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Ep. 497 Masterclass: Testing, Treatment & T3 Truths Revealed

  • Team Cynthia
  • 2 days ago
  • 29 min read

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We have the next episode in our series of thyroid-focused podcasts today.


In this episode, Dr. Shawn Tassone, Dr. Alan Christianson, and Dr. Amie Hornaman join me to dive into medications, treatment options, personal preferences, and the fear that often drives medical decision-making. We discuss the current prevalence of thyroid-related conditions and why iodine remains a controversial topic in thyroid physiology. We also cover the role of micronutrients and the impact and symptoms of hypothyroidism, clarifying the concept of thyroid pause, and the specific lab tests required for evaluation, in addition to sharing some practical strategies. 


Dr. Shawn Tassone advocates for a personalized approach to thyroid treatment, often preferring desiccated or compounded medications over standard synthetics, depending on patient response, insurance coverage, and symptom relief. He also addresses the ongoing resistance within conventional endocrinology to T3-based therapies, despite clear clinical improvements in patients using them.


Dr. Alan Christianson explains that the dramatic rise in thyroid disorders over recent decades is due to increased iodine exposure, particularly from processed foods, dairy, supplements, and cosmetics. While iodine is essential for thyroid function, even small excesses can overwhelm the system, triggering autoimmune responses. However, reducing iodine intake can significantly improve or even reverse thyroid dysfunction in many people.


Dr. Amie Hornaman explains that optimal thyroid function is essential for overall health, and the active thyroid hormone, T3, is needed by every cell in the body. She highlights the importance of comprehensive thyroid testing to detect dysfunction often missed by standard TSH tests, particularly in women over 40 or those experiencing symptoms linked to perimenopause, menopause, or Hashimoto’s.


This enlightening conversation, with three leading thyroid authorities, is packed with valuable insights, so you should revisit it more than once.

"Once you get the right number of iodine atoms in place, now you've got an active thyroid hormone, so it's essential. "


– Dr. Alan Christianson

Connect with Cynthia Thurlow  


Connect with Dr. Shawn Tassone


Connect with Dr. Alan Christianson


Connect with Dr. Amie Hornaman


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.


[00:00:30] Today is the next in the series of thyroid focused content with experts, Dr. Shawn Tassone, Dr. Alan Christianson, and Dr. Amie Hornaman. Today, we speak about medications and treatment and preferences and fear that drives a lot of decisions that are made in medicine, current prevalence of thyroid-related diseases, why iodine tends to be a controversial topic as it pertains to thyroid physiology, the role of micronutrients, the impact of hypothyroidism as well as symptoms, what thyroid pause is, specific labs for evaluations as well as strategies. Again, another invaluable conversation that is thyroid specific with these experts. I know you will want to listen to this more than once. 


[music]


[00:01:19] Well, and I think that lifelong learning, I think for any clinician is really critically important. I always tell my kids that I'll be learning till the day I die because I think that innate curiosity is what distinguishes good clinicians from mediocre ones, wanting to learn more, to understand more, to evolve from where you are. Now, you touched on thyroid health and this is always a popular topic for us. In your clinical experience, are you using a lot of compounded thyroid medications? Do you feel like that's more efficacious? I feel like the Nature Thyroid, Armour Thyroid. I've seen so many patients over the past two years that struggle to get, pharmaceutical agents that are uniform and not having recalls. I know there are certainly people that do well on things like Synthroid and Cytomel. 


[00:02:05] I know that bio-individuality plays a large role. But are you using quite a bit of compounded medication or just the traditionals? 


Dr. Shawn Tassone: [00:02:11] I probably use about 90% NP Thyroid, which is in the same aspect with Armour. And the problem that you have with the desiccated thyroid products is they make good products and part of that is they have to have consistency. So, if there's two standard deviations away from what it says is in the pill, they have to recall the lot. I haven't seen a recall in a couple of years, but it happens every once in a while, and it's usually because there's not enough. It's not because it's over, it's usually just it's not enough. And so there wouldn't be any harm in it. But they're being open and honest with their patients and I think that's great. I find that a couple of them have gone off the market. Nature-Throid and WP Thyroid have disappeared.


[00:02:56] So, you got Armour and NP and I've started doing the compounding. Again, compounding thyroid is a learning curve for doctor. And you have to figure it out and it depends. It's funny because NP Thyroid, sometimes it's 5 bucks, sometimes it's 125 bucks. And so, I have to play with the insurance. If it's a super high expensive, then I'll go compounded because it's $45 somewhere around there and it's the same stuff or I have Synthroid and Cytomel for people that want to use their insurance. So, it just depends. But I'm a huge fan of the desiccated thyroid. 


Cynthia Thurlow: [00:03:29] Yeah, it's interesting. I think the listeners are probably pretty familiarized with. I was on NP Thyroid, Nature Thyroid excuse me for years. And then two years ago, they did away with my dose and then, to never come back again. And so then started the journey of every other desiccated product then onto synthetics. And then I started seeing a mutual friend of ours and he said, “You have the most interesting thyroid panel I've ever seen.” I said, “I don't want to be interesting.” 


Dr. Shawn Tassone: [00:03:57] It just sounds like something Alan would say. 


Cynthia Thurlow: [00:03:58] Actually it was Aaron Hartman. 


Dr. Shawn Tassone: [00:04:00] Oh, Alan. That sounds like the interesting. But yeah, that's good. There's somebody that's open.


Cynthia Thurlow: [00:04:05] Yeah. And so now I'm on compounded, but every two weeks I get labs drawn. So, the reason why I'm bringing this up is that so people understand there are multiple options, but also understanding, like, it can take a while to become therapeutic. I have not been therapeutic on medication for over two years. I'm hoping I'm like crossing my fingers that my free T3, which is my active thyroid hormone, will hopefully be within range. We're getting very close. I'm like, “This is good. I can sleep.” And my thyroid is finally--[crosstalk]. 


Dr. Shawn Tassone: [00:04:35] And how many women do you see that are on Synthroid,-


Cynthia Thurlow: [00:04:38] And they don't feel good? 


Dr. Shawn Tassone: [00:04:39] -just Synthroid. And I always say that's like saying because T4, which is Synthroid, is the storage hormone and T3 is the active. So, having a nice T4, I always say is like, “Man, you got a million dollars in your bank account, but you can't spend any of it.” [Cynthia laughs] It looks good on paper, but you're broke. And that's exactly what it is. And so, what are we going to do? Well, let's put more money in your bank and tell you still can't spend it. I don't understand the theory behind that, but that's the endocrine notoriously don't use T3, or they hate the desiccated products. But luckily, I have a woman here in town that is-- endocrine and she's all about it. So, I can refer to her sometimes, but how many times have you had it happen where you'll get this patient happy on a desiccated product like Armour or NP? and then she goes to her endocrinologist and they take her off of it, and it's like, “Oh, God,” it's like six months down the tubes because they just didn't believe in what is going on. 


[00:05:39] I'm like, “How can you not believe in it?” It's there. It's a real. It's not like a ghost, you know, but it's a weird thing. 


Cynthia Thurlow: [00:05:46] No, it's interesting. That's definitely one of the specialties that I would say when I talk to colleagues who are endocrinologists, that they're still focusing on studies from the 1950s with some concern about desiccated products. And I always say, the patient and how they feel is what's most important, even if the lab suggests otherwise. 


Dr. Shawn Tassone: [00:06:08] I have a thyroid surgeon who's a friend of mine, drew her labs. Same thing. TSH is fine, free T3 below normal. She said, “Can you put me on NP Thyroid?” And I said, “Of course.” And she said, “Because I have two friends that are endocrinologists. And they laughed at me.” And she's a surgeon. She knows what she's doing. So, I put her on it, and she felt like a million bucks. And she's like, “I'm not even going to tell my friends that I'm on it because they're going to give me a hard time?” And I said that, “I just don't understand that. If you feel good, why wouldn't they say, that's amazing?” But that's what we run into all the time. 


[music]


Dr. Alan Christianson: [00:06:48] Yeah. So much of what we've learned has changed in the recent past, and so much of thyroid disease has changed recently. Thyroid cancers have tripled last couple decades. Prevalence of thyroid treatment and diagnosis for chronic disease has also tripled over this time frame. And there's been a lot of new initiatives trying to answer the question of “Why is this happening? What's going on?” One large group of medical reviewers, their conclusion was that many factors are responsible. However, the biggest single one by far is the change in our iodine intake. And they argued that it was not only the most important, but it was more important than all the other factors combined. So, yeah. [laughs] 


Cynthia Thurlow: [00:07:27] Well, and it's interesting because if we think about how much our health as a nation and most westernized countries has really shifted over the last 20 to 30 years, less people cooking at home, more consumption of processed foods, where I'm assuming there is more exposure to iodine, there's so much of it in the processed food industry. And interestingly enough, I was always feeling badly because every time I had a urinary iodine checked by my functional medicine provider, they're like, “Oh, you're so low. Eat more sea vegetables.” [laughs] And so, I'm grateful that I never actually took an iodine supplement, but I know that there's so much conflict about this particular micronutrient in particular. I think for so many people, we would not have made those connections that you've been able to make when you were piecing together all this research behind the book. 


Dr. Alan Christianson: [00:08:14] Yeah, big picture, there's some ideas that have become prevalent in functional medicine that I could talk in great detail about where it came from, why, and a lot of things are plausible with iodine, but it is not true. The way we think about nutrients in general is that vitamin C, magnesium, calcium, zinc, they work with some countless parts of our bodies and they do a myriad of important roles and we may get low in them, but there's really not a common issue of getting too much. Our body can regulate that pretty well. None of those things are true for iodine. [laughs] All the ways, we're used to thinking about nutrients do not apply to iodine. And it's important. We need it. It's not the bad guy at the story. 


[00:08:55] Most people, probably a slight majority, they can tolerate the normal occasional excesses of iodine and with no issue. You know, just like water off a duck's back, no big deal. But they're not the ones prone to thyroid disease. So yeah, it's something that the amounts in play are so tiny, the body concentrates it many fold over requirements. And just because of that variable, the whole relationship changes. There was a lot of times historically where we went back to pre1990, a lot of times globally in which people were getting just less than they need. But now it's much easier to get above a threshold that those who are sensitive can't tolerate. And then the really exciting part of it is that it's cool to know why things happen. But an explanation is not always a solution. 


[00:09:43] Humpty Dumpty might have fallen off the wall because a gust of wind came along, but that wouldn't fix him necessarily. So, the exciting thing is this can also offer a solution for many people that even if this were the thing that caused their disease, a really high percent of them can see their disease go away by correcting the problem. 


Cynthia Thurlow: [00:10:00] I think this is profoundly encouraging because when I talk to middle-aged women that are in perimenopause and menopause, nearly all of them are either on thyroid replacement or they're told they have a lagging thyroid. And people are feeling anxious because for many of them, maybe this is the first time they've needed to go on a prescription medication. To understand that there could be a reason for why this has transpired beyond just being, “middle age” is highly encouraging. Now, one of the things that I think is really important to talk about for those that are not familiarized with thyroid physiology and how iodine kind of fits into that, I think that it's important for people to understand that we just need very small amounts of iodine. It's not a proliferative amount that we need. 


[00:10:45] But let's kind of dive into the physiology of the thyroid because I think even understanding on a very basic level the way the thyroid works and how iodine interacts with that will help people understand why we have to be conscientious about this. 


Dr. Alan Christianson: [00:10:57] Yeah, so iodine is a really powerful substance. You know, the form that it circulates in the body is generally a more dormant one, but it gets activated within the thyroid. And iodine's been used forever as antiseptic. So, in a lot of ways you can think about it like you'd think about like bleach or hydrogen peroxide solution. It massively generates free radicals and that's great for killing infections. And that's useful in some chemical reactions, but it's exacting. So, there's a protein that the thyroid makes, and this protein is, I don't know, like a big coat hanger. And then iodine comes along and its various coats that fit on these hooks of the hanger. So, once you get the right number of iodine atoms in place, now you've got an active thyroid hormone, so it's essential. 


[00:11:42] You can't have hormones without the iodine, however, I don't know, you're in a cold part of the country too. I grew up in Northern Minnesota. You've got family over and soon the coat hanger is overloaded. [laughs] There's like coats laying on the bed and stuff on the floor around it and mittens and scarves. So, that's what happens with a little bit extra iodine, is that there's places for to be really precise each molecule of thyroglobulin has special residues to hold up to 13 iodine atoms. But if we get just a little more than our bodies tolerate, we might have 50 or 60 iodine atoms all jammed around that molecule. It's like the coats exploding all over the coat rack. And that by itself makes the thyroid proteins look weird. 


[00:12:29] Your immune cells come in, they say, “What's going on?” They start to attack them and now there's an autoimmune process. So, the thyroid is slowed down and that's the main trigger for it. This very thing that you need to work a little bit too much of that shuts the whole thing down. 


Cynthia Thurlow: [00:12:43] Well, I think that balance is really critically important, that people understand that iodine is not needed, that it's not absolutely necessary for appropriate thyroid function. But too much of any one thing is no good. Now one of the things I found really interesting was that in the book you talk about how our bodies need anywhere from 50 to 200 mcg. So, we're talking about a very small amount to actually make healthy thyroid hormone and it's the exposure that we go about on a day-to-day basis. Like people may be thinking, “Well, I'm not taking iodine supplement, I don't like sea vegetables.” But there are things in our environment in particular and what I found really disturbing and I'm not a dairy drinker, I don't eat cheese, I don't do any of that. 


[00:13:27] But you talk about the sanitization properties of iodine. And one of the reasons why there is so much iodine empirically in dairy products is that's what the farmers or dairy farmers will use to sanitize the cow's teeth. So, actually when they're going in to actually, I'm not even sure the technical terminology when someone's milking a cow, I don't know the other way to put it when someone's milking a cow that the cow's udders have been sanitized with iodine. So, you're getting it just from there. There is so many ways that we're exposed iodine without even realizing it. 


Dr. Alan Christianson: [00:14:01] Yeah. And we get some, we need some. And what happens is this is a story that's really about a change, a change took place around the mid to late 80s. There is other eras that are relevant to thyroid disease. The rates were lower, but around then it started really picking up. And there's been a constant amount in certain food types. We've always had some in iodized salt. There's always been some in egg yolks. We'll always have some iodine in seafood. Those things haven't changed all that much. Sea vegetables are really high sources. Most westerners don't consume that many of them. Some do. They're certainly relevant. But yeah, the big shift has been dairy, processed foods and cosmetics as being changes and then supplements. 


[00:14:42] So, dairy food and processed grain products, they comprise the top 25 sources of iodine in the average American diet. And 23 of those 25 top sources, the amount they contribute has doubled or tripled in the last several decades. So, yeah, this is a big source and it's really picked up. 


Cynthia Thurlow: [00:15:00] What do you attribute that to? I always talk about the rise of the processed food industry, but I think it's also the mentality a lot of people maybe take COVID out of it, people are much more than they were before. But how the processed food industry in many ways has convinced families and individuals that they don't know how to cook. I've got an easier, faster way to get food on your table, but the net downtoward effect, whether it's exposure to seed oils, processed sugars, all these other micronutrients that we think of as being fairly benign really aren't, cumulatively over time.


Dr. Alan Christianson: [00:15:34] You know, definitely a big factor. We also see micronutrients with high amounts cosmetics and somehow or other this combination has been a big shift. And yeah, globally in 1990, we had 112 nations that were severely deficient, and now there's none. But we've got 52 nations categorized as at risk for thyroid disease due to iodine excess. We are one of those. 


Cynthia Thurlow: [00:15:56] And so, when that initiative went through, and I also found this really interesting, the role of iodine and having an appropriately functioning thyroid is so critical for neurocognitive function. So, I'm presuming that was the impetus for actually creating that initiative to begin with. It was a concern that there are these at-risk nations that are severely impacted by these deficiencies. 


Dr. Alan Christianson: [00:16:18] For sure. Yeah. So congenital hypothyroidism, cretinism there's many ways that basically iodine, all things iodine, as far as human health, they're filtered through thyroid function. If there's ever the wrong amount, that plays out by changing how the thyroid works before almost anything else happens. And so, places that were severely deficient, they would have people developing with varying problems. Pediatric goiter, enlargement to the thyroid, probably one of the most benign of the problems. And funny thing is, most of those problems are more pronounced in younger populations and children. If someone does make it through adulthood, it's just less of an issue, it's less common. But yeah, pediatric goiter, congenital hypothyroidism, neurocognitive development, impairment, as you mentioned, those were big factors. 


[00:17:03] And if we were to go back even to the 70s and the early 80s, there was times in which almost a billion people on the planet didn't have proper brain function due to a lack of that. So, it was a big public health problem and they fixed it. It was successful, it was a good thing. But now we've gone a little too far in some areas. [laughs] 


Cynthia Thurlow: [00:17:22] The pendulum has really swung the opposite direction. [Dr. Alan Christianson laughs] So, if we've addressed the iodine deficiency and now we have this overabundance in many ways, there's overabundance on many levels. What are the things that people need to understand so that they can be proactive or be in a position where they can make more educated decisions about the products they're exposed to. You mentioned the cosmetic industry is a huge contributor to why we've got this iodine excess as well as the nutritional component. But what are the things that people need to be aware of so that they can, screen. Obviously, you've got a lot of great information in your book. I strongly encourage people to go check it out. But what are the things, the big things, the high-level things that people need to be aware of? 


Dr. Alan Christianson: [00:18:06] Yeah. The most important thing I want listeners to take away from this is just a sense about how much change is possible and how likely that change can be. There was one paper which didn't make it in the book because it hadn't come out yet. It was completed in May of 2020. And this was a paper looking at the role of deprescribing, which basically means someone who's not prescribing but deprescribing. Someone not need thyroid medications any longer. And in this study, they took people and they did the most cursory level of iodine avoidance. They said, here's some really obvious sources that have too much iodine, like sea veggies like you mentioned. Some supplements don't do these things and let's see if you can stop taking your thyroid medication and just doing that 40% of people who were on longer term treatment were successfully able to deprescribe, they could stop their medications, they could maintain normal thyroid function and they could maintain free, no symptoms, they felt fine, they had normal thyroid function. So, that was those on treatment.


[00:19:07] Now, those not yet on treatment. One of the studies that I cited in the book took those with Hashimoto's. They'd had it for about four to five years. They were severely hypothyroid and we could talk about numbers, but they were way outside the normal range, like a factor of four. And all they did with them was a more thorough avoidance of obvious sources of iodine. And in three months, 78.3% had perfectly normal thyroid function again. 


[00:19:34] And of those who didn't get better, most of them either didn't really follow all the instructions. There was still a lot of iodine coming out of their bodies or they were improving, but they started so far off that they just didn't yet have time to normalize. So, they looked at the numbers and said, “Okay, so who in this study did do things right but just didn't respond at all, to whom did this not make any difference? That was about 3% of participants. So almost everyone got totally normal or was heading that way. So, this is something that doesn't help some people here and there maybe. And this is something that doesn't help by like a subtle amount that you got to squint to see it. This is a big deal. This is like almost all people with thyroid problems can see their function radically improve or normalize in short periods of time. 


Cynthia Thurlow: [00:20:24] It's really incredibly encouraging. So, for listeners that aren't aware of this, the bulk of those with an underactive thyroid, it's generally-- and I've seen statistics anywhere from 70% to 85%, somewhere in between is probably correct are impacted by the autoimmune, so body attacking self, Hashimoto's and then there are the gray area maybe of 10% to 15% of us who have non autoimmune hypothyroidism. And then an even smaller percentage of people have hyperthyroidism. So, the overactive thyroid. And in those studies, was there any differentiation between each one of those groups or was it just a normalization just overall? 


Dr. Alan Christianson: [00:21:02] Yeah. So those that clearly have autoimmunity and then those that don't. So, hypothyroidism and Hashimoto's were both studied pretty much the same numbers. They also showed subclinical disease, where part of the labs are off, part of them aren't. Same numbers, basically. Funny brief aside. So, nonautoimmune hypothyroidism, we think now is like, really, really rare. Not most, but right around half of people that have autoimmune thyroid disease may never have measurable thyroid antibodies. So, a lot of doctors say, “Oh, you don't have thyroid antibodies present. You must not have autoimmune thyroid disease.” Like, nope, that's not a rule out. [laughs] 


Cynthia Thurlow: [00:21:35] That's really significant because even for clinicians who've been diagnosed with hypothyroidism, I thought I was always safe from Hashimoto's because my thyroid antibodies were always negative. I mean, they were zero. But that's suggesting that there are a lot of people who may indeed have autoimmune Hashimoto's without realizing it. 


Dr. Alan Christianson: [00:21:54] Honestly, the trend clinically has been to assume unless there's a clear reason otherwise. A lot of the other reasons for hypothyroidism are more historical than present. If someone had their tonsils radiated back when for a sore throat that doesn't go on anymore, or the couple handful of medications that might directly slow the thyroid or some other surgery or procedure that affected it. But barring that kind of stuff, it's pretty much all autoimmune. So, then you asked about hyperthyroidism, about Graves’ disease, and there have been trials looking at this approach. Now, with Graves’ disease, there's a fascinating feedback cycle between too much thyroid hormone and then the autoimmunity that causes one to release too much thyroid hormone. So, we call this the autoimmune hyperthyroidism loop. So, someone really first has to break that loop. 


[00:22:42] If they don't, if they can't lower their thyroid output by stopping their thyroid, it'll keep cranking on and keep escalating all by itself. However, once that loop is broken, whether that's by the gland spontaneously slowing, as it does for some or medications to slow it or other procedures to slow it, once the loop is broken, then there's a lot of data showing that iodine regulation makes things go a lot quicker. And funny thing about Graves’ is that in the moment, it can be more acute and more dangerous for cardiac effects. However, the rate of full remission-- full disease remission is actually a lot higher than it is for Hashimoto's. 


[00:23:18] So, when someone can get stabilized, and this is not based on new data. This is just old data that they've got about a 95% chance of normal thyroid function within 18 months just by stabilizing. 


[music]


Cynthia Thurlow: [00:23:34] So, let's pivot and talk about what happens when we don't have enough thyroid hormone over time, what is happening to our bodies. Because understanding that in every cell of our body, we have a thyroid receptor helps us understand why it's so important to make sure our thyroids are optimized.


Dr. Amie Hornaman: [00:23:55] Just exactly what you said, every single cell in our body has a receptor site on it for thyroid hormone. Now, specifically T3 thyroid hormone. So, if you have been diagnosed hypothyroid, you are on medication, which I have a little side note that I'll get to in a moment. If you are on medication, most likely if you're in the standard conventional medical system, you are on T4. So, you might be saying, “Well, you know, I am taking this thyroid hormone replacement, and it's just not doing anything. I don't feel better. I don't feel anything. That Cynthia just said, my brain didn't light up. Why am I even taking it?” And that's where proper treatment protocols come in. 


[00:24:38] But I want to back up and just address the medication piece because I get this question a lot from my patients, from my audience that they don't want to take a prescription. And I understand that, but we have to separate out what is a medication that you don't really want to be on, and can you do things to avoid it? Maybe those are the band-aid medications, statins, antidepressants, which I'm not saying no one needs antidepressant, but they are often prescribed as a band aid before getting down into the root cause, which very well could be thyroid dysfunction, which is triggering that, that increased anxiety and depression. Yes, we want to avoid the band-aid medications that are not necessary, but we have to put thyroid hormone and progesterone, estrogen and testosterone. 


[00:25:28] We put those into the hormone replacement category, where we are replacing hormones that are no longer being properly made by your body. And to my individual patients who maybe give a little bit of pushback and just can't seem to break through that I say, “Okay, if your child or loved one was suddenly diagnosed with type 1 diabetes and the doctor came out and said, “You are going to need to give your child insulin in the form of a shot or the pump, it is a hormone that is no longer being properly produced by their body.” You wouldn't say, “Oh yeah, no, I don't want to start my kid or my husband on a prescription because the doctor would say, well then they're going to die because this is a hormone that is needed for life.” Now, will you die without thyroid hormone? No, not necessarily, not quickly like you would without insulin, but your quality of life is going to decrease. And then getting into your point of how does the thyroid control everything? It controls everything. 


[00:26:32] You are definitely at an increased risk of type 2 diabetes, which we know that's basically the start of all-cause mortality. If we really look at it metabolic dysfunction then opens the door for a variety of different disease states. Obesity in and of itself increases your risk of all diseases, cancer, Alzheimer's, everything. All of those diseases that occur as we age that absolutely will contribute to an early death start with obesity, start with type 2 diabetes. So, we know that the thyroid literally controls our glucose regulation. How much insulin is being secreted by the pancreas, how we utilize our blood glucose, how we respond to food. 


[00:27:12] I have seen carnivores come into my practice with A1cs in the diabetic range and they've been carnivore for years. And it all comes back to-- they've also been walking around with thyroid dysfunction or Hashimoto's for years it was either untreated or mistreated. And because of that, there's that perfect picture of how the thyroid literally controls your entire body brain function. I have had many patients come in and say, “I think I'm getting early Alzheimer's.” I go, “No, you're not. Your thyroid's low.” You don't have enough active thyroid hormone in your body to get to the receptor sites on your brain. So yes, everything is low and slow. 


[00:27:56] When you think about the thyroid not functioning well, being hypothyroid, everything is low and slow, from digestion to brain function, to mood, metabolism, hair growth, skin cell turnover, heart rate, blood pressure, it's all low. It's all in the toilet. So, if your whole body is functioning at a very low level, then you can almost see the issues that are going to come. You can see that if we're not regulating our glucose, that can feed cancer cells. And we know that Alzheimer's is type 3 diabetes with dysregulated insulin. You can see that, okay, if my brain isn't firing and functioning, early Alzheimer's absolutely can occur. Heart disease increases with low thyroid functions. There are so many things that are tied to it that it will happen slowly over time. 


[00:28:50] You probably will receive all of those band aid medications as your symptoms continue, as your blood work looks worse and worse, as you move into a type 2 diabetic state, as your lipid panel goes in the toilet, you get prescribed a statin, as your blood pressure goes up and you get prescribed a blood pressure medication. You can see how it can happen, but it's going to happen so slowly that you're going to attribute it to aging. Your doctor is going to give you a band aid unless you are aware and educated, like we try to do on our shows. You might even miss it and dismiss it and not even realize that it could be your thyroid. And it could be as simple as going on thyroid hormone replacement. The right kind at the right dose and the right combination that is for you, that gets you optimized. It could be that simple. And now you can go over-- And now I'm going to tie it back to that statement I made. Now you can go over to the band-aid medications and slowly get rid of them, because you didn't actually need-- You weren't Prozac deficient, you were thyroid hormone deficient. And that's where it all ties together. 


Cynthia Thurlow: [00:29:55] And what is it that's unique about perimenopause and menopause that seems to increase the incidence of developing hypothyroidism? Because we know that it is much more common to see an underactive thyroid as opposed to an overactive one. 


Dr. Amie Hornaman: [00:30:11] Thyropause, which may not be the title of my next book, of course, as you know, it's all up to the publisher, but thyropause. So, I've actually defined that as, after the age of 40, when your hormones crap the bed, your thyroid goes in the toilet. Like, that's my very simple layman's term definition of thyropause. But to break it down, as we're moving into perimenopause and menopause, our hormones decline. We know that you can't escape it unless someone figures out how to age like Benjamin Button you can't escape hormonal decline. As those hormones decline, we know that decline can trigger Hashimoto's. So, let me back up when we're looking at hypothyroidism, low and slow thyroid function, 95% of that is Hashimoto's, which is autoimmune. And with autoimmune, there's this beautiful analogy that I absolutely love of a three-legged stool. 


[00:31:03] Whereas one of the legs of the stool, you have that genetic predisposition, the other leg of the stool, you have leaky gut. And to your point, who doesn't have leaky gut these days? And then that third leg is a trigger. Now that trigger could be a massive stressor in your life. It could be pregnancy. Even though having a baby is very natural, it's a huge stressor on a woman's body. I mean, let's face it, your hormones are on a roller coaster. Your body is rapidly changing. Well, now let's take that into perimenopause and menopause, where hormones are declining. And as a woman moves into that stage of life, estrogen is literally on a roller coaster. We could test a woman one day and she's estrogen dominant and we could test her the next day and she's estrogen deficient. 


[00:31:51] Her estrogen is on this wild ride. And that's a huge stressor on the body. Losing progesterone, losing testosterone, huge stressor on the body. So that stressor, independent of life stressors that are also going on as we move into middle age, that stressor is enough to flip the autoimmune switch from the off position to the on position. And when that autoimmune turns on, that's where we will hear women say, “You know, it was after my second child, it was as I moved into my 40s, that everything went to hell in a handbasket. I started gaining weight, losing hair, became fatigued, can't think anymore. Now I'm depressed.” And it's that hormonal shift that literally triggers a thyroid condition. 


[00:32:36] And my argument is that everyone, every single person walking this earth, male or female, at least at the age of 40, we always make everybody at the age of 50 go get a colonoscopy. Who really wants to do that? But at the age of 40, this should also be mandatory. You get a full complete thyroid panel and you do that every single year. And if you have symptoms, you do it more often because thyropause is real and it can affect both sexes, but especially women. 


Cynthia Thurlow: [00:33:09] Yeah, I think it's such a good point that we understand as we are losing our sex hormones, it has a profound net impact on our bodies. And I feel like a lot of women are symptomatic with an underactive thyroid for years. And this has a lot to do with traditional allopathic medicine. I am guilty of this, but I worked in cardiology, so I'll be very clear. I saw emergencies, which generally not what we were managing. That was usually the ER and the ICU. But a lot of women are just getting an annual TSH, thyroid secreting hormone. When you think about, starting at age 40, the labs that are most efficacious have the biggest bang for the buck. Talk to me about your recommendations about thyroid labs specifically, so that everyone who's listening can write these down. 


[00:34:03] And I had a woman DM me the other day that said, “And this is a nurse practitioner, she went to her primary and said, I want to have a reverse T3-- We'll talk about this. I want to have a reverse T3 done. And the physician looked at her and said, “Are you dying in the ICU?” And she said, “No.” And he said, “Then there's no reason to do that lab.” So, let's talk about optimal labs to do to assess thyroid function. Let's say if we start this at 40, what are the labs you think are most important to ask for? 


Dr. Amie Hornaman: [00:34:34] So, I usually give a laundry list of labs. So TSH, free T4, free T3, reverse T3, TPO and TG antibodies. You don't have to write those down. I'll break it down for you. But I want to even simplify it further because to really answer your question, what do we absolutely need to get? It comes down to two, free T3 and reverse T3. I actually don't even care if you get the rest, because here's the bottom line. TSH is very inaccurate at diagnosing a thyroid problem. It is a pituitary hormone. It's secreted by the pituitary to trigger your thyroid to produce more thyroid hormone, if the pituitary senses and gets the message from the hypothalamus-- so HPT axis. 


[00:35:24] If the pituitary senses there's not enough thyroid hormone in the body to do its job, it's going to poke and nudge the thyroid to make more thyroid hormone. So, if TSH is elevated, that's just blatantly obvious. But the problem is that TSH can often look really, really pretty. It can be within the normal standard lab value range or it can even be in the functional optimal range, which is less than 2. But a person can still suffer from hypothyroidism. So, my fear in even giving TSH out is that doctors will just rely on that. So, despite what your Free T3 and reverse T3 say, which we'll get into, they're going to look at that TSH, it's going to be a one, and you are dismissed. There's no way you could possibly have hypothyroidism because your TSH is within normal limits (WNL).


[00:36:12] I also have started to push aside the free T4, because I even see this with my community. People start chasing free T4 levels, and this is very much tied back to the reverse T3 that we'll talk about. People start to chase free T4, and if they are on thyroid hormone replacement, they'll add more. They'll go back to their doctor and their doctor will give them, instead of 112 mcg of Synthroid, they get 125 mcg and then they get 150 mcg, and then they get 200 mcg. And they're chasing this free T4 lab value to get to a certain range. But then when we look a little bit deeper at the most important labs, we see that reverse T3 goes up. 


[00:36:51] So, let's break that down. Just like you said, reverse T3, it is beautifully built into our bodies as a survival mechanism. So, if we are in the ICU or the ER, and I'm sure you saw this when you were working, when you test someone's reverse T3, it's going to be through the roof, thank God, because at that point in time, they don't need to burn fat. They don't need to make major life decisions. They don't even need to poop every day. They need to lie there and survive. And all energy has to go to healing in that moment of time. But what if that reverse T3 is elevated? Our bodies think that we're lying in the ICU or the ER fighting for our life. But we're walking around trying to raise a family and run a business and do 10,000 errands in a day. We don't want to not function. We don't want our bodies to think that we're lying there fighting for our life. That's why it's vital to test reverse T3.


[00:37:48] And here's something, if you remember nothing, here's one thing to remember. The only thing that converts to reverse T3 is T4. So going back to what I said in the very beginning, so many people say, “Well, this thyroid medication isn't working. What are you talking about? I don't feel like Cynthia did in three days.” If you are on T4 only, that T4 has two choices. It can convert to free T3, T3 thyroid hormone, the active thyroid hormone, or it can move down this path and go reverse T3. Because that conversion of T4 to T3 is really hard for your body to do. And there's multiple factors that can interfere with it. Insulin resistance, estrogen dominance, low magnesium, low vitamin D, low selenium, genetic SNP. Because there's so many things that can interfere with that conversion. It's very likely that as you go up, up, up in your T4 medication, you're pushing more and more to reverse T3. Cortisol plays a role too who isn't stressed these days? [Cynthia laughs] So, this is right, [Cynthia laughs] the truth. 


[00:38:58] My gosh. So, I see a lot of elevated reverse T3 a lot. And especially when people come to me from the conventional system where that's all they're on and their doctor just keeps increasing it. And one more thing I want you to remember, here's a stat for you. 98% of those with hypothyroidism need T4 and T3 or some need T3 only. Only 2% do well on T4. only 2%. And of that 2%, I would still like to argue, what do you mean, do well on? Are these the people that just accept being overweight and fatigued and they're just like, “Yeah, I'm fine. And that's their new norm?” I don't even know about that 2%. I would even argue it's possibly like.05%. You have that outlier that they're on T4 only, and they're a rock star and they're fine. 


[00:39:51] But the rest of us need a combination of T4 and T3, and it's mainly because of pushing to that reverse T3. So, reverse T3 and free T3, the active thyroid hormone that actually gets to the receptor site on your cell and turns it on. If you only tested those two markers. We have a full picture. We totally have a full picture now. I don't want to leave out the antibodies. I know people are going to be like, “Well, what about the Hashimoto antibodies?” You're not going to get treated any differently. I mean, yes, it's amazing to know whether or not you have autoimmune because then you can be proactive. Autoimmune be gets autoimmune where we see one, we see more than one. 


[00:40:30] You can do those proactive things like eliminating gluten, which my argument is we all should be doing anyways, whether you have autoimmune or not, like controlling your stress, which we all should do anyways, whether you have autoimmune or not, you can be a little bit more proactive to protect yourself. Maybe you go on low dose naltrexone, add in black cumin seed oil, which is amazing for inflammation and antibodies, but at the end of the day, even if you had those tested, I don't know, once a year, that's fine. But I want that free T3 and reverse T3 tested often so we could really see how you are doing and how you are moving through midlife and whether or not you need thyroid hormone replacement. 


Cynthia Thurlow: [00:41:13] If you love this podcast episode, please leave a rating and review. Subscribe and tell a friend. 



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