Thyroid Health, Hormones, and Breast Implant Illness with Dr. Amie Hornaman and Dr. Whitfield

Dr. Amy founded the Better Thyroid and Hormone Institute, offering personalized care for thyroid and hormone health across the US and Canada. Dr. Amy is also the founder of the Fixer supplement line targeting weight loss, fatigue, low libido, and hormone imbalances. Inspired by her own thyroid and hormone struggles, she is dedicated to helping others navigate thyroid and hormone issues with empathy and comprehensive care. All right, everybody, I have Dr. Amy Horniman, who's a friend and a colleague and badass at helping with thyroid problems. So I thought nobody better to bring on the show to discuss what I see all the time in my breast implant illness and explant cases are fluctuations in hormones, problems with hypo and hyperthyroidism at times, problems with testosterone suppression, estrogen toxicity, all the bad things. So welcome to the show, Amy, and you're going to sort all this out so I don't have to.

Oh yeah. Now I got your back on this. No worries.

So I would just tell everybody, like, you know, if I did not have a patient who had anything but hypothyroidism and testosterone suppression and estrogen toxicity, I wouldn't know what to do with myself because almost everybody I encounter in my practice has either one or all three of those things at the same time.

Oh yeah. It's even an issue outside of breast implants, breast implant illness. I mean, we see it in the majority of women. If you're over the age of 40, there's a term I use called thyropause. It's when your hormones start to shift and basically thyroid conditions show themselves, or at least they're going to show themselves in symptoms that you have. Now, whether or not you're actually properly diagnosed by your doctor, that's a whole other discussion. But it really is a huge epidemic, especially among women, that they're experiencing the symptoms of, but they're not actually getting the answers as to how to negate those symptoms and live a better life.

I feel like I always characterize breast implant illness because it doesn't have an International Classification of Disease code or ICD-10 code, which is how we normally would, you know, you would make a diagnosis, you'd attach the code to it. It doesn't exist. I just look at it as chronic inflammation, which we see a lot of patients, both you and I, with chronic inflammation, and it leads to all sorts of problems. But when you add a medical device and I tell folks the same thing, so when you're listening to me, I've dealt with all these problems pertaining to orthopedic surgery and neurosurgery and cardiac surgery. If you have an implantable device, a foreign body that gets infected or has biofilm, you're going to have an enhanced immune response. So a lot of patients ask me like, what can I test for that determines this? And forensically, I can tell you, I just submitted a paper of 700 of my explant specimens that show about 29 to 30% rates of bacterial contamination. So that's a high, high number, and that has been shown in both the laboratory and clinical papers to enhance your immune response and give you more symptoms. So with that kind of knowledge now, it makes more sense that more of my patients have hormonal dysfunction or hormonal suppression, or— and we talked a little bit off air about what happens after I explant Pituitary Pill. But in the setting of chronic inflammation, could you describe to the audience like what you see with the thyroid especially and how sensitive it seems to be?

Oh my gosh, it's so sensitive. It probably one— it is one of the most sensitive systems as part of the endocrine system or gland in your body because it's responding and reacting to all things around you. So environmental, toxic stress, whether that's something that you're encountering in your world, you're putting on your body, or you're putting in your body, the immune system is gonna respond to that. And especially if you have that predisposition for autoimmunity. So when we're looking at autoimmune in general, let's just take that. And specifically, we can get really narrowed down and say Hashimoto's if we're talking about the thyroid. Autoimmune is just like a three-legged stool. We hear this analogy all the time in our world. The one leg, you have that genetic predisposition. So somewhere in your genes, you have autoimmune. Maybe there's type 1 diabetes, psoriasis, Crohn's disease, celiac, somewhere in your family, maybe even Hashimoto's, and you have that predisposition. Then the other leg of the stool is leaky gut inflammation. We all have that, and we, we kind of fall on a spectrum as to where we land. Some people have really great control over their gut. They're doing all the gut healing protocols. They're living their cleanest life ever, and their predisposition for that might be really low, but we're all on that spectrum. We all have some level of inflammation because you just simply can't avoid it. And then that third leg is the stressor. Now that stressor can be any kind of hormonal shift. It can be toxin exposure. It could be your body just freaking out because you put in an implant. It really can be a, a large variety of triggers that then turn on that autoimmune switch. So if you picture it just like a light switch, you're in that off position. You could have autoimmune in your family. You know, 8 generations deep, and that switch is still in the off position for you because maybe the way you live your life, you're taking care of yourself, you're gluten-free, you're controlling your stress, you're meditating, you're saunaing, all the things. But then something happens, whether it's a huge stressor in your life or something like pregnancy, perimenopause, menopause, any kind of hormonal shift, using birth control, taking, putting an implant in, taking it out, anything that jolts your body. And it's a shift in your body that can turn that switch to the on position. And that's where you start to see the symptoms. And this is where you'll very commonly hear women say, it was after my first child, it was after I turned 40, it was after I got breast implants, whatever that shift is. It was after I changed jobs and moved. That's enough to turn that into the, turn that switch to the on position.

Absolutely. I always want to remind everybody, and Dr. Amy and I have talked about this, like autoimmune disorders predate breast implants. So autoimmune disorders were described in the late 1800s. If you look back, and breast implants were placed in 1962 for the first time in Houston by Cronin and Jarrell. So, and, you know, there's obviously other implants, but what she's describing is super pivotal in terms of something happens, some triggering event happens, And I commonly find people now who got exposed to mold and/or Lyme, a parasitic infection, in conjunction with those triggering events like a loss of a family member, a pregnancy, a delivery, a surgery, some other, you know, event, renovating a house. Oh my God, do not live in your house and reno your house. That is literally— if you don't kill each other, you're going to expose yourself to all of the environmental toxins associated with the building materials and/or mold and/or all above.

Very true, excellent point.

So I guess in my world, I explain it to my patients as, you know, I expect kind of the following things, and I don't know in what time frame they'll reorganize themselves, but I do always mention that if you're taking even Armour or if you're taking a synthetic thyroid replacement, that you have to be extremely careful after surgery to monitor both your symptoms because your level would actually— you need to have a blood draw. But if you all of a sudden get, you know, the symptoms of hyperthyroidism, that is not uncommon in my patient population. So they're all warned about it because I explain it as once your inflammation starts to drop, the drug becomes more bioavailable, and then you're going to get all the effects of that synthetic hormone.

Yes, yes, that's so true. So whenever you start to heal your body, whether it's, you know, post-explant surgery or you're just on this quest to really clean up your body and clean out your life and clean out your pantry and your cabinets and your cleaning products and all those things, we do see a shift in how much hormone the body needs. So, this can be thyroid hormone replacement or it could even be if you're on bioidentical hormone replacement. All of those hormones are so vital. Like, you brought up testosterone and estrogen and all that. We see all of that shift when you remove something from the body that is literally causing the body to think that it's in a war. And that's essentially what autoimmune is. It's— I always use the analogy of soldiers. So if we are testing, what we would test, let's say in the case of Hashimoto's, we would test your TPO and your TGA antibodies. And that tells us how many of these soldiers do you have that are going out and beating up your thyroid, like rheumatoid arthritis. We can get an RA factor. There are different markers that we can look at for autoimmune. But if you think of it as soldiers, you have these soldiers that are going out and attacking. So when we actually remove the perceived bad guy, we'll say, so the soldiers in your body, yeah, they like going out and attacking your thyroid, or maybe they haven't even attacked yet. But then here comes in an implant, and this is in some people, not all. So I don't want to generalize it. I have implants. I had no issues with them whatsoever, but some people just do. So here comes a foreign object into the body and the soldiers go, you know what, we're not quite sure what this is. I mean, it doesn't look like the thyroid like we normally like to go on and invade, but we're not happy about it. Like, this is not cool. It's a foreign invader. You know what? Let's just be on the safe side and start a war. And that's when all of that, like the autoimmune flare, all of those autoimmune symptoms can easily kick up. So that goes for putting in a device and then it also goes for when you take it out and then all your soldiers go, wait a minute, there's no war anymore. What are we supposed to do? And there's that period of confusion after an explant surgery. But when things start to balance out, you might find that you need a lower dose of thyroid hormone or hormones. To get optimized, right?

I feel like I've had 2 patients hospitalized for thyroid storm after explant. And so I'm very, very— I'm always going to say like, okay, this can happen. So you have to be extremely careful about this. And I would say people have, you know, habitually been told like, you cannot miss a dose of this thyroid medication. You have to be, you know, you have to take this each and every day, da da da da da. We just want to make sure that you understand hormones do work.

Yeah.

And in particular, these synthetic hormones, once your body can accept it, like Dr. Amy's talking about, it will work extremely effectively. It's almost— I have this running joke, you know, patients who come in and say like hormones don't work, like whether it's a sex hormone replacement with testosterone. And I'm like, okay, I just put it this way. I'm like, okay, we just had the Olympics. Do you think any of the Olympians would risk their legacy, both, you know, medals, financial, marketing, endorsement, if a drug didn't work? Like, there's a big absentee in the Olympics. You may have heard of it. It's called Russia, because they are notorious for doping. And they were all caught. If you remember the World Cup, all of a sudden the Russians were like this amazing, you know, soccer and/or in the world football team. And I was like, I was watching them run around, I'm like, this is very disturbing because there are no Russians who are elite soccer players around the world at the biggest clubs in the world. Because I, one, I've watched all this for many, many years now, over decades really, and I was like This is super creepy. And then all of a sudden they got banned.

Yeah.

And there's a reason why they got banned, because they're taking a substance and we don't— I just use, as Dr. Amy knows, I'm using a sex hormone. Like, we're old enough to know that was a common substance used a long time ago and they would, you know, dope with it. But now obviously they, they don't use that anymore. But when someone says something like testosterone doesn't work, it's kind of funny because of course it works, right? The only ways it doesn't work are you didn't deliver the drug to the target or you didn't use enough of drug. Those are the only two ways that testosterone does not work, right? Am I confused on— and so when I have somebody with libido suppression who says they took testosterone, it didn't help them, I'm like, well, okay.

Yeah, well, you know, for libido too, I actually just got this question this morning, and I have to remind people that libido is so much more than just testosterone because we tend to hone in and think like, well, all I have to do is get my testosterone levels up and then I'll have a libido. No, I mean, especially if you're a woman, there's, there's stress, there's how you feel about yourself, and actually estrogen is more important than testosterone. But to your point, yes. So I have many patients that come to see me and maybe they're on a thyroid hormone replacement standard of care that their PCP gave them. It's T4 only. They have all the symptoms. It's not working. So it's not— and they'll come in and they'll say, well, I'm just going to go off of it because this thyroid hormone replacement medication isn't working anyways. I'm like, it's not that it's not working. It's not in the right combination at the right dose for you. So we just have to tweak it and make it work for you. And then you're going to be like, oh, okay, now I get it, because you're going to feel the effects of that hormone.

Exactly. And that's why I get like, try to keep everything as simple as possible, but I have to like interject when I get those thyroid hormone doesn't work or testosterone doesn't work, you know, whatever. And then you, you listen to them and they're all dealing with estrogen toxicity. They probably, you know, you ask them, you know, has anybody ever checked your estrone level? They don't know what that is. They only have, you know, had their estradiol checked, which is not adequate. Much like, you know, when you are, are discussing, you know, thyroid and, and how— and maybe you can just, you know, touch on it briefly, like, what do you like to test for, for thyroid and estrogen and testosterone so the audience understands? It's not what you've been getting tested for that's the problem, is you haven't been getting tested for all the things that affect what Dr. Amy and I are talking about.

Yeah, absolutely. You know, 9 times out of 10, even if you go to your general practitioner and you say, "Hey, doc, can I have a thyroid panel done?" You're going to get TSH and maybe free T4. And those are actually the two markers that I really don't even care about. I'll look at them, I'll glance sideways at them. But when it comes down to getting you actually optimized in that thyroid hormone replacement and getting your body optimized so that you're free of symptoms, the most important test that you can get, free T3. So that is measuring the unbound form of the active thyroid hormone that actually gets to your cell and turns it on. So every single cell in your body has a receptor site on it for thyroid hormone, but specifically for T3. So that's important because like I mentioned earlier, maybe you were given T4 only and you're on Levo or Synthroid and you're like, well, this isn't working. That's because T4 only, T4 monotherapy works in about 2% of those with low thyroid function. 98% of the rest of us need either T4 and T3 in some combination, whether it's NDT or let's say Synthroid and Cytomel. Combined or T3 only in order to actually get optimized. So we wanna look at that free unbound form of the active thyroid hormone, free T3. We wanna look at reverse T3. Now this is important because this is your survival mechanism. This is your anti-thyroid hormone. So let's say that you are seriously inflamed, you're insulin resistant, you're estrogen dominant, you're an autoimmune ball of mess, any of the above scenarios. Your reverse T3 will most likely be high. And what that does is it actually blocks that active thyroid hormone from getting to the cell to do its job. Because here's what it, it basically is built into our system for reverse T3. We need it because if you're laying there, you've been in an accident, you're injured, you're traumatized, you're fighting for your life. Our body knows that during that time, You don't need to burn fat. You don't need to feel energized. You don't need to think to make major decisions. You don't even need to poop every single day when you're laying there fighting for your life. So reverse T3 goes up specifically to shut down all of those systems that you don't need right now. The problem is, is if we give you enough T4, or if you are a non-converter, I'm a non-converter. I don't convert T4 whatsoever to T3. Yep, that's what the body's supposed to do. In some people's body, it just doesn't do it properly. And there is a genetic snip that we can test for that as well. But if you don't convert properly and you're going to see your doctor and your doctor just, oh, okay, Susie, um, instead of 50 micrograms of T4, we're gonna give you 88, and then we'll give you 112, and then we'll go to 125. And you're like, what? You keep going up in my medication, I keep getting worse. No one's testing your reverse T3. All of that T4 is getting pushed over to the survival mechanism hormone reverse T3, and it's shutting you down and it's making you worse. So it is vital to test reverse T3. And then we want to check for Hashimoto's. So those two antibody markers are TPO, thyroid peroxidase, and TG, or thyroglobulin antibody.

So Amy's told you something that she's really said the quiet part out loud. Like when I have people come in and they tell me all their labs are normal, I'm usually, you know, pretty underwhelmed by that because, uh, those labs have not changed. I'm 55 and those labs haven't changed since I've been alive. They're basically the same things. And what she did mention is, uh, genetics. So SNPs are just single nucleotide polymorphisms. They're changes in your genetic coding that actually allow you to do what you need to do and are under the influence of different factors. But I think both Dr. Amy and I concentrate both on very, very detail-oriented in both testing and listening to patients and their, you know, what they're experiencing. Because patients, if you listen to them carefully enough, will tell you exactly what's wrong with them in the majority of the instances. And I will have her, because she's an expert on all things hormonal, so I'm going to have her touch on both the— what she kind of sees in estrogen toxicity coupled to testosterone suppression so that it's It's clear. And then I can add what I see all the time.

Yes. Okay. Yes. So sorry, I forgot to mention the sex hormones as well. Testing-wise for sex hormones, I like to look at total estrogen. So ladies, you have 3 estrogens. You have estradiol, which is E2. That's our most potent estrogen. That's the one that we really want to look at, especially in menopause, perimenopause, because as that number starts to drop below a 50, 5-0, you're in an estrogen-depleted state. But we also want to check estrone because that is more of the— we never want to call an estrogen bad, but if we're looking at potential rates of cancer, estrone or E3 is the more potent kind of growth-producing estrogen. And then estriol, that's usually only present during pregnancy. So we take a glance at that, but we like to look at that full estrogen picture so we can know you as a woman, how are you producing your estrogens and what are they doing in your body? Then we wanna look at progesterone, free and total testosterone. And then I really like to look at dihydrotestosterone and SHBG because I wanna know if all your hormones are stuck to a sex hormone binding globulin train. And they are just traveling around your body and can't actually get off the train to do it, do their job. And that kind of goes back to what you mentioned earlier, Rob, about, you know, okay, your hormones aren't working. Are the hormones actually getting to the site where they have to do their job, do the work? So that's one marker that we can look at to see if your hormones are bound up tightly. And then DHT is dihydrotestosterone, and this is gonna be for males and females. When DHT goes up, in certain cases, if someone pushes their testosterone down what's called the 5-alpha reductase pathway, you can produce more DHT, and that can contribute to hair loss, male pattern baldness, acne if you're taking TRT, dark facial hair in women. So we want to pay attention to that. It doesn't hit every woman. I mean, I have some women with elevated DHT and they're like, I'm fine. I, I have no side effects whatsoever. So it doesn't hit everybody. But in those that we see, like, oh, you know what, there's an elevated DHT here. Before we start you on testosterone therapy, let's bring in some saw palmetto, some nettles. Let's bring that DHT down and make sure that we push your testosterone down the proper pathway so you don't have side effects.

And so that's a super important thing because I've heard we've discussed it too, like if you have too much DHT in your patients, what are the, you know, whatever, top 3, 4 side effects they would experience?

It's the I'm growing a beard, right? Like, I think I need some laser hair removal on my chin and then cystic acne and then hair loss. But for women, so when a man's DHT goes high, we'll see that typical male pattern baldness. In the front. When a woman's DHT goes high, she gets more of like thinning at the crown. So her hair will just kind of thin out or she'll get little bald spots at the crown.

Yeah. So that's what I was trying to get to, to say that part, because this is very distressing when— and it doesn't happen. Obviously, there's lots of reasons for this to happen. But this DHT, you know, what Dr. Amy is talking about is something that really unsettles people. So women, you know, and men, obviously, when they're experiencing hair loss, there's a lot of emotion around that. And I get that a fair amount. That's also one of the reasons where people come in to me and they're like, woo, went off of, you know, replacement therapy because of this. And so your point, like, if you didn't look at all of that or didn't understand that maybe from their genetics and you just indiscriminately, which a lot of clinics around the this country do is just put people on, on replacement. And I know your preferences for shots, and I differ in this because I have so many people travel from outside of Texas and outside of the country. So I'm, I'm a little bit different in terms of, you know, what I'm looking for, for the window of time initially for recovery. So I'm trying to, you know, for everybody listening, I try to have max control around the 90 days of the, the first part of surgical recovery so I have enough hormone on board. And, you know, I think people probably find it a little odd that I talk so much about protein and amino acids and sleep and heck yes. Yes. You know, for me, pretty commonplace. But so if, if everybody listening, so none of your hormones will work if your gut doesn't work and if you don't have the proper supplementation and your gut doesn't work, you got zero chance. At all of anything working properly. That'll affect your sleep, your mood, your anxiety level, your, your overall, uh, performance, if we want to think of that, for activities of daily living or just interacting with, with others. So it is a, a very, um, not an uncomplicated, uh, situation to, uh, go through. And, um, I really appreciate you coming on my show and really enlightening Everyone. And that's why I send people to Dr. Amy, because I am not the thyroid expert and don't claim to be one. I want to thank you for coming on the show. Do you have any— oh, where can everybody go to find you?

Yeah, absolutely. So you can go to dramie.com, D-R-A-M-I-E. And on there you'll find all the resources that we have. We have free resources. We have the podcast, of course, Thyroid Fixer Podcast that Dr. Rob was on as well a couple of times. So you, you can dive into those episodes and learn so much. We have a public Facebook group called Just Fix Your Thyroid. In there you can jump in, you can post your labs and get feedback. If you're not quite sure what's going on with you, you can get answers in that group. I'm in there answering as well. And then if you do want to take it the next step further and you don't feel like you're getting proper care by conventional medicine, We prescribe to all 50 states. We prescribe to most of Canada. So we can do all the labs, all the hormones, all the thyroid, and really get your body up and ready. And last thing I'll say, Rob, I just wanted to comment on, on, on your last comment. You know, I, I feel like these hormone clinics are like when somebody goes to get plastic surgery and they get botched and then they come to you. It's like, that's what we see in the clinic all the time, are these people going to these hormone clinics. They're being treated like cattle. Here, same hormones for everybody. Here you go. Here you go. And they're not— there's a lack of follow-up. There's a lack of testing. So you really— my public service announcement for your audience is just be careful because thyroid treatment and hormones really are a nuanced art. And just like Dr. Rob said, it's not an uncomplicated case. It has to be nuanced and tied to you, and we have to figure out what you need, and we need to ask you how you're feeling and what your numbers look like. It's not a one-size-fits-all.

No, it's not. And, um, if y'all comment on this, whether it's on YouTube or in the, in the other platforms we use, I will answer them. And when I can't, I will ping, you know, Dr. Amen, we'll get it answered for you. The All this will be in the show notes for you as well. And once again, thank you so much for coming on, Dr. Amy.

My pleasure. Thanks, Rob.