Normal Thyroid Labs, Exhausted Life: What Your Doctor Isn’t Telling You

Welcome to Integrative Medicine with Dr. Leland Stillman. This show is for men and women who are exhausted, inflamed, living with brain fog, gut or skin issues, and who won't settle for answers like your labs are normal or just take this pill. Here we focus on the root causes of disease and on what I call repair deficit, the gap between what your body needs for optimal health and performance and what it's actually getting. This podcast is not personal medical advice. It is education to help you ask better questions so you can make better decisions about your health. Thank you for joining us and welcome to today's episode. Hello everyone, Dr. Stillman back for another episode of Stories of Hope, Stories of Healing. Today I am joined by my friend and colleague, Dr. Amy Hornaman, who I'm delighted to be interviewing today. Dr. Hornaman is a functional medicine practitioner and thyroid specialist known as the Thyroid Fixer. Her focus on thyroid health grew from her own experience of years of misdiagnosis before receiving cancer diagnosis later on. She's the founder of the Better Thyroid and Hormone Institute, host of the Thyroid Fixer podcast, and author of The Thyroid Fix, published this year, just last month in May 2026. Dr. Hormann, I like to start by asking everybody who they are and where they're from.

Well, so you already told everyone who I was, which I love. Thank you so much. But I am from now Des Moines, Iowa. So now I am officially a Midwest girl, born and raised in Pennsylvania, but moved to the Midwest and have totally embraced it because of, you know, the Midwest nice. I love the Midwest nice. However, when I tell people that I live in Iowa, number one, they're like, is that the potato state? I'm like, no, that's Idaho. Oh, that's Idaho. I get it. It's all I's. We're the corn state. And basically we're like the glyphosate state. So people are amazed that I live here because I guess our water is like the number one worst water in the country.

Yeah. But you've got a governor candidate, Zach Leland Stillman, I want to say, who's tackling that head on. He's a bit like— it's a bit like, I don't know, taking on the dragon in its lair.

Let's just say, big dragon. It's a big dragon because, I mean, listen, all of these fields, all of these farmers, and I mean, I know that this isn't a podcast about Monsanto and the government, you know, but let's face it, they're all using glyphosate and they're all using GMO seed, and it just is what it is.

But the fact that he won at all tells you that there's a real problem there. And the fact that he won as a Republican, when that's typically an issue that Democrats will go hard for, really tells you something.

Yeah, I think the Maha movement is starting to shift things. I mean, whether you like it or not, I mean, there's pros, cons, all of that good stuff with that.

Sure, it's also a big movement.

But it is waking people up to their health. I mean, the bottom line is it's waking people up to the importance of, contaminants in our drinking water and maybe actually paying attention to that. So if it, if it brings the collective mindset up a notch to go, you know what, yeah, I don't want to be drinking water and giving this to my children with cancer-causing ingredients in it. I mean, then, then that's a positive.

Yeah. And I also think, you know, it's, it's just the reality is what is this all about? It's about having quality time with family. And being the person that you want to be. And when you're riddled with cancer and autoimmune diseases because your water's contaminated, it doesn't matter what the price of corn is. You don't care. So people are just making the rational decision. I feel like they're making it in the 8th inning, and I wish they'd done it in the 2nd, but here we are. So you have an interesting story behind your thyroid— first your diagnosis and then your, your recovery. And I'm— I really want to dig into the first part of this specifically because there's so much, I think, for people to learn. Who were you? Where were you? What were you doing when you first— how were you first developed symptoms of low thyroid?

So I was in my 20s, and at the time I was, I was a massage therapist, personal trainer. You know, I was still into the health and wellness space, and I always loved that whole area of nutrition and health and, and, and changing our bodies and our body composition. But I wasn't deep into functional medicine at the time because functional medicine wasn't even a thing back then. So I was just basically taking care of myself and working out and studying this thing called nutrition and helping other people. And I started getting into competing. So I started to see these girls at the gym and they would, they would be in these beautiful sparkling bathing suits and they're posing in front of a mirror. And oh, they had these beautiful capped shoulders and six-pack abs and they're posing. They just look gorgeous. They're all tan. Their hair is done up.

I'm like, where were you? Was it Pennsylvania?

This is back in Pennsylvania.

Yeah. Where in Pennsylvania, by the way? Might as well ask.

Pittsburgh. Pittsburgh, PA. Pittsburgh.

Got it. Okay.

So down in Pittsburgh, and it was pretty big. Bodybuilding was pretty big in that town because the— anybody that knows that the arena, the NPC and the IFBB, basically the beginnings were in Pittsburgh, Pennsylvania. So a lot of competition there, a lot of shows. So it's really easy to find a trainer. I happened to be dating a trainer at the time that I was like, I want to compete. He did the whole show prep contest diet thing for me. And basically that's— it's really, really, really strict. So you're eating chicken, broccoli, asparagus. You're counting your macros like nobody's kind of macros before. You pack your food in a container to go to a restaurant for goodness sake, because you— you don't even want to eat the food at a restaurant because you don't know what they put on it.

Yeah.

So you are like hyper-focused, hyper-disciplined, hyper-controlled.

Question for you.

Yes.

I want to know, what was it about health and wellness that fascinated you to even become a massage therapist and then get into personal training and nutrition?

Deeper, uh, because I was a fat kid. No joke. No joke. Like, I took— if you looked at my family, you know, my grandpa died on the operating table during a heart operation because he had uncontrolled diabetes. Like, my whole family was obese basically, or struggled with weight.

Mm-hmm.

So I was no different. I mean, I grew up eating Lorna Doone cookies and French vanilla ice cream. Yeah. After every single dinner. You know, Pittsburgh, that was, well, this is back in Erie, PA, so I was born and raised in Erie, Pennsylvania.

Worth noting, that's where my family was. A very old industrial town. We see the toxins in people in these towns. It is not a joke. It is a real thing. And so I partly ask these questions of guests, but I also ask them of patients because like we have a really compelling case study from Western Pennsylvania of a whole family that because of the way that they're, they're, I think we, we're not really even sure. It's like we know that they've got mine tailings that are contaminating the water under their home and there was a machine shop somewhere and we think that's where the cadmium came from. And these kids are, and this is like a lot of my patients. They go to health conferences, they read books, they listen to podcasts, they eat organic, healthy, you know, non-GMO, cruelty-free, soy-free, dairy-free, not necessarily dairy-free, like, but they'll drink like raw milk. They're really going above and beyond. Right. And they still have these big contamination problems and it's a huge issue.

Yeah. Oh yeah. No, we're, we're, when I was growing up in Erie, we had Hammermill Paper Company. And it's funny, all of these in industries are somehow on the water. As well. Like, they're literally on the Great Lakes, so you know they're dumping, right?

Yeah.

So Hammermill Paper Company, which by the way, when you make paper, you use a lot of chemicals, it turns out.

Yes.

Then we had GE, which was making locomotives and, you know, different— I, I forget, I don't even know all the engines, all the different things that GE would make. I mean, we had multiple industries right there in a very, very small town. It's a very small area, very small town. So absolutely. I mean, we call that whole stretch of the Great Lakes the Goiter Belt, but now we're also calling it the Cancer Belt.

I don't think you guys can claim that because we also got the Carcinogen Coast down on the— I guess it's different coast, you know.

Oh, I haven't heard that one.

The Carcinogen Coast is the stretch of coast between— I would call it— it's really tough because the prevailing winds. So like Texas, Texas is a really interesting geography. You have some uranium production in the western part of the state and that gets blown over, I think, to the East Coast, but don't quote me on that. And then the whole Gulf Coast is industrialized from about Houston to L— to Louisiana and New Orleans. And then east of, of Mobile, it's really deindustrialized. It was all paper production. So there's a ton of cancer along the Gulf Coast.

Mm-hmm.

But anyway, that makes sense.

That makes sense.

Yeah.

So yeah, that's where I grew up. Moved to Pittsburgh, lived there for like 18 years. And that's where I was doing the competing. Now, Pittsburgh does come into play in the story. So I'll bring that back in, the importance of it. So when I was competing, so I got into competing, really like this whole, let's change my body. Let's, and I love challenges too. Like give me a challenge and I'll, I'll take it on, typical type A. So I really wanted to see where I could, where I could take my body comp doing these shows. And I fell in love with it. I did that. I did fitness modeling now because I was always, because I'm short, I'm only 5'2". And because I was a fat kid, I would always have to diet down. I wasn't one of these long, lean, beautiful ladies that all they had to do is lift some weights and eat some carbs and call it a day. Their muscles pop out and their six-pack abs show. I really had to bust my butt. So I was doing the two-a-days of cardio. I was packing my food. I was being super strict. And my body had responded multiple times. I did plenty of shows. So I decided to go more national level this time. I wanted to compete in one of the big shows and I hired a coach, a trainer that was is known for training ladies in this whole fitness and figure realm. And you know, when you're— when you hire a coach for anything, business, health, whatever, you trust them. You're checking in with them. You know, they're really staying on top of you. I had to send in my weight. I had to send in progress pictures. So I'm doing this, I'm getting ready, and every time I'm stepping on the scale, it's going up. You know, at first you're like, All right. Um, I don't know, maybe I ate too much salt.

Yeah.

Maybe I had too many carbs yesterday. I'm retaining water. You blow it off. And then, you know, things are getting tighter. So you, you start kicking up the cardio, like, all right, I'm going to go an hour this time. Maybe I'll go an hour and 15 minutes because that makes a difference. And I'm checking in with my coach and he's not believing me that I'm staying on my diet. He's literally thinking that I'm lying to him and cheating on my diet because the scale shouldn't be going up when I'm doing when I'm doing the planned out diet plan, it should not be causing weight gain.

Did he put it to you as, as he thought you were lying?

You know, it just little comments here and there, you know, like, well, are you sure you're tracking everything? You know, like, are you, did you, it's okay if you had a cheat meal. Did you, did you cheat like too much? You know, eat a whole pizza, whatever. I was like, no, I didn't even take my cheat meal this weekend because I'm too freaking frustrated that the scale's going up.

When or, or, and if, if he did, when did he finally say, maybe you have a genuine medical issue that should be diagnosed with some lab testing and exam?

He never did. That was it.

No kidding. That shocks me.

Yeah.

Because I would think that in that position, he would, he would, he would run into that enough that he would know.

You would think so. You would think so. Mm-hmm. But, and, and, you know, I don't know if I was one of the first to have this problem during a prep. Maybe, you know, we, we saw a lot of thyroid conditions come up after somebody competed. You know, when you go through that type of restriction and then almost kind of binge eat afterwards, the body will drop 20 pounds and it'll put on 20 pounds like that. I mean, I've seen people spring back 20 pounds in a week, which obviously isn't healthy for the body. So sometimes the thyroid can react to that and we'll see a thyroid issue show up after, you know, because of the trauma and the stress that the body goes through. I don't know if he ever saw somebody during, yeah, contest prep.

We say sometimes you don't have a thyroid problem, you have a thyroid result.

Yeah, canary in the coal mine, because the thyroid is, is literally responding to everything that you do.

Yeah.

So if you're restricting your calories and pounding your body with CrossFit or on the Peloton, then your thyroid's going to respond to that. Absolutely.

Yeah.

But yeah, this is the first time it was— I, I think it was the first time it was happening during contest prep. So I went You know, I went to my doctor, I started there. So I start with typical PCP and I get told you're normal. It's fine. Everything's great.

Did they do any lab testing?

You know, I'm sure they did. You're sure they did. And I would love, I would love, I know they told me it was normal, but I would love to go back and see what they tested. I mean, you and I can guess.

Did you have any other symptoms than the scale going in the wrong direction?

I had the fatigue and the hair loss, but it's almost like, and, and my ladies out there listening will resonate. You don't even care about that when the scale is going up, up, up, up, up, and it's go— you're like, it's all right, I can put in extensions. Can— and I'll drink another Red Bull. Can the scale just keep— can it go down? Like, can it stop climbing, for goodness sake?

Yeah.

So yeah, I did have the other symptoms, but I just didn't care.

But it sounds like just a few, and they must have been not that bad.

They were— well, the scale actually went up 25 pounds before I stopped getting on it. I'm pretty sure I gained 40.

Wow.

Total. When I look back at some of the pictures, I'm like, that's not a 25-pound weight gain. That's a 40-pound weight gain. Yeah. That's, it kept going after that. So severity of the weight gain was extreme. I didn't get the whole cluster of symptoms, like the constipation and the brain fog and the depression. Well, I was depressed because I was frustrated, but I know I didn't have like clinical depression.

Yeah. Yeah. So then what happened?

Well, you know, you hear about this second opinion thing. Mm-hmm. So you go to doctor number one and they tell you you're normal, everything is fine. You leave, you're like, that doesn't resonate with me. It's just not sitting well.

Okay. And this was what approximate time period or era?

Oh gosh, this is late '90s, early 2000s, early 2000s.

So you had, did you have got doctor, I think you had Dr. Google by then.

We did have Dr. Google, but I joke that it was on like a dial-up gateway computer. You know?

Yeah, I know.

Terrible noise it makes. So we definitely didn't have podcasts. We didn't have AI. We didn't have podcasts.

Yeah.

We did have Dr. Google. But I, I still started though. I started just going to doctors. Like I wanted to do the in-person, test me, please tell me what's wrong. So I went to a total, a total of 6 doctors who all gaslit me, dismissed me.

Just, wow.

You're fine. You're normal. One of them said to eat less and exercise more when I literally brought him in my, my diet plan. I'm like, please look at this.

How much time did each of them spend with you on average?

5 to 7 minutes.

Okay. How many of them did a thyroid exam?

It wasn't until doctor number 7 that someone touched me.

Good for them.

Yep.

Not, not the 6 that before, but number 7.

Number 7. Number 7 finally laid her hands on my throat.

And she, was she a regular PCP or what?

She was an endo. She was another endo.

Oh, okay. So you have to endo.

This is all a mix of like PCPs, endocrinologists, OB-GYNs, and how did you even get into the endo though? How did I what?

How did you get into the endocrinologist?

Oh gosh.

Were you just not taking no for an answer? Were you just not accepting the medical gaslighting or the, I can't stand this, the, have you mistaken your Google search for my medical degree?

Exactly. Oh, you know, that's a great question. I don't know what kept me going. I, I just tenacity and, and, and I wasn't going to accept that this was my fate.

Uh-huh. You know, did you have a belief that no matter what you were gonna solve the problem?

Absolutely.

Where do you think that came from?

I think it's innate. You know, I think it's part of, uh, my husband and I talk about this all the time, like the drivers, you know, the doers.

Yes.

The drivers, the people who, who get stuff done and keep going no matter what.

Yeah.

It's born in. I mean, yes, I think nurture and environment can bring it out of you and make it stronger, but I think you have to have that innate tenacity that you're not going to accept the norm and you know how things should be and you're going to push for the right thing all the time.

Yeah, absolutely. I make a point of, I usually don't do it explicitly. Like I don't, I don't hand somebody the line. That you just gave us. But I, and I mentioned, I make a point of this on every podcast because it became very apparent after like 3 or 4 of these episodes, it didn't take very long, that everyone who had a compelling story had this like, oh yeah, I was not going to settle for this mediocrity. There was no way. I would like crawl across broken glass, like go to the ends of the earth, climb K2, you know, whatever it took.

Yeah.

And yeah, so I'm not surprised. We're only at minute 18. It's clear that that's part of your personality.

Well, and you know, and it's, it's almost like, and I know you're doing this through the podcast too, I love giving hope. Like if you don't have any here, borrow mine.

Yeah. Yeah.

And hold on to that. You know?

Absolutely. That's why I do this podcast series.

Exactly.

Because so many, so many people are just thinking I'm broken. There's something wrong with me. I've been to everyone. I've seen everybody. I've tried everything. And we hear that. More often than not, we have, we track how many people people have seen and the average is 4 to 5 doctors. And so we've got people with like 30 and we got people where we're their first stop because they just happened to find us.

So, oh yeah, absolutely. You know, and I think telling people, giving them this message that we're giving them now and that you give on the show is so important because without that hope, you do stop. And believe me, I think many, many times, what if I would have stopped? And even doctor number 5, I mean, that's 5 licensed medical professionals who supposedly know medicine.

Yeah.

And bring back in the Pittsburgh thing. I was in a major medical system. I was in UPMC Pittsburgh, which is the equivalent to everybody rushes to Cleveland Clinic or Mayo Clinic because they think that's where they're going to get the best of the best care. I was in UPMC Pittsburgh, a top-notch medical system.

It is.

And I was still misdiagnosed 6 times and I still wasn't treated correctly on the 7th time. I was given standard of care treatment on the 7th time, which didn't work. So even being in the best of the best healthcare system, you can still get tossed around. And, and just because you have 6, 7, 8, 10 doctors tell you that you're normal, everything is fine. There's nothing we can do here. You don't accept that. You keep going.

Well, I have to say, I think that institutions undergo a kind of institutional rot, and Nassim Taleb has written about this. His work has been very shaped, very much shaped what I think about it. And it's just a sad reality of institutions that as they get bigger and older, you know, people want to be a part of it who are not necessarily brilliant and smart and clever. And then the brilliant, smart, clever people are having new ideas that upset the apple cart of the existing paradigm. And they're all, they all burn out in that system. Like I burned out. I was destined for academia. I thought I was destined for academia. I wanted to become a fellow and this and that and stay in academia and do studies. But I just got to a point where I said, I am not really helping anyone here. And all of it is, is disturbingly controlled. Even when I was leaving, I said, there's just things you can't say. Like they'll, they'll just, they'll cut your funding or they'll, they'll just not approve your funding, which I think is different, like stealing funding someone's already had rarely happens, but just not renewing grants, deciding to renew the competing lab, whatever. It's real. And it's part of why our scientific— I don't know what to call it— our scientific literature has gotten so— you know, people will say, well, there's no evidence for that. It's like the people in charge of looking for this are not looking for it. They believe a priori that it doesn't exist. And if you bother to step into the real world and try something different, you'll be shocked at how undeniable this is. And like, case in point, you know, you take 100 people on levothyroxine and you put them on natural desiccated thyroid and they'll be like, I had no idea I had brain fog and fatigue. And I just thought I was lazy and overweight and a couch potato. And I didn't even realize that I was wearing an extra sweater half the months of the year. And oh my gosh, My hair hasn't been this thick since I, I just thought that I was getting older, but it's just so consistent that it's actually a bit infuriating when I listened to your, in prep for this, I listened to your episode where you commented on Peter Attia and I can't remember the other guy's name.

Antonio Bianco.

Mm-hmm. Yeah. Their, their podcast on thyroid hormone. And I, I, I knew I was gonna have a good time talking to you when I heard your take on their podcast, cuz I was like, oh, we're having the same experience in our practices. Mm-hmm.

Yes.

Yeah.

Yes, exactly. Well, and I like to talk about this in the book too, about functional medicine, now we have, we're, so we, we've, we've kind of enlightened people to the fact that we now have an alternative. We have this functional medicine, which was birthed out of integrative medicine, naturopathic doctors, alternative medicine is what it was called back when I was, I was in the system and I was being misdiagnosed and decided to trash conventional and, and go the route of, of functional, but we didn't even have the term functional back then. And so I think the, the awareness is fantastic, but we also now we have a whole other kind of responsibility to our audience in educating them what to look for in functional medicine. Cuz now we have conventional docs using the term functional cuz they just don't wanna bill insurance anymore.

Ooh.

But they still treat conventionally. And that's really what we ran into. Yeah. With Peter Attia and Antonio Bianco in that it was positioned as if this is a functional medicine talk cuz that's what Peter Attia was into. Right. And. And yet when you listen to it, it's like, no, no, no, this is just going to ingrain more conventional thinking into people's minds. And to your point, they're going to believe that the way they feel is as good as it's going to get because they're taking their Synthroid every day and their TSH is down. And so everything is good, but it's not the case. And that's what this book is about, is just really enlightening people to the fact that you can feel better and you don't have to live with a new norm of mediocre. You don't have to live there, right?

Let alone a new norm of 40 extra pounds, right? So the endo— and that's endocrinologist, by the way, for people who are not hip with the lingo, which means a doctor who specializes in hormones of all varieties— lays hands on you, detects a thyroid nodule, right? Yes. And then what happens?

Well, she says, okay, so you have a thyroid nodule. We're going to get an ultrasound done. But according to your labs, whatever those labs were, You have hypothyroidism. Here's a pill.

Uh-huh.

And so of course I left her office super excited because now I had a name.

Yes.

For what was going on with me. I had that diagnosis.

Yes.

And I had a pill that I thought was gonna be a game changer for me.

Uh-huh.

That pill was T4 Synthroid, Levo. And I took it religiously for 5 months and it didn't do a thing. So that's when I went to Dr. Google. That's when I started searching and I, and I found out, I'm like, wow, okay. So she gave me this inactive thyroid hormone that literally does nothing in the body. We don't have a receptor site anywhere.

Yeah.

For this T4 thyroid hormone. Yeah. It has to go through this metamorphosis. It transforms, it becomes the active thyroid hormone, T3. And then I'm reading some more and I find out, oh wow, there's, there's a medication, there's a hormone out there. That can be prescribed to me called biothyronine that is T3. I'm like, oh, that's interesting. Okay. And then there's natural desiccated thyroid medication that has T4 and T3 in it together.

Yeah.

So I go back to her, I'm like, you know, it seems like there's these other treatment options outside of one pill.

Mm-hmm.

And T3 is the active thyroid hormone. It just makes sense.

Mm-hmm.

Why don't we put it together? And she says, that's not standard of care. I don't do that.

Yeah. So to give people a little bit of background, because we're using some lingo here, T4 is inactive, T3 is active. T4 has to be converted to T3. If I had to give you an analogy, like, what is T4 to T3? If you're not familiar with the gasoline you put in your car, it comes from something we call petroleum. And one of the, one of like the varieties of this is called Brent crude, which is like a type of gas that gets pulled out of the ground and then refined into gasoline, jet fuel, everything, right? Giving someone T4 is a bit like giving them Brent crude. You can't put it in your car. Now, some people seem to be able to convert it well, and some people cannot. It's more— this is in the book. I don't want to geek out about this too much because it's— we have so much to talk about. Read, buy the book, read the book. And so some people can convert it, but a lot of people don't. And so I was— I mean, I saw this in my conventional training too. I put people on thyroid hormone, they're like, I feel the same. I'm like, how can you feel the same? I gave you the thing that resolves the problem that you presented with and that I diagnosed you with. Why are you the same? Quick pause. If you're listening to this and thinking he's talking about me. I'm tired, foggy, inflamed, and it feels like no one can figure out why. Then your next step is not another random protocol. It's a structured assessment with myself or a member of my team. Go to stillmanmd.com and click book a call. Pick a time that works for you and add it to your calendar. On that call, we'll look at your story in more detail and see whether our framework is a good fit for your situation. If it is, we'll outline what a realistic path forward could look like for for you. This is not emergency care, and it's not a promise of cure. It's a calm, structured way to stop guessing and see whether our approach is right for you. We have a limited number of these appointments each month. If this conversation is hitting close to home, visit stillmanmd.com now and book a call with myself or a member of my team. Thank you for listening. Now back to the episode. So what happened next? So I fired her, and by which you mean you did not go back, right?

Yeah, I said thank you., but I'm going to find someone who actually will do this because I really felt in my gut that this is what was needed. Yeah. And I kept hearing the name of this integrative practitioner. You know, it's like when, when, when God starts to send you a signal, you listen. When you hear the name 3 times of somebody, maybe give them a call. So I kept hearing them like, okay, okay, I will go. And, you know, Dr. Leland Stillman, at the time, I, I talk about this all the time. More so in the context of where people's mindset is right now with insurance. You know, they all feel like I have to use my insurance. I have to use my insurance. I pay a premium. I have to use my insurance to get help. I remember vividly, I was making $300 a week. I was in my 20s, like, for goodness sake, like I was just starting out and I was making $300 a week. And this functional practitioner at the time literally had like a $900 entry. You know, because he was gonna spend 90 minutes with me and do all these tests and all of that.

But that's a lot even back then.

It's a lot, right? Yeah. But he was like, that's the best. And I'm like, yeah, I gotta, I figured it out. Like $300 a week. I basically spent 3/4 of my monthly income.

Yeah.

Finding, being able to go to this guy and he sat down with me for 83 more minutes than any other doctor. And and went through 10 additional pages of labs that no other doctor had pulled before and really explained to me what was going on in my body, that I wasn't converting well and that I needed something different. This is why the T4 only wasn't working. And we did nutrient support and, and we looked at everything. And I just remember just sitting there amazed that he was, he was putting the pieces of the puzzle together in a way that made so much sense and that I could understand.

Yes.

And, and I loved it, but I was also really angry that I had gone through all this time and all these doctors, and here he was explaining it to me in such a simple way. And it's the same way that what we do with our patients now. It's like, yeah, that's, it's black and white. It's, it's right here. It's clear for us. And, and like you and I could look at thyroid labs and interpret them with our eyes closed and hands tied behind our back. But why is it so hard for a conventional doctor to just look at what we look at. Well, number one, they don't test. I know. But if they did, if they actually tested everything, like, it's right there in black and white. But unfortunately, conventional medicine is still going by the standard lab value range. He wanted me optimal. So that was the big thing that I took from, from sitting with him is not only understanding my body, but also understanding that where I fell in those lab ranges, I didn't want to be normal. And I joke in the book, I say normal is a setting on the dryer. It shouldn't be used to describe your health. Or your laugh.

I love that. That is so good.

You know, so I think that was, that was the big change for me is having someone that listened, having someone explain to me what was going on, having someone for the first time ask me how I feel and care about it. And then actually breaking out of the standard of care model for treatment and using what my body actually needed versus checking a box for big pharma.

So what did they start you on?

I actually started on Armour. So I started on natural desiccated thyroid medication, which is a blend of 80%, roughly T4 and 20% T3. Mm-hmm. We started there and like many people, I see this in my patient population too, I started off really good. Like it was a beautiful shift from T4 only to Armour, but then over time my body didn't like it anymore.

Really?

And it turns out that I have found out many years later, cuz we didn't have this type of genetic testing available in the United States at the time. Now we do, I know I have a DIO1 and DIO2 SNP, so that actually gives me the propensity to not convert very well. Mm-hmm. I am now on T3 only. I have been from really for, I, I don't even know, 17 years, something like that. But I am now T3 only. So it was a little bit of a trial and error.

Yeah.

You know, moving from the T4 to the Armor and then eventually T3 and T4.

Yeah.

And then every time I would put in like 12.5 micrograms of T4. I would gain weight and become clinically depressed. So then I would pull that out again. Yeah.

I love that. I love that you're open to talking about that because I, I, I, I didn't really think I would share this, but my journey with this was you get outta training and, and, and someone smart ahead of you in the integrative field says to you, oh yeah, by the way, that levothyroxine you've been throwing around since residency is garbage. Don't use it. Use, put everyone on Armour. You'll be fine. Like, I'll, I'll never forget this. This is from Ty Vincent, who I consider a mentor and a friend.

Yeah.

So I was like, I would just put everybody with hypothyroidism, a prior diagnosis, or they, they look like it on like, I think it was a half a grain. And he is like, I just told them to go up. I don't remember exactly, but they went up by a certain number of dose, a certain dose increment every week or 2 weeks or something. Yeah. Until they felt good.

Yep.

And I was like, huh, there's nowhere else in clinical medicine that I was taught to like treat the patient to the endpoint they want. You know, and there's a lot of different ways to dose this, and we could probably geek out about that for a while. But that was where I started. And then I had patients coming to me saying, I still don't feel well. And I would look at their free T3s and I'm like, this is still low. What am I going to have to do to make this go up? And then they started to come to me with, hey, I read this book about free T3 therapy, T3-only therapy. It works really well. Will you prescribe that for me? And I said, yes, so long as you understand that I don't have the body of evidence to support its safety. That I do for other things, I'm comfortable. So we had that shared decision-making conversation, a lot of which to me is around uncertainty. And one of my questions I want to ask you later, not right now, because we could probably spend the rest of the podcast on that, is what we don't know about the thyroid and thyroid hormone, which is going to be really fun to unpack. But I just started to prescribe patients more along the lines of what they wanted to try based on what they were thinking, feeling, and experiencing. And it was, quite candidly, it was a mixed result. You know, people would try this and try that and not feel better or feel worse. And I'm sure a lot of this comes down to genetics that we haven't really gotten in our practice deep into testing that you're obviously up on. But I also wondered along the way, like, do I really need to test everyone's genetics? I can try them on all of this, you know, for very little money, and they can then tell me what works best.

Yeah. Yeah.

What are your thoughts?

Yeah, you don't have to check genetics every time. You really don't. I mean, I talk about it in the book, even just going trial and error, because as we know with genetics, even with those, those Diodonase SNPs, it's not a sure thing. Like all genetics, like you can have the SNP, but that's not your fate. That doesn't mean it's going to happen. So you have to do the trial and error thing. So I'll always look at, I'll look at a person's reverse T3 and see where, where that's kind of floating based on how much T4 we have in, whether it's in the form of levothyroxine Synthroid or whether we're, we're using NDT. You know, we wanna look at that reverse T3 and then we go by how they feel. And sometimes I'll, I'll tell patients to do the trial and error method that I did.

Yeah.

Like, okay, we're gonna go T3 only to really bring down this elevated reverse T3 that you're walking around with and low free T3. So let's T3 only. Okay, you're feeling better. Awesome. Now let's try to add in that savings account. So sometimes I'll, I'll love your analogy of the crude oil versus the gas, especially when you're talking about the conversion.

Yeah.

Then I also talk about having a checking and a savings account where T4 is like your savings account.

Totally.

T3 is your checking. And because people will ask me all the time, well, why do I even need T4? I'm like, well, if you can handle it, it's nice to have money in savings, isn't it? It's nice to be able to have that, that comfort that you can pull from savings into checking. Whereas I have to live on my checking account. I'm always living on the T3 that I give my body every single day. So if we can have some in savings, cool. If we can't, not a problem. We work with that as well. So sometimes we'll add in that T4 and then I'll say, listen, monitor your feelings, monitor your body, monitor your symptoms. And if you go a week or two adding this T4 in and you're like, it's no different. I'm fine. Well, then we know, okay, you can add in your savings account. That's good. If you're like, my gosh, my clothes are tight. I just put on 5 pounds and I don't feel so good. Okay. Then pull it back out again. Let's pull it back. Yeah. Maybe we'll try it in another month or two. Right. And we'll give it another shot. But if we do this a couple times and every single time we add it in, you go hypo.

Mm-hmm.

Then you're T3 only. We'll just call it a day.

One of the questions that comes up most often is, okay, we've established that T3 with or without any T4 is working really well for them. And I know you've done a deep, deep dive on the literature on this. I've done, I'm not gonna say I've done a deep dive on the literature on this. I've read enough to satisfy my curiosity is what I'm doing at least reasonably safe with informed consent. I'm really curious your perspective on how safe is T3 only, and we might extrapolate that to richer mixes of T3 to T4, like more T3 versus less T4. What's your perspective on the safety data there? Like, what do you think the data actually says?

We've seen no issues anecdotally. Interesting. You know, and way back in the day, yes, we, because I think this was a theory that was taught in med school at some point, and then it was one of those that kept getting rinsed and repeated. Instead of actually someone looking at the studies and looking at the data.

Have you ever heard the saying that the truth— the— a lie gets halfway around the world before the truth has time to get its pants on?

I love that.

No, isn't it true though?

It's so true.

And it reminds me of another 2020. Yeah, boy, boy. Anyway, and that, that reminds me of another similar episode in medical history, which was the link between testosterone and prostate cancer. So, and the famous story behind this is that Abraham Morgenthaler and his colleague, they were going back and forth about who was gonna present the data showing testosterone caused thyro— prostate cancer, excuse me, prostate cancer. And he said to his collaborator, he's like, I don't have any of this data. Where did this data come from? And it turns out that it came from like one totally anecdotal, something like an animal paper that got filed away at someplace like Harvard. So it was a lot of authority behind it. But this whole narrative of a hormone causing a cancer was basically just based on one anecdotal observation from like the 1940s. And I think it was cows. And that led to this whole thing of testosterone causes prostate cancer. I mean, what a huge lie that's done so much damage to men. And I think of this when I think of thyroid hormone.

Yeah, yeah, exactly. I mean, the, the narrative was that T3 only or giving too much T3 or suppressing TSH levels will cause bone loss and AFib. Yeah, basically. So, okay. If you give T3 only, or like you said, the ratio is, is leaning more heavily toward the T3 to T4 ratio to an elderly patient who doesn't take vitamin D or magnesium and does nothing for their bones, doesn't do any kind of weight-bearing exercise, has no hormones on board. So she's already osteoporotic.

Yes.

Sure, sure. Yep. She might lose some more bone. Okay. But if you're taking a healthy person, even moderately healthy, and you're putting them on T4 because moderately— because actually fixing their thyroid is going to help with the insulin resistance and the obesity and the high blood pressure and the high cholesterol that you're giving statins for. So, we can even say moderately— give me your moderately healthy individual, I'll put them on T4, I'll reduce the amount of pharmaceuticals they need. And if we also address their hormones at the same time and give them basic nutrient support and tell 'em that for goodness sake, do some kind of resistance training, their bones will be fine. Totally fine. And they're not gonna go into AFib unless they drink 10 Red Bulls and pop extra T3 that they're trying to, you know, abuse because they wanna lose 10 pounds quickly. Like, no, the safety profile is there when it's used in the proper amounts. Same thing with GLPs. Like, yeah, you can, you, you can wrongly dose your GLP and get gastroparesis and lose all of your muscle and look like you're 80 years old cuz you lost your facial fat, or you can do it the right way and reduce your inflammation and protect your muscle. Yeah. And, and not look older and lose all your hair. You know, it's the dose is in the, the, what is it? The, what's the saying?

The dose makes the poison.

The cure versus the poison's in the dose. Yeah. Yeah, yeah, exactly.

Do you guys see hyperthy— active hyperthyroidism frequently in your clinic?

We just don't take those patients on. We'll refer them out. Cause we really specialize in hypothyroidism.

Good to know.

Yeah.

And I'll tell you why I ask, not only what I want them to know upfront listening to this, but also what I've seen in treating active hyperthyroidism cases. And I've had 3 in the last few years is that, you know, and, and let's make a really clear distinction and talk, you know, very, very basic. Hypothyroidism is low thyroid hormone levels. Hyperthyroidism is high thyroid levels. The vast majority of patients, at least that I see, who come in with hyperthyroidism, and I shouldn't, maybe I shouldn't say the vast majority, but they've either got a toxic hot nodule, which is a piece of thyroid tissue that's sort of lost its autoregulation. It cannot be sort of corralled back into normal behavior and it's just producing thyroid hormone sort of off the chain. And Graves' disease, which is an autoimmune thyroid condition that causes excessive release of the thyroid hormone. Taking care of those patients, what I've noticed is their free T3s tend to be crazy. Like 8, 9, 10, 12. For reference, the normal— normal, not optimal, for, for the, for the record— 2.1, 2.2, depending on how you ask, up to like 3.8, something like that, 4.2. So these people are like 2, 3 times the upper limit of, again, normal. And so what I recall from med school was if your patients have untreated hyperthyroidism in these very high levels of thyroid hormone, it makes sense that they'll get AFib and bone loss and all the rest of it. Due to that. But yep, this would be like saying, you know, you can't drive your car at 75 miles an hour because people tend to crash at 150. It's like, you know, I don't think that it's really fair to say that. This just doesn't add up to me. Right. So what I've seen in those cases is you treat the hyperthyroidism conservatively, medications, supplements is what we do. We've seen some great turnarounds without having to remove the thyroid hormone gland, the thyroid gland, which I've been very happy to see, and you get rid of the toxins and the other things that are, that are causing the autoimmune picture, and then people get better and they can go on about their lives. Sometimes they need some, some thyroid support, sometimes they don't. It just depends. I think that's where that idea came from. I also am curious, there was a, a study I did read where they looked at the higher the dose of T3, the higher the risk of this, that, or the other complication. But, and, and it was along the lines of what you mentioned, you know, hip fractures, AFib, heart problems. When I looked at that study, I said, like you pointed out, "Okay, you're taking all these people, you're putting them all in the same thing. We don't know anything about how much food do they eat, how much protein are they getting, what is their micronutrient status, are they replete in all the vitamins and minerals that make thyroid hormone, do they have enough hormones, hormonal support, or are they maybe just abusing this to try and lose 5 or 10 pounds that frankly they may not be able to lose?" Like, I don't know if you see this, but we'll see patients who are like, "I wanna lose weight." It's like, you're actually like to lose weight unless you're very careful, you're gonna sacrifice bone and muscle mass. Mm-hmm. But you're maybe perimenopausal, postmenopausal. We need to be really careful about how you cut and lose weight because if you lose muscle mass, getting it back is so hard. Right?

So hard. Yes. Yes, exactly. And, and that's the thing. It's, it's, it's, it's using the tools that we have or the hormones that we have. To bring you into the optimized state, but not push you over the top.

Right.

So, you know, again, even in the world of bodybuilding where I came from, sure, they, the reality is, is that bodybuilders will absolutely use T3 to lose weight, to lose those extra 10 pounds before a show, to increase their metabolism. But the, the issue with that is when you're using a thyroid hormone or any hormone for that matter and it's not appropriate. Your body isn't in a deficient state. You're not replacing that hormone nor do you tend to proceed with that hormone optimization working with a practitioner that's going to guide you maybe the rest of your life. Because when your hormones are deficient, it's very rare that we can just toss them back in and be like, "Okay, you only need that for a month and then you can go off of it." No, you're going to go back to baseline. Yeah. Back to low hormone function after you go off of it. The reality is, is that we would see men and women have a thyroid problem after they got done competing. Yeah. Because they used and abused thyroid hormone where they shouldn't have. So if you're gonna do this or any kind of whatever, any hormone, any, any weight loss effort, you really should be working with someone who knows what they're doing to guide you appropriately.

So I feel like I got actually derailed from us hearing your story. So you, you, you figure out you started on Armor, went well. Yeah. I'm assuming you lost the weight, your hair came back in, you realized, oh my gosh, I feel so great. You pursued this whole new career around this experience of yours. Is there anything else worth mentioning about the transformation from gaining weight, feeling terrible, miserable to where you are now that people who are struggling with their thyroid should hear?

You know, it, it comes back to what we were talking about earlier is just having that hope and Knowing that there's better. So in the book I talk about, and this absolutely ties in, I was thinking about this when you were, you were speaking earlier that in the book I talk about this story about sitting next to a woman on a plane. And, you know, you do this small talk. Hi. Hi. What do you do? And she's telling me, oh, I have a thyroid problem and I'm taking Synthroid and I'm doing fine. Or my doctor says I'm fine. I forget the language she used. But in her mind, because her doctor told her she was normal, fine, all her labs are fine.

Yeah.

She thought this is as good as it's going to get. And I mean, I'm looking at her going, okay, I can see her scalp. She's lost so much hair. I can literally see her scalp because it's so thin and so gone. And I mean, she's like it or not, because when you're carrying excess body fat, it's not healthy. So I feel like I can say she was. 75 pounds overweight easily. Mm-hmm. And, and body positivity or not, that's not healthy to carry around 75 extra pounds of adipose tissue.

Yeah, absolutely.

So, you know, I just remember thinking like, she literally has been brainwashed into thinking that this is it. This is as good as it's gonna get. So get used to it, honey. We'll just recheck you in 6 months and make sure your TSH is the same and we'll give you more T4. And you know, it's, it's it's having that hope that there is better, almost, you know, using someone who has moved into optimization land. Use me, use whatever. I don't use a testimonial, whatever you need to hold onto to pull you through, to know that there is better on the other side. And don't medically gaslight yourself. You know, don't, don't join in on it and make the situation worse by telling yourself, just like you said earlier, Dr. Leland Stillman Stillman. Well, maybe I'm a tough case. No one's been able to help me till this point, so no one will ever help me. This is, this is it. This is as good as it's going to get. But don't gaslight yourself because there's enough medical gaslighting out there. You got to have the hope to keep pushing and keep pushing and demanding more and being an advocate and learning about your body and learning how your body works. That would be the message that I mean, that, that's what I did. That's the only thing that pulled me through.

I love it. Our process when we see patients, regardless of thyroid hormone status, is always we look at it. We, we do screen for it in the initial round of labs we run because it's just so, first of all, even if you don't, even if for some reason you don't give them thyroid hormone, I've found that it is so informative of what is their metabolic state, their stress, their underlying physiology, their protein intake, all kinds of things come through in that panel that I love. Our process is let's optimize everything about your diet, your lifestyle, your environment. There will be cases where we we don't treat with thyroid hormone and they achieve all their goals and don't want or need, arguably thyroid hormone. Or I've also had patients say, I don't want to use thyroid hormone. This is my next question to you, which is when patients tell me they don't want to use thyroid hormone, what I explain to them is I want you to understand something. As you get older, thyroid hormone production declines inexorably, and that's part of aging. But because we have thyroid hormone available, As a prescription, as a controlled, totally identical to what your body makes product, we can basically use it. And I gotta tell you, the data's really clear. The people who optimize have better quality of life, better longevity, better and better outcomes medically than the people who don't. So I respect if you want to refuse it, but I also am going to tell you candidly, when you want to lose that extra 5 pounds, you want to have that crystal clear vision and mental clarity. You want to be able to run, jump, you know, swim, whatever. You wanna be able to keep up with the grandkids. At a certain point, we run out of other things to do. I can't tell you to take an herb or supplement. The analogy I'll sometimes give is like, you, you see, cuz your thyroid regulates so many things around your body. Let's say that you were in a, in a, in a house that was cold. You could put on a hat and a sweater and some slippers or some fuzzy socks. You could have a cup of tea. You could— you can do all these things, and you can also just walk over to the thermostat and hit the button that makes the temperature go up. And it's not wrong to live in a house that's 55 degrees, yeah, you know, and wear a lot of extra stuff and have some hot tea. But some of us prefer at a certain point— and, and I don't also don't want to give people the false impression that like it's not the same, right? So like At a certain point, if you really want to be optimal and you want to age well, you pull the trigger on this. Fair?

Yeah. Yes, yes, yes, yes, yes. I love this. I get it all the time. Number one, you have to shift your thinking of thyroid medication and put it in the hormone replacement category because the medications are the big pharma ones that we don't want you to be on the rest of your life that are quite frankly 9 times out of 10 Band-Aids. For your low thyroid, low hormone function, you know, toxic load, whatever. So yeah, the antidepressants, the statins, the sleeping pills, the blood pressure medications, those are medications all day long. You put those in the category of like, I don't wanna be on that. Over here we have the hormones. We have these beautiful bioidentical hormones that we can replace. And when we do that, you get back quality of life. So if, and I always use this analogy too, if you were sitting in the doctor's office and your doctor came in and you had your child with you and the doctor says, you know, I'm sorry. Hey, uh, Mrs. So-and-so, your child has type 1 diabetes. They need to be on the hormone insulin because their pancreas is no longer producing enough of this hormone. So they need to take the hormone to replace what's not being produced by their body. You wouldn't be like, do they have to be on the medication the rest of their life? I don't really want that. Let's do natural things.

The doctor's gonna—

well, your child's gonna die. Yeah.

Yeah.

They're gonna die. You need to replace hormones that aren't being properly made. Now, I always say, like, are you going to die quickly? Without thyroid hormone? No, but you are absolutely at an increased risk of heart, heart attacks, cardiovascular disease, Alzheimer's, dementia, Parkinson's. Now just came out in a recent study that low thyroid function is related to a higher incidence of Parkinson's. So yeah, I mean, not only quality of life, you know, we're talking weight and hair and energy, but longevity too is so key. Is so key.

Last question. I know you have to go. If we, what do you wish we knew about thyroid hormone and the thyroid gland?

That it really is the master. It's at the top. Think of like the star on a Christmas tree.

Yeah.

Right. So what drives me bananas is in conventional medicine and in functional medicine, sometimes we're not giving the thyroid gland enough love. You know, I'll get the question all the time from people like, well, shouldn't I look for the root cause of my thyroid issue? I'm like, well, yeah, the root cause could be Epstein-Barr virus, which you can't do anything about. Pretty much all of us have. Or was it your pregnancy? You can't undo having a baby. So there's that. How about perimenopause and menopause? Have you figured out how to age in reverse? Because I haven't. So if you have, definitely let me know. But you can't undo that drop in hormones that are going to happen. Yeah, we can put in hormones too, but your thyroid is still going to take the hit. So sometimes the thyroid is the, is the root cause of your other problems. Fix and address the thyroid that's at the top, and then maybe you'll save money and won't have to do the gut healing protocol that you think is going to magically change your life. Or the adrenal fairy dust that this influencer wants you to do because they can't actually prescribe you thyroid medication. You know what I mean?

So it's like, you talk, you talk like a real practitioner who actually talks to patients, which I find really fun.

Let me, I always say, I'm gonna tell you what you need to hear, not necessarily what you wanna hear.

Yeah. It's funny you answered the question. I know, I understand why you answered that question that way, but what I actually was getting at, and I love your answer, but what I really wanna know is what do you wish we knew about the thyroid gland, like scientifically that we don't know? Like if you had, if you were the NIH chair or whatever they call it tomorrow and you had like complete control over the purse strings of thyroid hormone research, what question would we answer?

Okay. I would like to research kind of tying into what I said, how optimizing the thyroid can reduce the need for pharmaceuticals and like really start studying, which big pharma would never let this happen, but really start studying the, the fall off. Yeah. Like the drop in prescription. Cuz right now Synthroid is number 2. The number 2 most prescribed that's under blood pressure medication, but they used to battle for antidepressants for number 1.

Yeah.

So like how many pharmaceuticals would, would drop?

Oh yeah.

Yeah.

Yeah. You would, you, you might meet an untimely end if you set that research agenda at the end of the day.

I think that too. Yeah. That's a good call. Yeah.

On that note, this has been such a good time. I hope you had as much fun as I did.

Amazing. This has been fantastic. Thank you so much.

Where can people find you?

So you can go to dramy.com, D-R-A-M-Y.com. .com to find all the links to, you know, podcasts, the store. You can book a call with my team if you wanna explore becoming a patient. And then you can go to thyroidfixbook.com to grab the book. We still have a lot of bonuses and goodies, but you can also find the book on Amazon in all the different formats. The Audible, I provided a little bit of extra at the end of every chapter. Just kind of doing the David Goggins thing, throwing my own riff in there. So that's, that's really fun if you're a book listener.

Cool.

Love it.

Thank you for joining us again. Thanks everyone for joining us. We'll see you on the next episode. Thank you for listening to Integrative Medicine with Dr. Leland Stillman. If this conversation felt uncomfortably familiar and you're ready for someone to take your story seriously, your next step is to book a call with myself or a member of my team. Go to stillmanmd.com and click book a call. Choose a time that works for you. You and confirm it. On that call, we'll look at your story in more detail and see whether our framework is a good fit for your situation. If it is, we'll outline what a realistic path forward could look like for you. This is not emergency care, and it's not a guarantee of results. It's a calm, structured assessment where we'll create a plan to help you achieve your health goals. We have a limited number of calls available each month, so if you see a time that fits your schedule, book it right away. Again, the link is stillmanmd.com. If you find this podcast helpful, subscribe, leave a review, or share this episode with a friend or family member who needs help getting their health back. I'm Dr. Leland Stillman. Thank you for listening, and until next time, be well.