Modern Thyroid Masterclass: Empowering Your Journey

Before we start, of course, we have to do the general disclaimer of, this is not medical advice. This is for educational purposes only. I cannot give you medical advice. I'm not your clinician. We would love to help you at modern thyroid clinic, but unless you are our patient, we cannot give formal medical advice. This is simply for fun and education only. If you guys have questions that you want me to answer at this, I know that this is like the question answer section is huge for y'. All. If you can go ahead and type your question into the Q A area of the zoom session, that would be super helpful. So they'll be queued whenever I am able to answer questions at the end. Let's dig in. So let's talk generally about laying a foundation of what kinds of thyroid conditions there are and what each thing means. I want to break it up into two main categories, stories that very often get confused. Okay, I want to break it up into the autoimmune thyroid issues and thyroid function. Those things are two distinct, separate entities with two different ways of addressing them, treating them, resolving symptoms, etc. Okay? So the autoimmune thyroid conditions involve Hashimoto's, which is definitely the most common and graves. Hashimoto's is measured by way of two antibodies. TP, TPO and thyroglobulin antibodies. If your TPO is above 34, and if you guys are freaking out, taking notes wildly because I'm going through this, you will get a replay to your email. So Hashimoto's is measured by TPO and thyroglobulin antibodies. Thyroid peroxidase is what TPO means. A TPO above 34 is indicative of Hashimoto's, or a thyroglobulin above 1 really significantly above 4 is significant for Hashimoto's. What I want you all to understand is Hashimoto's is different than hypothyroidism. Okay? Hashimoto's is where your body gets confused. It attacks itself, thinking that, hey, this is a foreign invader, maybe this is a bug, maybe it's a virus, etc. But instead of attacking a bacteria, a bug, cancer, a virus, it attacks itself and it mounts that response against your thyroid. And over time, that attack yields lower function. It basically destroys your thyroid gland over time, and it leads to hypothyroidism or underactive hormone production. Okay? Regular medicine views Hashimoto's as random. It's like the reverse lottery. It's, oh, my gosh, you have this thing, there's nothing you can do about it. Um, we just have to wait until you're hypothyroid enough to treat you with medication and that's all right. That is very much not our approach. That is not the approach of functional medicine. With autoimmune thyroid conditions, they are very much able to be influenced. They are very much able to be reversed. And in the next section, the next session of this series, we're going to talk a lot about lifestyle, how to reverse Hashimoto's, et cetera. But for now, what I want you to know is it is reversible. You can either get it into remission completely, which I have done myself. I've been in remission for over 10 years. I had very severe Hashimoto's and so many of my patients have done the same. Many more patients too have not achieved remission, but massively reduced their antibodies, which is wildly valuable. Y'. All. It. When you reduce the attack on your thyroid gland, it reduces the amount of thyroid gland that you're losing in real time, right? The higher your antibodies are, the more significant the attack, the more thyroid function you're going to lose over time. It also translates to a higher risk for other autoimmune diseases. So when you have one autoimmune disease, whether it's Hashimoto's or lupus or Ms. Or ulcerative colitis, you're at a 30% increased risk of developing another autoimmune disease. Okay. The lower we get your antibodies, you can kind of use that as a view of risk reduction of developing another autoimmune disease, which is amazing, right? Because you, you, you don't want other ones. Most other ones outside of Hashimoto are quite a bit more serious, more significant, and have more, more ramifications for long term health outcomes. So ideally we'd want to get those Hashimoto's antibodies. TBO less than 34, thyroglobulin less than 4, ideally closer to 1 to say that you're in remission. Okay. A goiter is a pretty common manifestation of Hashimoto and a goiter is that sort of fat pad looking thing on your lower neck. I used to have one myself. You guys can probably see I don't have one anymore. But again, when I was in the thick of it with my thyroid condition, my flare, I had a very, very significant goiter. So that is Hashimoto's. Okay? Autoimmune condition number one. Autoimmune condition number two is Graves disease, and Graves disease does not elicit hypertension. Both thyroidism, like Hashimoto's Graves disease is an autoimmune attack on your thyroid that elicits a response that triggers hyperthyroidism or over medication of thyroid hormones. For those of you here with Graves disease tonight, I know that you all don't have a ton of resources and there is not as much information that is readily available to you all as compared to Hashimoto's. Right. I want you to go and listen to my podcast episode on Modern Thyroid and Wellness about Graves disease, because I do a deep dive dedicated completely to you all. But some highlights I want to pinpoint tonight are like, Hashimoto's Graves disease is reversible, okay? And the unique thing about Graves disease is the severity of your antibodies correlate with the severity of your hyperthyroidism or overproduction of thyroid hormones. Okay? So as we. What that means is as we reduce your antibodies, the swings of your thyroid hormones become less frequent and less severe. And I give an analogy of Graves disease to a roller coaster, okay? So you're strapped into what I call a GRAVES roller coaster. Sometimes your thyroid hormones are huge. Sometimes they're suppressed. They swing up and down. You don't have control over it. And that creates a lot of, like, suffering for people with Graves disease. If we can reduce the severity of those swings, it attributes like nervous, massive quality of life gains to you all. So I talk about ways of doing that in in my podcast episode. But number one is we want to reduce your antibodies. And we'll dig into that again next time, the same way that we're talking about reducing Hashimoto's antibodies. And the second part of Graves that I want you all to be empowered to know tonight if you have it is called block and replace therapy. And what that means is you guys are adapted to with Graves disease, and they put you on methimazole ptu, they block all your thyroid hormones, and you become hypothyroid, right? That's not what we want. So that is miserable for all of you here with hypothyroidism. You know, life is not fun when you have it. So you want the balanced approach with Graves. You don't want to be hyper, you don't want to be hypo. And block and replace therapy is a way to accomplish that. We block enough of your thyroid hormones to create stability and predictability in your Graves, and then we give you back your thyroid function by way of thyroid medication. Okay? So now we talk about thyroid function. We've dealt with autoimmune thyroid conditions, okay? Now I want to talk about hypothyroidism and hyperthyroidism. Hypothyroidism is one of the most common endocrinology issues in the country, honestly, just after diabetes, the most common. It means you have low functioning thyroid. Generally, it is diagnosed in the traditional sector by an elevated tsh. We're, we're going to dig into that deeply later. But it usually has, you know, the classic symptoms that we'll also talk about in a moment of hypothyroidism. Graves is the opposite. It's overproduction of thyroid hormones. And we will talk about symptoms of that as well. So with hypothyroidism especially, symptoms are normalized in medicine. You guys are written off, right? You are told, oh, you're just tired because you're pregnant now. You're tired because you just had a kid and you're breastfeeding, you're up all night now you're tired because you have toddlers, you have kids in elementary school. I, this is the story I'm told over and over and over from women. Literally. They tell me, they show up in my office when all of their kids are off to college and they're, I don't have a reason to have these symptoms anymore. I don't have an excuse. Why am I still like this? You don't want to do that. Like, we want to intervene so that you can enjoy your children growing up and not just survive it. Right. Not just get through every day. But symptoms of hypothyroidism are fatigue, brain fog, weight gain, weight retention, brittle nails, brittle hair, hair shedding, hair breaking, loss of the outer portions of your eyebrows, slow digestion like constip, cold intolerance, cracking on the bottom of your feet, elevations in your blood sugar and your cholesterol. They try to put me on Lipitor at 27 for my thyroid problem instead of fixing my thyroid problem. Yeah, so medicine says, well, these symptoms are just there. So many conditions. They're not really thyroid problems. They're just, these people need to eat less and exercise more. They need to take care of their bodies. That the list of excuses is ongoing. And the reality is, in my opinion, if you have four or five or more thyroid symptoms, you likely have a thyroid problem. If it looks like a duck, it walks like a duck, it quacks like a duck, it's a duck, right? Of all the people that come to modern thyroid clinic, I would say 95 plus percent of them come terrified that their symptoms are not from their thyroid. I have turned away. We have turned away one person and said, listen, this really isn't your thyroid. Like, it's something else. Let me help you find where to go to get help. But it truly isn't your thyroid out of thousands and thousands and thousands of people. So I think the proof is in the pudding that if you're having these symptoms, and a lot of them, you have to get a proper workup to actually know if it's not your thyroid. Because people can check your TSH all day long, and you can have all the symptoms of hypothyroidism, and they will tell you all day long that it is not your thyroid. And let me tell you, as a person who is told that myself, when it was a thyroid problem, you do not. That's why we're here today, together, right now. I want you to leave here empowered to know after this conversation that you will be able to differentiate, Is it my thyroid causing all of these symptoms or is it not okay? Because you. You have to drive your care for thyroid. We are not yet at a place in medicine that you can simply show up at a doctor's appointment or an appointment with a healthcare provider and expect them to diagnose, treat, manage your thyroid condition effectively to the degree that you get your life back. It's not going to happen. You have to navigate this yourself and direct your career. Okay? Hyperthyroidism. So there's a few different stages of this, but classic symptoms are elevated heart rate. If you exercise, your heart rate gets fast, too quickly. And I mean elevated. I mean, your resting heart rate can be 120 when you're sitting doing nothing, 160, 230 when you're exercising. Sweating, palpitations, anxiety, hair loss, loose stools, weight loss. Those are the classic symptoms of hyperthyroidism before treatment. Okay? Eventually, in severe cases, hyperthyroidism looks and feels a lot like hypothyroidism because your body starts doing whatever it can to get rid of those thyroid hormones and get them out so they don't threaten your health. Okay, so those are kind of the classic symptoms. Again, if it looks like a duck, it quacks like a duck, y'. All. It's a duck. So we're here today for you to be able to define what is a duck, and how can I know if I am one? All right, so comprehensive thyroid testing. Let's talk about it. So if you are going to a clinician who is tracking your TSH to screen you for thyroid dysfunction. If you are going to a clinician who is checking your TSH and your free T4 to diagnose or manage your thyroid condition. Run. Okay? Don't passco. Do not try to convince this person to practice medicine in a different way. Do not think that the answer to your problems lies in asking them and them obliging to check a full thyroid panel. Okay? Number one, they probably won't do it. Number two, even if they do, you know what guys, they do not know what to do with that information. They do not know how to help you. What is the next step if you get that accomplished, it's not enough. So you need to find someone who knows already organically the value of a full thyroid panel and is absolutely checks them all the time to determine you know what is going on with your thyroid. Don't try to convince anyone to practice medicine in a different way than they are practicing because it hurts no one but you in the long run. So I will say here and maybe one of my co presenters Haley or Carl can type it into the comments what a full thyroid panel entails. We could also potentially drop the link to our thyroid lab guide which is always linked in all of my social media too. So if you want to download that you can but it is TSH free T4 free T3, reverse T3 and antibodies. Okay, again I'll repeat that one more time. TSH, BRI T4 free T3, reverse T3 and antibodies. Antibodies for Hashimoto's, remember are TPO antibodies and thyroglobulin antibodies. I hear people all the time that come to me that are like well my doctor thinks maybe I have GRAVES disease but they're not sure. Well there's like a totally definitive way to find out and it is checking GRAVES antibodies. So those are TSI thyroid stimulating immunoglobulins and T rab thyrotropin receptor antibodies. Okay, you all need a full thyroid panel to determine what is happening with your thyroid, okay? Especially if you are on a T4 based medication. Those include levothyroxine Synthroid, Levoxyl Unithroid, T and there's multiple other variations too in other countries, but basically these are levothyroxine based mets. If you are on a levothyroxine based medication, your TSH is completely useless at that point if it's under 2 and your T4 correlates directly with your TSH and your T4 level does not tell you at all how well you are using your medication. So levothyroxine based meds are all T4. They are all what's referred to as inactive thyroid hormone that has to be activated. And I'm going to go on to my next slide because I think we cover this in this. Here you go. You can take a snapshot of this. So testing, right. If we are testing TSH or TSH and free T4 to check your thyroid status, I describe it as we are throwing darts at a dartboard blindfolded, trying to hit a bullseye, okay? We are trying to, out of sheer luck, land on a diagnosis and a treatment modality that will work for you. And it's rarely happens. If it does happen, like if you are on love with thyroxine and you feel great, which I don't think you'd be here tonight, but if that happened, I would say go buy a lottery ticket because you're really lucky. And those people exist, and that's amazing for them. Love it. But the vast majority of people will never get well on levothyroxine. So those are the labs that you need. Before we talk about medication types, which I almost sneak peeked right into, let's talk about optimal ranges. Optimal versus standard, and why it matters. Okay? What I think people don't understand, even clinicians, I don't even think clinicians are aware of this. There is no standardized range for what is normal versus abnormal for thyroid labs, okay? There is not like this gold standard. It doesn't exist. So what ends up happening is you go to your lab and let's say it's LabCorp. Your doctor gets your results. They just scan your results and see if anything is in bold or off to the side. If it is in bold or off to the side, they're like, guess what? You have a thyroid issue. If it's not, they say your thyroid labs are normal. Okay? What's the problem with that? Let's talk through it, because the devil's in the details with us. The problem with that is the lab core that you went to their normal ranges that your doctor is banking on being right, are different than quest. Are different than the hospital locally where you live. The lab corp by my house, normal ranges is different than the LabCorp by my office's normal ranges. There again, there is no standardized range, not even with each lab, okay? And the way that that happens is every lab, even lab locations, create averages of people in their database. Okay? So let's say for hypothyroidism, they might trim off the really extreme high, the really extreme low, and they lump everyone together and they create averages to establish what is normal. Okay? Let's think through That a little bit. One, they are not ruling out people with thyroid conditions when they are putting them into the data set to establish what's normal versus abnormal. Okay. Two, who is going to lapse? People that are like, oh, my gosh, I feel so great. I wonder what my thyroid labs look like today. No. Right. People are going to the lab in search of answers of why they feel terrible for the majority of the time. And so now we are creating averages to dictate what is, quote, normal based on sick people potentially with the condition we are trying to rule out. Also, none of the lab ranges align. Right. It's a terrible plan. So I want to break this down. What can happen when you go to your doctor? The person in front of you has a TSH of 5.1. Okay? The doctor walks in, and they say, oh, my gosh, I'm looking at your quest labs right here, and you have your TSH is 5.1. And it's in bold, right? It's off to the side. So they're like, you have a thyroid problem. We need to treat this. Let's go ahead and start you on medication. Okay? You go in, same doctor, right after that patient. Your TSH is 5.1. Okay? But you went to the local hospital lab. So they pull up your labs, and that local hospital lab says, your labs are normal until your TSH is 6.3 and the doctor looks at it. Nothing's in Boulder off to the right, and they say, your labs are normal. You don't need any thyroid treatment, even though your labs were identical to the person in front of you. There is not critical thinking happening, y'. All. There is not complex thought going into this. It is simply, are you in bold or off to the side? No. You're normal. Yes. You're not normal. Okay? That's a problem. Right? So what I want you all to know is you can be well within normal margins by any lab standards and be debilitated from thyroid symptoms full stop. How do I know I was one of them? How do I know our practice is filled with them? Okay? It is our belief at modern thyroid clinic, and the proof is in the pudding, because it's what we see all day, every day, that unless your thyroid labs are tightly controlled into narrow, narrow margins, you will be debilitated with symptoms. Okay? Your labs need to be optimal. They need to not be normal. And how we arrived at our optimal ranges is unique. We did not take them from anyone else. Do they fall within everyone else's definition of normal? Yeah. They don't they don't need to be crazy. You don't need to have a crazy amount of T3, but you need to be not in this margin. You need to be in this margin, within it. Okay? And we arrived at our ranges in the beginning. We based it on functional medicine standard ranges, which, again, takes a little bit off the top, a little bit off the bottom, and narrows those margins. Since the beginning of modern thyroid clinic, what we do very well is we analyze data, we reanalyze data, we reanalyze it again, okay? So every 12 to 18 months since the beginning, almost a decade ago, we have taken our data of where and analyzed where do our patients feel well versus where do they not? Okay? And slowly, every 12 to 18 months, we've narrowed our margins more and more and more based on that data. And now we're left with ranges that are this wide. But if we get our patients into them, you know what happens? They get their lives back. And so that's what you need. I describe, and I did not know this 10 years ago, I describe thyroid function as an on, off light switch. Okay? You are in margins. Everything is tightly controlled. You are perfect, and the light is on. Or something is off, something is outside. Something isn't perfect. The light is off. It is not a dimmer switch. It doesn't matter how far you are outside of range. That does not dictate how you feel. All right? It matters if everything is perfect. And everything needs to be perfect for the light to come on and for you to thrive, function, and get your life back from a thyroid problem. So that is the goal. It is perfect thyroid function. It is nothing less than that. And medicine, sadly, is heading in the opposite direction of perfect thyroid function. Instead of narrowing these margins, we are widening them. And now medicine is saying, well, technically, maybe we don't need to treat people unless their TSH is above 10, because if their TSH isn't above 10, they're not really getting better on love with thyroxine. So I think we just need to not treat them, which is crazy, y'. All. By the time your TSH is 10, you're basically almost, if not already on disability. Your relationships are failing because you can't function in them. Friendships, marriages, kids, the whole thing. You are barely getting out of bed. You are not a functioning human. And so now that is the way that medicine is viewing thyroid care is just don't treat them until their TSH is above 10, because the medicine doesn't work anyway. And you know what is wrong with that? Guys? You know how that study should have been interpreted before it was put into practice? It should have been interpreted as, hey, maybe levothyroxine doesn't work for everyone and maybe that is why they still have symptoms. And maybe we need to look at other treatment options like we do in every other aspect of medicine. If a medicine doesn't work, we don't just stop there. If the antibiotic doesn't work to fix your cellulitis, you know what we don't do, say, well, we just shouldn't treat it then until it's more severe because it's not working anyway. No, we give you a different antibiotic. Right. Which is exactly what needs to happen with thyroid. If people are not getting well on levothyroxine, maybe we need to look at alternatives and we're not there yet. We're devolving. We're not evolving in our thyroid care anymore, sadly. So let's talk about optimal ranges. Let's get your pencil pen out. Let me see what my next slide is. Yeah, okay, so let's talk about optimal ranges. Okay. Our optimal ranges, which again are not taken from anyone else. If you find them somewhere else, they are taken from us because they are not replicated from another source. Our ranges are a TSH less than 2, truly less than 1.8, ideally closer to 1. And if someone's TSH is above 1.8, above 2, it honestly doesn't matter what the rest of their labs are. They're usually significantly struggling with thyroid symptoms. Because a TSH reflects how much energy your body is putting in to produce your output energy. Okay, if your output energy is great and you are using way too much energy to produce it, guess what? You're using more energy than you're producing. So you're in the negative. So TSH needs to be truly anything above 1.8 and people start showing up debilitated. T4 free. T4 needs to be between 0.9 and 1.2. Is that a narrow margin? It is. Does it matter? Yes. Should it be between those numbers? Absolutely. So 0.9 to 1.2, that is your inactive hormone. Many of you are walking around with too much T4 because you're on again, T4 based meds that are levothyroxine, Synthroid, unithroid, etc, and that's an issue. 3T3. 3T3 is your active thyroid hormone. It is your most important hormone that no one is really checking. Okay? It is your gasoline. If T4 is your crude oil. We don't put crude oil in Our car, but we need it to make gasoline, to put in our car, to make it go anywhere. T3 is your gasoline hormone. It's what we directly need to fuel our body. Okay, I want your free T3 to be between 3.6 and 4.2 for most of your day. What does that mean? If you are on a T3 medication, you are going to peak above that range because the peak is a very brief period of time so that you can spend more time in that range. But where I want you to spend most of Your day is 3.6 to 4.2. Reverse T3. Reverse T3 is an inhibitory hormone. It actually competes with the absorption of your gasoline hormone, your free T3. That's why it's called reverse T3. It's actually a mirror image basically of your free T3. What that allows it to do is land and bind in the same spot as free T3. But instead of activating that binding spot for things like your energy, your metabolism, your mood, your cognition, reverse T3 just actually lands. Binds in that spot, doesn't let free T3 bind, so it sits there. Three T3 balances around. It is not able to activate and engage your energy, your cognition, your mood, your stamina, all the things, digestion, metabolism. We want your reverse T3 between ideally about 8 and 12. If your free T3 is really robust, it can easily be up to 15. Not a big deal, right? Because the higher your free T3 is, the more it's going to offset that reverse T3. But when your reverse T3 is elevated, when it's 18, 19, 20 and your T3 is in the gutter, it's a really big deal and it interferes with your quality of life. Antibody numbers we discussed earlier. So those we are good with. Do you want to get controversial with me? Let's do it right. How to properly get labs drawn for accurate results. Okay. So the thing that we do really well at Modern Thyroid Clinic, like I mentioned before, is we collect data. We are data analysts. It's what allows us to be really successful at treating people who have not gotten better anywhere else. Okay. We are able to effectively predict where someone's labs are going to land in three months based on our medication changes. Because we start with very stable, predictable data as opposed to what happens generally in medicine, which is, hey, you need more medicine, we're going to increase your dose one step up and we'll see what happens. In a few months, who knows, right? You get labs, a few months later, you go back, they're like, oh, you need more. We're just going to increase you to the next dose up and it's always one dose up, one dose down and we'll see what happens. That's not what we do at modern thyroid clinic. So we actually know what's going to happen. So we're able to increase your medication in small microscopic dose increases over about a month. So we accomplish like a year's worth of work in your first round of treatment, which allows people to get better sooner. But we're able to do that because we are not guessing because we have analyzed hundreds of thousands of pieces of our patients data to understand what happens with medication changes. However, we have created a system of stability and predictability to do that. And what you'll hear elsewhere that is not safe, is not predictable, is not controllable, is if you are on a active thyroid hormone to skip it the morning of your lapse. Active thyroid medications include Cytomel L, Thyronine Armor, np, Adisa. Okay, that is not a good, good thing to do. Okay. So if you. And I'm going to give you an example. Okay. So if you want to protect someone from over a medication of T3, which we'll talk about today as well, side effects of too much active thyroid hormone because they get a very bad ra, it can be dangerous. Right. So the way that you do that is understanding what someone's T3 medication is doing. And you do that by checking their labs while their medication is in their body. Right. If you don't take your medication before you get your labs drawn and it's short acting, your T3 level will always look low and your medication will perpetually be increased. Right, of course. Because your labs will always look low. And how can we decide what to do with the medication if we don't test your labs while you're on the medication? You can't. Like it's impossible. Again, people are guessing at that point. And good thyroid care does not involve guessing. I want to talk to you about a patient that came to see us a few months ago and this has been happening literally for the first time in my career to the degree that it is so severe that it's I. We are having people transfer to us in a life threatening condition and we've had people over medicated on T3 for years that transfer to us. And it's like, yeah, you're overmedicated. Yeah, someone hasn't been checking your T3 while you're on your meds and we need to reduce your meds. But it's not like acutely, you might actually have a heart attack and a stroke. But a patient named, I'll call her B.J. came to see us. She is 62 years old. So the risks for too much T3 include atrial fibrillation, which increase your chance of heart attack and stroke substantially. The older you are, the more you are at risk for atrial fibrillation in general, with or without thyroid meds. But obviously thyroid meds can propagate it. She came to see us and had been tested for a decade almost. I think it was eight years off of her meds, off of her T3 meds. So her T3 perpetually came back 2.9, 3.2. Right. Remember, my range is 3.6 to 4.2 for both the bulk of your day. So she came to see us and of course we're like, yeah, no, we have to check your labs on Mets. So we checked her labs on meds. Her T3 was over 34. We don't even know what it was because it was over the detectable threshold that labs can even pick up. And this woman was literally going to have a heart attack or a stroke like it was simply a matter of time. She was a ticking time bomb. And how does that happen? It happens because one, people are checking labs off meds over and over and over and perpetually increasing people's medication. They your labs will always look low, your T3 will always look low. If you are on T3 and you do not take it before your lapse. Okay? The other thing that's happening in the world right now, that of the world of thyroid care for the first time, is there are online telemedicine platforms for thyroid that actually don't know what they're doing. They are run by people who are non clinicians, they are non physicians, even though they say doctor such and such. Here's my thyroid program. They're not a doctor and it's really hard to figure that out. They make it very difficult. But they are a doctor of nutrition, they are a doctor of religion. They do not have a medical degree whatsoever. So they are not, one, they are not afraid of losing their medical license. And two, they don't know what they're doing. They don't know how dangerous it is. They're just employing other clinicians telling them what to do. And now people are suffering the real consequences. But because now, several times a month, people are coming to modern thyroid clinic in a state of life threatening T3. And I, as many times as I saw elevated T3 I never saw life threatening T3 I mean maybe once every two years. Now I see it like once a month. So you, you guys need to be careful truly. So a T3 difference of 2.9 to 3.2 to above 34, any even a 20 year old is at risk for a heart attack and a stroke at a T3 of over 34. So I can't even imagine a 62 year old. Let's talk about treatment options. Let's talk about various types. Right? So there are a couple categories of medication and if you guys have questions, type them into the chat window. I'm going to try to be more efficient so I can leave a lot of time for yalls questions. My goal is to wrap this part up by eight. Answer questions at eight. So couple categories of meds. Natural versus synthetic, active versus inactive. Okay. Natural versus synthetic. So natural thyroid medications are armor np ada. The reason they're natural is because they come from pig thyroid gland. Okay. They just, it's ground up thyroid gland. It has part T4, part T3 and some cofactors, T2, some other things. Those are natural. They are mostly T4 and a little bit of T3 and then they're synthetic. Synthetic is cytomel, lyothyrene. Those are T3 meds. And then T4, levothyroxine, synthroid, unithroid, levoxyl, tyrosine. Right. So those are synthetic. Active versus inactive. So inactive meds are what 99% of people get put on. It's what medicine trains us to use. Full stop period. T4 based medications only, inactive hormone medications only. Lev, Synthroid, t Levoxal, unithroid. Okay. Our training is do not use medications with active thyroid hormone in them. If you do, you are going to give your patients a heart attack or a stroke. So naturally we don't know how to use those meds and we're very afraid of them, rightfully so. Right. Because we're not equipped to properly manage them. But those are kind of the two main categories. Let's talk about pros and cons of each medication type and then we'll break down like some unique circumstances that are important that I want to share with y'. All. The cons of everyone getting put on T4, everyone getting put on levothyroxine based meds are again, levothyroxine is a crude oil hormone. It is an inactive, it's completely inert. It does not do anything in your body until it's activated. And let me tell you, y' all a Lot of people will never be able to activate enough of that hormone to ever feel good in their lives after they get put on it, or ever be able to feel optimal. I was that person. I was on Synthroid when I was 27 and going to bed at 3:30 in the afternoon every day and being told that my thyroid labs were perfectly normal. And in fact we need to reduce my thyroid medication because my TSH is too low. And also let's put you on Lipitor because your cholesterol is high from my thyroid problem. But that wasn't recognized. The world is filled with, with what I call poor converters. People that can't convert their crude oil hormone to gasoline, either their endogenous T4, their endogenous inactive hormone or medicine they're taking like levothyroxine, Synthroid, etc, So I, at modern thyroid clinic do not ever use exclusively T4. Okay? If people do well on those meds, they do not need us. They can see their primary care doctor, they can see their endocrinologist and they do well. They just go on with their lives and live normal. Right? That's not, I think that's a very small percentage of people. And sadly, levothyroxine is the number one prescribed medication in our country for about four of the last six years. What does that mean? There are millions and millions of millions of people walking around needlessly suffering because they are on a thyroid medication that will never work for their body. Okay? So that is the one thing we do not use by itself at modern thyroid clinic. Do I use T4 in conjunction with T3? Meaning if someone comes to see us on levothyroxine, will I add T3 to it? Absolutely. Okay, what I want you guys to take away from this slide is a lot of people get confused about what is good thyroid treatment. And online they run into forums that say, look, natural desiccated thyroid is the best. It will make you feel the best because it's natural. Okay? That is not true. And I love desiccated thyroid. I'm on Armor myself. I got my life back from armor. I prescribe it every day at tha of it. But it's not better because it's natural. It's better because it has T3. Okay? And in fact, there is a huge subset of the population that will not ever get completely well on desiccated thyroid alone on NP armor ATA because it has 75% inactive hormone, 25% active hormone. What does that mean? Means you have to still convert pretty darn well to use that medication effectively. And a lot of people don't do that. I don't do that anymore. I can't convert enough of my armor to feel well in my life. So I've had to add cytomel to my armor to skew the ratio of T3 and T4. Okay. Desiccated thyroid is better because it has T3. There are some outlying examples that we'll talk about in a minute. But T3 ultimately is the ticket to people feeling well and getting their lives back. Not natural versus synthetic. And I am practice functional medicine. I get the whole natural appeal. But I also want to be honest with you all. The other thing that you have to optimize is timing. Anything. Guys, I need you to write this down in your long term memory. Any thyroid medication with T3 needs to be dosed twice a day. It needs to be dosed in the morning and it needs to be dosed at 2 to 3pm Otherwise the T3 that you are on in the morning is gone by 3 or 4pm you crash at 3 or 4pm you don't have a metabolism. Your adrenals kick into full force at nighttime and you get anxious right before bed and you can't really sleep well. Your metabolic function, your cholesterol, your hormone production, your hair, all of the things that your body needs access to proper thyroid hormone over a large window of time is not able to effectively function because you only have T3 for anywhere from three to eight hours a day, which is not enough. So every T3 based medication, Cytomel, Lyothyonine, Armor, NP, Abdisa. These meds need to be dosed in the morning and in the afternoon. And I'll tell you, modern thyroid clinic is the one that has pushed that narrative and changed, changed treatment of these meds. And now it is finally being accepted that these meds need to be dosed twice a day. Let's talk about side effects with T3. Let's talk about realistic versus unrealistic. Okay? Unrealistic is really, for the most part, unless it's in extremes. What medicine teaches us as clinicians, do not use these meds. Meds. If you use these meds, you'll give your patients a heart attack and a stroke. Medicine views T3 meds as wildly unstable, wildly uncontrollable, wildly unpredictable. And you know what? That's true. If you are not having a system to check med labs on meds. If you're just randomly checking labs on people's T3, sometimes they're on it, sometimes they're off Guess what? It really appears unstable and wildly changes because there is not a system developed to properly evaluate these meds, which, again, we are neurotic about at Modern Thyroid Clinic. So these meds are very predictable, very controllable, at least all of them, except for one that's kind of constantly under investigation for not having consistent amounts of thyroid hormone in their product. But outside of that example, T3 is very predictable, very controllable. At Modern Thyroid Clinic, we can predict within about a 0.2 variance of each of your labs, where your labs will be at your next appointment, based on our medication changes. And you know what, if your drugs aren't stable, that doesn't happen. Right. But can people get overmedicated to the degree that they can have atrial fibrillation, they can have a heart attack, they can have a stroke? Yes, it can happen. And yes, for the first time really, in my career, I'm seeing this become a pervasive problem because of practices that are not equipped to deal with this. Do I view. Do people randomly have heart attacks and strokes on T3 when their T3 isn't elevated? No. Like, that doesn't happen. What h. The other problem in medicine that views these meds as unpredictable, scary, uncontrollable is what they are trying to do is test your TSH and infer what your T3 is. Right? It makes no sense. They're like, oh, gosh, your TSH is low, your T3 must be through the roof and you're going to have a heart attack. No, like, just check their T3. Right. Why aren't we just actually getting the data that we need to know if people are safe versus unsafe. So we need to test a full thyroid panel. Especially, obviously, if people are on T3. There is. It is hard to mess up someone's T3 treatment so badly that they're actually at risk for heart attack and stroke. It's actually takes medical negligence or having absolutely no idea what you're doing, or perpetually testing off of meds and increasing people's medication over and over and over. It takes one of those three things. It is not happenstance. It is not random. It does not just all of a sudden happen when their T3 is reasonable. It is wildly out of range. It is 34, right. It's above 20, it's above 30 that people become at risk, which is honestly very hard to do if you know what you're. It's impossible if you know what you're doing. Like, it doesn't ever happen. We have never just Randomly had come back with the TS, the T3 of 15 in our practice. 20. No, that doesn't happen when details are accounted for. It doesn't happen when systems are in place. Let's talk about some special considerations and exceptions. Post thyroidectomy, people. If you are post thyroidectomy, it is going to be very hard for you to get adequate amounts of thyroid hormones in the ways and methods that you need them. If you are trying to do that with NP armor at Thyza, Okay. Unless you are at modern thyroid clinic, I basically don't trust anyone else to give you adequate amounts. People get underdosed, undermedicated, and you cannot afford to do that with a thyroidectomy. Okay? Pregnancy. In pregnancy, your most important hormone is the hormone T4. And I know that's counterintuitive to everything else I say, but in pregnancy, the only hormone that can pass the placental barrier is T4. Do we use T3 in pregnancy with our patients? We sure do, but. And does T3 help people get pregnant, maintain pregnancy, especially early on? Yes, it does. Do people have a history of recurrent miscarriages or in inability to get pregnant with low T3? Yes, they do. But when someone is pregnant, we have to of course try to keep their T3 at levels that make them feel good. And most of our pregnant patients feel better pregnant in our program than they do. Not pregnant outside of it. But the baby takes precedent, right? Like our first goal is making sure that the baby has access to enough T4 throughout pregnancy. We're kind of crazy. We're neurotic with our pregnant ladies. We just make sure everything is perfect and we stay ahead of any curveballs. Elderly patients is the last exception. The older you are, the more at risk you are for having atrial fibrillation. And so we have to go lower, slower, take our time using T3. And we have, I mean we had a 94 year old patient come in this week for treatment. It was actually really exciting. I treat an 87 year old that has completely gotten her Life back using T3 and just absolutely. I love her. She's an angel and so fun. She works full time still. She's like, I don't want to not work. Like I want energy to work. And we gave it to her and it was just, it's. She's is amazing. But you have to be extra careful with these people because they are at more risk for atrial fibrillation. We have to be more conservative. Another special consideration and this will apply to most of you on here tonight. Okay? People on Synthroid, levothyroxine, Levoxyl, T unithroid, people on T4 drugs, do not try to. In my opinion, this is not medical advice. Education only. Do not try to switch over to desiccated thyroid, okay? That is a surefire way to get a lot worse before you get better. If you are on a robust dose of T4, the from that to natural desiccated Thyroid Armor NP at Thyza is brutal. It is hard. What the fastest path to getting your life back is you'd stay on your T4. We have to adjust the dose to make it work for your physiology. You add T3 to it, you add cytomel, you add lyothyrene. And instead of you getting worse before you get better, you get better on like day one. Like, you start feeling improvement in the first few days, which is what we want for you. We don't want you ever. When people come to Modern Thyroid Clinic, our two goals in their first round of treatment is we never want you to get worse before you get better. And we want to set you up with the path to get better the fastest long term. What can we do now to make sure that we get the path to you getting your life back is as short as humanly possible. Okay? So for those of you on T4, the fastest, easiest way to accomplish that is by adding T3 to it again. Cytomel, lyothyrene. Let's talk about persistent thyroid symptoms. And this is where our. I'm going to try and finish this in eight minutes. This is where our next chapters, our next series or lectures in this series come into play. Because if it was as simple as everyone coming to Modern Thyroid Clinic and the only thing we did was fix their thyroid and they got their lives back, we could all do that, like while we were half asleep, like, it'd be great. Check, check, done, done. You're better in three months, right? By the time people come to us, their thyroid problem has led to multiple other issues in their physiology that need to be addressed for them to get their to their highest form of health. For example, if we fix your thyroid and we do not address your adrenals, your adrenal function will mask the improvement in your thyroid. Both of these things have to be addressed. If we fix your thyroid and we do not fix your hormones, guess what? You do not get to your full self your highest sense of vitality. So most common cause of persistent thyroid symptoms is low T3, inadequate thyroid hormones, poorly balanced thyroid hormones, wrong medication for your physiology, wrong timing of Those medications or right medication, wrong dose, wrong time. And I give the analogy of people are like, well, I got put on armor and I don't feel better, and I should feel better because I'm on armor now. No, I wish it was that simple. It's the right medication at the right time at the right dose. Think of it like insulin, right? For a type 1 diabetic, can we just give a type 1 diabetic some insulin and be like, you should be fine now? No, it's all about the dose. The timing, the nuances are what allow us to control these people's physiology. And let me tell you, it is the same with thyroid. So you've got to get your labs perfect, your meds perfect, your timing perfect, all of it. Then you have to address other issues, right, that also could be weighing down your physiology. Hormones, adrenals, mitochondria, inflammation, insulin resistance, blood sugar, and metabolic dysregulation. All of these things matter in conjunction with your thyroid. Medicine has separated our physiology and segmented it into all these different parts. We are one integrated person. Our bodies systems are very tightly interconnected. So we influence thyroid, it influences hormones, we influence thyroid, it influences our metabolism, you know, so it influences our adrenals. All of these things have to be addressed together. That's where these come in, right? Beyond medication, next topic would be holistic approach lifestyle interventions, supplements. What can we do to improve adjunctive and other parts of our physiology that also help us get our lives back? Because the goal is ultimately, we want you to get to optimal health. Okay, what does that look like? I mean, our definition of optimal health is when people come in, they tell us their top three symptoms. If I could wave a magic wand and get rid of three symptoms, what would they be? So the goal is get rid of those, improve and perfect thyroid function, reduce antibodies, if they have antibodies, optimize any hormone dysfunction, adrenal dysfunction. And then I tell people, I want you to think about your energy, your vitality, your sense of well being. On a scale of 1 to 10, 10 is perfect. It's unattainable. You have to live in this little lifestyle bubble and revolve your whole entire world around your health, right? No one wants to do that. I don't want people to do that. I don't want to do that myself. So my goal for my patients, our goal for our patients at Modern thyroid clinic is to get them to an or an 8.5 out of 10. Honestly, that's where my patients told me to stop, like, years ago. They Were like, I'm at like an 8.5 and I'm good. Like, we don't need to keep going. And what that creates too is room for. You want to live your life. You don't want to revolve your whole life around your health. But ultimately we want you to know what optimal feels like. So that if in six months or six years you deviate from that even 10%, we know you know right away. Because you know what optimal feels like. You're not living in this land of muddy water not knowing anymore what you even what normal is, what optimal is. It's been so long since most people have felt that. But when we can show that to you, you know, so if 10% deviation, you're like, oh, I gotta call my clinician, I gotta get labs, I gotta go back, something's not right, then we can intervene early. We can fine tune it, we can get you back on track. And it's as simple as that. You never need that initial overhaul again because you will be empowered to know what you are supposed to feel like. Okay, so let's recap. Full thyroid panels, y'. All. Full thyroid panels, TSH, free T4, free T3, reverse T3 antibodies, medications that include T3, whether that's layering Cytomel into your Levothyroxine, Synthroid, whatever, or starting armor, Adisa, etc, getting labs checked at appropriate times. And I have a free thyroid lab guide that tells you what labs you need, what they mean. But I also have a free lab medication guide that tells you how to take your medication before labs. Both are linked. On my social, both you can find. I want to answer Q and A questions. I hope that this has been super helpful. If there's any topics you guys want me to talk about next time. We have our whole plan too, that was honestly built around things you all told me you wanted to learn about. On social. I always pull my Instagram people. So if you don't follow me on Instagram, please do, because you guys dictate a lot of what content I release because I cultivate it around what you need. But lastly, before we dig into questions, we have a special going on, if you guys follow me. You know, we don't really do specials, we don't do sales and that kind of thing. But until December 1st, we are giving you all a discount for 75 off your first health coach appointment. And you can use the code. The wait is over. So our first visits involve a health coach appointment where they order your labs, they do your intake, they take Your history, they find out your goals, they order them exactly how we need them to be, which is important. We've talked about that. So that by the time your labs come back and a clinician has an opening a few weeks later, you're already set to meet with that clinician, start treatment day one. As opposed to waiting four weeks to see a clinician, meeting them, having them order labs, waiting another four weeks for a follow up appointment. Right. So we've streamlined this to basically speed up the amount of time that it takes for you to get improvement after your first treatment cycle. So if you want to take advantage of that again through December 1st, you can go to modern thyroidclinic.com forward/new-patient and if you book your appointment, you can simply enter the code, the wait is over. And save $75. I love it. Okay, I'm going to exit out of my share screen so I can see yalls Q&As. I hope. Like I have so many messages initially that says y' all couldn't hear me, but I don't think I was on yet. Okay. I just panicked that I did the entire presentation and you guys didn't hear anything. Okay. It will be recorded and shared later. Okay. Ideas on how to lower reverse T3. Great question, missy. So I, I want to give you guys an example that I think you guys can relate to on why reverse T3 elevates. And I want you to think about when you're sick. When you're sick, you're tired, you could actually sleep all day. Right. Part of the mechanism that your body makes you tired so that you lay down, you rest, and you recover is it drives up your reverse teeth rate. Okay, so reverse T3 is an inhibitory hormone. Remember, it blocks the absorption of T3. So when your body wants you to lay down, rest and recover, it increases it. So think about when it would do that. When you're sick, when you're stressed, when you're inflamed, when you're pregnant, when you are micronutrient depleted. Just initially that says y' all couldn't hear me, but I don't think I was on yet. Okay. I just panicked. When you're protein deficient, when you're over exercising. Okay. When you're stressed that I did the entire presentation and you guys didn't hear anything. Okay. It will be recorded and shared later. Okay. Ideas on how to lower reverse T3. Great question, missy. So I, I want to give you guys an example that I think you guys can relate when you're not sleeping, your body increases reverse T3. I also want you to think about the standard American lifestyle, right? We're stressed, our food is pretty nutrient depleted, it's pretty darn inflammatory, we're often not sleeping well. Are there is a standard American lifestyle amount that drives up reverse T3 in my opinion and then there's excessive crazy amounts of reverse T32 that show up. But so if you want to reverse engineer that and reduce your reverse T3 you can of course take a thyroid supplement that gives you nutrients to help help activate your hormone. Two on why reverse T3 elevates. And I want you to think about when you're sick. When you're sick you're tired, you could actually sleep all day, right? Part of the mechanism that your body makes you tired so that you lay down, you rest and you recover is it drives up your reverse T3. Okay so reverse T3 is an inhibitory hormones that is a very small piece of the puzzle. Stress reduction, getting enough sleep, eating a high micronutrient hormone remember it blocks the absorption of T3. So when your body wants you three and high protein, low inflammatory diet, resting, right, recovering, meditating, those types of things can help the activation of your thyroid hormone can cytomel cause massive headaches? We have about 2% of our people that get mild headaches that are self limited and go away with cytomel. If you're getting massive headaches it's likely because you're over medicated. How to manage brain fog T3 for sure and adrenal support. This is not medical advice but for those of you on here pretty much and I'm going to talk about this more in depth to lay down rest and recover it increases it. So think about when it would do that. When you're sick, when you're stressed, when you're inflamed, when you're pregnant, when you are micronutrient depleted. Next time I shout from the mountaintops the benefits of ortho molecular when you're protein deficient, when you're over exercising, okay? When you're stressed there's adrenal adrene dash all most everyone with a thyroid. When you're not sleeping your body increases reverse T3. I also want you to think about the standard problem has poor adrenal function and you can fix their thyroid but they're still going to have brain fog if you don't address their adrenals and adrenal has micronutrients and minerals to help nourish and support your adrenals but it also has cow adrenal glands in it which like armor. Right. Has pig thyroid gland. It's meant to make you feel like you don't have a thyroid problem even though you do so cannot recommend adrenal enough. What type of birth control do you recommend for women with Hashim Gert? American lifestyle, right. We're stressed. Our food is pretty nutrient depleted. It's pretty differently on Yaz but I have blood clots so I'd like an alternative. Oh gosh. If it were up to me, if I was your clinician I would say a copper IUD is your safest bet for sure. And yes, it can cause heavy periods at first but then that usually resolves especially if you have someone to help you with your hormones and it lasts for 10 years. Can we aren't inflammatory. We're often not sleeping well. Are there is a standard American lifestyle amount that drives up reverse T3 in my opinion and then there's excessive crazy amounts of reverse T32 that show up. But so if you want to reverse engineer that we add T3 only Med to armor thyroid. That doesn't seem to be really working. I mean yeah, absolutely. If your T3 is low and armor has too much T4 for you, it's. It's so nuanced. I would need to know what your labs are Usually if armor isn't working it's because it's not properly dosed at the wrong it's not given twice a day. It's just inappropriately used then A that's like 95% of people. Right. It's just poor clinician management. The 5% need the addition of cytomel. So I would look for in medicine we say the horse not the zebra. Like the more common thing is inadequate inappropriate dosing of armor. What should your TSH level be if you are on desiccated thyroid medication? Good question, Melissa. It should be less than 1.8 and it is very hard to and reduce your reverse T3. You can of course take a thyroid supplement that gives you nutrients to help activate your hormones. That is a very small piece of the puzzle. Stress reduction, getting enough sleep, eating a high micronutrient. Get an appropriate TSH level on once a day dosing of desiccated thyroid. Okay. The reason is because to get enough T4 to regulate your TSH you need morning afternoon dose. Cuz T4 is longer acting it stacks on top of each other to create stability for your TSH to lower. Also your thyroid doesn't want to lower TSH when you have T3 in the morning then it's all gone and it's like like we don't have any thyroid hormones in the afternoon. High protein, low inflammatory diet, resting right recovering, meditating. Those types of things can help the activation of your thyroid hormone. Can cytomel cause massive headaches? We have about 2% of our people that get mild headaches that are self limited and go away with cytomel if you're getting we need to keep stimulating her tsh we need to use all this energy to produce these hormones and again that's you massive headaches. It's likely because you're overmedicated. How to manage brain fog T3 for because of clinicians just not understanding the nuances. Sure. And adrenal support. This is not medical advice but for those of you on here pretty much and I'm going to talk about this more in depth. How do you know if your adrenal gland is really the problem? I'll be honest with you, pretty much everyone that at least in my data point might be skewed right? Like my data point might be the only the severe people come to modern thyroid clinic but pretty much everyone that comes to modern thyroid clinic needs an adrenal support. Like after years of thyroid dysfunction your adrenals have compensated that entire time and they do not work as well. If I ate gluten one time three weeks ago but otherwise have diligently avoided gluten for two and a half months will my thyroid antibody test this week be invalidated for next time I shout from the mountaintops the benefits of orthomolecular checking gluten sensitivity. I'm not glurz adrenal adrene dash all. Most everyone with a thyroid problem has poor adrenal function and you can fix their thyroid but they're still going to have brain fog if you don't address their adrenals. And adrenal has micronutrients and minerals to help nourish and support your adrenals. But it also quite sure what you mean but basically I would not if you ate gluten once in two and a half months I wouldn't use your antibodies as a reference point for how you responded to that. Now they could skyrocket, right? Especially if you're celiac or something. But a lot of people can tolerate tiny amounts of gluten and be okay. Not everyone but a lot of people can. And it's hard to say without so many more details and so much more information. I've been off on Armor thyroid meds and felt very tired. I was off for two weeks due to a pharmacy problem. I felt so much better now that I'm so Has cow adrenal glands in it, which, like armor. Right. Has pig thyroid gland. It's meant to make you feel like you don't have a thyroid problem even though you do so. Cannot recommend adrenal enough back. I feel tired again. Any suggestions? I have Hashi. So honestly, Tammy, throwing darts at a dartboard blindfolded until we get labs. Like, there's just. It's guessing and you don't want people to guess about your thyroid, y'. All. You really don't. What type of birth control do you recommend for women with Hashim? Currently on Yaz. But I have blood clots, so I'd like an alternative. Oh, gosh. If it were up to me. If I was your clinician. You don't. You don't. This is an important one. Linda, newly diagnosed. If you guys have questions or some. I see some of y' all raising hands. I'm not going to, like, allow people to talk or do video on here just because there's so many of y'. All. And I can't quite do that. But if you have a question, please type it in the little Q and A section at the bottom. Newly diagnosed acute. I would say a copper IUD is your safest bet. That for sure. And yes, it can cause heavy periods at first, but then that usually resolves, especially if you have someone to help you with your hormones and it lasts for 10 years. Can we add T3 only Med to Armor Thyroid. That doesn't seem to be really working. I mean, yeah, absolutely. Thyroiditis. Three large nodules. Biopsy benign, thankfully. That's wonderful. Surgeon said I likely have Hashimoto and it needs to come out. I said thanks for your opinion. And I'm working extremely hard to decrease the size of the nodules at 6. If your T3 is low and armor has too much T4 for you, you. If it's. It's so nuanced. I would need to know what your labs are. Months follow up through dietary changes. Do you find red light therapy to be beneficial for Hashi patients? So there's a lot to unpack here. Linda, I cannot give you medical advice, but what I can tell you is what I would do and what I would never have my patients do, which would be I would never have them take out their thyroid for Hashimoto unless they physically cannot breathe because their goiter is so big. Full stop. What happens usually if armor isn't working, it's because it's not properly dosed at the wrong. It's not given twice a day. It's just in the world of thyroid guys and all of you need to hear this is people are inappropriately taking out thyroid glands for inappropriate reasons. Okay. They dangle this idea that oh, if we just take it inappropriately used then a SM like that's like 95% of people, right? It's just poor clinician management. The 5% need the addition of cytomel. So I would look for it out. It'll be so much easier. Everything will be better. Let me tell you what happens post thyroidectomy. Nothing is better. Everything is worse. It is very hard to get adequate treatment if not impossible. And it's very hard to. In medicine we say the horse, not the zebra. Like the more common thing is inadequate, inappropriate dosing of armor. Ever feel like yourself again? In my opinion, the only reason I would have my patients take out their thyroid gland number one is cancer. Cancer number two is wildly treatment refractory Graves disease. And I've what should your TSH level be if you are on desiccated thyroid medication? All the Graves disease patients we've ever treated there has been one that needed a thyroidectomy. Everyone else didn't. So I'm sure anyone on here that can has had a thyroidectomy can talk to this and good question, Melissa. It should be less than 1.8. And it is very hard to get an appropriate TSH level on once a day dosing of desiccated thyroid. Okay. The reason say how difficult life is post thyroidectomy. As far as red light therapy goes. Research studies show, and I have seen personally, red light therapy can reduce Hashimoto's antibodies, Graves antibodies and it is because to get enough T4 to regulate your TSH you need morning afternoon dose because T4 is long. Prove thyroid function, improve the conversion of T4 to T3. So it is a win for me. I talk about red light therapy and how much I love it all the time. And that is why. When you say autoimmune destroys the thyroid, can it be seen on ultrasound as in the destruction? Yeah. So it can be seen in two different ways. It can be seen as hypervascular, interacting. It stacks on top of each other to create stability for your TSH to lower ulcerity on ultrasound, which is the acute finding in Hashimoto's or autoimmune thyroiditis. And then it can also be seen as what's called a diminutive thyroid where you don't. Or thyroid doesn't want to lower TSH when you have T3 in the morning, then it's all gone and it's like we don't have any thyroid hormones in the afternoon. We need to keep stimulating her tsh. We need to use all this energy to produce these hormones. And again, that's. You really have a lot of thyroid gland anymore. More so, yeah. I am hypo and hashi. I have chronic heat intolerance. For years, no doctor supply because of clinicians just not understanding the nuances. Prescription has been able to help me. What causes this and how can it be treated? I'm curious what your manifestation of heat intolerance is. But part of people think about thyroid disorders as being like cold intolerance, like they're always cold. There's another side to this that is called anhydrosis, meaning you don't sweat. And what happens with thyroid people that can't sweat is they can't regulate their body temperature. How do you know if your adrenal gland is really the problem? I'll be honest with you, pretty much everyone that at least in my data point might be skewed, right? Like my data point might be the only the severe because sweating is what allows us to cool our body temperature when we're hot. And if you can't do it, people come to modern thyroid clinic clinic. But pretty much everyone that comes to modern thyroid clinic needs an adrenal support. Then you can't cool your body. So I would say start with treating your thyroid for sure. When diagnosed with Hashimoto's and hypo, like after years of thyroid dysfunction, your adrenals have compensated that entire time and they do not work as oh, do you recommend a certain diet or get tested to see if certain foods might not be good for you? I have my first appointment next Tuesday. Good for you, Danielle. Oh my God. Your whole life is about to change. Sister, I'm so excited for you. So at modern thyroid clinic, we do not take a one size fits all approach to diet. Okay. We also do not. We don't ask people to do things that we haven't done, aren't willing to do again and don't do ourselves, which you know what I'm not doing. I'm not living an autoimmune paleo protocol for the rest. While all. If I ate gluten one time three weeks ago, but otherwise have diligently avoided gluten for two and a half months, will my thyroid antibody test this week Be invalidated for checking gluten sensitivity. I'm not of my life. Not doing it. Not necessary. Less than 5% of people actually need it based on testing. So we test everyone. We do food inflammatory testing. It looks at about 200 foods. It tells us with particularity. Quite sure what you mean, but basically I would not. If you ate gluten for you. What foods drive inflammation and what foods don't. There are definitely certain patterns that we see, but it doesn't apply to everyone. We want goals to be realistic, attainable. We people show up to us debilitated and hardly functioning. Number one, we do not ask them to ever change their diet until we give them the energy, capacity and motivation to do it. Meaning? Meaning we fix their thyroid, make them feel better first once in two and a half months. I wouldn't use your antibodies as a reference point for how you responded to that. Now, they could skyrocket, right? Especially if you're celiac or something. But a lot of people can tolerate tiny amounts of gluten and be okay. Not everyone, but a lot of people can. And then we ask them to do hard things because they are able to do it at that point. But two, we. We do not ask them to do unnecessary things. So it's all about testing and data. I know you've recommend taking. It's hard to say without so many more details and so much more information. NP thyroid in two doses a day. Would you still do that even if the prescribed dose is 15mg or 30mg? I've been able to split my 15 tablet easily. My 31 isn't so easily split. They said doses are only beneficial to split at 60 milligrams or higher. No, that's not true. So usually people need the equivalent dose or close to the equivalent dose in the afternoon that they need in the morning. Okay. I've been off naturally. Our rhythm of T3 is a little lower in the afternoon. So some people can take lower every single dose of NP or armor. If we're being candid, I would try and switch to ARMOR or ADISA on armor thyroid meds and felt very tired. I was off for two weeks due to a pharmacy problem. I felt so much better. Now that I'm back, I feel tired again. Any suggestions? I have hashi. So honestly, Tammy, throwing darts at a dartboard blindfolded until we get labs, like there's just. It's guessing and you don't want people to guess about your thyroid, y'. All. You really don't needs to be dosed twice a day, irrespective of dose. Dose, full stop. And if you're. If your T3 looks great on 30 milligrams in the morning, if you split that, that T3 is going to reduce by 50%. So you don't need half of that. I can't speak to you, but in general people don't need half of that dose. They need the equivalent dose in the afternoon. So you need to talk with your clinician. What are your thoughts on using trulicity instead of semaglutide? Will it help as well for thyroid issues, I'm on it. For diabetes it's hard. Like I don't have a data pool of people on trulicity, but it is the same class of medication. And what I tell people about glp, you don't, you don't. This is an important one Linda piece is people say what what's the best glp? The best GLP is the one newly diet. If you guys have questions or something, I see some of y' all raising hands. I'm not going to like allow that you can get access to like that's it, the one that your doctor will prescribe that you can afford that how people to talk or do video on here just because there's, there's so many of y' all and I can't quite do that. But you know those types of things because GLPs in general are so life changing. When is a good time to if you have a question, please type it in the little Q A section at the bottom. Newly diagnosed acute ML to your levothyroxine journey when you are not well on levothyroxine, when you're fatigued, when you have brain fog, when you have weight gain or weight retention, hair loss, dry skin, brittle nails, low libido, depression, all the classic symptoms of hypothyroidism. On levothyroxine, if your T3 is low, basically if your T3 is less than 3.6 to 4.2 or your reverse T3 is elevated, it's time for T3. I can't give you advice but generally speaking, thyroiditis, three large nodules biopsy benign thankfully. That's wonderful. Surgeon said I likely have Hashimoto's and it needs to come out. I said thanks for your opinion and I'm working extremely hard to decrease the size of the nodules at point some six. Thanks so much for hosting this session. You're so darn welcome. Trying to conceive in the next few months after A miscarriage earlier this year my TSH went up to around 5 I'm so sorry for your loss. It's currently at 3 point months followup through dietary changes. Do you find red light therapy to be beneficial for Hashi patients? So there's a lot to unpack here Linda, I cannot give you medical advice but what I can tell you at 97 I don't have antibodies in my free T4 is good doctors leaving up to me to take Synthroid and or NP np. What would you suggest? My goal would eventually to be off medication once not pregnant. What is easier to wean off of? If you were my patient I'd absolutely recommend synthroid. Maybe some T3 added to it. The likelihood your clinicians going one NP is not the most stable they're currently under investigation. They're under repeated issues with RE is what I would do and what I would never have my patients do which would be I would never have them take out their thyroid for calls etc because of instability of medication. Secondary to that the likelihood that your clinician is going to prescribe an adequate amount of NP twice a day because that's what it takes to lower your TSH to set you up for Hashimoto unless they physically cannot breathe because their goer is so big full stop. What happens in the world of thyroid guys and all of you need to hear this is people are inappropriately taking out pregnancy success is unlikely. So I in in all honesty I would err towards Synthroid more than np. In an ideal world I would say sister Synthroid plus Cytomel like see someone who can do thyroid glands for inappropriate reasons, okay. They dangle this idea that oh if we just take it and make that happen for you get everything perfect before you go in to active pregnancy planning. And lastly number one cause of miscarriage in early pregnancy especially with thyroid patients is low progesterone. Get out. It'll be so much easier. Everything will be better. Let me tell you what happens post thyroidectomy. Nothing is better. Everything is worse. It is very hard to get adequate treatment if not impossible and it's very hard to ever feel like yourself again. In my opinion the only reason I would have my patients take out their thyroid gland number one is cancer number two is wildly treatment refractory Graves disease and of okay in modern thyroid clinic if someone has a history of miscarriage the moment they get pregnant I tell people we are call number two we start checking your progesterone. We check it and adjust it week by week to basically eradicate any Risk of miscarriage that comes from low progesterone. Okay. That is a very important thing to consider when when talking about miscarriage alternatives to getting T3. If you cannot tolerate T3. I'll tell you of all the patients we've ever had, which is thousands and thousands of patients, I have had one that cannot tolerate T3. Every other case it has been clinician error. So in all likelihood you can tolerate T3. You just can't tolerate it from people who don't know how. They don't understand the nuances of how to appropriately do it. Again, you can work on your natural conversion like I talked about earlier, the same things that reverse T3 improve conversion of your hormones. Stress reduction, low inflammation, diet, high micronutrients, sleep, meditation, exercise, but not too much exercise, protein. Those all the Graves disease patients we've ever treated. There has been one that needed a thyroidectomy. Me everyone else didn't. So I'm sure anyone on here that can has had a thyroidectomy can talk to this and types of things. TSH was 15.5 October 9 due to say how difficult life is post thyroidectomy. As far as red light therapy goes, research studies show chest pain ended up in ER three days ago. TSH was 0.3. What could cause such a huge drop in numbers? Would this be considered? And I have seen personally red light therapy can reduce Hashimoto's antibodies, Graves antibodies and a thyroid storm. So you would need a full thyroid panel. In my opinion I never would diagnose thyroid storm, Graves disease or anything based on TSH alone. So I would check a full thyroid panel including GRAVES to antibodies. Write this down. TSI thyroid stimulating immunoglobulin and tap suggestions on how to lower dhea. So DHEA is an adrenal hormone. It over secretes commonly with stress in your environment. So optimizing your thyroid will take the burden off of your adrenaline, improve thyroid function, improve the conversion of T4 to T3. So it is a win for me. I talk about red light therapy and how much I love it all the time. And that is why. Ashwagandha about 500-1000mg a night only night, never morning. When you say autoimmune destroys the thyroid can it be seen on ultrasound as in the destruct? So what I give to my patients to calm adrenal stress and in third is supplementing with zancion. Yeah so it can be seen in two different ways. It can be seen as hypervascular 30 to 50 milligrams a day can help your body upregulate the excretion of dhea. Yes. The recordings will be sent afterwards. Y' all. At mtc, do you help people that have not been diagnosed yet with hypothyroidism? Runs in all the women in our family. My sister has seen a doctor and told her she's normal, does not need treatment, but shows signs something's off with her thyroid. She wants to figure out answers but doesn't know if she had e on ultrasound which is the acute finding in Hashimoto's or autoimmune Thyroiditis has to be diagnosed first. Absolutely not that. Come, come to us. Let us help you. You are our people. Every single person at modern thyroid clinic has been told a it's not your and then it can also be seen as what's called a diminutive thyroid where you don't really have a lot of thyroid gland anymore. So yeah, thyroid, you don't have a thyroid problem or B your thyroid labs are normal. I am hypo and hashi. I have chronic heat intolerance for years. No doctor supplement. Your symptoms are not due to your thyroid. Those are our people. Honestly too everyone that comes to see us, 100 of people are terrified, y', all that they're going to show up for their first appointment with their clinician and their clinician is going to tell them their labs are normal. That has happened one time ever. That poor gentleman, I feel terrible for him one time ever. Everyone else that has shown up thinking, hoping it's their thyroid, it's been their thyroid. So yes, come to us. Is cellular danger response a root caused to thyroid issues. Prescription has been able to help me. What causes this and how can it be treated? I'm curious what your manifestation of heat intolerances. But part of people think about thyroid disorders as being like cold intolerance, like they're always cold. There are, how do I say this kind of kindly. There are people on the Internet that there's another side to this that is called anhydrosis, meaning you don't sweat. And what happens with thyroid people that can't sweat is they can't regulate their body temperature. Try to find 1 million reasons for thyroid problems except thyroid problems. Because they can't prescribe medication, because they don't. They're not equipped to do so. They don't have the infrastructure to do so. So they sort of fabricate a lot of things that can't be measured that can't be finitely defined because sweating is what allows us to cool our body temperature when we're hot. And if you can't do it, then you can't cool your body. So I would say as thyroid problems. And it's very easy to blame those things because no one can concretely prove them wrong. My opinion is the exact opposite. If people come to me and I do my job, we do our job well. Start with treating your thyroid. For sure. When diagnosed with Hashimoto's and hypo, do you recommend a certain diet or get tested to see if certain foods might not be good for you? I have my first appointment next Tuesday at Modern Thyroid Clinic. We get them into optimal ranges. We address the things that need to be addressed. They get their lives back. It's black and white. There is no guessing. There is no. There is nothing that's unexplained in black and white data. Everything is accounted for. It's. It's predictable. It's controllable. It's not this intangible thing. And I think you guys need to be careful of those people because that's not the case. It is tangible. It's good for you, Danielle. Oh, my God. Your whole life is about to change. Sister, I'm so excited for you. So at Modern Provable, it's predictable, it's controllable, and there's hope in that. That there's not hope in. Well, it's this weird abstract thing we can't really measure or define or talk about or see on paper or labs. Thyroid clinic. We do not take a one size fits all approach to diet. Okay? We also do not. We don't ask people to do things that we haven't done, aren't willing to do again and don't do, but we can fix it. No, don't do that. Don't do that, y'. All. It's not a good situation. Calm ourselves. Which you know what I'm not doing. I'm not living an autoimmune paleo protocol for the biased, but I. We have a system that works. It's proven, it's predictable, it's replicatable. That's what you guys need. Okay, so I'm seeing questions about working with us and becoming patients. Appointments are available this year, but many patients are booking now to use my life. Life. Not doing it. Not necessary. Less than 5% of people actually need it based on testing their HSA FSA dollars. If you do want to work with us this year, if you have to do that, you need to do that sooner rather than later because we closed the last week of December. I know that some of y' all are on. So we test everyone. We do food inflammatory testing. It looks at about 200 foods. It tells us with particularity for you what foods drive inflammation and what foods don't. There are definitely certain patterns that we see time limits with the FSA HSA thing. And we do take that. Like we absolutely do. But at some point, the slots are going to get full and then the clock for y' all in particular starts over. So keep that in mind. But it doesn't apply to everyone. We want goals to be realistic, attainable. What if your TSH is completely shot? Is that a concern? My labs are looking better. I don't know what you mean by completely shot. I would need more definition of that. But you guys need a full thyroid panel. Not just that. Okay, I'm gonna put the states that we're opening now into the chat window. I hope you all can see the chat window that we people show up to us debilitated and hardly functioning. Number one, we do not ask them to ever change their diet. See everyone. Okay, those are the states we're in now. I'll drop the booking thing because y' all are asking. Oh, no, my chat window. Okay. Until we give them the energy capacity and motivation to do it. Meaning we fix their thyroid, make them feel better first. I'm doing so many administrative things while I'm doing this, y'. All. I'm doing my best. I hope this is working for you guys. Then we ask them to do hard things because they are able to do it at that point. But two, we do not ask them. Okay. Can you explain if you are dosing armor bid when drawing labs, you recommend them to do unnecessary things. So it's all about testing and data. I know you've recommended take three to four hours after your first dose. Where does the second dose come into play for labs? Because it seems like you are drawing labs on half your daily dose. Good question. Let me draw a picture. So let's talk about this. Let me draw my little NP thyroid in two doses a day. Would you still do that even if the prescribed dose is 15mg or 30mg? Diagram. So we're just going to look at your T3 because that's really the time sensitive thing in labs is I've been able to split my 15 tablet easily. My 31 isn't so easily split. T3, T4 is longer acting. It's cumulative in armor. So it doesn't. They said doses are only beneficial to split at 60 milligrams or higher. No, that's not true. So fluctuate as V in a volatile way like T3. So this is my optimal range. Okay. 3.6, 4.2 T3. We're checking labs after your first dose of armor. Let's say that's 60 milligrams. Usually people need the equivalent dose or close to the equivalent dose in the afternoon that they need in the morning. Okay. We want to capture it at your peak, right? Doesn't matter if we capture it at your peak here or here. It's the same. Now, if you have 60 milligrams of armor here and 45 here, we can presume that this dose is a little bit lower. Where I think you're getting confused is you think that your armor dose looks like this in the afternoon. Naturally, our rhythm of T3 is a little lower in the afternoon. So some people can take lower. Every single. The dotted line gets higher because you've taken that second dose. No. So armor peaks and troughs in about five to eight hours. Cytomel or lyothyrenine in three to six hours. So it's peaking and it's going away. Dose of NP or armor. If we're being candid, I would try and switch to armor or adisa. Needs to be dosed twice a day, irrespective of dose. Full stop. And if you're. One of our clinicians described it in one of our clinician round tables last week as like a mountain and a valley and a. Another mountain. Okay. The mountains aren't stacking on top of each other. You're hiking to the peak, you're coming down, you're hiking to the second peak. So that's why we check it. Also, your natural T3 in the morning, your endogenous. Excuse me, T3 in the morning is the highest. So again, if we want to protect people from over medication of T3, if your T3 looks great on 30 milligrams in the morning, if you split that, that T3 is going to reduce by 50%. So you don't need half of that. I can't speak to you, but in general, people don't need half of that dose. They need the equivalent dose in the after afternoon. So you need to talk with your clinician. What are your thoughts on using tricity instead of semaglutide? Will it help as well? For thyroid issues, I'm on it. For diabetes, it's hard. Like, I don't have a data pool of people on trulicity, but it is the same class of medication. And what I tell people about GLPs is people say what? What's the best GLP? The best GLP is the one that you can get access to, like that's it. The one that your doctor will prescribe that you can afford, that you know those types of things. Because GLPs in general are so life changing. When is a good time to add Cytomel to your levothyroxine journey? When you are not well on levothyroxine, when you're fatigued, when you have brain fog, when you have weight gain or weight retention, hair loss, dry skin, brittle nails, low libido depression. All the classic symptoms of hypothyroidism on levothyroxine. If your T3 is low, basically if your T3 is less than 3.6 to 4.2 or your reverse T3 is elevated, it's time for T3. I can't give you advice, but generally speaking, thanks so much for hosting this session. You're so darn welcome. Trying to conceive in the next few months after a miscarriage earlier this year my TSH went up to around 5. I'm so sorry for your loss. It's currently at 3.97. I don't have antibodies in my free T4. Is good doctors leaving up to me to take Synthroid and or np. What would you suggest? My goal would eventually to be off medication once not pregnant. What is easier to wean off of? If you were my patient I'd absolutely recommend synthroid. Maybe some T3 added to it. The likelihood your clinicians going one NP is not the most stable. They're currently under investigation. They're under repeated issues with recalls etc because of instability of medication. Secondary to that the likelihood that your clinician is going to prescribe an adequate amount of NPC twice a day because that's what it takes to lower your TSH to set you up for pregnancy success is unlikely. So I in all honesty I would air towards Synthroid more than np. In an ideal world I would say sister Synthroid plus Cytomel like see someone who can do that and make that happen for you. Get everything perfect before you go in to active pregnancy planning. And lastly number one cause of miscarriage in early pregnancy especially with thyroid patients is low progesterone. Okay, in modern thyroid clinic if someone has a history of miscarriage the moment they get pregnant I tell people we are call number two. We start checking your progesterone. We check it and adjust it week by week to basically eradicate any risk of miscarriage that comes from low progesterone. Okay, that is a very important thing to consider when when talking about miscarriage alternatives to getting T3. If you cannot tolerate T3, I'll tell you. Of all the patients we've ever had, which is thousands and thousands of patients, I have had one, one that cannot tolerate T3. Every other case it has been clinician error. So in all likelihood you can tolerate T3. You just can't tolerate it from people who don't know how. They don't understand the nuances of how to appropriately do it. Again, you can work on your natural conversion like I talked about earlier. The same things that reverse T3 improve conversion of your hormones. Stress reduction, low inflammation, diet, high micronutrients, sleep, meditation, exercise, but not too much exercise, protein, those types of things. TSH was 15.5 October 9th due to chest pain. Ended up in ER three days ago. TSH was 0.3. What could cause such a huge drop in numbers? Would this be considered thyroid storm? So you would need a full thyroid panel. In my opinion, I never would diagnose thyroid storm, graves disease or anything based on TSH alone. So I would check a full thyroid panel including GRAVES to antibodies. Write this down. Tsi, thyroid stimulating immunoglobulins and T rap Suggestions on how to lower dhea. So DHA is an adrenal hormone. It over secretes commonly with stress in your environment. So optimizing your thyroid will take the burden off of your adrenals. Ashwagandha. About 500 to a thousand milligrams a night only nights, never morning is what I give to my patients to calm adrenal stress. And in third is supplementing with zinc. 30 to 50 milligrams a day can help your body upregulate the excretion of dhea. Yes. The recordings will be sent afterwards. Y'. All. At mtc, do you help people that have not been diagnosed yet with hypothyroidism? Runs in all the women in our family. My sister has seen a doctor and told her she's normal, does not need treatment, but shows signs that something's off with her thyroid. She wants to figure out answers but doesn't know if she has to be diagnosed first. Absolutely not. Come. Come to us. Let us help you. You are our people. Every single person at modern thyroid clinic has been told a It's not your thyroid, you don't have a thyroid problem or B your thyroid labs are normal, your symptoms are not due to your thyroid Those are our people. Honestly, too, everyone that comes to see us, 100% of people are terrified, y', all, that they're going to show up for their first app with their clinician and their clinician is going to tell them their labs are normal. That has happened one time, ever. That poor gentleman, I feel terrible for him. One time ever. Everyone else that has shown up thinking, hoping it's their thyroid, it's been their thyroid. So your symptoms are not due to your thyroid. Those are our people. Honestly, too, everyone that comes to see us, 100% of people are terrified, y', all that they're going to show up for their first appointment with their clinician and their clinician is going to tell them their labs are normal. Normal. That has happened one time, ever. That poor gentleman, I feel terrible for him. One time, ever. Everyone else that has shown up thinking, hoping it's their thyroid, it's been their thyroid. So, yes, come to us. Yes, come to us. Is cellular danger response a root cause to thyroid issues? There are, how do I say this. Is cellular danger response, a root caused to thyroid issues use. There are, how do I say, this kind of. Kind of.