Ep. 478 Thyroid Truths: Labs, Adrenals & Appetite Explained with McCall McPherson

Today, I am thrilled to reconnect with McCall McPherson, the visionary behind Modern Thyroid Clinic, a thyroid-centered functional medicine practice, and the owner and Chief Hope Giver of Thyroid Nation. She is also a frequent guest on podcasts and summits and is the host of the Thyroid Nation Podcast.

In our discussion, we explore common thyroid misconceptions, the importance of lab timing, the impact of defensive ideologies and traditional allopathic medicine within endocrinology, and the connection between thyroid and adrenal health. McCall shares some of her favorite methods of support, highlighting the importance of resting your way out of adrenal health issues, and offers her take on various lifestyle measures and alcohol use. We also dive into appetite regulation, hunger, metabolic hibernation, and recent research on microdosing with GLP-1s.

This conversation with McCall McPherson is exceptionally valuable and worth revisiting more than once.

IN THIS EPISODE, YOU WILL LEARN:

• Why thyroid testing must be done when levels peak 

• Various challenges with the traditional endocrinology approach

• How we need a broader understanding of thyroid health beyond TSH levels alone

• Some common misconceptions surrounding thyroid health

• How T3 and T4 impact thyroid health outcomes

• McCall clarifies the concept of normal thyroid levels, highlighting the need for optimal thyroid function

• The link between thyroid and adrenal health 

• What happens when people in a prolonged hypothyroid state go into metabolic hibernation?

• Some helpful strategies for supporting adrenal health

• The benefits of microdosing with GLP-1s 

• How alcohol affects thyroid and adrenal health

Bio:

McCall McPherson is the founder of Modern Thyroid Clinic, a thyroid-centered functional medicine practice in Austin, Texas, and the owner and Chief-Hope-Giver of Thyroid Nation. She is a physician assistant, TEDx speaker, and a thyroid expert, having been a thyroid patient herself.

Her passion is helping women rebuild their lives from the devastating effects of thyroid and hormonal disorders. Her philosophy is simple: There is no reason to still have thyroid symptoms.

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“Overdosing people on active thyroid hormone can be dangerous.”

-McCall McPherson

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Connect with Cynthia Thurlow  

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Connect with McCall McPherson

• Modern Thyroid Clinic

• On Instagram and TikTok

• Modern Thyroid and Wellness Podcast

• Thyroid Lab Guide

Transcript:

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. 

[00:00:29] Today, I had the honor of reconnecting with friend and colleague McCall McPherson. McCall is the visionary behind Modern Thyroid Clinic, a thyroid-centered functional medicine practice, and the owner and chief thyroid hope giver of Thyroid Nation, a frequent podcast and Summit guest, and now the host of Thyroid Nation's podcast.

[00:00:48] Today, we spoke about some of the biggest thyroid misconceptions, timing of labs, the impact of a defensive ideology, and traditional allopathic medicine with regard to endocrinology, the connection between thyroid and adrenal health, and some of her favorite supports, and why you need to rest your way out of adrenal health issues, the impact of microdosing of GLP-1s in recent research, what impacts appetite regulation and hunger, as well as metabolic hibernation, and last but not least, her thoughts on alcohol use and other lifestyle measures. This is a truly invaluable conversation one you will want to listen to more than once. 

[00:01:30] Well, McCall, so good to have you back on the podcast my friend. 

McCall McPherson: [00:01:34] I am so grateful to be here. I love our conversations. I love your podcast and thanks for having me. 

Cynthia Thurlow: [00:01:39] Absolutely. One of the first things I was thinking of when I knew we were going to have a conversation today was to better understand your perspectives on lab work as it pertains to assessing thyroid function. And I know that there are a lot of opinions on this, but obviously your zone of genius is thyroid health.

[00:02:02] The patients that you're working with, what are the instructions you provide them with to get a best sense of whether or not their thyroid dose is meeting their needs? Are you looking at peak? Are you looking at trough? What is your perspective on timing for thyroid testing?

McCall McPherson: [00:02:19] Yeah, so when people are on thyroid medication, especially medications with active thyroid hormone. So, that's T3-containing meds like Armour, NP Thyroid, Cytomel, Liothyronine, compounded blended medications, basically anything except T4 like Levothyroxine, Synthroid, Tyrosine. These meds have active thyroid hormone in them. There is a lot of fear and medicine around overdosing people on active thyroid hormone, which sure can be dangerous. It needs to be done in extreme lengths. But theoretically, yes, it's possible to create dangerous situations with too much T3. 

[00:03:00] So, inherently our goal at Modern Thyroid Clinic is obviously, 1, to get someone to a perfect thyroid function state, but 2, do so in a way that protects them from any of the negative outcomes that can come with over medication. So, in order to do that, the way that we test people's labs is we actually have them go at peak. So, I want to know what does your T3 look like at its highest possible threshold throughout the day so that we can know, “Hey, you're safe.” We also know on the flip side of that, your T3 doesn't actually look like that all day, there is a peak and there is a trough, and the timing of that varies for each individual kind of class of active thyroid medication.

[00:03:43] But sadly, what is really normalized in medicine, as you know, is going before you take your meds, so going off meds. And so, let's talk through that concept, because that is what most people that are listening right now are going to think or it's just I was never given any instruction at all, so we're just randomly picking a time and we're going and having our labs drawn.

[00:04:05] The problem with that is, let's say you're on Armour and you take it once a day in the morning or twice a day, which is what most people on Armour should be doing morning and late afternoon on a Monday. So, your last dose is at 03:00 PM on Monday. You have all evening, you go to sleep, you wake up, you go get your labs drawn in the morning before you take your meds. All of your T3 is out of your system at that point. It has peaked, it has troughed and it's gone. So, we can have an understanding of, “Hey, what is your thyroid doing without medication?” But that's not really helping us figure out how to dose your med, like, how do we know what to do with your medication if we don't know what it's actually doing in your body? So, we need to have an understanding of what that looks like.

[00:04:51] So, obviously the best way to do that, the best way to decide what to do with someone's medication is to test and see what it's doing. That way we know, do we need to go up? Do we need to go down? What is the level at? And so, we always advise on meds and peak. So, for Armour, for compounded, for NP, for compounded long acting, that's about three to four hours after your dose of medication. If you take it twice a day, go after your higher dose, if one is higher versus the other. And then if you're on Cytomel or Liothyronine, that is a shorter peak and trough. So, you ideally go between two and three hours after you take your medication.

[00:05:30] One of the only ways that I have seen bad things happen in the realm of thyroid is think about it. I'll give you a perfect example. I had like a 73-year-old patient a few years ago that came to see me and she transferred care to us and this is kind of what normally happens. She'd seen the same clinician, the same physician for years. He tested her labs, increased her Liothyronine, tested her labs, increased, why? Because every time she got it, her labs drawn, her T3 was like 2.3, it was very low. So, obviously he's like, “Well you need more.” So increased, increased, increased until she came to Modern Thyroid Clinic. We tested it and her T3 was 17 at peak, so-- 

Cynthia Thurlow: [00:06:10] Oh my God. 

McCall McPherson: [00:06:12] Yeah. So, she's 73, she's at risk for AFib, right?

Cynthia Thurlow: [00:06:16] Yeah.

McCall McPherson: [00:06:17] But if you're not testing people off of meds, they will always, always appear low. And so, what happens when they end up on this hyper dose of medication? Their T3 is through the roof. And another example, a woman came to me that was 62, same deal, her T3 was over 35. It was over the detectable threshold. Normal, optimal for us is about 3.6 to 4.2 for most of the day. People can peak above that certainly because again, the peak is short lived. But a 62-year-old-

Cynthia Thurlow: [00:06:48] terrifying. 

McCall McPherson: [00:06:49] -above 35, terrifying. I'm like, “You are really lucky to be here today and not have had a heart attack and not have a stroke,” because that is really when things go wrong. And that's the main way that I see that happen is irresponsible testing.

Cynthia Thurlow: [00:07:02] Yeah, you know it makes so much sense. And yet even as a clinician, I think there's so much variability. And the reason why I'm asking, starting off asking this question is this asked frequently in my free group and there's a lot of like well-meaning people out there that are listening to podcasts like yours and mine and they hear a clinician and expert saying that and then they're thinking like, “Oh, my clinician does something totally different. And because my T3, T4 always low, we've got this like slow creep that's ongoing with these drugs.” 

[00:07:36] And for the benefit of listeners who may not be familiarized with high free T3, atrial fibrillation is an arrhythmia that puts people at risk for embolizing clots to our brain. So, a lot of patients I saw in cardiology, atrial fibrillation is more common in menopausal women in the setting of low estrogen. Many, many women in perimenopause, menopause are in a hypothyroid state to begin with, generally from Hashimoto's, obviously you could speak to other reasons why that happens. 

[00:08:04] And so, a free T3 that high is really putting someone at risk for-- The worst sequelae that we see is thyroid storm, which I only saw a handful of times in the ER, but obviously very concerning when everything is revved up, you're sweating, you have palpitations, you can have diarrhea, just everything that you can imagine can then happen, and it's not a state that we want to stay in perpetuity. 

[00:08:32] Now, with someone with a free T3 that high, I'm just curious, just from a clinical perspective, what other things did you have to do to help bring that back down? 

McCall McPherson: [00:08:41] Yeah, it has to be a slow process, right? You can't take someone from 35 to 4. It's not comfortable. It's not okay. So, it's a year in the making- 

Cynthia Thurlow: [00:08:52] Oh, wow. 

McCall McPherson: [00:08:53]-to get someone. We reduce them grossly, significantly on the front end to get them into a state where they're actually safe day in and day out. But then it's a slow reduction over time, and your physiology tries to compensate for that. It works very hard to try to usher out all of those excess hormones to protect you. So again, you're shifting your physiology in a way that creates a lot of chaos. Less predictability, less control, which is always what we want. We want predictability and control of people's thyroid function to a nuanced level. And so, it's quite the undertaking. It truly is.

Cynthia Thurlow: [00:09:30] I can imagine. And for me, because in cardiology, we oftentimes would see lots of patients in atrial fibrillation, the big takeaway is stroke risk. And there's a lot of things that can lend itself to that. When you're meeting with patients, talking about timing of labs, what are some of the biggest thyroid misconceptions that you feel like as a clinician, you are helping to upright with your patients, or on the flip side, across social media because you have such a large presence, you're probably getting a lot of questions. What are some of the most common misconceptions that you feel like you have to explain to your patients or even to your followers online.

McCall McPherson: [00:10:09] Yeah, there's a few. Obviously, starting with the very basics is TSH is not enough to diagnose a thyroid condition. And I really want people to know, like, studies are coming out on a monthly basis at this point to widen the scope of what is acceptable and further stratify people to make them ineligible to receive thyroid treatment when our starting point was way too wide. And so now there is enormous pushes for not treating people until their TSH is above 10, not treating people until their TSH is above 20. And that is a recipe for long term, very poor health outcomes in almost every single capacity, poor health, poor socioeconomic, poor employment outcomes like these things are all very measured in the research that we have available to us. 

[00:11:05] So this is a field, you know this so well, Cynthia, that people have to advocate for themselves. They can't just go to their doctor and say, “Well, my doctor said my thyroid's normal, so even though I have all these symptoms, I guess I must be normal,” No. So, 1, we need so much more than TSH. We need a full thyroid panel. I'm happy to share my lab guide with your followers and we can include it in the show notes, yeah, so that.

[00:11:29] Once someone gets on thyroid medication, especially Levothyroxine, Synthroid that class, TSH is completely unreliable at that point. It is so heavily influenced by that medication that it's useless on its own. So again, if you're still having symptoms and you're on thyroid medication and your clinician's only running your TSH, you're free T4, you have to ask for a full panel. TSH and T4, I saw a study on this a week ago, influence T3 about 1%. So, 99% of the influence of T3 cannot be assimilated from those data points, and so, we have to check it. And then, the follow up to that is normal is not optimal. You can be debilitated. I was debilitated. And in a very “normal” thyroid range, so we have to really focus on the nuances, tight, narrow margins, basically perfect thyroid function is honestly what we're going for.

[00:12:35] And then a big, big misconception that I really try to have people understand that isn't really spoken about is when you are on Levothyroxine, Synthroid, Tyrosine, Unithroid, Levoxyl, that class of medication, what 99% of thyroid patients are on. The worse you are at using that medication, the better your labs will look to your clinician. So, the worse you're able to take that medication and activate it to make it usable to make you actually feel good, have a metabolism, have hair, have skin, have a libido, have digestion, the worse you are at doing that, the lower your TSH will look and the better your T4 will look because you start to accumulate that T4 or what I call crude oil hormone. You stockpile it and it creates this artificial feedback to your brain to lower your TSH. You've got a great level of T4, why? Not because your medication's right, because you're actually not activating it and converting it into gasoline. You're not making it usable. 

[00:13:37] So, that's a really, really other important thing that truly for women, it ultimately, all three of those boil down to-- if you are having thyroid symptoms and there are five or six of them, people will tell you they're nonspecific. They'll tell you they could be so much-- Anything, right? If you have a lot of them, it's probably your thyroid. And you just need to look deep enough to uncover that truth. 

[00:14:01] And the last one, I would say I read this fascinating study last month that looked at T3 compared to T4 and health risks. And it's true, like we talked about. T3 in extremes, it's dangerous, it's not safe. Too much of any good thing is bad. And then the same goes for T3. But again, it takes extremes. Medicine has adopted this idea that T3 is dangerous in general. So, we're not trained as clinicians how to use it. We're trained to be very afraid of it, and that's that, so, we only use T4. 

[00:14:35] But when looking at outcomes of death, mortality, osteoporosis, osteopenia, heart attack, atrial fibrillation, and when we compare T3, your active thyroid hormone to T4, the medication that everyone is so comfortable giving, death rates, heart attack, osteoporosis, osteopenia, are inversely proportional to elevations in T3. So, the higher someone's T3 is within a reasonable range, the lower risk for those things. The higher someone's T4 is, the higher their risk for all of those things. Not only those, but also unemployment, lower socioeconomic status. The higher your T3 is, the less likely you are to come from a low socioeconomic status or be unemployed. And the inverse is the case with T4. Isn't that fascinating?

Cynthia Thurlow: [00:15:25] That is fascinating. And yet what do you think contributes to traditional endocrinology being so reticent to expand their scope of lab values, considerations, because I have friends who are endocrinologists who I love as people. 

McCall McPherson: [00:15:44] Yeah. 

Cynthia Thurlow: [00:15:45] And we have just had to stop having conversations around this. They're very rigid and dogmatic. And I'm sure there are people who are integrative and functionally focused. I'm by no means throwing all the endocrinologists into one lump. But why is traditional endocrinology so reticent to think from a different perspective? I feel like we're looking at 1950s lab values in most instances. I know if I called an endocrinology consult, I generally found it completely unhelpful. 

McCall McPherson: [00:16:14] Yeah, sadly. I'll say this. I think there's a couple things. First of all, I don't know if I've ever found anything in medicine that people feel more protective of than their ideology around thyroid. People are incredibly defensive about it. They are completely attached and refuse to evolve. I think medicine passes down generationally ways of practicing and we don't evolve. And it's like the idea of Armour and desiccated thyroid, Armour, specifically.

[00:16:44] Armour is pig thyroid gland. It was the first thyroid medication around for a half of a century before Levothyroxine was created, okay. So, 50 years, it's all we have. Back then, in the early days, it wasn't stable, it wasn't predictable, and there were dosing errors because of that. That ended in 1983. 

[00:17:05] Since 1983, we've wrapped our heads around the dosing of these meds. They're stable, they're predictable, they're controllable, at least most of them. But medicine hasn't updated its view. It still says they're unstable, they're unpredictable. Why would anyone ever want to be on these medications? And we are 50 years out from that almost, you know, it's crazy. 

[00:17:24] And then I've spoken with a lot of other clinicians to kind of temperature gauge this, and I'd be curious to see your thoughts. But my training for thyroid as a PA and in no way am I trying to say that my training as a PA is equivalent to an endocrinologist training on thyroid. But I have had endocrinologists tell me that their training is similar and the same and lots of other MDs. It's “Do not put your patients on T3, only use T4-based meds. Synthroid, Levothyroxine. If you put your patients on T3, you're going to give them a heart attack or stroke, so don't do it.” So, what that leads to is, number one, we are trained that these meds are bad. They are not safe, they are dangerous. Do not ever use them. If you do, you're going to kill people. Secondary to that, we're not actually trained how to use them safely. So, there's a lot of fear and lack of knowledge, and it's so strange, but in medicine, I have never seen us analyze research and look at a condition in such a narrow-focused lens.

[00:18:30] And I'll give you an example. In about 2018, 2019, the first study came out looking at how people respond clinically, symptomatically, to the treatment of thyroid conditions with levothyroxine, okay. And the result of the study that now many studies are based off of was people aren't really getting well unless their TSH is really high. So, unless their TSH is above 10, they're not getting symptomatic improvement. So, the result of the study and the advice from it was “Let's stop treating people if their TSH is less than 10. Let's only treat them if their TSH is above 10.” The problem with that study and in any other area of medicine, I truly believe it would be analyzed differently. 

[00:19:13] We should also be looking at is the lack of improvement of these people because of the treatment? We have one treatment option for 99% of people why are we looking at them and saying “They're not getting better unless their thyroid problem is so severe, let's just wait to treat them” Instead of, “Is this medicine not working for a huge amount of people? Do we need to look at alternatives?” But that's not what we're doing, we're just simply accepting that the medication works. And every assumption that we make is based on that as the foundation, which is terrifying because sadly, many of you listening here are experiencing symptoms despite being on Levothyroxine and Synthroid. That was certainly myself on my own thyroid journey years ago, and it's the case for the vast majority of people in Levothyroxine and Synthroid. 

Cynthia Thurlow: [00:20:04] Yeah, it's interesting because I think there was little to no education about thyroid.

McCall McPherson: [00:20:08] Yeah.

Cynthia Thurlow: [00:20:09] It was like a blip on the radar. And because I was always dovetailed into acute care medicine, we were told to stay in our lane unless we saw myxedema, coma, or thyroid storm, which are the extreme extremes that are emergencies. And I cannot tell you how many of my patients had in their charts always females, “If I'm in the hospital, I refuse to take generic Synthroid. I refuse, I refuse, I refuse.” And you have a big-- And this is back when we had paper charts. So, this dates me substantially-- There'd be a big chart, big sticker, “Patient refuses generic medications.” 

[00:20:44] And I think that in many ways-- If, as an example, if we were dosing high blood pressure medications and we looked at their blood pressure metrics, whether it was high or low, based on symptoms, we would make adjustments. And yet with thyroid medications, in many instances, we let patients really flounder and suffer instead of looking at bio individuality wise, like, what is best for this patient. Applying this one size fits all approach. When I was dosing blood pressure medications, there are probably seven, eight drug classes and multiple variables between everyone. And I can show you there was no cookie cutter medicine done with any of my patients. 

[00:21:28] And yet with thyroid, I feel like in many ways, this, along with probably adrenal health, which I'm sure we'll talk about, there is this lack of nuance, lack of understanding, lack of clarity, a degree of cognitive dissonance that I think is hugely problematic. And then we're really speaking to women in perimenopause and menopause who make up the bulk of the patients with an underactive thyroid. And what typically happens, women are gaslit, their medications aren't adjusted. There's no consideration of transitioning them from Synthroid, which is synthetic. And for many people, this works fine. So, if you're on it, I'm not suggesting you stop, but there are other options. And I'm sure for you, with the trajectory of your career, do you feel like you're starting to utilize more compounded T4, T3? Do you feel like that's becoming more accepted or do you still feel like there's quite a bit of pushback from patients being fearful about compounded bioidentical thyroid replacement? 

McCall McPherson: [00:22:27] Yeah. So, in my practice, all day, every day, I use compounded bioidentical hormone medications. I actually stay away from thyroid, and I prescribe my last compound in 2018. And I'll share with you a story that Alan Christensen shared with me, gosh, close to a decade ago, and it's brilliant. 

[00:22:48] When we're dealing with progesterone, with estrogen, with testosterone, we're dealing with milligrams okay. So, we are essentially baking muffins and trying to fit the same amount of blueberries in every muffin in a dozen, and it's-- You can get pretty close, like, that's attainable. When we're dealing with micrograms with thyroid, we are dealing with flaxseeds, like we are trying to fit an even amount of flax seeds or poppy seeds into each muffin in a dozen. And the likelihood of doing that time in and time out is challenging. 

[00:23:22] And I'll give you my last patient example in 2018. She had been my patient for years, stable for like three years, was on a compound, came back from three months, perfect thyroid function and her TSH was 12. And it was like, that was the last time, I'm like, “Okay, I'm done. I can't do this anymore,” because inevitably at some point people pick up a 90-day supply of a prescription and it's not correct and then it takes us back so far. I think the better the compounding pharmacy, the less frequent, less severe that happens, but the way that our whole premise at modern thyroid clinic is we're not guessing. Like when we change someone's thyroid medication, we actually know within about a 0.2 variants what their labs will look like at their next appointment.

[00:24:07] When you're not sure of dosing and compounds come into play, we remove that predictability and control that we so value that allows us to be so incredibly effective. So, we don't do a lot of compounds. If someone really is doing fantastic on it and they don't want to change, sure, like everyone is in charge of their own health and we're there to facilitate their goals. But by and large, we use combinations of T4 and T3 separately that we can titrate like Levothyroxine and Cytomel, or we use desiccated thyroid, Armour thyroid. There's another new one coming out that's going for FDA approval for the first time in history called RenThyroid that we're really excited about. So, we try to use those medications to really hone in on the predictability and control piece. 

Cynthia Thurlow: [00:24:52] I love the analogy. And that really hones in, especially for listeners maybe who are not prescribers, the difference between milligrams versus micrograms. And what's interesting to me is in the ability of like-- You know, I'm on hormone replacement therapy. I take thyroid replacement. Right now, I'm on a bunch of peptides to fix my gut and support my immune system. And that's another day I'll talk to listeners about that. But the point that I'm making is you really are at the beholden nature of each compounding pharmacy. And there are good ones and there are not so good ones out there. And so, hopefully, if you're working with one, you've had great experiences. 

[00:25:33] But having said that, it is like you don't want your pharmacist being asleep at the wheel when you're talking about micrograms of medication. I 100% agree with you. Now, I think we'd be remiss if we're talking about that without talking about adrenal health. 

McCall McPherson: [00:25:49] Yeah. 

Cynthia Thurlow: [00:25:50] And I think this is kind of kissing cousins. But in many ways, I feel like adrenal health really doesn't get sufficient emphasis. I think the term adrenal fatigue has gotten so many traditional allopathic providers completely triggered. And, yes, I think there's other ways to describe what's happening physiologically to women as they're navigating middle age and beyond. So, let's talk a little bit about adrenal health. What is your overall kind of gestalt, your perspective about how you work with your patients, how you support their adrenals? Because we all know as we start navigating the early stages of perimenopause, our adrenals have to be supported, not just then, but throughout that second half of our lifetime. 

McCall McPherson: [00:26:29] Absolutely. So, I'll start with the fact that almost 100% of our patients need their adrenals addressed. And if I give someone perfect thyroid function and I do not address their adrenals, they don't feel the improvement in their thyroid. If I fix their adrenals, but I don't address thyroid dysfunction, they don't feel that improvement either. They are so intricately intertwined that to give someone their actual life back, their full sense of vitality, you need to address both. 

[00:27:02] And to back up a little bit, our adrenals sit on top of our kidneys. They're responsible for our stress response. They secrete cortisol, stress hormones. But that also helps to regulate our sleep-wake pattern, how we feel when we wake up in the morning, our energy, our clarity throughout the day, they are a huge role in our vitality. 

[00:27:19] And medicine views our adrenals as working perfectly or in one hour, in one day, in one moment, they both completely stop working, and then we're in adrenal failure, it's either/or. And I've said that for years. I actually heard an endocrinologist say that exactly sentence on social media within the last six months. I was like, “Wow, you said that out loud, [Cynthia laughs] and you didn't realize how impossible that is. Like, wow, okay, so you really do believe that.” So that is not how normally things work in the world, much less our physiology, there is a slow breakdown over time. 

[00:27:54] For sake of the convenience, we've termed that adrenal fatigue. It can be adrenal dysfunction, whatever it is, but it's not adrenal failure, it's not Addison's, and it's not perfect adrenal function. It's somewhere in between. And it drives the similar symptoms on the continuum of adrenal failure, but much less severe, obviously. And so, in my opinion, it's a very real thing. I see it change people's lives when we address it literally every day. And when you have low thyroid, your adrenals are trying to compensate. So, because they are connected and so intimately related to, they make up for the other one constantly. So, someone that's had thyroid dysfunction for 10 years, their adrenals have been overworking for 10 years. And like anything that we overuse and overwork, eventually it gets worn out, it gets tired, and that's what we term adrenal fatigue. And I am a huge proponent in the diagnosis and treatment of that. 

Cynthia Thurlow: [00:28:49] Yeah, it's so interesting because I think that for every woman listening north of 35 whether it's acute stress, chronic stress, you have to be attuned to stress management because your adrenal glands can work with you or against you. And I always use myself as the example not just mention my own personal experiences over the past year, which has been like, way more-- Everyone has stress, but way more stress than I would normally experience. But anytime I'm talking to a patient who's gone through a divorce, they had a big move, someone lost a job, someone in their family got sick, maybe they had a major life milestone. A kid got married, graduated from high school, college, etc. We always have to buffer those life experiences with additional adrenal support. And that can sometimes look as simple as lifestyle adjustments, but also could be nutrition mediated, could be sleep mediated, could be adaptogenic herbs, could be sleep support, there's so many things. Do you have favorite supplements or favorite strategies that you like to use with your thyroid patients to support their adrenals? 

McCall McPherson: [00:29:53] Oh, my gosh, yes. I'm so glad you asked me that question. Okay, so obviously the lifestyle piece is important. You have to rest your way out of adrenal dysfunction. You can't push your way through. So, my over exercisers, my really type A business women, hardcore moms just going 100 miles an hour, you've got to rest. So, you have to compensate for this work that you are putting on your body. Take a nap when you can. If you have the ability to do that and you're tired, do it. Get enough sleep, get enough salt. Your adrenals need salt. If you notice you're craving it, that's why. Those are kind of some basics. Meditation, stress reduction, all of those. Do not over exercise. 

[00:30:34] Most important thing, do not over exercise. It is the most intensive way to break down your adrenals. So, only exercise to the degree that you feel just as good later that day or more energetic, never depleted, never sick, never need a nap. That's a good sign you're overdoing it. 

[00:30:52] My favorite supplement of all time of anything, of any category, is Ortho Molecular's Adren-All. It works better than any adrenal supplement I've ever tried, personally or with my patients. It has a blend of things that help nourish and restore your adrenals, but it also has cow adrenal gland in it. So, basically like Armour, like desiccated pig thyroid. We are giving your body what it's missing. So, one, we're taking the workload off of your body, allowing it to rest its way out of this situation. But two, you also don't feel like you have adrenal fatigue. And it is incredibly life changing, so that's my number one. 

[00:31:31] I also do use Ashwagandha very, very frequently with my patients. And it's fine to take when you have a thyroid issue, even if you have Hashimoto's, unless you are on an absolute extremist diet, which I don't recommend doing anyway because then you're just further taxing your adrenals, so those are my two favorites, but certainly Adren-All. 

Cynthia Thurlow: [00:31:51] Yeah, it’s a-- Ortho Molecular has amazing products and I love that you mentioned you have to rest your way out of adrenal issues and I think that that is a huge issue for so many high-functioning women. Maybe these are women who are at the sea level. Maybe they have just really demanding jobs. They're dealing with extremes, their parents are getting older, their kids are teenagers. They just have a lot being thrown at them. I also think about the women that I call it the triad, but it's the over exercisers who over restrict food, who also over fast. And inevitably I get asked, “Can you safely fast if you have thyroid issues?” My answer is, “Typically, it depends. It depends.” 

McCall McPherson: [00:32:33] Mm-hmm. Right. 

Cynthia Thurlow: [00:32:34] “Is your thyroid function stable? How are you feeling?” But when you're looking at that kind of triad, that constellation of symptoms. Those women in particular, I feel like, have the hardest time. I always say perimenopause and menopause, the pause is there intentionally. We really-- It's a time to recalibrate. It's a time to reinvestigate. It's a time to really look at our choices. Do you feel like you probably have women in your practice that are like that as well? How do you coax them out of those extreme of extremes on every level in terms of how they look at lifestyle and exercise and nutrition?

McCall McPherson: [00:33:13] Yeah, I've got a lot of those women probably because they come to me. I'm sure they come to your programs and care as well, because they've tried everything, and it's not eliciting the result that it's supposed to, so they just keep doing more and it becomes really dangerous. Truly, some of the only people that we can't fix at Modern Thyroid Clinic are those exact people. 

Cynthia Thurlow: [00:33:38] Yep.

McCall McPherson: [00:33:39] People that over exercise, they-- When they're exhausted and they feel sick, like they have the flu, the next day after they workout, you know what they do? They're like, “Oh, I just have to work out harder, so I'll get stronger.” And then they decline so significantly that it's really difficult to heal them. 

[00:33:54] So, that's kind of what I tell people, look like, don't get on that bus because it becomes very difficult to unravel that. And just because you can't do all these things right now doesn't mean that in three, six, nine months you won't be resilient to them, because you will. As you rest, your body becomes more resilient and can take more stress. But we don't want to manufacture stress when you're already in such a physiologically stressed state. It's like cold plunges. It's like very frequently get asked about those for my patients, and I'm like, “Yeah, no, absolutely not.” We're not fabricating stress. We're not creating hormesis and making your body stronger when you first come to us and it's already so weak, we need to build up your constitution first, and then you can become resilient to all those stressors or two hours of traffic commute, or major decisions at work or family dynamics that are challenging. 

Cynthia Thurlow: [00:34:53] Yeah. It's interesting. I think it was Stacy Sims that was saying that we women physiologically are not primed to be able to do the cold plunge. So, we talk about this role of hormetic stress, beneficial stress in the right amount at the right time. And I think there's also a genetic component. Like I will be the first person to say, “I'd rather be warm than cold.” And for me, 30 seconds of a cold shower or three minutes in a cryo-chamber, I'm good. I don't need a cold plunge. I don't need that degree of hormetic stressor in my life and I acknowledge that. 

[00:35:25] But I have colleagues that will continue to push themselves. These are even licensed healthcare providers that just because they saw a guy do it, they think they need to do it. And I think certainly the more that I speak to other experts like yourself, it's really about honoring our own bio individuality and really asking yourself, “Is that intense workout worth it if I come home and I'm so tired I have to take a nap? Is that three-day fast really worth it if I lose my menstrual cycle? Is that cold plunge really worth it if I'm completely anxious and like wired all day long because my body's just like, I've been overstimulated?” And so really asking ourselves that question or certainly our patients, because I find for a lot of individuals, they've never really given themselves the possibility of the fact that they can course correct. Like they're like, “This is just always what's worked for me. I need to continue doing this and I'm not willing to entertain the possibility that I'm wrong or that I need to course correct.”

McCall McPherson: [00:36:24] Right. Like I'm too weak for that. No, like you're not weak because your body is trying to communicate to you that this is not helpful. And women especially, I think we just push through and it can come at a high cost when we chronically do that and we don't take a step back and see what actually is serving us and our health.

Cynthia Thurlow: [00:36:46] Yeah, I think it's so important to have those conversations. Now, I know the very first time that we connected, before we recorded, you had reached out and had said very astutely, “I think there's a conversation about microdosing of GLP-1.” So, you are way ahead of the curve, McCall- 

McCall McPherson: [00:37:03] Yeah, I remember that [chuckles] 

Cynthia Thurlow: [00:37:04] -and I want to make sure I give you that credit. You reached out in my DMs and you were absolutely correct. This very nuanced conversation. How has your opinion about GLP-1s continued to evolve since our last conversation? I really do think for myself, both from what I've seen within my patients, my family members that are on GLP-1s, I really do think these drugs are incredibly powerful if used judiciously and appropriately. So where is your stance on GLP-1s? I know you're still pro the utilization of them. I know the microdosing piece is still a large part of what you talk about, but where are you right now on GLP-1s?

McCall McPherson: [00:37:43] You know, it's been cool. So, we definitely were ahead of the curve here and we’re microdosing people before that word was being used for GLP-1s and had really taken a different approach and started collecting massive amounts of data on our people really diligently immediately. And so, what's happening that's so cool and rewarding is things-- the patterns that we found three years ago are now coming out in the data and they're reaffirming what we've already been seeing and what we've been saying. And it's been an incredible journey for us, it truly has. 

[00:38:23] So I think-- There's a couple dynamics, one, is there's the standard of care approach to GLPs and I think that there's a lot of negative truth to what we're hearing in the media about that particular regimen. We have tried to apply dosing for diabetics to the general population in a one-size fits all manner and people are overmedicated and overdosed and no one is tailoring this medicine to each individual person or not enough people are. And it's coming at a high cost. People are losing muscle, they are having eye issues, they're losing hair, they're losing collagen. The way to do all of those things is to not eat food and be micronutrient depleted and lose a large amount of weight in a short period of time. 

[00:39:07] It's independent of the GLPs actually, but because people are so overmedicated, they're not eating food. So, I agree there are some negatives. When you remove yourself from that treatment modality and you start to do things in a different way, tiny, tiny microdoses. And I'm not talking about the lowest dose of the Ozempic pen, like that is not a microdose. I'm talking about a quarter of the lowest dose, a tenth of the lowest dose, increased only when necessary. When people build up a tolerance and it's no longer effective, some people never have to increase their dose. Everyone else on this side is increasing every four weeks, no matter what's happening. 

[00:39:45] When you put people on to tailor dosing, microdosing, you adjust them in unique manners. The outcomes are completely different, like we don't have-- There inherently is muscle protection in GLPs. There is bone density protection built into GLPs and are not causing osteoporosis. What we talked about before, so amazing, incredible things are happening and what's been so cool is things that we were attuned to-- that we expected to happen now are coming out. Cancer risk reduction, breast cancer risk reduction of 13%. Reduction of the progression of MS visually on an MRI, psoriatic arthritis, Alzheimer's, dementia, Parkinson's. If you have a stroke or a heart attack, your chance of dying is like 50% less if you're on a GLP compared to if you have a heart attack or a stroke if you're not one. Just the utilization and the benefits of these medications are so incredibly far reaching. 

[00:40:51] And so, the big thing that I try to communicate to people, because what are being told in the media is not the truth. We are being recycled over and over these messages of fear and we are only hyper focusing on these very rare side effects that largely are due to over medication. And big picture, when you take a step back, GLPs, I don't know if you think the same, but they have the lowest side effect profile of any medication I've ever seen. The highest potential benefits and all we are talking about are these side effects that largely, almost ubiquitously can be avoided if we don't overmedicate people. 

Cynthia Thurlow: [00:41:34] Do you think it's because, again, we could look at this traditional allopathic model, there's like two doses for this drug and that's all that people are using. I think that this degree of nuance and subtlety that you have been, again, I want to give you full credit because you reached out to me and I was like, “You completely changed my perspective on GLP-1s.” I think for so many patients and it's not just patients who are obese and overweight, I'm talking about people who are reducing cardiovascular risk factors by virtue of the reduction in inflammation, oxidative stress. 

[00:42:08] I have a colleague-- a physician colleague who was like, “I'm on a GLP-1, microdosed because I have high Lp (a) I don't want to be on a statin.” And so, I think that there are innumerable ways that these drugs can be utilized judiciously, cautiously and with intent. And I think that the fear mongering that has gone on about muscle loss, inadequate protein intake, infarcted guts and all these other issues, very astutely, are in patients that are not being given the information. You have to eat enough protein. You've got to maintain muscle mass. You have to strength train. This is no longer a drug that should be utilized with the lack of information of saying these are the ways to avoid the sequelae, the things we want to avoid dealing with. 

[00:42:58] Curious though, even at microdose levels, are you finding that your patients are they still hungry to eat or are they feeling like a lot of the benefits of GLP-1s is just a reduction in the desire to eat? 

McCall McPherson: [00:43:13] Such a good question. So, this is like the most common comment I get on social when I talk about this is, well, of course they're having all these benefits. Of course, they're reversing their Hashimoto's because they're eating less inflammatory food. No, so what we found and study in the fall that came out verified this, one injection can reduce CRP, an inflammatory marker that's measurable in blood. We saw it reduce by 50%. It was actually 60%. One injection of a quarter of the lowest dose of a GLP. So, these medications influence, for example, inflammation. I found four inflammatory pathways in research that they influence completely independent of food.

[00:43:55] So, the study that came out in the fall looked at these pathways and the shortest duration of time that they checked them was six weeks. And what a study that came out in April, I believe showed all these inflammatory markers are reducing before any amount of significant weight is ever lost, which is exactly what we see. So, we do have appetite reduction even at microdoses for sure. My goal is that people's appetite actually doesn't get overly suppressed. So, I'm honestly particular people are like, “Well, which GLP do you like better? Semaglutide, Tirzepatide?” And I always say, “Listen, like for the vast majority of people, I start them on Semaglutide, why? Because Tirzepatide bombs their appetite too much and they're not eating enough food.” 

Cynthia Thurlow: [00:44:36] Interesting, okay.  

McCall McPherson: [00:44:37] Yeah. And so, they can always graduate to that if they need to. But my goal is people want to eat. They have enough of an appetite to get enough micronutrients, macronutrients, so that this is a long game that can benefit them and without the negative outcomes involved with low caloric intake, low protein intake, low micronutrient intake. 

[00:44:59] And then, another thing that I feel like is worth mentioning that I'm hoping people are coming around to now is most of our patients are not on these drugs forever, like they transition off of them. We work to reverse metabolic dysfunction that is incredibly common in the thyroid community. And we look for specific parameters within their labs. I don't openly share them yet. They're like the one thing that I hold back from sharing because it's proprietary and we've sort of discovered them on our own. But once people reach certain measurable numbers of hemoglobin A1c, leptin, insulin, a lot of these people can successfully transition off, maintain their weight or more easily influence their weight in the future even in the absence of these medications. The one thing that doesn't persist is inflammatory reduction.

Cynthia Thurlow: [00:45:43] Yeah, I think that this is where that nuance is so interesting to me, especially as someone that has some cardiovascular risks that are genetic. And, we're trying to kind of augment and monitor that without going on a statin. And if anyone's taking a statin, I'm not telling you to stop a statin. That is not what this conversation's about. I just personally do not want to have to take one.

[00:46:07] With that being said, I feel like a lot of middle-aged women, whether they're on a GLP-1 one or not, struggle with hunger cues and hunger issues. They are hungry for one meal. This is where the OMAD community, I think, really gets stuck, certainly, other people in the intermittent fasting community. So, when women come to you, whether they're 35, 45, 55 or older, and they say to you, “I want to eat, but I'm only really hungry for one meal a day.” What is the way that you approach that? And I'm not per se talking about the GLP-1 microdosing community, just in generalities, because this is another question that comes up frequently. 

McCall McPherson: [00:46:43] Yeah, so we get that all the time because when people have a prolonged hypothyroid state, they go into metabolic hibernation. So, they're not burning through their fuel. They're eating and they're storing fat and they're never burning enough to trigger more hunger. They're just sort of eating because they're supposed to or undereating because think about it like a fire. That fire is almost out, it's just barely burning and they're never actually burning through all their wood to trigger them that they need more. So, a big part of that for us is actually fixing their thyroid. Like if you fix someone's thyroid even in the first couple of weeks in their journey, which in no way is their whole thyroid issue solved, but they start to feel hungry. That's one of the first signs that their T3 is getting better, that their thyroid functions improving. They start to burn through their fuel, and their body starts requesting more, which is exactly what I want. That's obviously triggering for some women, so we have to warn them, “Listen, this is good. This means you're getting an increase in upregulation in your metabolism and that's what we're looking for.” 

Cynthia Thurlow: [00:47:51] Yeah. I feel like this has become so common now that people will share this, that I was like, is it a change in sex hormones? Because we know that estrogen and progesterone are intricately related to gut motility. I was like, is it thyroid? Is it some other-- Is it a micronutrient deficiency? Leptin?

McCall McPherson: [00:48:10] Once it gets so high, people lose hunger. 

Cynthia Thurlow: [00:48:13] Yeah. Trying to figure out like what could be, because I don't think it's a one size fits all. I think there's a lot of different contributors. And sometimes this even happens in thinner patients, which is why I was like, okay, all the normal players that I'm thinking about when patients talk to me about not-- And it's not an eating disorder behavior. It's truly like, “I'm hungry for one meal, but not for a second.” And I'm like, “Okay. If we're trying to put on muscle mass, if we're trying to be conscientious about maintaining muscle mass, putting on muscle, then we have to be eating more than once a day.” 

McCall McPherson: [00:48:42] Yeah. And, our body, the cool thing about it is it will respond like ghrelin or hunger cues get patterned by our habits. So, if you eat once a day, your hormones that try to trigger you to eat by making you hungry peak once a day. If we can make someone eat more meals during the day, eventually their hunger cue hormones adapt to that and will start to reinforce that behavior. And so, sometimes it's just about creating the habit and allowing your physiology to catch up. 

Cynthia Thurlow: [00:49:16] Yeah. I think it's important for people to give themselves some grace, because in many instances, whether it's the toxic diet culture that our entire generation has kind of grown up in, where women are-- Dr. Mary Claire always says that, “We were encouraged to be skinny.” Thin was what was-- Thin is in, you know that kind of mantra, and yet now we're really encouraging women to be strong, to maintain some muscle, to not be afraid of weight training, to not be afraid of those things. Where does alcohol fit into your discussions with patients, especially those of us that are north of 35?

McCall McPherson: [00:49:51] Gosh. You know what's so sad is when you get into the perimenopause state, for some reason, we just can't tolerate alcohol anymore. [laughs]

Cynthia Thurlow: [00:49:58] Nope. 

McCall McPherson: It's so frustrating. I would tell people in my early 30s, when I was practicing, “Look, I'm never going to take away your coffee and I'm not going to take away wine on occasion. Like, you can have those things.” I think most women need balance. I always encourage women. Let's not go to extremes. Let's not create rigid rules around food, because we already try to implement those so much in ourselves, and it's really damaging to our relationship with our food. And so, I say, “Look in small amounts, moderation, always know alcohol is best.” The data is pretty clear. I'd love to say, “Hey, a glass of red wine really is--” it's not. When weigh the pros and cons, no alcohol is always better than even low amounts of alcohol. So, if you can abstain, do so. I'm trying a few of these newer drinks with herbs and things that you can substitute for wine. I'll let you know how it goes. I'm not sure yet. The jury is out. [crosstalk] Yeah. [Cynthia laughs] But, I think I try not to in any way truly create rigid and dogmatic rules with my patients. I also never ask my patients to do anything I'm not willing to do myself. And I'm going to enjoy a glass of wine on occasion, even if it completely ruins my night of sleep. 

Cynthia Thurlow: [00:51:16] Yeah. And I think that perspective is one that is reasonable and not overtly restrictive, because someone asked me recently on a podcast what my nutritional paradigm is? And I said, “Well, let me be very clear. I'm someone that has multiple autoimmune conditions, all in remission. This is what works well for me.”

McCall McPherson: [00:51:36] Yeah. 

Cynthia Thurlow: [00:51:37] I am not suggesting that this be applied to the entire listening community, because inevitably there'll be someone that's triggered if I say, “I don't eat gluten, I don't eat dairy, I don't drink alcohol just because they don't make me feel good.” I was even reintroducing a little bit of whey protein over the past couple months, and I was like-- even with eating it infrequently, I was like, “You know what? I need to pull it out. I need to reassess where things are right now. I'm having no way for the past couple weeks.” So, I agree with you that we never want to ask our patients to do something that we're not willing to do ourselves and be really transparent and honest. I used to love a vodka martini once or twice a month, and I think it was really just my conduit to salt because I love salty things. 

McCall McPherson: [00:52:17] Oh yeah. 

Cynthia Thurlow: [00:52:19] That being said, I've just gotten to the point I don't feel good when I do it anymore. And, yeah, my sleep is wrecked, which is really a bummer, because again, I think it was a conduit to salt more than anything else. 

McCall McPherson: [00:52:28] Yeah. 

Cynthia Thurlow: [00:52:29] Is there anything on the horizon for you? I know you have a book that you're in the process of-- Congratulations again, an amazing book that will be on thyroid that will be out in 2027, so obviously we'll have you back before then. Anything that's new on the horizon, new supplements, new things you're excited about in your practice, new research that you feel like would be helpful for listeners to get a little bit more insights that may be able to help them navigate advocating for themselves and their thyroid.

McCall McPherson: [00:52:57] Yeah, we are going to start a clinical study at Modern Thyroid Clinic just looking at outcomes for people who layer in T3. Sadly, a lot of the studies that look at active thyroid hormones compared to Levothyroxine and Synthroid don't show improvement in quality of life. Meanwhile, we have like a 95% success rate at Modern Thyroid Clinic. So, I think the studies are poorly done and it's by people that don't really know how to effectively use these medications successfully and safely. So, I'm really hopeful about that. 

[00:53:26] I really want to evolve-- In my lifetime, I want to evolve thyroid care. I want women to be able to successfully get the help that they so deserve and that is incredibly hard to find at this point. So that's still probably another-- It'll be out before the book is completed, but still at least a year. We are launching our sister company and have launched it Modern Weight Loss, which is a nationwide program, utilizing GLPs in the same way that we've utilized them for the last three and a half years with our patients at Modern Thyroid Clinic. So I'm really grateful. Like, that whole journey has been sacred to me. It's been something that I feel so impassioned about, and I never thought I would find something else that I feel so passionate about as I do with thyroid, but I have witnessed it change thousands of lives at this point and it's just been an incredible experience, so I'm excited to bring that to people and access. And then Modern Thyroid Clinic now we're nationwide. We're waiting on four states only. So again, access for these people that need help and can't find it is where we are putting every ounce of our energy into.

Cynthia Thurlow: [00:54:30] Well, and I refer to you all regularly as I tell everyone, I'm like, listen, you want to go to the licensed healthcare professionals for guidance on thyroid management? Are you able to share which four states you're still waiting to get licensed in? Did I put you on the spot? 

McCall McPherson: [00:54:45] Oh my gosh, you did. They're small. 

Cynthia Thurlow: [00:54:47] Okay, small states. 

McCall McPherson: [00:54:48] They're not even any of the big ones. They're like small, random. It's not Alabama. No, I can't remember. But we're all in all of like the California- 

Cynthia Thurlow: [00:54:54] Amazing. 

McCall McPherson: [00:54:55] -the New York. The really-- Chicago, Illinois, we're waiting on that one. That's the only one I can remember offhand. 

Cynthia Thurlow: [00:55:01] No. Sorry to put you on the spot-

McCall McPherson: [00:55:02] No. No problem.

Cynthia Thurlow: [00:55:02] -but I was hoping to [crosstalk] hand now. Please let listeners know how to connect with you out there outside of the podcast. How to listen to your amazing podcast. Get on your email list. Obviously, we'll include your lab guide in the show notes for patients that want to take a look at that and use that as another education piece to take to their provider. 

McCall McPherson: [00:55:19] Yeah. So, you can find me at-- on Instagram @mccallmcphersonpa. I love TikTok too, @mccallmcpherson. And then Modern Thyroid is on all platforms as well. We would love to see. We try to really pull back the curtain and share every ounce of information that we have freely. That's why we share our thyroid lab guide. It tells you what labs you need and it also shares the ranges that we use at Modern Thyroid Clinic for optimal treatment as opposed to “normal treatment.” So, I'll of course share that with Cynthia. I'm happy to share that as a resource with you all. And you can also find my podcast, Modern Thyroid and Wellness. I need to have Cynthia on there as soon as she gets-- Comes up for, you know, some air. But yeah, we share not only about thyroid, but longevity and health in general and just things for women to reach their highest potential.

Cynthia Thurlow: [00:56:06] Thanks again, my friend. So good to connect with you. 

McCall McPherson: [00:56:09] Thanks for having me. 

Cynthia Thurlow: [00:56:12] If you love this podcast episode, please leave a rating and review subscribe and tell a friend. 

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