyroidism or even Hashimoto's. So you have to be delicate with that as well. It's, it's strange. It's not always causal. Like thyroid causes hormone issues, sometimes hormone issues cause thyroid issues. So it's important to think about both of those. So this is really our big topic, like I mentioned at our next chat, but we're going to go deep in metabolism, really some strategies on how to improve this because this is a huge, massive issue for people with thyroid dysfunction. But I at least wanted to talk a little bit and lay the foundation of what we see in medicine with thyroid disorders. And I'm kind of a classic example of this in my own journey when I was 27 and in my own thyroid crisis, I went to the doctor, I was already on Synthroid and had all the symptoms and was going to bed at 3:30 in the afternoon every day and like begging him for help and did all this, you know, did TSH and did my cholesterol and all the things and told me, oh yeah, no, well, your thyroid's fine. Like your TSH is fine, but your cholesterol is high. So let's put you on lipitor. I was 27, y'. All. Like, imagine what. So early indications of thyroid dysfunction are elevations in blood sugar and cholesterol. Can you guys hear me? Okay, I just got like a notification that says my Internet's unstable, but it seems like you guys are doing okay. Okay, so what ends up happening? You know how I think what most people can relate it to is they gain weight. Right? Like people start to gain weight when they have a thyroid issue. Well, the reason you're gaining weight is because your metabolism is no longer functioning well. You're becoming insulin resistant. Your body is needing more and more insulin to maintain your blood sugar. You're becoming leptin resistant, meaning you are having more cravings. You're not feeling feelings of satiety after you eat. Your body is getting a message to overly store fat as opposed to using it for energy. And these things very quickly, quickly cascade into increases in cholesterol, circulating fat, reduction in your metabolic function. As you become leptin and insulin resistant, your metabolism simply doesn't work as well anymore. And that is what leads to weight gain with thyroid issues. Right. It's interesting, like, this is why I'm such an advocate for the use of GLP medications. Because I think the world looks at weight loss as like this mathematical equation. And if everyone just does less calories in and more calorie expenditure, then you'll lose weight. And that's not true. Like, there is no mathematical equivalency for everyone. Our metabolisms simply do not function at the same rate. And people with thyroid dysfunction who have lost that metabolic potency very, very much have a disadvantage. And the effort that they put in to lose weight is not what yields the outcome. Okay. And so finding creative ways of solving that problem is very, very powerful. So again, that's what we'll dig into deep next time. And I'm excited about. It's. You know, I didn't. It was, honestly, until three years ago or so, it was like, it was like that the nail in my side in my clinical practice, because I could give all of these women back their lives and like, make them feel so great and this high sense of vitality and just so wonderful. But I could not get them to lose weight despite everything being perfect because their metabolism was so damaged. So being able to do that and not only allow people to lose weight, but heal their metabolism using GLPs has been such a exciting and like, special experience for me. It's. I'm so passionate about it. So, anyway, I'm excited to dig in it. We will talk about GLP some next time, of course, for sure, and then lifestyle optimization. So we want to. I want to talk about just some basic things today that I get a lot of questions about that I feel like that you guys can use and build off of. So some nutrition essentials I want you guys to think about. Nutrition with thyroid, there's two kind of aspects to this one is simply, I have Hashimoto. What can. I mean, I don't. I'm just saying, theoretically you do. I used to have Hashimoto's. I've been in remission for over a decade now. But if you have Hashimoto's, people want to know what can I do to reduce the severity of that or ideally go into remission. Right. And. And that's a big part of the conversation. And then the other part of the conversation is what can I do to make my thyroid hormones work better? How can I make my thyroid function better based on nutrients? And I've included a list of like basic supplements down here or nutrients like you can. I think I'm going to. As I was prepping for this, I decided I was going to make like a little guide for nutrients that support your thyroid function and where you can get them from food. So I'm going to work on getting that out in the next week or two for you all. So stay tuned on that. But here are some basics. I don't have iodine on here because it's a complicated thing, but these are the safe, easily accessible ones that you don't need to worry about getting so much of that it could damage your thyroid, et cetera. But you know, when we think about diet, nutrition, we, you know, things like selenium can reduce the severity of Hashimoto's. Vitamin D can also reduce the severity of Hashimoto's. Zinc and iron can help the formation and even magnesium of your. Of your active thyroid hormones, make your thyroid hormones more readily available to use. And then in addition to that, I want to also talk about kind of food groups that I've seen in my practice that worsen or put people at risk for Hashimoto's. Okay. And those are really, I mean, this is all based on data. Right. So I can just accept. Sure. Like what people tell me and functional medicine and integrative medicine, which is always gluten. Gluten. Gluten, Right. And I could just repropagate that and that's fine. It is an issue for a fair amount of people. But after testing thousands and thousands and thousands of people with Hashimoto's, the number one food group that I see that creates inflammation almost twice as often as I see gluten is dairy. So it's sad because there are no real super great dairy alternatives. But just telling you how it is. So that is the number one most inflammatory food group that I find in people with Hashimoto's based on Data number two is gluten. Okay. So what I tell people if they're not a patient of ours, like if I'm just educating you all on social, is if you want to change your diet and take out a food group like gluten or like dairy. What I always recommend if you have Hashimoto's is check your Hashimoto's antibodies before you begin. So TPO and thyroglobulin antibodies go, let's say dairy free for three months, and then recheck those antibodies and see if they've dropped. Because if you have a real dairy issue, they will. They'll have dropped. And then that gives you the encouragement of, oh, my gosh, all this work that I've put in is paying off and I'll continue it. Right. As opposed to just blindly hoping that it's doing something and not actually continuing flip. The same thing goes for gluten. I never recommend people do the same, like gluten and dairy at once, because you don't. If your antibodies drop, you don't know what's doing what, and then you have to continue both of those. So unless you know that you feel so much better, it's worth it to do it that way. I always recommend doing them one at a time, but I am like an overly realist. I try not to just take away a bunch of food from my patients unnecessarily. And then the other thing. So that can directly influence Hashimoto's antibodies. Right. The other thing that reducing inflammatory foods can do is it can improve your. The activation of your thyroid hormones. So specifically, the conversion of your inactive hormone, your T4, to your active hormone, your T3. Because when we are inflamed, our body halts that activation and it tries to make us go into recovery mode by making us tired. So pulling down that inflammatory response can be super, super beneficial. Um, there was one other thing I wanted to add there. Oh, yeah. Nutrient dense foods. So, you know, another thing. And protein. So another thing that your body needs to feel comfortable to activate your thyroid hormones is enough micronutrients, enough protein, enough macronutrients, even enough calories. Like when we are calorically restricted, our body tries to put us into hibernation. It tries to slow our metabolism. Part of the way it does that is it halts the activation of your thyroid hormones that your metabolism actually does slow. I hope you guys are enjoying this. Okay, I get this question a lot. Exercise, finding the right balance. So this is super important, mainly because some of the only people that Come to modern thyroid clinic that actually, like, we can't give them back their lives are people who have profoundly ruined their adrenal glands by over exercising. After years of having a thyroid and an adrenal problem. I was going to see. Can you guys hear me? Okay. I just didn't know if I have my microphone on or if it's my computer speaker. But let me know if you can't hear me and I can fiddle with all this. Um, so when you have adrenal. Okay, good. Thanks, Shauna. When you have adrenal dysfunction. When you have thyroid dysfunction, you have adrenal dysfunction. Right? We covered that in the beginning. When you have adrenal dysfunction, you cannot tax your body intentionally over and over again multiple times a week with overly intense exercise. Okay. The sign for you having overworked out or over exercised is you work out. And after your workout, you feel tired at first. That's it. You just feel a little tired later in the day. Then it turns into, oh, I needed a nap later in the day. Then it turns into, oh, I feel sick later that day. Then, oh, it takes me days to recover after a workout. And then I, oh, I feel sick for days after workout out. By the time you get to those kind of last two stages, honestly, it's extremely difficult for us to fix those people. And that's pretty much the only people we can't really fix. And so you guys do not want to do that, because it says a lot if we can fix even the most complex thyroid and hormone and adrenal people. But those people are really, really challenging. You don't want to become those people. So only the big picture is only ever exercise to the degree that you feel more energetic or as energetic, energetic later that day. Okay. If you feel tired, you overdid it and you need to pull it back. Some exercise that I really like is weight training, especially slow weight training, where you allow your heart rate to come down between sets and circuits, especially in the acute or early stages of recovery of thyroid and adrenal issues. Walking is another great one. Doesn't really tax your adrenals. It's low intensity, sustained training. It's really good for your cardiovascular system in a sustained way. It's really good for your joints, for your overall health, but it's not going to tax your adrenals. Yoga is really great too, and even can also help mitigate some of the stress response. Some forms of exercise that I tell my patients in the acute phase, meaning we are actively fixing their thyroid and their adrenals and they're not back to their normal selves yet. I don't let them do hits. I don't let them do CrossFit. In fact, honestly, I never really recommend people do CrossFit. I know that a lot of times people don't like that. And not no one, but my patients now, when they've built up their resilience, when their thyroid is fixed, when their adrenals are fixed, like, they become so much more resilient to exercise. And what maybe would have made them tired 6 or 12 months ago doesn't really make them tired anymore. And that means they can do more, right? They can progress with that endurance. Um, but early on, sometimes people think, oh, I get tired after I work out. I just need to work out harder. And instead of getting stronger, better, their body recovering better, they're getting worse, and they're further depleting themselves. Sleep and stress and the effect on thyroid activation. So I kind of touched on this with the nutrition piece. When your body. So the conversion of your hormones is delicate, the conversion or activation of your thyroid hormones is intentional. So when your body feels threatened, like it wants you to go into, like it needs you to recover, it will halt the activation of your hormone, your hormones, so it will not convert to T3. It even often will convert to an inhibitory hormone called reverse T3 that blocks your active hormone. So it even further makes you tired so that you lay down, you rest, and you recover. And so think about things that would make your body want to do that. You're sick, you're stressed, you're not sleeping, you're pregnant, you're breastfeeding, your micronutrient depleted, you're inflamed, you're calorically restricted, you're over exercising. In fact, some of the people that I see with the worst activation and the worst reverse T3 or inhibitory hormone are people that over exercise and under eat. So their body goes into this emergency state of, oh my God, we need these people to stop this. We need to shut off their metabolism, we need to make them so tired they can't get out of bed. And so in a similar fashion, sleep and stress, right? Like, I think that's even a lot of the reason. Stress and even inflammation is a lot of the reason why so many people need us at modern thyroid clinic. Like, there is a degree, in my opinion, of poor thyroid hormone activation that has almost become normal in our country at this point. And it's standard. Like, it's not extreme, but it's like, if you Live everyday life in America, you're kind of stressed, you're kind of inflamed, you're not really sleeping great and your micronutrient depleted and that leads to poor conversion. And so people aren't getting, they aren't feeling well on levothyroxine or Synthroid because they can't use it. They're not feeling well, they're not converting their own Natural endogenous T4. So improve sleep, reduce stress, huge. And I've gone on such a big stress reduction journey over the last, you know, six or eight months just because of stuff that's going on in my own family, with my own kids, health and I really am like still, even this afternoon I was like working on trying to find ways of even furthering my, my hrv, my parasympathetic system, my calming system. So if you guys ever want tips on that, if you follow me on Instagram, I kind of talk about it a decent amount. A few times a month I'll talk about things that I'm trying to, what's working, what's not working. But it is important. I will send out the replay of this. Yes. Okay. Environmental pollutants. I won't go too, too heavily on this and I, I'm going to save plenty of time for Yalls questions. I love that you guys have so many but environmental pollutants, you know, do a few things. One, they make people more at risk for Hashimoto's or Graves or autoimmune thyroiditis. They reduce the activation of your thyroid hormones. I believe personally that they, they further the breakdown of your actual thyroid gland tissue quicker in life. I think more people are hypothyroid earlier in life now than they were 50 years ago. And I don't think that's because of testing. I think that's because we are actually losing hormones at a faster rate now than we were a half of a century ago. Because you know, pollutants directly interfere with hormones, not just thyroid, but estrogen, testosterone, progesterone, all of it. So finding ways of reducing that not only can reduce your Hashimoto's burden, your burden of Graves disease, but also improve your thyroid function. So you know, I talk about some of these on my social media but I also like on my podcast, if you guys hadn't didn't see the interview with Jasper Air, like a really high quality air purifying company, you should check it out. I mean it really is, it's fascinating stuff. So what you can do to reduce that toxic burden and you know, here's some basics do because it really goes a long way, not just for your thyroid, but absolutely for every aspect of your health especially, especially your hormones. And do little things like it doesn't. You don't need to do all the things at once. You don't need to like. And if you guys do tune into my content, you probably know I'm not an extremist, right? Like I don't need everything in my life to be perfect. I don't need my mascara to be clean mascara. But I don't want to put body lotion all over my body in the surface area of that every day that has a lot of pollutants in it that are directly absorbed into my skin in high concentrations. So kind of pick and choose and think about the things that you can. The biggest intervention. And this is kind of the fascinating thing about the interview that I did with Mike from Jasper. I don't think people think enough about air quality in their home, not outside because the air in our home is like five to eight times more polluted than the air outside of our home. And the fastest way to get pollutants and toxins into your body is by breathing them in. More than putting them on your skin, more than eating them. Y' all like our. Our body is highly adapted to take in air and directly incorporate whatever is in that air into our bloodstream immediately. That how we Exchange oxygen for CO2. It ha. And we breathe air in all day, every day. So cleaning up the air in your house is one of the most important things that you all can do, hands down, far more. Like I see too, it's not too many, but I see so many people putting all of their emphasis on like their beauty products and stuff. And I'll tell you, the air that you breathe is a probably a hundred thousand more important times more important than the beauty products that you're putting in on top of your body and your skin and your shampoo, et cetera. So started the big places, right? Other environmental things. I was going to bring up red light therapy just because you guys are always so curious about it. Red light therapy for thyroid is pretty interesting. So there are studies on this. I definitely use it with my own patients as well. I personally use it to. Red light therapy can reduce antibodies for Hashimoto's and Graves disease just by sitting in front of a red light. And I definitely have seen that, that I've seen the studies for that but I've seen it also in my own clinical practice. And red light can also Improve, this is mainly I've seen in clinical studies, can improve the activation of your thyroid hormones or the conversion of your T4 to your T3. So it also is great for so many other things. Inflammatory reduction, it has a calming effect, collagen production, wound healing, mitochondrial function, energy production, all of these things. So it's a. It's a really cool tool as well. And it's nice that now these days, like more people know about red light, that wasn't the case six or seven years ago. Okay, we're getting close to Q A time, so the last thing I just want to mention here is, you know, as far as, like, putting together a package of what you need as far as your lifestyle to be on track for your thyroid. You need to be empowered on your thyroid journey. You really do. That's the whole reason we're here tonight. It's the whole reason I do these. Thyroid is not an aspect of medicine, nor are hormones an aspect of medicine that you can simply go to your doctor and do what they tell you to do. Okay. Or your clinician not saying, just doctors. Medicine has not evolved to the level that even remotely decent thyroid care is happening as a standard of care. In fact, consistently, two more studies have come out in the last three months that take our thyroid care back so much further away from where it needs to be. We are not getting better as a standard of care for thyroid. We are getting worse in medicine. And so you all have to. To know what you're looking for, what you need to get to, what you need as far as information goes, to get the answers that you need. So you need to know what labs you need. You need to know the difference between optimal versus normal labs. You need to understand the different types of thyroid medications and how they impact you. And then the other thing that I really want you guys to know is, and I had a conversation in one of my interviews today about this, is you need to be empowered so that you can find the right clinician, partner, care team. You do not need to be empowered with information to teach them how to do their job, because you will not be able to do that. Okay? Nor will most clinicians change the way they practice medicine. And what I mean is, so much of the time I hear people on social media ask me, mccall, how can I get my thyroid doctor? How can I get my doctor to run a full thyroid panel? How can I get my doctor to prescribe me T3? Do not, do not do that, like, run from those people. Because even if they order a full thyroid panel, they do not know how to interpret it. Even if they knew how to interpret it, they don't know how to appropriately use medications with T3 in them. So you cannot navigate that on your own. It is extremely nuanced, all of those things. So I try to give you all the information that I possibly can that allows you to determine, is this person the right partner for me? Is this the right care team for me? Do I need to look somewhere else? And I know that trying to find a thyroid clinician that you feel like can help you is very hard. It's disheartening, it feels hopeless, and you're tired. I know because I was there. But I had this literal conversation with the physician today in the interview of I think back at how frustrated I was and how scared I was to leave my doctor to try and find another doctor to help me and how it's like I don't even know where to go from here. I'm so freaking brain fogged. I don't. I can't even figure it out. But had I not pushed to find that doctor, I literally would not be doing what I'm doing today. I'd be on disability. I would not be a functioning member of society. So it's worth it. It's huge. Hormones are powerful, powerful things in our bodies. You need to make sure that they are optimized correctly so that you can live your life in every aspect of it to the highest possible level. So resources for continued learning and support. These are some of the ones that I try to share with you guys. They're all on my link tree, which is like link Tree, forward slash, McCall McPherson. Obviously you can go to Modern Thyroid clinic too, but I have a free thyroid lab guide that tells you what labs you need and what they mean. That I give you the thyroid lab ranges, the optimal ranges we use at Modern Thyroid Clinic all day, every day. If you guys haven't tuned into our podcast, do it. It's where we get to go deeper. Right? Like it's kind of like this. I'll pick a topic and go deeper. Either myself or usually I'm interviewing other people also linked to my link tree. And then right now I'm. I co hosted a reversing Hashimoto summit. It's totally free, but it's like 40 experts that tell you if you're interested in learning how to reverse your Hashimoto's. It's linked in my link tree. It's free until I guess it's the summit ends. I don't remember the exact date. I think maybe the 16th. And then it's only for purchase. So if that's something you're interested in, go check it out. Like, I interviewed Isabella Wentz and Alan Christensen. And I mean, all. All the leading experts are on there. So it's a great tool, too. Again, all linked in my link tree. If you need to find that, it's in all of my social too. So Q&As. I'm going to stop the share because this whole, like, black screen thing with my face giant in the front, I don't like it. We're taking off my. We're taking off my jacket. We're getting, like, cozy and comfortable because it's like almost 8 o'. Clock. All right, questions? Let's do it, guys. I'm gonna try to get through as many of these as I can. Can I make the slides larger? Oh, gosh, Kimberly, I wish I saw that one a long time ago. Okay, so the, the link to the first class, I think it's going to be offered again soon on an evergreen basis. So I won't be doing it live, but it would be like the replay. So stay tuned. You got. Because you signed up for this one, I'll try and ask my team if they can send you that one as well. Can you still have all those symptoms and have normal labs so you can be virtually disabled from thyroid symptoms and be in normal lab ranges? Guys, like, if a clinician tells you your thyroid is not your problem, your labs are normal, you never believe them. Not ever. Not once, not ever. 100% of people that come to modern thyroid clinic have been told at least once, but often 10 plus times, that their symptoms are not due to their thyroid and that their thyroid labs are normal. There is no standardized normal. There is no true definition of what medicine says is normal for thyroid. And normal by the lab standards that your doctor is likely going by is absolutely horrible and not optimal. So you guys need to be optimal. You can download my free lab guide if you want to know the lab ranges that we use. They need to be perfect, legitimately perfect. Nothing needs to be out of range. Can you touch on subclinical hyperthyroidism and the relationship between cardiac symptoms, afib tachycardia, palpitations? So subclinical hyperthyroidism? You know, there, there's. Obviously, there's a huge continuum with hyperthyroidism in general. And so the higher someone's T3, specifically not TSH, but T3 gets, the more increased risk they are for atrial Fibrillation, heart attack, stroke. Palpitations can come early. They can come from adrenal issues. 70% of the population has palpitations without thyroid issues. So palpitations I'm not so worried about. It takes pretty significant and extreme levels of hyperthyroidism to trigger AFIB and cardiac arrhythmias and stroke. So medicine kind of breeds this. A lot of fear around that. The older you get, the more at risk you are of AFIB and arrhythmias. But for most people it has to be pretty, pretty elevated. Crazy enough, I actually do see people at those levels that transfer to us these days. Like there are a lot of practices wildly, grossly, negligently over medicating people on T3. And for the first time ever, I'm like, wow, like we are really dancing close to the line here. And I'm not convinced that this person is not a walking risk for a stroke. Does adrenal dysfunction cause issues with your thyroid function or does your thyroid dysfunction impact your adrenals? Both, Shannon. They are. They have a bi directional relationship. Adrenal issues can cause thyroid issues. Thyroid issues can cause adrenal issues. Oh, y', all, I'm so sorry that the slides were small. I wonder why that was. I wonder. I'm not good at the presenting of the slides, but I think it seems like you guys like the slides so I need to keep doing them. But I'm not good at it. Like, I don't. I do not like the way that Zoom presents slide. The company for adrenal is Ortho Molecular. Someone said I was taking Ashwagandha at night. It helped with sleep and then she's back to waking up at 3am A lot of times people need more. In that case, sometimes I'll have them double. Would adrenal be a long term supplement or just for a shorter amount of time it takes? I. Most people are on adrenal in our practice from about on average 9 to 18 months. Supplements. Are the two adrenal supplements safe while trying to conceive? Do they negatively interact with trying to conceive? Typical supplements. So adrenal I do not like my patients to be on when they are actively pregnancy planning. It has vitamin A in it and I'm particular about that. So I stop people who are on it who are actively pregnancy planning. Ashwagandha is not tested in pregnancy, so I would not say that it's safe. It's been used for thousands of years when women are pregnant, but technically it's not tested for safety. I personally use it with my patients until they're pregnant and then I'll have them stop it. But adrenal I'm, I'm more particular about because vitamin A is a fat soluble vitamins so even if you stop it, it takes time to leave your system and you don't want a lot of vitamin A when you're trying to conceive. Can you explain if there's anything we can do for postpartum thyroiditis with Hashi? Hashi seems to be elevating my liver enzymes. I've definitely heard of mold. I've, I've not even heard of it. I've personally seen mold create Hashimoto's from nothing. So that's absolutely an issue. Liver enzymes are tricky. They're so volatile. So if you have an ibuprofen, if you have a glass of wine, if you took Tylenol four days before your liver enzymes are up. So there's something that needs to be checked and rechecked because they're constantly shifting according to demand of thyroid. I mean excuse me, of supplements, medications, et cetera. And then postpartum thyroiditis. I love to use LDN in those women because it is a very quick way to get antibodies down. It is safe for breastfeeding and it doesn't require you to change your whole diet and overhaul everything when you're not sleeping at all. Right. So that's like a quick simple way that I like to, to do that. Progesterone doesn't so much apply to men as well. Progesterone. Men do have some progesterone and it does have some like neuroprotective benefits but it's not something that I generally use with men. With men who are anxious and irritable and agitated I would either look for low energy which is making them irritable and agitated because they can't deal with things that the world is bringing to them or I would look at their adrenals and maybe start some Ashwagandha to calm their adrenals down. Connection between having both PCOS and hashi what to do in trying to conceive. I would say get your thyroid in order and try and reduce Hashimoto's severity. I also again like call me biased. I love GLPs for PCOS. They're not tested for pregnancy, right. But you can take them up to two months before you're actively attempting pregnancy and they improve egg quality, quantity, the timing of your hormone fluctuations. Literally everything like GLP is there. There's a Reason we have so many what's called Ozempic babies right now, it's because these drugs actually make people more fertile. Not even just with pcos, but especially with pcos, but even the regular population. Okay. Oh, goodness. So Jenny's labs, her TSH is 1.54, which is pretty good. Her T4. I don't have your free T4, Jenny. That's like your total, but your free T3, if your free T3 truly is 1.75. Oh, my goodness. That is so sad. That is the lowest T3 I've seen in months. And then your reverse T3 is elevated, which means it is binding and blocking the landing spot for your T3. So you're not even absorbing that tiny, tiny bit of T3 that your body has access to. So I'm not surprised if you have a lot of thyroid symptoms. Levothyroxine is the medicine that you're on, and it clearly is not converting to T3, so doesn't matter how much levothyroxine you take, it's not going to convert and activate to T3. The name of the adrenal product is Ortho Molecular Adrene All Adrene Dash. All. Y', all, I'm so sorry about the size of the slides. That's the third time you guys asked. Y' all are so sweet. It's funny. They were big on my screen too, but I guess they were not for y'. All. What's the shortest amount of time you would suggest taking a glp? Is six to eight weeks too short to be worth all it all? Sorry, my daughter's little seizure monitor went offline. It all depends on where your starting point is metabolically and what your goals are. Are you trying to simply lose, like five to ten pounds and you can do that in eight weeks? Are you trying to repair your metabolism? And if so, what was the starting point? Okay, sorry, guys. Iodine supplements seem to increase my TSH when I take it. Is that common? Iodine can definitely create quite a bit of disruption and it can increase the severity of Hashimoto's, which would therefore to increase your tsh. So it is very possible. I don't honestly supplement with iodine with my thyroid patients, especially not if they have a history of Hashimoto's. Sorry, guys. I just don't want to, like, not have her monitor on. Okay. Can't. Okay, that's exciting. Jenny, I can't tolerate adrenal or Ashwagandha. They give me insomnia. I'm super sensitive Anything stimulating. Do you see that in your practice generally? Definitely. Adrenal can be stimulating for sure. The people that get stimulated from Ashwagandha, I have them take it in the morning. Those are the only people I have them take it in the morning. Let me see if I got this to work. How do I differentiate menopause sleep issues from thyroid sleep issues? My thyroid labs are almost perfectly ideal with your narrow standards. Even so, I suspect menopause post menopause as the symptom seems to be getting better as I get older, maybe. So I would test your progesterone, and if you're postmenopausal, your progesterone is going to be basically zero. And then most likely you are going to have sleep issues from low progesterone. And so I would absolutely put you on. Put you on some progesterone. Okay. Sorry. I'm trying to keep track of what I've answered. Okay, Sounds good. Hear you loud and clear. Thanks, guys. Y' all are so sweet. How much water should we add to the quarter teaspoon of salt for your adrenals? Great question. I would say you could do a cup or two. If you only do a cup, I want you to drink more water. But the goal is definitely that you put enough salt to drink the water and then add more water to it to dilute it down in your physiology. Basically, it doesn't matter if you put it in with the salt initially or you drink it after. I was asked to stop all supplements D, zinc, omega turmeric because my T4 is. My free T4 was 2 when my numbers had been in normal range. I have GRAVES or hyper. Never been told definitively. I was taken off methimazole to see if I'm in remission. So is there something I should avoid? You poor person? Michelle, I feel really good and I think these supplements are important. So it's so fascinating. I see this kind of a lot where people are like, I think I might have graves. My doctor said I think I might, but they're not sure. Well, you can totally, like, definitively find out if you have graves. And you can test your GRAVES antibodies, which are T rab or thyroid receptor antibodies and tsi, thyroid stimulating immunoglobulins. You should always check those. In fact, with our GRAVES patients, I check them at every single lab because they directly correlate to the severity of your Graves disease. So if your antibodies were dropping and you're in remission, you would be able to see that data point. If you check those Labs. So check them, check them, check them. I also did a really deep dive on hyperthyroidism and Graves on my podcast like a month and a half ago or so. Modern Thyroid and Wellness. Go listen to that. Because I know you guys don't have a lot of resources, so I dedicated a whole episode to y'. All. I. We. You guys will get the option for the replay for this so specific selenium supplement I recommend. I think the one that I recommend is Thorn. It's all saved in my EHR. It's 200. The important thing is 200 micrograms a day, roughly, is a good place to end. 150 to 2 even. Thorn is a good one. Pure is a good one. Those are some decent brands for sure. What are your thoughts on mold and heavy metals? Should we make it a point to get tested for these and doing some sort of expensive detox? Those are last resort for me. We don't do those at Modern Thyroid. We refer out for both of those. And I would say most people do not need to do those. There are people that I am suspicious of mold with and I refer them out to a specialist to get really formal testing. And so that's very important. But it usually kind of. There's a clinical picture that takes place. Have had graves for 25 years from a young age and want to know who I can see in Milwaukee area. Oh, gosh. For help beyond diet with resources and diet beyond endocrinologists. Last three years. I feel terrible. Definitely look at the podcast that I gave. I don't. I mean, Modern Thyroid Clinic will be there if we're not already there virtually. Right. But I don't have a contact. I. I know one person in the country that even remotely treats GRAVES like we do. Like it's. We do a very progressive job. It is tricky. Graves is not indicated by an elevated tpo. TPO is Hashimoto's. GRAVES is TSI and TAB antibodies. Missy, your free T3 is not 0.3. I think maybe you did a typo. And I don't see a reverse T3 on here either. I'm going to skip that one. Does Graves actually go into remission? Absolutely. A lot of times it does. So the fastest I've ever gotten anyone into Graves remission was less than six months. That was in 2015. She's still in remission to this day, so absolutely is possible. A lot of people too have Graves and Hashimoto's simultaneously. I know that sounds weird, but they have both antibodies. Those people vary a lot of the time, their graves will fade away and their Hashimoto will persist, which is. I know that doesn't sound great. It's so much better than graves. Hashimoto is so much better than grapes. We absolutely deal with graves better than anyone that I know. Literally. Again, listen to that podcast episode. There's so many of graves people on here. If someone has their right thyroid removed, do they have to be on medication? In my opinion, yes, absolutely. Other people will be like, oh, we'll let your other part of your thyroid compensate. No way. I. No one. No. There's no way. People are not going to be symptomatic about that. My doctor only ordered tsh. I asked about Hashimoto's and she said, you might have it, but we don't test for it. Run, Jan. Like just. Just run. Don't. Do not pass go, do not wait. They don't do a full thyroid panel. They don't. Clearly they don't even care if you have an autoimmune disease, which in and of its. Even if you don't believe you can do anything about it, which sadly, medicine doesn't, even though you can. I'm a perfect example. My Hashimoto's has been in remission for over a decade. You need to know, because you're at risk for developing another autoimmune disease if you have one. So we need to test. Right? It's like, why are they trying to save your insurance company like, $6 and not test you for Hashimoto's antibodies? Because that's really how much it costs them, if that even. I've been on Adderall for 25 years. I take 20 milligrams every day. I was diagnosed with hypothyroidism 13 years ago. Does the Adderall have an impact on my thyroid? It absolutely has an impact on your adrenals. I'm be super candid with you. But it trashes your adrenal glands very much. That is why when people try to come off of it after prolonged use, they basically are bedbound. They have extreme brain fog and fatigue because it pushes your adrenals and it makes them secrete stress hormones so you can engage and activate. And every time you do that, you're just depleting it more and more and more you're forcing it. So it's tricky to be able to be on Adderall over a sustained period of time without depleting your adrenals is. Is tricky. So you definitely want to be sure that you are supporting your adrenals and your thyroid both. How do you know if symptoms are thyroid or estrogen or progesterone deficiency? All seem similar. They're all a little nuanced, to be honest. But for me, it's lab testing. I rely so much on lab testing. It's such data for me. Like, I always test, don't guess right. Like, I want clear data that allows me to make effective decisions that can help people get their lives back as quickly as possible. I don't want to guess and be like, well, maybe it's this or maybe it's this. Let's see. You know, you're so welcome, Andrea. Oh, I'm so glad you are a patient of ours. I love that. Thanks for being on here too. Any idea and we'll be accepting patients from Idaho. You know what? I don't have the list in front of me. That kind of tells me the running list of kind of timeline. But I'm what the goal like our goal and certain hope is certainly hope, is to be in all states by the end of the first quarter of so end of March, April, My TSH was 0.129 and my doctor said to only take my Levo six days a week. So this is how I describe doctors managing people's thyroid by watching, looking at their TSH alone, it is like throwing dartboards at a dartboard blindfolded, trying to hit a bullseye. It is like, like really hard to give someone their life back like that. It's a lot of guessing. So I would say if you have a lot of symptoms, find someone that does much deeper looks. Do you recommend treating the thyroid and adrenal simultaneously or is it best to do one at a time? So definitely my cadence is people come in, I start with their thyroid. Six weeks later max, three months later, I start them on adrenal support. I want them to understand what T3 feels like and what their thyroid feels like. Because adrenal is dosed depending on how you feel, I want them to be able to understand how it is making them feel so they feel empowered to adjust the dose and know how it's affecting them. What is methomazole classified as? It is a Graves medication. So methimazole blocks your thyroid hormones. So it's the opposite of something like levothyroxine or cytomel. Instead of increasing your thyroid hormones, it will actually reduce your thyroid hormones. I want you to listen to my podcast Modern Thyroid and Wellness on Graves and hyperthyroidism. So many of y' all are hyper engraves here. If you guys go listen that podcast, it'll be the most insightful information that you all have ever heard on graves. Not to toot my own horn, it's just you guys don't have access to good information and no one really honestly does what we do. So go listen. It's super, super powerful. What do I like estrogen to be at pre menopause and what do you like it to be at postmenopause? Good question. So it's tricky. Like premenopausally, our hormones are fluctuating, right? So you have to time your estrogen labs at the correct time, which if you have a 28 day cycle, that's day 21. Day one is the first day of your period. So about a week before your period, essentially. Truthfully, it's the midway point between ovulation and your next period. But that's kind of complicated for people to wrap their head around. So let's say day 21 out of a 28 day cycle. At that point in a pre menopausal woman, I want their estrogen to be 80 to 120. Postmenopausally. I want them on hormone replacement. I want them to be between about 35 and 75. About six months ago, my doctor increased my levothyroxine or Euthyrox from 25 to 50. When we checked my levels, when my TSH was 0.18, my antibodies went to 700. From 700 to 1900. Is it possible the medication caused this raise in antibodies? Very unlikely. I also had to switch from tversent to euthyrox for insurance reasons. Then it actually is possible. So T percent does have less fillers. It is a little more tightly controlled and so it's possible I would also look at other factors. Did you change your diet? Was it the holidays? Did you move? Were you really stressed? Anything else change in your life too? Because it could be that, but it also could definitely be something else. What is the air purifier brand? It is Jasper J A S P R and it is better than Air doctor. So in my opinion, for sure, I, I absolutely love them. I love everything about what they do. They're actually in California right now doing free air consults. He's like, the owner is very, very passionate about fire restoration. That's what he used to do before. That's why he made Jasper to help people after fires get their air back. Oh, more, more questions about increasing the slide size. I'm so sorry guys. That sucks. What are other factors that can Cause thyroid antibodies other than gluten, dairy. So definitely, I mean a lot of things, genetics, poor glutathione, like low antioxidants, other inflammatory foods. It's not always gluten and dairy. It can be pollutants in your air, in your skin, care in the environment, receipt paper. It can be heavy metals, it can be stress, it can be not sleeping. Like anything that can create an inflammatory response or a stressor on your body can worsen antibodies, nutrient deficiencies. A suggested list of supplements for post thyroid cancer patients. I don't have a list of them. I would say personally, I like if they were my patient, I would consider low dose naltrexone or ldn, which is a medication. But it triggers like a natural reaction and definitely adrenal support. And you absolutely can take adrenal support without a thyroid. What does it mean if we act to like 20 foods with a sensitivity test? So food sensitivity testing is, is more than just like, do you react or not? It's about painting pictures of patterns within food groups is a big, big part of it. It's not like every individual food. So it's a little bit nuanced. And I would say a lot of people react to 20 foods. Not severely, but low levels. I don't get rid of all the foods people react to with food testing. I look for severity and patterns within food groups. I've had night cholesterol that started creeping up at 28. Could this be a sign of poor thyroid function? Absolutely. Absolutely it can. My doc said I could get osteoporosis if my T3 is slightly too high. I feel great on this dude, and don't want to lower it. Thoughts? Yeah, Marisa, I did a deep dive on this on social media probably last month. It's a lie. It's a lie. You can get osteoporosis if your TSH is low and your T4 is high. That means everyone on here that's on a little too much levothyroxine, which doctors put people on too much levothyroxine all freaking day, every day. Those people are at risk for osteoporosis. People with even low TSH and normal T3 are not at risk. Or even slightly higher T3 are not at risk for osteoporosis. My daughter's texting me. All right, I gotta go soon. Let me tell her. Okay. She wants to snuggle and watch a TV show, so I gotta go soon. Is there an Ashwagandha supplement? I prefer so I like seeking health And I actually like pure too, but I'm not super particular about it. Do you prescribe lyothyonine in your practice for hypothyroidism? Absolutely we do. Every one of our is on some form of T3. Oh, thanks. Do we get access to this recording? You do. You'll get. You'll get the. You'll get the replay. And she said my slides were cute and I had a cute wallpaper background. You guys know I love that stuff. That's why I didn't like like the black floating head. Why do that? Why can't I just be like this? How does all this treatment meds balancing thyroid apply if total thyroid has been removed due to cancer, it is so much more important for you guys and time is of the essence. Anyone who's post thyroidectomy, try to get good thyroid care as human as soon as humanly possible. Because the timing makes a difference more than it does for people who have plain old hypothyroidism. Also, I like to manage yalls thyroid a little bit tighter and I also like your TSH a little bit lower. If I'm being honest, I'm told that I'm overt hypothyroid. Is it possible to improve that or will it not change? I would need a little more information, Tammy, to know what that means. If your TSH is high and you have a history of Hashimoto's, you can improve your Hashimoto's and things, but you're not going to regrow like lost thyroid tissue. Can you explain GLPS and LDN peptides and decreasing inflammation? Yeah. So LDN reduce it or. Or ends up increasing opioids that lower inflammation. That's kind of one pathway. I found four pathways in research that GLPs reduce inflammation. I am confident there are many more clinically in my experience. I have no research data to back this up. This is observational. If I had to compare the inflammatory reduction between LDN and GLPs, and I love LDN. I'm on LDN. I would say GLPs are 100 to a thousand times more potent at reducing inflammation than ldn. It is wild, y'. All. I've never seen anything like it at all. Price for glp. Is price going to go down anytime soon? For us, for our program, probably not. The thing that we do though is at modern thyroid clinic we charge per vial and we do a lot of microdosing. So that vial tends to last a really long time. So even though it's money up front, it's drawn out a long time and our. A lot of our cost is we are really involved in your care. Like we don't just give you a prescription and be like, good luck. Like, figure it out, wing it. So I don't think our price is going to shift anytime soon. Maybe like pharmaceutical, probably not. But in maybe four or five years. What can we do to stop leaky gut and stop large particles from getting through? I would say glutamine cycled in 3 month cycles max. My doctor added T3 now to the Levo. That's exciting. Didn't answer all my question. I don't know what the rest of your question was, Jenny. Okay. Did she write it down here? It's okay. She added T3 level. So I can't speak to your case. Right. Like, I don't. I'm not your clinician and I don't know your. Your specific thing, but I do think your T3 was really low. I think you were the one at 1.7. I absolutely would have added T3 to my patient if their T3 was 1.7. On Synthroid for Hashi. How are these labs and what should I change? So Anonymous with the T4 of 1.86, that's way too much T4, like way too much T4. Your reverse T3 is probably in the 30s. It's blocking all of your active hormone from absorbing your T3. Your T3 is also slightly low. So you are way over medicated on T4 and you have very little T3. And I don't know what your reverse T3 is, but I can promise you it skyrocketed. If you are my patient, I'd reduce your T4 and add in T3 like Cytomel. All right, I'm going to take a couple more. You're welcome. Sarah, is it okay to take NP and Cytomel together? Do you recommend that? Not recommend that. I absolutely. I'm on armor and Cytomel. We use that combination all the time to skew the ratio of inactive to active thyroid hormone. I. I prefer armor over np. Or there's a newer y'. All. There's a really exciting new medication coming out in the world of desiccated thyroid that's going for FDA approval. No desiccated thyroid drugs have ever been FDA approved. And it is freaking exciting. I'm going to share more on that soon. But I am trying so hard to use this as an opportunity to escort us into a higher, more advanced, better level of thyroid care. Like, I am going to do everything I can to make that happen because it's a very complex issue. This whole desiccated thyroid thing and the reputation of it for so long has been so bad and this is an opportunity for us to change that. On average with your patients, how long does it take for someone to get their health hashi in remission? Oh my gosh. It's so varies, Kelly. Like it truly, truly does. I can see people's antibodies drop 500 points in three months or 50 points in a year. Like it's pretty individualized. Jocelyn, you need your free T3 checked. Unfortunately you're missing that and it is your most important hormone. So I can't answer what kinds of medication post thyroidectomy you need and how much because that's completely lab dependent and it's unique. There is no one medication that works for everyone in general or post thyroidectomy. It all depends on your unique thyroid hormones. But if I had to choose blanket right, I would say a combination of T4 long acting like synthroid, tyrosin, levothyroxine with cytomel or T3. There's a lot of nuanced reasons for that that I won't go into, but if I had to pick, that's what it would be. Absolutely. I find patients anxiety reduces once their thyroid and adrenals are fixed as long as their progesterone is also good. Okay, y' all on the new patient of yours and I'm very grateful. I love it, I love it, I love it, I love it. Your whole life's about to change. When and how might we know if you take Wisconsin patients, y'? All I so it's on our website on modern thyroclinic.com we will be in all 50 states soon if you want to get notified when we make it to your state. Linked in my link tree. It's in all my social media. My brain isn't working. It's been a long work day. It's in all. It's been 12 hours. In all of my social media accounts there's an out of state waitlist sign up where you can sign up to be notified when we make it to your state. I can't remember if we're in Wisconsin right now but if you go to modernthyroidclinic.com it's the first thing that pulls up. Thank you so much for doing this master class. I love the way you explain everything. Love learning from you. I'm a patient of mtc. I'm just trying to learn all I can. So thank you. I love that, Tammy. Like, that makes me think maybe we need to have a masterclass just for MTC patients. That's a good idea. Like maybe every month or quarter or something. We are virtual in all the states that we're in. I do not use D. Dutch testing. I do not believe that they are valid. Sorry. I compare them to blood values for labs and they do not match when I know blood values are correct. So years ago, I threw Dutch testing out the window. Okay, y', all, I'm gonna go. I love you guys. I could sit here and do this all night, like, answer Yalls questions. I love doing this even more on, like, tick tock and Instagram when we do lives where we can, like, dialogue back and forth and, like, comment and talk and stuff. So maybe I'll schedule another one of those soon. But thank you all so much for being here. It's like 8:30 central almost. So thank you you for just hanging out with me. So many of y' all stuck around. I hope this was valuable. Honestly, this was like the. The least heavy information of the three sessions. So I'm glad you guys got some stuff out of this. I'm excited for our next one. So stay tuned there. All about metabolism and hacking it with your thyroid. And I can't wait. And I will find a way to make the slides bigger next time. I heart you guys. Y' all have a good night. Okay, bye.