Thyroid 101 Everything You Need To Know About Thyroid with @DrAmieHornaman

One doc raises his hand, says, that's all we've learned. So I really believe that that's the answer. That's all they are learning in medical school is test TSH. If TSH is above a 4.5, then give T4. Be an educated patient. Take all of this information, listen to it five times and write it down. And then that way you will be armed when you're going in.

Welcome back to my Life Conversations. I'm so glad you all are here. I've got my very good friend. I know people say my very good friend all the time on podcast Interview host Amy is actually a really good friend. She's a newer friend. I just met her about a year ago. Gosh, seems like I've known you forever. But I've got Dr. Amy Horneman, who is known as the thyroid fixer. She is incredible. She knows all things thyroid. She's great with hormones. She's great with a lot of things, but thyroid is her absolute expertise. She's got a big Facebook group around it. This is what she does, this is what she helps with, this is what she fixes. Thank you so much for being here, Dr. Amy.

Oh, Natalie, I love you so. It's my pleasure. It's my pleasure.

So when I met Dr. Amy, we met at a Mastermind event and we quickly became friends. We've done some collab stuff together. She is one of big advocates for my total body thrive. We have a lot of crossover on audience and I told her from day one, thyroid is not my expertise. And it's funny because as I dove in more into midlife topics, things that get more relevant, like hormones, I want to know more about that. Obviously, a lot of blood labs. As many of you listeners know, I've dove deep as I'm navigating things because that's how my brain learns. I'm navigating something I learn, I dive deep in and then I teach it back. Thyroid is one of those things I never really had to deal with. And I've never not told women to check their thyroid. It was just not something I understood until they started really showing up as red flags on my labs. So we're going to do this today as really a basic thyroid, one on one for all of you. I do think knowledge is power. I think the more we can understand what markers are, what's optimal health, what's not, the better. We are equipped to ask our doctor for guidance, to ask our doctors for help, to ask for appropriate labs. We want to have a general understanding because as you all have learned just relying on a doctor's opinion and a five minute appointment is not going to be enough for us. We have to be our own health advocate for our own health detective and dive deeper. So that's what we're doing today. Thyroid 101.

Love it. I love it. And you know, when you came to me and you said, you know, hey, I want you to look at my labs, I think there's something going on here. And then we proceeded to have that conversation of, wait a minute, I don't know that much about thyroid. It hit me hard too, to make me realize I need to teach the basics often because, you know, I'm, I'm out there talking, talking, talking, doing my show and you tend to forget about the people like yourself who are just newly navigating this whole area of thyroid.

Yeah. So we're going to get into like the one on one and the full education, but I just want to give a little bit of context and backstory about why thyroid became your focus.

So like many of us in this space, you deal with your own stuff. So I was just like you. I got diagnosed, I dove deep as to the why. And this was in my early 20s. I was competing, I was doing fitness modeling. And I knew how to get my body in shape. I knew how to get it down to where it needed to be. Lean, height, muscular, the whole deal, done. Plenty of them. There's one show in particular that I was getting ready for. The scale went up. I stopped weighing after it crested 25 extra pounds. Now, this is all while I was doing a competition diet. So that is fish, chicken, broccoli, asparagus, very little carbohydrates. You're hitting the gym twice a day. Sounds a little extreme because it is. But still, biologically speaking, the body should respond to that. The body should respond to the caloric deficit, the clean eating and the exercise. And it was going the other way. So I knew that there was something going on.

This doesn't make sense, doesn't add up. You're like, you were truly doing all.

The things, all the things, all the things so biologically just didn't make sense. Went to my doctor, said, hey, this is what's going on. He ran a few tests, said, you're normal, everything's fine. And that's what so many people get told today. So I know a lot of your listeners will resonate with that. You're normal, it's all in your head. Or just eat less and exercise more.

Yeah, right. We've all Heard that.

Yeah. Right. And that is standard of care and conventional medicine. So I didn't accept that. I went on to get a second opinion, and that ended up being opinion number three, four, five, and six. I went to six different doctors who all misdiagnosed me. They all told me I was fine. It's in my head. Eat less, exercise more. And I remember at one point just crying in my car and begging God for any diagnosis. At that point, I would have taken anything. Wow. Just to have an answer. Yeah. Just to have, you know, here's. Here's a label for why your body is rebelling against you. And then the seventh doctor actually diagnosed me. So she's the one that gave me that diagnosis of hypothyroidism, slash Hashimoto's, and gave me a pill. And I was given T4. And I didn't know any better. I took that pill and I thought, oh, my gosh, this is going to change my life. This is going to be the answer to my prayers. This is it. Five months later, no weight loss.

I didn't feel better.

Nothing worked. Nothing. And to only learn later that T4 is totally inactive. It's the inactive thyroid hormone. It can push up your reverse T3 and put your body in survival mode. And it really doesn't convert well in most individuals because there's all of these things that interfere with conversion of T4 to T3, the active thyroid hormone. So when I went back to her and I said, you know, I did some Dr. Googling.

Yeah.

And it turns out there's this T3 thyroid hormone, too. So can't we add that in? She goes, no, I don't do that. I said, well, I'm going to find somebody who does.

Yeah.

And that's what led me into the world of functional medicine. I mean, back then, I don't even think we used the term functional. It was like integrative alternative. But my functional medicine practitioner saved my life, became my mentor, saved my life, totally changed careers, because I was in a major medical system, too. I mean, I was in UPMC Pittsburgh, which is the equivalent of the Mayo Clinic or the Cleveland Clinic. And I was getting the run around. I was getting told I was normal. So I thought, oh, my God, how many women are just. And they're getting told the same thing, or they're in the major medical system.

Getting told the same thing? Okay, so let's break this down, because even you talking right now and saying those things, I start to go, I don't understand what all that means. So you're so close to it that I think it's super easy for you. But I want to break down, like, what is T3, T4, TSH? There's all these different things with thyroid. Let's start with when you get regular labs. What is the main thing that most doctors are checking when it comes to thyroid? Let's start there, and then let's talk about optimal, what we should be checking for.

Yep. Okay. We'll break it all down. So the main thing that you will always, always, always get that most likely the eye was tested for the very first visit is tsh.

Okay.

And that's thyroid stimulating hormone.

Okay.

It's important to remember that that is not a thyroid hormone. It's a pituitary hormone. So your hypothalamus in your brain talks to your pituitary, which talks to the thyroid gland and the pituitary. I love using analogies so people understand. It's kind of like, you know, the blind man with a stick, like, kind of feeling. Feeling around what's in my environment. That's a pituitary. It's going, hey, all right. Do we have enough thyroid hormone here? Yes. Okay, then I don't have to yell at the thyroid today, but if the answer is no, then it starts pumping out thyroid stimulating hormone, basically poking the thyroid gland, saying, hey, buddy, you're not doing your job here. You need to wake up and start making some thyroid hormone. Wow. That's where when we see TSH go up, it means that your pituitary is screaming at your thyroid gland, and the thyroid isn't listening, so it just screams louder and louder and louder. So that means you're in a hypothyroid state when it goes up.

So let's talk about for a second that. Let's talk about. Start with tsh. So most doctors are just tech checking tsh. It's screaming. If it's going up, what is normal versus optimal numbers on that one, specifically?

Okay, so optimal, we want it less than 2. The normal standard lab value range goes all the way up to a 4.5. And to note, it used to go to a 6, and before that it was a 10. Wow. So you could be walking around with a TSH of a 10 feeling absolutely horrible. And again, your doctor would be like, well, it's in the normal range. You're within normal limits, so you're fine. Then it. It got reduced to a 6. Then it got reduced to a 4.5. But still functional medicine goes, no, I'm sorry if that TSH is over a 2. That person is going to be suffering with hypothyroid symptoms, and we need to do something about it. So, optimal.

You want under two? How much under two?

It doesn't matter. It. It really doesn't matter. I. I get this question a lot, too. Someone's TSH will be, let's say 0.07.

Okay.

And their doctor will freak out, oh, my gosh, your TSH is suppressed. This is bad. And I say, well, wait, are you on thyroid medication? They say, yeah, I've been on it for 10 years. That's why we have to go back to basic thyroid physiology. What I just said, the pituitary is sensing. Is there enough thyroid hormone? If it senses there's enough, it's going to get quiet so that TSH goes down. It doesn't have to react.

So mine. I'm looking at my labs. Mine is a 1.98. So I'm right at the borderline. So you. By looking at that and hearing you correctly, I'm okay with a tsh, but it's creeping up. Is that. That's how you would look at that? Because it's pretty close to a two.

Well, it is, but we have to look at the other lab values. I mean, at the end of the day, TSH doesn't matter. I have plenty of patients that come in with a TSH below a 2. But then we move to their other numbers, like we're going to with you, and then we see some answers that we go, whoa. So here's the problem with conventional medicine. If they're only testing tsh, there are many, many, in fact, millions of people moving through that system getting undiagnosed. Because I would be looking at mine.

That would be me. I would be like, you're fine. So why. Why are they only looking at tsh? Or is it because they don't understand this? Is it because of insurance? Like, what's the reason they're only looking at TSH standard of care?

And really, I'm still searching for the. For the why answer. Because years ago, I gave a talk to a group of integrative wellness physicians, and we talked about why they aren't testing thoroughly. And we're going to go through today all the different tests you need. Why aren't you testing thoroughly? And why are you only using one medication, I. E. T4. That's what I was given. I said, why are you in the Synthroid box? And the one doc raises his hand and says, that's all we've learned. So I really believe that that's the answer? That's all they are learning in medical school is test TSH. If TSH is above a 4.5, then give T4.

That's that what that is Synthroid Levo.

Yep, but it's all T4.

Okay, okay, so let's break it down then. What are these other things and what should you be asking for?

Okay, so then next up, and your doc actually might test this one is free T4. Okay, and what does that mean, free T4? T4 is the inactive thyroid hormone. And the free version of that is just how much is in your system, unbound to a, to a protein deliver like a delivery truck. So it's not bound up, it's free in the system, ready to be converted to T3. So let's go to cellular physiology. Every cell in your body has a little receptor site on it, like a lock and key. For T3, it does not have a receptor site on it for T4. So T4, when we say it's inactive, it is inactive. It does nothing in the body, nothing. Unless it converts. So what has to happen? It has to lose an iodine molecule and literally become T3. Now, it has the right structure, just like a lock and key. It's like it became the right key to fit into the cellular lock and turn it on. So that's what's turning on your metabolism, your brain, your energy, your gastrointestinal system. All systems require T3. So when we look at free T4, we kind of look at it with a sideways glance, like, okay, it's there. And I will look at T4 in conjunction with what I see. The rest of the picture is, so then we have to move on. We have to move on to free T3.

So before we even talk about what is optimal or not optimal for T4, you're saying I need to know T3.

Yeah.

Okay.

Because a lot of people will get, and I've noticed this more lately with my community, they'll get locked on optimal T4 and they'll chase it. And I say, and this is going to become very relevant to you and your labs, I say if you chase T4, what you're going to do is push up the reverse.

Okay, so explain what that means.

Don't chase the number.

Tell me what that means. You're going to push up the reverse.

So the only thing that can can convert to reverse T3. So let's talk about reverse T3. We'll go there first and then we'll tie in the free T3. Reverse T3 is your anti thyroid hormone analogy. It's like a bouncer at the club sitting outside your cell door, arms crossed, looking at T3, going, you're not getting in tonight. You can't get in. I'm blocking you. So reverse T3 is built into our body as a survival mechanism. We want reverse T3 elevated. If we're lying in the ICU or the ER, we're fighting for our life, we have a traumatic injury, Our bodies are so smart, it knows that at that point in time, you don't need to burn fat, you don't need to have energy, you don't need to grow your hair, you don't even need to poop or make any kind of major decision. You need to lie there and survive. So it's going to shut down all of those metabolic processes in order for your body to heal and survive. Yeah, I mean, brilliantly built into our body. Here's the problem. If we're walking around living life with an elevated reverse T3, we're walking around in survival mode, okay? And the only thing that can convert to reverse T3, the only thing that can drive up reverse T3 is the T4 thyroid hormone, whether it's we're making it ourself or we're taking it.

And what is. So when you say reverse, that's why so, because people are going to look at their labs while they're listening to you. Like, what is. Like what is? The numbers you're talking about. Like, what is, what's optimal, what's high, what's low? We don't know what that means. Yep.

So reverse T3, we want less than 12. Now, that range will go all the way up to a 24, 25. And again, you could be coming in at a 19, 20, 21.

Mine's 19.

You're normal.

Yeah, mine's 19. So based on that, you would say you're already seeing it's higher, but you would say based on that, it would be considered normal.

It would be considered normal by conventional medicine. It would be considered high by functional medicine.

Got it. Okay.

Yeah, got it.

So moving to now, T3. What does that mean?

T3. So that's the active thyroid hormone. That's the one that we want T4 to convert to. Now, we make a little bit of T3 on our own, too. Our thyroid gland produces four different thyroid hormones, T1, 2, 3, and 4. And it produces them in different amounts. So we can be producing our own, but we also could be exogenously taking it in the form of thyroid medication. T3 is what gives you a metabolism, what grows your hair, what lights up your brain. That's what you need. So we want to know the free, unbound amount of T3 that's in your blood ready to get to the cell to do its lock and key mechanism. Again, standard lab value range.

Oh, my gosh.

It goes from most labs start at like a 2.2 and goes up to usually like a 4.4 is a standard cut off in America in the US so this is why I say I, I always Want your free T3 to be in the upper quadrant of the range, just in case your lab, I mean, even the labs here, quest, what.

Number, what would be your optimal that you would see?

Well, so we'll take the lab core lab value range. That goes up to a 4.4. I want you like a 3.8 or above, you know, up to a 4.4, but sometimes even over. I mean, some people's optimal, and this is where personalized medicine comes in. Some people's optimal might be a 4.8 or a 5. I mean, it's okay if it's a little bit elevated, if you're feeling good. So we always pair up your lab value with your symptoms.

Now, what is anti TPO and anti tg? What do those mean?

Those are the tests for Hashimoto's. So that's for us to find out. Do you have the autoimmune form of hypothyroidism? Is your body attacking your own thyroid gland thinking it's a bad guy?

And which numbers would tell you that? What would that like? So if an anti TPO is, what would that be a trigger for that?

Any number, we want those at zero. So think of, think of autoimmune or and specifically Hashimoto's, like having soldiers that are confused and they think that your thyroid's a bad guy. If you have, and this is the beef that I have with conventional medicine too. If you have 13 soldiers, you have 13 soldiers. You have 13 guys going out and beating up your thyroid gland. But conventional medicine says like most labs will have a cutoff of a, let's say a 34. I don't even know where they got that random number. But let's say, okay, so we're going to wait until this person has 35 soldiers before we actually officially diagnose them with Hashimoto's. Meanwhile, in their buildup of from 14 to 35 soldiers, they've gained an extra £20. They can't get off the couch. They've lost half of their hair, but Nobody paid attention.

Wow.

35.

So anti TG and anti TPO are the things that are showing for Hashimoto's. Is that. Did I hear you correctly?

Yes.

And you said you want them zero.

Zero. And I believe you had some antibody.

Fifteen. I have 15. Which I was told was not Hashimoto's. Interesting.

I mean, you still have. And now are you at the point where you could suppress those soldiers? Yes, you could. Like, you're right. In those beginning stages where we could optimize your thyroid with thyroid medication, we can give you iodine. That's a. That. That brings down reverse T3 and helps with your immune system against those soldiers. Black cumin seed oil is a big one, keeping your vitamin D levels optimal. You're in that. That state where we could push you into remission and push those to zero, hands down. No question.

Got it. So that's what you. So this is why this conversation is important. Not just my labs. I want you all to look at this because I don't have. I don't present pretty much any of the symptoms. I've. Like when Amy really dug with me, there's a few that we thought, okay, maybe that's related. Yeah. But this is why it's important to pay attention to our labs. Because if I didn't jump in and start paying attention to this, that could push to Hashimoto's.

Like you're saying it could. It could. And your free T3 was really low as well. So when I look at your lab, you have this. You have the start of Hashimoto's. You have an elevator reverse T3 at A19 with your body in survival mode. You have an actually flag low. Like, you actually have an L next to your free T3. You are low. Like, wasn't a 1.9. Right.

Am I wrong?

1.7. So as I look at this, I go, okay, I know you're not presenting with a boatload of symptoms now, but I'm concerned about what would come.

What would happen? Yeah.

Like, the floodgates would open. Then you're like, oh, my God, I'm 20 pounds heavier. What in the hell happened?

So let me all. Let me tell you all for listening, because we're using mine as an example, so you can look at your own stuff. What's presenting for me, I don't have the hair loss. I don't have. Here's the two things that are presenting as me. Number one, definitely getting a little bit more tired. In the afternoon, which is new for me. So that's happening. And I was saying. I told. Described it to my doctor and Amy as like, a boredom feeling. And I was putting that with my add. Like, it's like a. Like maybe it's my dopamine dropping. That's what I was relating it to. But nothing that I couldn't push through. Like, so there's that. And then the second thing is a raspy voice. I've noticed that changing a little bit. So. So those are two things that I didn't think really anything and that could be connected to that. So. Okay, so let's talk about. Let's talk about what you would do in this case. And I want to relate it to other people so they can think through on their own, too.

Yeah, yeah. So this is where that big question comes up. Do I do this just through lifestyle, diet and supplementation, or do I move into the thyroid medication? And one thing.

If you do and which.

And which one. So we'll break those down. But first and foremost, I want you to think of thyroid medication as thyroid hormone replacement. You are replacing hormones that are no longer being properly made by your body. So to give an example, let's say your child was diagnosed with type 1 diabetes, and the doctor came in and said, your child needs insulin. Insulin is a hormone that the pancreas is no longer producing. You wouldn't say, yeah, I don't really want my kid to go on a medication. The doctor would be like, well, then your child's going to die because you need that hormone.

Right.

So you have to think of thyroid hormone as exactly that. It's a hormone that you're replacing. Just because it comes in a orange little prescription bottle doesn't mean you need to be scared of it. Yeah, okay. Because it's going to improve your quality of life. Now, if someone is kind of at the. The precipice like you are, you're kind of at the border. The free T3 makes me want to use thyroid hormone replacement. If you didn't have that low free T3, I'd be like, all right, well, let's just. Let's just hit this hard with iodine, magnesium, D selenium, which I was already.

Doing all those things.

Black cumin seed. Yeah, let's do all that. Let's support your mitochondria for energy function. You know, let's do all that we can to see if we can't get you out of this. This hole. But now I'll take another patient. Let's Say, your age, your lab values. But here's the thing, she's 30 pounds overweight, she's lost half of her hair, she's constipated, she's, you know, fluctuating moods. Are we going to try to do it naturally with her? No, because quality of life is already in the toilet. We want to give her her life back. So that's where 100% thyroid, proper thyroid hormone replacement would come in. And now we can get into the different types.

And so just so you know, my Amy, what Amy coached me on and what I'm going to be starting is T3. So let's. So. And you. Can you explain why you suggested that other people.

Because your body isn't even converting your own thyroid hormone properly. So hypothetically, let's say you were on T4, only you went through that same.

Which is what I was going to do when I called Amy, by the way. I was going to start T4 and she was like, no, no, no, hold the phone.

Right, so explain this, because other people.

Are getting told to start T4 too. So.

So, yes, this is very, very important. And this is why it's important to check your reverse T3. So Natalie's own production of T4, her own T4 is not being properly converted. And you listen, the things that interfere with conversion are many. And if we have the time to go through all of them, sure, you can check the box and make sure that you're not insulin resistant, estrogen dominant, magnesium deficient, iodine deficient, selenium deficient, D deficient, that you don't have a DE101.

We did check all that, by the way. We. I did check all that.

I didn't.

Yeah, we thought I was selenium. We thought all that and it didn't show that I wasn't.

Right. So it's quite possible that you have a genetic SNP on the D101 and.

D102 gene, which I believe because I'd had this creeping down lower for years.

So, yeah, yeah, so I have it too. I finally got tested and my, my epigenetic coach is like, yep, there it is. I'm like, yeah, I figured because I'm. I'm T3 only. I don't convert at all. So as healthy as you can be and as healthy as you are, that doesn't guarantee that you're going to have proper conversion. So that's why we really want to check that reverse T3. So essentially your body is converting your own T4 into reverse T3. Now what happens if we give you.

T4 only, which was what we were going to do.

Right. Or even let me even mention, natural desiccated thyroid. So this is your armor and your NP thyroid. That is 80% T4 and 20% T3. So either scenario is not going to work with a person with elevated reverse T3 because remember, the only thing that converts to reverse is T4. Wow. It's okay. We give you more T4. Reverse is going up.

Got it. So supplementing. So in this case, if you have low T3 specifically.

Yep.

And you've got a higher reverse teeth, like what you just said, the higher, then you want your doctor to be looking at T3 supplementation. Did I say that correctly?

Yes. So we can do a little bit of T4. So for you, really starting on T3 only to begin, T3 will push down that reverse while you're doing all the other things for it. So we start off with T3 only. And then at some point in time, and I've done this with my patients before, at some point in time, we'll try to add in a little bit of T4 and that can be in the form of Synthroid. It could be in the form of a natural desiccated thyroid, which is 80% T4. We're just going to add in just a nice low dose and you're going to see how you feel. If you take that T4 and all of a sudden you go, oh my God, I'm tired, I can't get going. And oh, I put on five pounds. What is going on with me? Then that tells me, okay, no, pull it, pull it. BT3 only for a little bit longer. You might be a T3 only candidate. So let's go T3 only a little longer. Let's try it again in a month. And then you try it again, you're like, nope, nope, I got worse. I can't do it. Well, then that, that's the answer. So we don't always rely on the reverse to tell us if someone is a non converter. Sometimes it's a trial and error. Now we might add in that T4 and you go, okay, I'm fine, I'm good. Okay.

I understand why so many doctors. And I'm talking. I go to great doctors, like I go to functional medicine, like, you know, the people that I work with.

Yeah.

Why is it so autopilot to go to T4 and odd and the Armor Alls and the Synthroids and all that. I don't understand. Like, you're the only one, literally the only one that suggested no.

T3, the thyroid is very nuanced. And, and you know, listen, functional medicine, integrative medicine is fantastic. And when they specialize, that's really, you know, you want to go, if you have a gut problem, you want to go to a functional medicine gut expert, but you don't want to go to a gut expert. If you have a thyroid problem, you want to go to a thyroid expert. So it really is this, this nuanced art form that, that every person needs to be treated differently because you are different. You're, you're not like Susie Q or Betty sue over here. You're a different human being.

So it makes sense to me. Like, if you are listening, you, like, I, you know, you have a thyroid thing, then you go to a thyroid doctor, you go to Dr. Amy, you go to someone with thyroid. But I think a lot of women are like my camp, where we're, we're doing fine. Like, we, we're okay. We're just staying on top of it. We want to be optimal. I know a lot of listeners of the podcast are this, so we're going to a, a well rounded doctor. You, you find a great naturopath or great functional medicine. So we're checking all the things. Like, I didn't go in specifically saying, hey, my thyroid, something's wrong, kind of found it by accident. And I thought, oh, wait a minute, maybe the stuff I'm blaming on estrogen or blaming on ADD is maybe this, like, it just kind of connected the dots. So in that case, sometimes we're ending up not with a thyroid specialist. Is this something we should be presenting to our doctor and say, hey, can you please check all these things to, can we have that? Like, should we be suggesting, hey, why would you not put me on T3? Do we ask that?

Yes, absolutely. So first of all, you want to go in with the list of labs that we just talked about. You want to get all of those done. Rule of thumb number one is if your doctor says no to testing, it's time to get a new doctor. So that's kind of your, that's your first litmus test for the doc that you're seeing. And then, yes, absolutely have that conversation. So if you have your bulleted list of symptoms and you go in and you're having this conversation, this can be functional medicine, this could be conventional medicine. You're having that conversation saying, listen, I have done enough research to know that these symptoms that I have are paired up with these labs that you just ran on me. And oh, look, my reverse T3 is a 19. My free T3 is a 1.7. And I'm tired and I have all of these other symptoms. So therefore, that tells me I really need to be on T3, because if you give me T4, it's going to push up the reverse. Be an educated patient. Take all of this information, listen to it five times and write it down. And then that way you will be armed when you're going in.

I also want to share you all. I am an age optimizer. I'm not a biohacker. I'm an age optimizer. I want to age well, so I am there. I personally am very proactive with the labs that I get. I'm very proactive with featuring guests on the show about these different areas because that's what I want for you. So hopefully one of the things that you're learning through some of these episodes is to just be super inquisitive and we have to be a student of our own health. So this is the best way I can explain it. It's. It's like when we were in school years ago. Like you're learning so you could be an educated human. We don't stop learning as a midlife adult, midlife female. We have got to be educated on what all these things mean in all areas. I'm not just talking about thyroid. All areas, blood sugars, cortisol, like all of it. Because if we don't and we just rely on a five minute doctor appointment, that's a problem. I will also share that. I go to a lot of amazing doctors. I have a. Some great connections. I go to them and I still, I still cross check T's, dot eyes, ask questions. And I'm not afraid. The doctor that two doctors that suggested, two doctors that suggested T4 for me, I was not afraid to tell them, hey, I talked to my friend, Dr. Amy, who, this is her expertise. Can you consider this? They were not insulted or upset or anything. They said, you know what, that's a good point. So I think, don't be scared to do that and ask the questions. I do have some more questions, Amy, too, about, like, when it comes to thyroid, how much of that connects to other things? Like, for example, let's start with. I'm gonna start with one by one, like cholesterol. How. What is the connection with thyroid and cholesterol? Is there one?

Oh, my gosh. So much so I'm actually gonna pull in insulin into this conversation because there's a There's a thyroid cholesterol insulin triangle.

Okay.

So the thyroid will absolutely dysregulate your, your lipid panel. So your cholesterol might be off or wonky. And you're wondering, oh, wait a minute, it wasn't like that last.

Which is exactly what happened to mine, by the way.

Like, yeah, changed my eating, like, what the heck happened? Right. So then that we can tie back to the thyroid. Now, also, attaching the thyroid controls your glucose control your, your blood sugar response, and the amount of insulin that your pancreas secretes. So if the thyroid again is off, it's wonky, it's just not working properly. Oftentimes, I mean, 99% of the time we see insulin resistance. I don't think we saw that in your case, but most of the time we'll see insulin resistance, especially if this problem has been gone going on a long time and gone untreated.

I think the only reason I don't show insulin resistance is the way that I eat, because I literally don't eat sugar. So I feel like if I ate high starches and sugar, it would present that way, which is why type 2 diabetes and dementia is in my family. Very heavy. Yes, I do think I would present as insulin resistance if I just ate whatever I wanted. My A1C would jump very high. It would jump to.

It would.

The way that I eat, it stays low.

Well, I would even argue even if you were one of these people that are like, well, I do eat really well through the week. And then, you know, on the weekends, that's when we go out, we got pizza, beer, wine, all that. I mean, if you went out and had a high carbohydrate, sugary, alcohol laden meal twice a week, you would, you would be.

Yes, I would.

Yes, you would be. Yeah.

Yeah.

Even though it's twice.

That's where epigenetics and like lifestyle does help. It doesn't mean it's going to prevent it forever, but it prolongs it. It does prolong it totally. So there's a connection there. So I want to make sure we understand this. So you said when thyroid is. Explain how this works again, thyroid is lower. What? Tell me how the triangle works.

Yeah, so thyroid is, is off, it's wonky. So you could be full blown hypothyroidism, full blown Hashimoto's, you know that you have it, you're diagnosed, you're on T4, but you're not being treated properly. Or you could be kind of walking around like Natalie, like, well, it's subclinical. We didn't, didn't really know that there was an issue until now. Still, that's enough. Even in that subclinical mode, that's enough to start throwing off the insulin. So now we're in this state of insulin resistance, borderline type 2 diabetes. What is the biggest driver of cholesterol? Insulin. High glucose. That's going to drive up your cholesterol faster than anything. Anything.

Yes. So it's not.

Yeah, we're going to see not your.

Egg yolks or your shrimp driving up your cluster.

No, no, it's not the red meat.

It's not the right.

So it's either your lifestyle or we can tie it back to thyroid.

Okay. This is, this might be outside of your scope, but I'm going to ask it anyway because this is something that drives me nuts. Someone presents high cholesterol, higher cholesterol, abnormally. They've got low thyroid insulin stuff going on. Their doctor says, we must get your cholesterol down. Here's cholesterol statins, which to me, your body is creating the cholesterol for protection. And now if we take the statins to remove that, we're now release, removing the protection. Can you help tie a bow on this? Because I don't know that I explain it right or if I'm even completely accurate on this.

Oh, no, you nailed it. So, first of all, yes, then we have to get into the, the conversation of what is actually high cholesterol. That total cholesterol used to go up to 300. They've narrowed it down and pushed that standard lab value range down to 200. So if you're at a 220, at 250, you're getting flagged with an H. And your doctor is going to present you with a statin because guess what, they get kickbacks for that stat. Right? They get massive kickback. So that's problem number one. And of course, we have to look at what your ldl, which, your hdl, which is very heart protective. We have to look at your triglycerides, which really directly reflect back to what you're putting in your mouth. So is it really bad or is it not bad? And you know, listen, if you're coming in with a cholesterol of a 500 and you know your LDL is a 300, then maybe we have a conversation. But even at that, even at those numbers, I would say, well, let's try to.

Even in the 300, even in the 300s, you're going to first, look at these other things.

I had a patient that was. Well, she. I mean, she is like 82 now. She was like 78 when we were working together. And she, her LDL was 342. Okay. And I forget what her total was, but basically like, red, red, red, flag, flag, flag all over the place. In her 50s, her doctor put her on a statin. And luckily her husband was astute enough to start looking into statins because they both got put on a statin at the same time. And I always say with these statins, you're either lucky or unlucky. You're lucky if you get symptoms right away. You get these leg cramps, muscle weakness, fatigue, walking up the stairs, you're out of breath. Then you know, oh, my gosh, that was the statin. If you're unlucky, it's going to happen over time because it will happen. Those side effects will happen. In addition to spontaneous femur fracture, which is one of the big ones with statins, meaning you step off a curb and your leg bone breaks in two.

That's not good.

Major, major issue with statins. So if you're unlucky, you're going to be on this thing going, well, I guess I'm just getting older, you know, I just don't have the stamina I used to. My muscles hurt. So, I mean, 100% of the time, statins are going to have a side effect. It's just, are you going to notice in the beginning or the end? So she, she's on this statin and she starts getting these major, major symptoms. And her husband looks it up and he's like, absolutely, go off of that. Go off of the stat. She water skis. She works out every day. She snow skis. She is a healthy, wow, speaking badass of a human being, she does not need a statin.

Now, I read somewhere too, maybe I have this botch that, that it only lowers. Like lowering your cholesterol through a statin doesn't even reduce your heart attack risk. Is that accurate?

Mark Hyman, I'll give him credit, he said this and it stuck with me. He said, the only time we use statins is after a heart attack when someone is maybe just a little bit more prone to that. And it only lowers the ldl. It does nothing for the triglycerides. It's not going to bring up your hdl. So, yeah, I mean, just the, the mechanism of action of a statin is pretty weak to me.

It's like, I'm going to use my analogy it's like coloring our gray hair.

Okay.

You can color it all you want. It's still gray underneath. It's like you. So this, to me, it's like when you do a statin, you can lower it for lab values all you want. It's. We still have the problem that we haven't figured out.

Yeah. There.

You still have to figure out what's creating that. And it's not always the diet. So I can't stand when they just go right to diet and workout when it. You could be doing that. It could be your. Like you're saying it could be your insulin, it could be your blood sugars, it could be your thyroid. There can be a lot of other things happening. There's also a connection, I understand, with estrogen and cholesterol.

I mean, you said it earlier though, as well, is that we need cholesterol as a building block for our hormones. All of our hormones are built off of cholesterol. So oftentimes when we see women on tamoxifen or blocking their estrogen, that will have the reverse effect on cholesterol, and it'll. It ends up lowering it too much. Like, we can have a situation where a person has too low of cholesterol. Now, you don't have that building block. Well, you don't have the protection around the cell because your cells are made of a lipid layer. So now you don't have enough of a protective layer around your cell, and you're. You don't have the building blocks for hormones, so your hormones start to tank.

Wow.

Now, if there's like a different connection that you heard, you'll have to expand on that. But that's the one that I know with estrogen.

So good.

Okay, well, we got a whole thyroid education today.

What am I missing here that I didn't ask about thyroid. That we need to know.

Okay, so the medications. Just one more once over with those. Because I want people to understand, because a lot of people are on thyroid medication now, and they're not getting optimized. Just remember that there are a variety of different combinations we can do. We can do T4 and T3. We can do a little bit of T4 and a lot of T3. We can increase your T3. So let me just give you an example, because there's a lot of practitioners functional as well. I fired a lot of them from my team because they wouldn't go above a certain number of T3, a certain amount. They'll give 5 micrograms or 10 micrograms. And that's it. And the. The common talk amongst practitioners with increasing T3 is what's going to. It's going to cause osteoporosis and a heart attack and cause afib. That has since been deemed false. We have multiple studies showing no, T3 does not cause a heart attack. Obviously, you want to be aware if your heart rate increases to a point where you're doing cardio while you're sitting down, I mean, that's a problem. You're probably overmedicated slightly. But just using T3 is not going to directly cause that. It's based on the individual, does not cause bone loss. And the. Where you fall in that. That. How much do you need range? I get this question all the time. Well, you know, what's. What. What dose Is average for T3? I go, there is none. You might be optimized on 20 micrograms. You might need 150 micrograms, like I do. I take 150 micrograms. So the range of where you're falling really needs to be tailored to you. And if your doctor isn't tailoring that or if they have a cap in their mind.

Right.

I won't go above XYZ dose. Then you might result in not being optimized or being mistreated.

So you're on 150 micrograms?

Yeah, I've been for 20 years. Just got a DEXA scan. My bones are fantastic. I've had two in a row. Two years in a row. Okay.

So me starting 2.5 is like literally a microdose. Yeah.

You're doing a little baby D, but that we have to start low and build up with T3. And that's the other key. So if you go to Thorn in my side, one of these cookie cutter medical clinics on the corner that are going to hand you out hormones and thyroid medication. I saw this in my group. Someone said, I went to XYZ Medical, just one of those cookie cutter clinics. And she goes, they gave me 50 micrograms of T3. I'm like, oh, my God. You do not start there. They tell you that you have to. She goes, no, they just gave it to me. I'm like, oh, my gosh, you're going to have a heart attack. Like, you can't do that. So it really is important to be working with someone that's going to guide you to go slow.

Yeah, that makes sense. Okay. Wow. A lot of good information here.

So I.

Based on what I've heard from women and general labs, I think the first big problem is the doctors aren't testing for all these areas. So that's the first thing. So if anything, takeaway, you want them to be looking for T3, T4, all. All of the things.

Number.

So write down everything you learned from this podcast. Like, so, you know, like, these are the specific things that I need to take in and have tested. Number two, you need to advocate for yourself on where you want to be optimal. And just. Just to let you know, like, if I walked into a regular doctor and we did regular tests, there would have been zero. Like, they wouldn't have said anything. Then if I had gone deeper and this happened, they would still tell me, oh, you're not at any risk for Hashimoto's. You. Let's just watch it. And then if anything, let's try some T4, which would have been completely the wrong information. So. And then if by doing the wrong information, that could push problems with blood sugar A1C, it could push problems with cholesterol even further, it could push all of that. So this is why it's so important to catch things early. So that's how you optimize. That is literally how you optimize. And I would say the same conversation around your hormones, around your blood sugar, around everything. Like, don't wait till your A1C is an alarming high before you start addressing your blood sugar. Like, you have to be looking at the patterns, looking. If this is creeping up now, somebody listening might go, well, isn't this my doctor's job? I mean, no, it's our job. We have to be our own health advocate.

Exactly. You have to be. You absolutely have to be. And don't be scared to fire your doctor. Don't be scared to fire your functional doctor. I know you've probably paid thousands of dollars already, but, yeah, many. You need. You need a specialist for each thing. And that sounds like such a pain in the butt. But if. If you want to address thyroid and hormones, you need a thyroid hormone expert. If you want to address a mold problem, then you need a mold expert. Expert. There is not one person that does it all. Even in conventional medicine, you have endocrinologists.

But I do think it's good to have, like, I like having an overall general one. I'll tell you why. Because, like, like, I could call Amy for help with the thyroid part. I can call Laura with help with the gut. I have my. My people, right? But I still like to work with my general functional medicine person because she's got an education around all of It. So yeah, she helps you. Because what also could happen is if you just go to the hormone doctor for like they don't know there's something else. Yeah, they just think it's. That's like the surgeon thinking everything is that leads surgery, you know, cut out.

Right. Yeah, I think you're right. Well rounded approach. So.

And please, I've said this so many times, do not let insurance dictate your treatment. This is. I know this is a really touchy subject for people. You will spend more money long term letting insurance dictate your treatment. Your insurance is a business. It does not care about us. It does not care about us, period.

Right.

It doesn't. It's a business. So we have. I will pay out of pocket. And I understand that sounds very privileged. I'm not trying to, but I would find a way before I'm buying new shoes. I just would. I will pay out of pocket for good information because if we don't, then we pay later with our health and.

You lose time out of your life that you're not getting back. All of our days are numbered. We don't know if we have two years or 50 years. So why would we waste it feeling horrible? Life is meant to be lived and you're supposed to live it vibrantly and feeling great. And listen, I got to tell you, back in the day, in my early 20s, I give this story. I tell the story often. I was making $300 a week and I found a way to pay my functional medicine doctor because after I had gone through seven doctors, I was already in the whole thousands in co pays. So I found a way to pay him. And you know, eating Raymond noodles, I don't even know. But. But I figured it out. I think when you want something bad enough, you find a way to get it. You just do.

And I'll continue obviously to have guests on here on this podcast of Amy. Dr. Amy has a fantastic podcast as well. I've been on hers a few times talking fat loss but she's got. Can you share where they can find you the name of your podcast, how they can work with you all the things.

Absolutely. So name of the podcast is the Thyroid Fixer podcast. We've had Natalie on multiple times. A great, great information on there. Free information on there. We talk about everything more in depth and deep diving deep into all those topics that we talked about today. And then we do prescribe. So I have, I've curated a team that where we can prescribe to all 50 states and parts of Canada. Thyroid Hormones, the peptides, everything. So that was an important part of my mission when I was being misdiagnosed and tossed around the medical system. To be able to give women everywhere, not just in one town or one state, the help that they need, but really to be able to give women everywhere the help they need.

Yes. And Amy is going to be. She's going to. Not like that I'm saying this right now, but we've been talking about it behind the scenes. She is going to launch a program like, like, like we do with Total Body Thrive, like Laura does with her stuff.

We're.

She's going to launch something around thyroid. I'm holding her accountable to it because I think a lot of us will need that.

And I think it's a great way.

To, to be able to work with her directly if you can't work with her one on one directly. So that's not coming up anytime in the very near future, but it will be happening in the next year for sure.

We know. Yeah. First of the year. Yeah, exactly.

And we'll have you back on, I'm sure, as we progress on this. Thank you so much, Dr. Amy. You're awesome.

Thank you. Thank you. My pleasure.

Sa.