Ep. 501 Is Your Thyroid Medication Failing You? – The Most Overlooked Fixes for Energy, Weight & Mood with McCall McPherson

Today, we have the first episode of a series of AMAs with McCall McPherson.

McCall McPherson is the visionary behind Modern Thyroid Clinic, a thyroid-centered functional medicine practice in Austin, Texas. McCall is a physician assistant and thyroid expert. She is a recent TEDx speaker, a frequent guest on podcasts and summits, and the owner, host, and Chief Thyroid Hope Giver of the Thyroid Nations podcast. 

Today, McCall joins me to dive into a range of listener questions, covering whether intermittent fasting damages the thyroid, the role of GLP-1s, constipation, split-dosing medication, adrenal health, ADHD, phentermine versus Glucophage versus GLP-1s, and how HRT affects thyroid medication. We also explore the impact of lipids on thyroid health and the role of nutrition, and we share our opinions on the Dutch test. 

This invaluable AMA was made even more special by the flood of questions submitted by listeners.

IN THIS EPISODE, YOU WILL LEARN:

• The benefits of adopting a nuanced approach to intermittent fasting 

• How Graves' disease and Hashimoto's differ in terms of fasting

• Why fasting is not advisable when taking GLP-1s

• Do thyroid medications cause constipation?

• Strategies for overcoming constipation and improving gut health

• McCall shares her rationale for splitting thyroid medication doses

• Will progesterone increase free T4 levels?

• The importance of rechecking thyroid labs after starting or adjusting HRT

• Foods to avoid and include in your diet for thyroid health

• Is the Dutch test worth using?

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"Normal does not mean optimal."

– McCall McPherson

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Connect with Cynthia Thurlow  

• Follow on⁠ X⁠,⁠ Instagram⁠ &⁠ LinkedIn⁠

• Check out Cynthia’s⁠ website⁠

• Submit your questions to ⁠support@cynthiathurlow.com⁠

Connect with McCall McPherson

• Modern Thyroid Clinic 

• Modern Weight Loss

• On Instagram and TikTok

• Modern Thyroid and Wellness Podcast

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. She's the visionary behind Modern Thyroid Clinic, a thyroid-centered functional medicine practice in Austin, Texas, the now owner and Chief Thyroid Hope Giver of Thyroid Nation, a frequent podcast and Summit guest, and now host of Thyroid Nation's podcast. She's a physician assistant, recent TEDx speaker and thyroid expert. 

[00:00:54] Today, graciously, McCall joined me again to go over listeners questions that ran the gamut from does intermittent fasting hurt my thyroid? the role of GLP-1s, the impact of constipation, split dosing medication, adrenal health, ADHD, phentermine versus Glucophage versus GLP-1s, how HRT impacts thyroid medication, the impact of thyroid health and lipids and the role of nutrition and lastly, our take on the DUTCH test. This is a truly invaluable experience, one that was made extra special because so many of you submitted questions. Obviously, I will need to bring McCall back multiple times to get through all of them, but today is the first of a series of AMAs with McCall. 

[00:01:47] McCall, thank you for carving time out of your busy schedule to meet again. Our podcast that we did a few weeks ago was so popular and you very graciously said, “Hey, if we're getting a lot of questions, let's do an Ask Me Anything.” And we’re truly overwhelmed with questions. I had to pare them down, otherwise you and I would be talking for hours and hours, which of course would be a joy for me. But we have personal lives that we have to get to. So, welcome back to the podcast. 

McCall McPherson: [00:02:13] Thank you so much. I will always come anytime I'm invited. This is one of my favorite things to do. So, you're an exceptional host. Thanks for having me back. 

Cynthia Thurlow: [00:02:22] Absolutely. We got a lot of questions about a topic that is tied to me intimately, intermittent fasting and thyroid health. What are your thoughts? I bet you it's nuanced, but a lot of people are asking, “Can I do 16 hours safely? Can I do OMAD? Can I do 20 to 24 hours?” What are your thoughts given your experience working with women, probably most of them, I'm guessing north of 35. So, in the prime of their lives bordering on middle life. What do you think about fasting? 

McCall McPherson: [00:02:57] Yeah, well, I have to start by saying without intermittent fasting, I think my health would be a wreck. Like, I just wouldn't be where I am today. I wouldn't be as productive as I am because I like a lot of our people, I think struggle with inflammation and finding ways to work around that is incredibly powerful and it's underrated. So, I am a very, very big advocate for intermittent fasting. And this is always such a divisive thing. Like, it's so surprises me how volatile people can become when the conversation of fasting enters the chat. 

[00:03:30] So, here is how I view it. One before anything else, like most things, listen to your own body. If you're fasting and you're feeling horrible, don't do it. If you're fasting and you feel amazing, hey, this might work for your body and your physiology, but the vast majority of my patients, I've been intermittent fasting with them for, gosh, close to probably eight or seven years now. And it is transformative, so it can reduce antibodies. I have seen it powerfully reduce Hashimoto's antibodies without a single food group restriction, with no other dietary changes. Again, because it's influencing our inflammatory pathways. But the way that I educate my patients on fasting is, look, you can start low, start slow. You can start with 12 hours, right? My rule of thumb is to work up slowly, as comfortably as they can to a 16:8, eating in an eight-hour window, fasting for 16 hours. I have my people do that only four or five days a week. So, it gives their body a break. It doesn't tax their hormones.

[00:04:36] Could it cause some theoretical increases in cortisol that everyone's so concerned about, like taxing your adrenals, taxing your cortisol, sure. But what really taxes our adrenal glands more than skipping breakfast is inflammation all day, every day. Just walking around inflamed literally influences our thyroid function in a negative way. It keeps us from activating our hormones. It can propagate obviously Hashimoto's antibodies. So, if we can cost benefit analysis, that for me personally and for the vast majority of my patients, the risk versus the benefits, the benefits far outweigh the negatives. So that's my viewpoint. Women can also not fast during their cycles, their periods, etc. I view fasting probably a lot like you do. It does not have to be this extremist dogmatic thing that's going to tank someone's health. 

Cynthia Thurlow: [00:05:32] Yeah. And I think what's interesting is there seems to be this all or nothing methodology, that fasting is either good or bad. And I think taking a really nuanced approach is important. And I think there can be seasons of our lives when fasting works really well. And there can be seasons in our lives where we're like, “Hey, I'm focusing on putting on muscle. Maybe I need to have a, a wider feeding window.” And that's okay too. And so, I don't think anyone should ascribe to rigid dogmatism. I think it can be problematic. Do you see any differentiators with Graves’ disease and fasting versus Hashimoto's? And for listeners to understand, Hashimoto's is the most common reason for an underactive thyroid, the autoimmune component of hyperthyroidism. So, an overactive thyroid is Graves. It tends to be much more rare. 

[00:06:23] But obviously, I'm sure you see plenty of Graves’ patients in your practice. 

McCall McPherson: [00:06:28] I would not object and haven't objected to people with Graves fasting once they're controlled. If they're coming into our office and their T3 is 20, 15, very, very high, they're hypermetabolic, they're using their fuel almost too efficiently and we don't want to deny them more fuel. Weight loss is an issue with Graves. And so, we want to make sure that they have enough sustenance and fuel to keep going. So, long term, once they're better controlled, once their hormones are a little more balanced, I wouldn't have any issue. And I think it can do the absolute same. It can reverse Graves’ disease or the severity of their antibodies, which in turn reduces the severity of their hyperthyroidism directly, uniquely with Graves. 

[00:07:16] So, yeah, no, I wouldn't have a problem with that. The main category of people that I see, and right I see thyroid people, hormone people, weight loss people. The one time I almost across the board say not to intermittent fast is on a GLP. So, it is just extremely difficult for these people to get enough calories in, protein in, and micronutrients in when they're already on a GLP weight loss medication. 

Cynthia Thurlow: [00:07:39] I think this is an important distinction and this will lead to the next question. So, if someone is listening, whether they are on a standard dosing pattern for GLP-1s or they are microdosing, which means at a reduced dose and that might be the right dose for that individual, how do you encourage your patients to get enough food in? Because the one thing that I hear from women, and I don't prescribe GLP-1s, is that they'll say, like, “I really want to eat, but I literally have no desire to eat.” And it's not a restrictive food piece. It's just since I started, I feel like I could just not eat and I would feel great. And so, finding that balance of nourishing our bodies and being conscientious about hunger cues, which are being blunted, and then the food noise for many people is really blunted.

[00:08:27] How do you counsel or recommend to your patients how to navigate that issue? Because it is an issue. There's a lot of benefits. But I would say this is one that I think some women probably come to and they're like, “Wow, I've never not had an appetite.” Unless maybe you're sick and you have a degree of anorexia or not feeling like you want to eat. And that's a byproduct of your body trying to heal. But in this specific circumstance, how do you like to address that? 

McCall McPherson: [00:08:52] Yeah, so a couple ways. One is, if they have that significant of a low appetite, they're on either too much medication or the wrong medication class. So, a lot of times I see this with tirzepatide. I love tirzepatide for certain subsets of people, but I try to not start people on it because their appetite is overly reduced. So, I would much prefer for, I would say 90% of people to start on semaglutide at a low dose. If, let's say they're on that, they're on too much at that point. So, we have to trim it down, reduce it by 25%, 50%. And it's a delicate thing that does need active participation from a clinician, not just like, “Hey, here's your vial, good luck, see you on 90 days or whatever.” [Cynthia laughs] You need to figure out the dose that works for them. 

[00:09:40] And then we get really specific on how to have people order their food when they're eating. Meaning in what order do I eat each category. And for the first couple meals of the day, we have them start with protein and then dense micronutrient, low-glycemic index foods. So, they're not really filling them up as much. They're not eating a lot of carbohydrates. I love, love, love to incorporate green juice in with these people so we can fit, like, the whole day's serving of vegetables into one, 8-to-12-ounce jar. That's not going to occupy so much space in and work for their digestive tract. So that's kind of my protocol.

[00:10:22] And then for dinner, same, protein, nutrient dense, veggies, fruits, etc., and then sugar, carbohydrates. The number one sign that I see of people overmedicated on GLPs, other than like the classic nausea and things, is I only want to eat carb foods. I only want to eat comfort foods. And those people are actually the most prone to regaining weight when they come off. And also, they're more prone to losing muscle mass, hair, all of these things because they're eating nutrient-void foods because they're overmedicated and they feel nauseous. 

Cynthia Thurlow: [00:10:55] That's such a good explanation. And for listeners, I think that GLP-1s are revolutionizing the way that clinicians are practicing. And I think they're really important. And I would imagine it's probably a small subsect of your patient population that experiences these things. And so, if you are experiencing a complete obliteration of your appetite, talk to your clinician. Because I do think, and I have to believe, like, I'll find the reframe. I have to believe that most individuals that are prescribing GLP-1s are doing so very responsibly and they are saying, “Hey, if XYZ happens, please make sure you follow up with me so that we can make adjustments in dosing.” 

[00:11:36] But I have heard through the proverbial medical grapevine that sometimes patients are like, as you said, come back and see me 60 days, 90 days, and then there's no support in between. And this is a great reason for why we have to be giving clinicians feedback not just about GLP-1s, but any medication or drug that you are taking, for sure. Okay. A lot of questions around constipation. I think that for people, and I'm not laughing at anyone who's ever experienced constipation, I've never had this problem, but I certainly have family members, patients, it can be miserable. Do you think that thyroid medication can exacerbate underlying constipation? The question is, my gut seems to go from bad to worse since I was a kid. So, it sounds like she's had this progressive, worsening constipation issue and now that she's on medications, I would think it would be the opposite. But everyone's an individual. 

McCall McPherson: [00:12:28] I would say my thought line is with yours. So, what's probably happening is it's not the medication, it's what the medication is treating. Your thyroid problem is persistent. It's constantly evolving, it's worsening. Most people sadly don't have access to the best thyroid care. And so that hypothyroidism in an ongoing way, probably low T3, etc., is driving the constipation and it is not, in fact, the medication. If I was a betting person, now, everybody, there's always room for unique rare individuals, of course, but by and large that's the pattern. I would definitely improve thyroid function, get full thyroid panels, look for optimal, not normal labs, and then also I would take some magnesium citrate before bed every night, quite a bit of it until you begin to have a bowel movement every morning. And a lot of people need that for good. They just need access to magnesium daily for a plethora of reasons, but the number one telltale sign is constipation. 

Cynthia Thurlow: Yeah, I would agree for anyone that's listening, if you're struggling, obviously if it's new-onset constipation that needs to be evaluated. But if you are a lifelong-- I have a family member and she gets mad when I say this. I'm not going to call her out, but I'll just say this family member, we call her the non-public pooper. And it's because if she goes on vacation or she travels or she's not in her own personal home, she cannot go to the bathroom. And if you are one of these people, you may need to take, whether it's Triphala, which is this ayurvedic supplement or magnesium citrate, bisglycinate. If you need to take supplements like that that is totally okay. 

[00:14:01] Some people just need a little like, it's almost a little gentle shove to say to your body, “Okay, we're safe, we can go. We don't need to be preoccupied about feeling unsafe. It's time to go.” I think that's really important. And I'm oftentimes surprised, McCall, I'm sure you are as well. I'll be going through, just an intake and someone has not pooped more than once or twice a week their entire life. And they think that's normal because it's their normal. And so, I always say constipation can be a sign of many things being out of balance. But if something as easy as magnesium at night is helping you have bowel movement, that's okay. Everyone needs magnesium. Not necessarily all the same formulation, but magnesium can be life changing for a lot of people. 

McCall McPherson: [00:14:43] Absolutely. And I'm also that person. My body will not go to the bathroom on vacation. I just got back from vacation. Every time I come home, I go to the bathroom immediately on my way home from the airport. [Cynthia laughs] I walk right in and it's over, like my constipation's over. But its miserable-- [crosstalk] 

Cynthia Thurlow: [00:14:57] Your body is like “I am safe I am home.”

McCall McPherson: [00:14:58] Yeah, I know. My husband's like, “I think this is psychosomatic.” I'm like, “I don't know but this is how it is.” 

Cynthia Thurlow: [00:15:04] “Home is where it's safe and that's where I go for sure.” Do you personally split dose your thyroid medication? So, this is going back, hearkening to our previous conversation. Do you split dose your medication? Is that on a case-by-case basis with your patients? How do you go about making that decision?

McCall McPherson: [00:15:24] I absolutely split dose my medication where I wouldn't be able to work in the afternoon and evening like I would be a non-functioning human. So, every day at 3 or 4 PM, I would crash and burn. Also, I never ask my patients to do anything that I don't do myself or haven't done in some form or fashion at some time. So, essentially 99.9% of all of our patients are in split dose medicine. And I don't mean split like half and half. Usually, people need the equivalent dose in the afternoon that they take in the morning because a couple reasons. I'm on Armour and about six years ago I had to add Cytomel to my Armour. I've now switched to RenThyroid. So, technically I'm on RenThyroid and Cytomel, which is desiccated thyroid and pure T3. 

[00:16:06] Both of these are short acting forms of T3 because essentially all T3 is short acting. To get enough T4 or your inactive hormone, the hormone your body needs access to all the time for hormones, metabolism, hair, skin, your long-acting thyroid supported mechanisms. It is very difficult to actually get enough T4 when you're on a desiccated thyroid without getting too much T3. So, you have to push that dose so high to get a decent amount of T4. But then at that point your T3 is in the 6s, 7s and it's reasonably high. Most people have side effects at those levels, so that's all a moot point with twice a day dosing, your T3 can peak beautifully perfectly and your T4 is longer acting in desiccated thyroid and so, it stays stacks on top of each other to give you adequate amounts of T4.

[00:16:59] So, when I started doing this twice-a-day dosing 10 years ago, people thought I was crazy. I did not know a single other person doing this. And now I'm hearing more and more and more that this is becoming the norm and I'm so grateful because think about it. If we have T3 access in a third to a quarter of our day, we are missing a huge percentage of our day for things that our body needs access to T3, T4 for our long-term health. 

Cynthia Thurlow: [00:17:30] Yeah. And it's interesting, since our last conversation, I've started creating a list for my functional med doc just to say, “Hey, are these things we need to consider?” I would happily go back to non-compounded drug therapy because for me, I'm always the person that waits till the last minute to order compounded meds. And of course, it's always the-- [crosstalk] 

McCall McPherson: [00:17:48] When you travel. 

Cynthia Thurlow: [00:17:49] Right? Exactly. I'm traveling and I'm like, “Okay, I can't go without thyroid medicine that might be a little bit of a disaster. Next question is, “Why don't I feel any better even though I'm on thyroid medications.” T4, T3, and my labs are “in the normal range,” I feel exhausted after even the slightest exercise, sometimes just a brisk walk and oftentimes I need a nap afterwards.” This is a long question. “Could that be related to my thyroid, adrenals or something else?” I'm going to start with that question because there's quite a few here. 

McCall McPherson: [00:18:18] Yeah. So, I would say consider all of those things. So, if there's one thing that I want every person that's listening to really, really understand. And it's like my mission and why I'm on social media so much and why I'm on podcasts so much. It is, do not ever believe someone who tells you your thyroid labs are normal. First of all, that's why I share all of the optimal ranges that I do. That's why I share very intellectual property extraordinarily openly. Because I want people to be able to look at their labs and know for themselves, “Am I optimal, really? Am I outside of this optimal range?” Because the slightest deviation from optimal, people are debilitated. The light is on or off, it is not a dimmer switch either everything's in range, tightly controlled, the lights on or it's not. 

[00:19:09] So, that's most Importantly, but when you say things like this, “Exercising makes me tired. I need a nap.” Those are giant red flags for adrenal dysfunction and those people who tend to continue to exercise that come to see us and think, if I just push harder, if I just work harder, I'll get stronger. I just need to do more. They spiral and they get worse and worse and worse. And they're actually some of the most difficult people that come to our practice to fix. And so, find someone immediately that can help you work on your adrenals. I love Ashwagandha, I love Adren-All by Ortho Molecular. These are wonderful things.

[00:19:51] Stress reduction, salt, getting enough sleep. Do not exercise to the degree that you feel worse later that day. Full stop. Do not push. Use this season to rest and recover. Just because you have to do that now does not mean you'll have to do that forever. But I would imagine it's some combination of thyroid and adrenals. You can also check your testosterone. I would assume that that's low when your adrenal dysfunction is as profound as it seems to be. But find you a good partner with your health because you need it right now, you want to start building up that resilience and not worsening.

Cynthia Thurlow: [00:20:25] And I think I've seen more women in perimenopause that start to have that slippery slope of decline in sex hormones, underlying probably subclinical or poorly treated hypothyroidism. And then you add in the adrenal thing, and what starts to happen is people think, “Oh, I need to do more. I need to restrict more. I need to fast more. I need to have no carbs, low carbs, less carbs.” And those are actually the things that will make it worse. And I oftentimes will say, if you exercise and you need a nap, that's a-- Even for me, even though my thyroid, for the most part, is optimal, I do all the right things for my adrenals, my testing is on point. I had a really, really intense workout yesterday and my husband was laughing. 

[00:21:09] He said, “I came home and you were asleep. Like, not just a little asleep. You were asleep for an entire hour.” I was like, “Oh, I woke up and I felt amazing.” But that was too intense. Like, that Saturday morning exercise, that class I took, way too intense. And I think for all of us, it's understanding that, sometimes you have to just go back to the basics. It may just be that you're walking, it may not be that you're doing a class. you may not be running. When you say brisk walk, a lot of people's brisk walk is a slow jog. So, helping women understand that a lot of times the things we're doing that are otherwise healthy can undermine adrenal and thyroid health. And adrenal and thyroid health go so closely together, okay. 

[00:21:49] One other question that this individual asked was, “What's the connection between ADHD and thyroid dysfunction? I know the symptoms can overlap, like fatigue and brain fog and difficulty focusing, but how do you approach patients with both or potential misdiagnosis?”

McCall McPherson: [00:22:06] Yeah, so it's my approach with most other things that can be confused with thyroid. And medicine views thyroid as like, nonspecific symptoms. So, that's a lot of the way that people can be dismissed at times is because they're like, “Oh, well, these symptoms aren't just thyroid, they could be a slew of things.” So, my solution to that with people is always, “Look, I want to perfect everything that I possibly can, and then let's see what's left.” So, let's fix your thyroid. Let's address hormones. Let's look at your adrenals, which clearly this person has significant adrenal dysfunction. Let's look at inflammation, all of the things that blood sugar, blood sugar is huge for fatigue and brain fog, etc. 

[00:22:48] So, let's look at all of these. Let's optimize them. And if in six months you still have ADD, ADHD and it's interfering with your life, then maybe consider seeing someone about it. But until then, the really scary thing for this person is if they're on a stimulant, what is that doing to their adrenals? It is Ooh. And I did psychiatry that for years. In the end--[crosstalk] 

Cynthia Thurlow: [00:23:11] Perfect question for you.

McCall McPherson: [00:23:13] Right? In the end, I was like, “I cannot justify in any form, really ever the chronic use of stimulants.” Like, it's just no matter how hard I tried, no matter how low I went, no matter how the-- med breaks people had, they ended up with adrenal fatigue. And so, repairing adrenals while on a stimulant and amphetamine is very, very difficult. So, really dig into that root cause, really build up your resilience and your constitution before considering a stimulant, because likely that's going to do you even more harm than the exercise that you're doing that's making you have to nap. 

Cynthia Thurlow: [00:23:47] You're making such an excellent point. I saw a lot of adults in cardiology that were on ADHD meds, low dose, and they all, by the time they were 40, all ended up developing high blood pressure as a direct result of the stimulation. And so, we would have to have these conversations where I would say, “Okay, you've now declared yourself. This is three separate times you've come in, your blood pressure's been high. We need to put you on medication.” And they were like, “I don't want to go on medication.” I said, “I respect that, but if you're going to continue on this medication to allow you to focus, you need to understand that there's side effects and these side effects do need to be treated.” I think on the flip side to that, you mentioned these stimulants. 

[00:24:25] A lot of women in middle age are stuck, they're frustrated, they're weight-loss resistant. There are still clinicians that are prescribing phentermine. I got several questions in my DMs about phentermine in particular. Women saying, I can't afford a GLP-1. I don't qualify to have insurance coverage, my provider prescribed phentermine and then the next thing I said was, I only can have it for 90 days. And so, again, it's a slippery slope. What are your thoughts around phentermine for weight loss, especially for these underactive subclinical thyroid patients?

McCall McPherson: [00:25:02] I think it's a slippery slope and a dangerous option. There is a medication called Qsymia that has more of a microdose of phentermine combined with Topamax or topiramate, and the two synergistically work together. Before GLPs, I would use that in a select group of people. Never liked it either. But these women were desperate. So, I would use it, try to keep them low, really go slow. Still had adrenal side effects. Had two people end up going into Graves’ disease,- [crosstalk]

Cynthia Thurlow: [00:25:31] Oh, wow.

McCall McPherson: [00:25:31] -which I'm not even sure that's a documented side effect, but definitely think it was. And I think, look, what phentermine does is it compromises your health. It puts you at a much, much higher health risk in almost every regard. Mostly cardiac, which is our most important thing and the thing that kills most of us in order, in hopes that later you'll lose weight and come off of it and your health will be improved. Women often don't want to come off of it. They want to stay on it. They do stay on it. So, now they're in this prolonged cardiovascular risk whereas that ultimately, you're probably going to potentially pay some price for from a long-term health span point of view, compared to GLPs, which yes, they cost more. I mean like our program, I think it's like $390 a month or something. 

[00:26:18] So yes, that's more, it's expensive. I'm not trying to say that it's not. But you are going to save that money on your long-term health. While you're on GLPs your cardiovascular risk reduces your chances of having a heart attack/stroke, dying from a heart attack/stroke. It's actually shown to repair or prevent the breakdown of heart-ish tissue during a heart attack. Like all of these incredible benefits. So, you just have to choose with all the possible information and what the media is telling these people about GLPs is not the real information. So, in my practice I might recommend Qsymia or a phentermine-based product. Not really ever plain phentermine, 0.0001% of the time.

Cynthia Thurlow: [00:26:58] Well thank you for that. And that was a question like I mentioned, came in multiple times and of course being incredibly sympathetic that all of us have different budgets, we all have different things we're saving money for. And so, I'm supersensitive to that. But knowing that there are potential long-term effects from using phentermine means it should only be used for the shortest duration as possible and then consideration to other medications.

McCall McPherson: [00:27:23] And I would also, Cynthia, before I would put someone on phentermine, I would put them on metformin 10/10 times because that's cheap, it's readily available, it can influence blood sugar, even cholesterol, it can help with weight loss. It's more conservative than phentermine. But still, I would do that before I would offer phentermine. 

Cynthia Thurlow: [00:27:40] I think that's a great suggestion and I think for a lot of people, like I had a shared patient, wonderful patient I've been working with for a long time and she was adamantly opposed to GLP-1s. We tried for like an entire year. Both this other clinician and I-- didn't do well on metformin because it made her nauseous no matter how we dosed it. Went on the GLP-1 and said “Oh my God, I don't know why I fought you so hard because I feel so much better.” Like the food noise is blunted. I don't feel like I want to be in the bag of chips and the ice cream at night. I can make better food choices. And she's been able to reduce her inflammation and start losing weight, which was huge. So, I could not agree more. 

[00:28:17] A lot of Questions came in McCall, around the influence of hormone replacement therapy and thyroid, specifically progesterone. It wasn't even a study that I thought much of, but it keeps coming up in our free group for anyone that's listening if you're not aware of it, it's Midlife PAUSE/ Cynthia Thurlow, NP on Facebook, free group, you can ask questions. I go in and personally answer questions a few times a week. HRT and thyroid medication, do you see any contraindications or anything that you get concerned about? This one individual kept asking about progesterone and I was like, “I don't know what you're talking about.” If you don’t have adequate progesterone you are not going-- like thyroid and progesterone are important for one another. So, if you're low in progesterone that could worsen your thyroid issues? 

McCall McPherson: [00:29:02] No, absolutely. And they're interrelated. So, low progesterone can influence thyroid issues activation, etc., utilization. But low progesterone is one of the first hormone deficiencies that I see among hypothyroid people. That and low testosterone show up almost ubiquitously, literally in over 90% of women with a prolonged thyroid issue. So, if you've got symptoms of low progesterone or testosterone, certainly get a workup. What ends up happening when you have lower levels of hormone or higher levels. when those levels change, a big part of what influences downstream thyroid or hormones is your sex hormone binding globulin. So, think about it like the taxi system for your hormones, not just your reproductive hormones, also your thyroid. So, they share the same amount of taxis.

[00:29:57] So, as thyroid gets increased, you have less access to progesterone. Especially, if you're genetically prone to have lower levels of sex hormone binding globulin or inversely. These people who add hormone replacement their taxis in their body try to increase, they're like, “Oh gosh, there's more.” We need to upregulate sex hormone binding globulin. And a lot of your hormones end up getting bound or think about them as hyperexcreted, metabolized out and so, you have less access to thyroid hormones. Birth control or oral estrogen especially, this is the most amplified impact. Like it can require a 20% to 30% increase in thyroid medication when you start something like that. 

Cynthia Thurlow: [00:30:40] Okay, let me make sure you say that twice. So, oral contraceptives and/or is it oral estradiol or any type of oral estrogen?

McCall McPherson: [00:30:48] Any type of oral estrogen. 

Cynthia Thurlow: [00:30:50] This is huge. You may need an adjustment in your dosing. That's significant. 

McCall McPherson: [00:30:54] Yeah. Or let's say you stop it and you change to transdermal. Like, you can need a reduction. So, anytime we influence your hormones, you need to be checking your thyroid three to six months after. Because this is not separate systems. These are like very integrated systems and there's a push-pull, an influence on one another. And so, it's not surprising at all that these women are writing and saying, “Hey, look, I started this hormone replacement, now my thyroid is off. Could that be related?” Absolutely, for sure. 

Cynthia Thurlow: [00:31:25] Yeah. We don't exist in a vacuum and our bodies are not siloed, although allopathic medicine would like to think otherwise. The next question is about desiccated pork thyroid. So, this as a clinician I've never prescribed desiccated pork thyroid twice a day. I know we touched on what is the rationale behind that? And if I were to switch some of my patients over to this regimen, would you take their current daily dose and split it in two? I think we address this. Does it depend on what brand Armour, NP thyroid, I believe I also heard that you recommend checking lab levels a few hours after taking the medication. That would be a yes. Just to reaffirm what we had discussed earlier about, your rationale, which to me makes complete sense, your rationale for twice daily dosing of thyroid medication. And if someone were to transition from compounded to a desiccated product, is there a way to do that safely and cautiously? 

McCall McPherson: [00:32:22] Yeah. Definitely, so, the rationale is twice a day because we touched on a little bit earlier T3, let's say in desiccated thyroid, it peaks and troughs in the blood in about six to eight hours. Liothyronine is three to six hours. So, it's a very, very short up and down window. And what you'll find if you ask your patients is, “Well, how do you feel at 4 PM every day?” And they're going to say, “I crash at like 3 or 4 every day” because their T3 is too far gone out of their system. And that impacts quality of life, but it also impacts everything else. Your hormones, your digestion, everything that your thyroid is needed, which is everything. And then again it goes back to also, if you are checking labs at peak, this clinician, meaning with desiccated thyroid, three to four hours after they take their morning dose, you will see to get enough T4 that their T3 is too high. 

[00:33:17] And so, it's important that you look for that when you think about transitioning someone from once a day to twice a day. Check labs at peak, right? If their T3 is within level, then they likely need that same amount later in the day. Because think about these as separate doses of medication. We are not stacking their T3 peak, okay? They are peaking, they are troughing and then you're peaking and troughing. So, these are two separate mechanisms. So, so if they're peaking wonderfully, let's say they're at 4.2 and you take that dose and you split it and put it in the afternoon, their peak is now going to be 3.2 and they'll never hit a therapeutic window. 

[00:33:57] So, most people need the same or almost the same dose in the afternoon that they take in the morning. So that we're peaking and troughing, mimicking one another. Normal physiology, our T3 peaks a little less in the afternoon, so it's okay if they peak to a little bit less, but that's what most people need. And if someone was once-a-day dose, I would slowly increase them maybe up to a half grain every treatment cycle and see how they do over time. You'll also notice the other thing that clinicians should watch out for in once-a-day versus twice-a-day dosing is it's actually pretty difficult to regulate and get a feedback mechanism strong enough to influence TSH on once-a-day dosing. 

[00:34:42] So, the classic presentation of people inappropriately dosed once a day on desiccated thyroid is high T3, low T4, intermediate TSH, like 2, 3, 1.8 kind of thing. Well, if you add the smallest bit of a second dose, their body's like, “Oh my gosh, I can lower my TSH. I don't have to be constantly compensating for every afternoon and evening and overnight where I know this person's not going to have thyroid medication access.” Did I answer the first part of that question completely? 

Cynthia Thurlow: [00:35:13] Yes. Absolutely. 

McCall McPherson: [00:35:14] Okay. Cool. And then the second is switching someone from compound to desiccated. It's a delicate thing. So, it's the same as switching someone from Synthroid or Levothyroxine to desiccated. It should be done, in my opinion, over multiple treatment cycles. Now, if that person's on compounded med once a day, I would use that opportunity to start adding in desiccated thyroid in the afternoon. Even if they're on long sustained release compound, it's peaking and troughing in six to eight hours. It's not lasting 12 hours and people generally will feel that. So, I would start by simply tacking on afternoon desiccated thyroid, come back the next treatment cycle, reduce their morning compound by 50%, add them on desiccated. Because when you try to abruptly switch things like that, people generally get worse before they get better. And that's always not my goal. 

Cynthia Thurlow: [00:36:04] Yeah, it's interesting. I think I was sharing this on another podcast, but when I was started on desiccated thyroid, the first two weeks, every time a dose was changed, I would get insomnia. And it was so significant that I remember saying, “I feel so much better during the day, but then I know I'm not going to sleep that night.” And it was such a bizarre thing. 

McCall McPherson: [00:36:25] Totally normal. That's often because of once-a-day dosing. So, what happens is you take it in the morning, you slowly get the medication out, and then it hits its lowest point throughout your waking hours before bed. And your adrenals spike because they are compensating for low T3 and most of the time, also low T4. So, your cortisol raises at nighttime and people can't sleep. If you do it twice a day, everyone always comes in, they're like, “I have trouble sleeping. If you add me on a second dose, I won't be able to sleep.” Almost every last time, they're like, “I sleep so much better now” because their adrenals are not in crisis. 

Cynthia Thurlow: [00:36:59] Yeah, this is significant. And I did not know that 10 years ago, but I've since learned better. [McCall laughs]: I love when they call me Ms. Thurlow. I'm like, “You can call me Cynthia that works.” [McCall laughs] Question is, “I really enjoyed the first podcast with McCall. Thanks for coming back. I've had Hashimoto's for 30 years. I was diagnosed when I was 27. I recently started hormone therapy in October of 2024 after six years in menopause. All during menopause, I remained on the same Synthroid dose and my labs are always in the normal range.” This is very telling. “I'm currently using two pumps of Estrogel and 100mg of oral micronized progesterone. Since starting therapy, I've had thyroid labs done twice and my free T4 levels are at the very top of the normal range and my free T3 at the very bottom. 

[00:37:43] I'm assuming it's one or both of the hormones causing this. See, there's a circuitous method to this conversation, but to reinforce things, I feel okay but how should I interpret these labs? “You should not have to interpret your labs. Your provider should do that.” Thanks for sharing your expertise. I appreciate it.

McCall McPherson: [00:37:59] Yeah. So, I would say you are a poor converter. Now, that could be influenced by your hormones. It can also just be influenced by inflammation, age. Most of us walking around are poor converters. And if you're on a hefty dose of a T4 and even if you're on a small dose of T3, your conversion is not handling that. So, what's happening is-- So, yeah, she's on too much Synthroid. So, she's accumulating the crude oil that we're giving her in hopes she's converting it to gasoline, but she's actually not. So, she's stockpiling it all in her garage. Her gas tank is on empty. I would also say anytime you're on T3 again, always be sure you're checking labs on T3 or it will perpetually always look low. Or if you're not timing it intentionally, it'll be all over the map. 

[00:38:45] People will be like, “Why is it so unstable?” Well, it's because you're checking it at peak and then trough and everything in between. So, yeah, you can work on conversion via your lifestyle, stress reduction, reduced inflammation, increased micronutrients, zinc, selenium, sleep, what else? I said inflammation, yeah. So, all the things that slow your body's conversion, you can work backwards or you can independently adjust them. The likelihood that you will out convert too much Synthroid is not likely. Most likely, you're going to need a reduction in that Synthroid, because if it's on the top of what's normal, that means it's way too high and likely shunting to your inhibitory hormone or your reverse T3. That's actually blocking-- [crosstalk]

Cynthia Thurlow: [00:39:30] It is like the breaks.

McCall McPherson: [00:39:32] It's blocking your active hormone. So, it's hurting more than it's helping. 

Cynthia Thurlow: [00:39:35] Yeah. And so, big takeaway from this conversation, y'all, is if you are put on HRT or adjustments are made, you very likely may need adjustments in your thyroid medication. So that's not at all surprising. Next question, my free T4 levels have increased to the very top of the normal range since starting progesterone. Everyone is convinced it's the progesterone that's driving the thyroid piece. Should we be adjusting Synthroid dosage even if all other thyroid labs are normal? But we don't know what the labs are. And I feel fine. So again, we're reinforcing just to make sure we hone in on this so that it's very clear to everyone.

McCall McPherson: [00:40:12] Yeah. Three and six months after you change your hormones, check your thyroid and expect shifts. Honestly, the same goes for GLPs. GLPs hugely influence sex hormone binding globulin. Same mechanism. People need constant adjustments in their thyroid when they're on a GLP as well. And again, it all goes back to we share these two transport mechanisms- [crosstalk]

Cynthia Thurlow: [00:40:36] Little cars.

McCall McPherson: [00:40:36] -backlog, little cars, little taxis, and they can get backed up or hyper metabolized. And so, we have to account for all of those shifts. And the best way to do it is collecting data. And again, always reaffirming normal does not mean optimal. And I think, especially for women, we push through and we think we feel good and we don't feel good. We think that, oh, I'll even treat people in one round of treatment and they're like, I feel great. I think we're done. And I'm like, “No,” [Cynthia laughs] I can look at your labs and I can tell you certainly that we are not done. Wait until everything's perfect and then see what you look like and that will be your optimal. And so that's what we do. But women can very much get sucked into I feel good, I feel fine. But they felt like this for two decades and it's their new normal. 

Cynthia Thurlow: [00:41:22] Yeah, I think it's helping people understand it's a marathon, not a race. And it's usually not a one and done. There's constantly fine tuning, especially when we're speaking to hormones, because hormones are so complex. Like, things change in our personal lives, our professional lives, we may need more or less hormones in response to that. Just so everyone knows, my team, when they sent me questions, did not include the names of the individuals. So, if you're wondering why I'm not specifically saying your name, it's because I don't have it. 

[00:41:49] Next question, “Hello, Mrs. Thurlow. I'm doing everything right at 55, I'm still in perimenopause. I eat real whole food nutrition, mostly paleo Whole30, but some legumes and potatoes. She's small. I weigh 150 pounds, so I do some healthy carbs. I weight train, I do cardio. My TSH is 6. Having it retested along with antibodies, ferritin, iron, etc. Any thoughts on the first things to look for? It sounds like a lone high TSH. I'm decreasing my coffee and start eating in Brazil nuts again. I ate plus plenty of protein and healthy fats. All information is appreciated. Yes, I have lots of stress and I'm decreasing my coffee because it's high cortisol, robbing my thyroid function.” Sounds like there's a couple different things that might be going on here. 

McCall McPherson: [00:42:33] Yeah. So, I think there's almost two sides to this coin. One is, look, if you don't feel horrible, it's okay to wait and recheck, to a degree. The flipside of that coin is when your TSH is 6, you're going to have cardiovascular impacts, you're going to have blood sugar impacts that might not manifest outwardly right away, but under the surface, likely insulin is increasing, leptin is increasing, triglycerides are increasing. Like these components that are very, very important for our long-term health are stacking up under the surface. Low, mild subclinical hypothyroidism, low T3 even can increase risk for cancer. So, there are really important benefits to having your thyroid optimized, even if you don't necessarily feel bad. But again, I would say, “Do you really not feel bad?” Like, are you compensating by living a perfect lifestyle? 

[00:43:35] Because women will try and do that as well. They can't deviate from this bubble that they live in. Or they feel bad, but they're like, I feel good. I just have to control every aspect of my entire life. So, I would say that would be some big advice. Check it again in two to three months. TSH can fluctuate to a degree. But a TSH of 6 shows, in my opinion, true loss of thyroid function. There is part of that thyroid gland that is no longer secreting hormones and your body is trying to compensate for that and it comes at a cost.

Cynthia Thurlow: [00:44:04] And I think the biggest thing for listeners is to know there's this inverse relationship with thyroid secreting hormones, that TSH as it's going up, it means your thyroid is less and less functional. I think for a lot of people, they assume much like free T3, free T4, if it's high, it means no, this is an inverse relationship. As you start seeing that number creep, that's not the highest TSH I've ever seen, but certainly McCall brings up a lot of really good points about the things that are going on beneath the surface that you may be unaware of. So, definitely rechecking it. 

[00:44:33] Next question is “My TSH is 4.51. My Lp(a) is 171, which is high, my ApoB is 97, which is not optimal, glucose is a 100, again, not optimal. How is my thyroid related to high LDL? My total cholesterol is 292.” You go ahead and answer if you feel comfortable answering this and then I might have an opinion too. 

McCall McPherson: [00:44:54] Yeah. So T3 and TSH elevations in TSH, I consider 4.5 very high. As thyroid hormone production goes down, we are no longer able to effectively clear cholesterol. So, T3 specifically increases LDL receptor activity to try to move it out. It influences our gallbladder. So that is a huge mechanism of transporting out our cholesterol that we no longer need. It influences another mechanism to help promote beneficial cholesterol synthesis. And T3 also enhances lipoprotein lipase activity to help get rid of triglycerides, which is what also creates the damaging part of our LDL cholesterol, which is called VLDL. 

[00:45:45] So, again, it's like people so often are like, “Well, I don't feel horrible.” Yeah, but you're actually at an increased cardiovascular risk. Like, this is so vital. And then also, low T3 correlates directly with elevations in insulin, slow elevations in blood sugar. Certainly, I see it influence leptin, though I haven't found a lot of studies correlating those two. Looking at those two independently, it certainly influenced metabolic function.

Cynthia Thurlow: [00:46:09] Absolutely. Thank you for that. And what I would also add is that as our estrogen is plummeting, as we are navigating perimenopause and menopause, we don't make bile as well. We don't emulsify and break down fats. We become fat malabsorbed. When I see a glucose of a 100, the first thing I think is my conversation with Robert Lustig, which I've never forgotten. He's like, “A blood sugar of 90 to 99 is not benign. You have a 30% greater likelihood of developing diabetes.” That is based on science. I also think about as we see this creep along to your point about what's happening with thyroid, is we are dealing with inflammation. It's also understanding as we are dealing with a decline in sex hormones. There's a lot that changes with lipids and understanding that an Lp(a) of 171, that's genetic.

[00:46:54] It's not like you're doing something terrible that's contributing. But as we are navigating perimenopause to menopause, we will see lipid changes. And this is a lot of what we will see. But this is someone who very clearly needs to be having conversations about medication. I always use the reference to Boston Heart, which has specialized testing. There's a cholesterol balance test. These are the types of patients I like to know. Are you a hyper absorber? Are you a hyper-synthesizer? Because it can make a lot of difference in terms of medications and what guides therapy. But I agree with you. If we know that cardiovascular disease is the number one killer of women, these are the things we have to remain astute to. We need to know our numbers. We need to be proactive, not from a place of fear, but just from a place of advocacy.

[00:47:39] Because sometimes, quite honestly, and I know this to be correct, because I get asked this question almost every day on social media, there are still clinicians who just look at a total cholesterol, an LDL, an HDL and triglycerides, and they think that gives them the full picture. And I'm like, “No, it's just a stepping point.” Probably this individual, I'm guessing, probably has higher normal triglycerides. Their HDL is probably low. They already have some degree of brewing insulin resistance. It's all contributing to this. So, there's a lot going on. But definitely have a conversation with your provider. Get on top of these things because these are reversible with lifestyle and medication for sure. 

McCall McPherson: [00:48:17] Yeah. And the other last thing I'd say about it is a lot of these people who put so much emphasis on their health feel like they're failing if they take medication. They're not. I mean, this will make your lifestyle work. Like, it makes it work for your physiology. Because at some point, if you don't address it, a perfect lifestyle will no longer even maintain the progress that you need to live a healthy life. It'll be a losing battle and I see it all the time. And so, it's so important. It's not either/or, it's definitely a both/and.

Cynthia Thurlow: [00:48:46] Yeah. And I think it's important just to disclose, like, I was never on cholesterol medication until I went into menopause and I always say like, “I got a lot of good things from my parents," but I inherited a lot of what I would describe as lipid abnormalities that my lifestyle is pristine. My lifestyle couldn't better. It is not a lifestyle mediated thing. It is a genetics thing. And so, I take Zetia, which is fantastic because it acts directly at the lumen of the small intestine. It is not a systemic drug for me. It dropped my ApoB down to 60. And my Lp(a) we're still working on, we're doing everything we can to avoid a statin.

[00:49:22] If you're taking a statin, I'm not telling you to stop taking a stat and just putting that out there. Last couple questions, McCall are about food. I know this is an important topic. “I'm very confused. I have hypothyroidism. Can I eat eggs? Can I eat sweet potatoes? Is there a basic or general criteria of what foods to avoid?” I'm sure you have answers there. “What foods you recommend? Probably nutrient dense whole foods.” But when you're talking to your patients that have underlying thyroid issues, what are some of your favorite things to recommend avoiding as well as including into their diets?”

McCall McPherson: [00:49:56] Yeah, I love doing food testing so that I don't make people overly restrict so we can look at, “Hey, what is driving inflammation for you especially in Hashimoto's.” But there is certainly a pattern. I've tested thousands and thousands of women with Hashimoto's and looked at their food inflammatory results. And the number one food group that causes inflammation in my patients with Hashi and thyroid dysfunction is dairy. So, dairy's number one, gluten is number two. And these are literally in descending order. Number three is legumes, number four is grains, number five is eggs, and number six last is nuts and seeds. By the time you get to nuts and seeds, it's only like 5% of people. So, everyone's always like, well then what do I eat? Everyone doesn't need this diet. Only 5% of people need all encompassing all of those. 

[00:50:43] And that usually signifies gut inflammation. So, I would say pick, the couple most inflammatory foods if you wanted to go big, would be dairy and gluten. You could even start with one, especially if you have Hashimoto's. This is so powerful because you measure antibodies, you take away dairy for 90 days and you remeasure your antibodies. The half-life of these inflammatory molecules that I test, IgG, is about 26 days, meaning in roughly two months, it's all out of your system. Then you have a month of clearing and just maintaining that lower inflammatory state. So, you recheck antibodies if they lowered, continue. If they haven't, circle back and maybe try gluten as opposed to dairy the next time. Checking and rechecking antibodies. And you can use that as like a direct measure of your inflammatory response to these food groups. 

[00:51:31] So, obviously those are the things to take out, the things to put in protein, micronutrient dense foods. Again, I love green juice. Green juice is a powerful way for people that don't have a lot of time, energy to cook two or three meals a day to get a lot of micronutrients in. Sweet potatoes are fine. Like carbs are not terrible. Again, I like for people with thyroid dysfunction to save them for the evenings so that their blood sugar can be as low as possible as long as possible during the day, peaking only before they go to bed at night and have their longest stretch without eating again. But it's all about balance too. It's about not being so rigid and dogmatic that you set yourself up for failure and finding what works for you and your body and what makes you feel well. 

Cynthia Thurlow: [00:52:13] Well. And I think you bring up such a good point about the bio-individuality piece and then looking statistically like what are the most common things that your patients don't tolerate. I think I was introduced that concept, molecular mimicry, probably by a book I read probably over 10 years ago. And that really affirmed for me when I would talk to patients and I would say, gluten and dairy, for a lot of people, the thought of removing either is so daunting because they have to rethink a lot of what they're doing day to day. But if it abides you the opportunity to reduce antibodies, to reduce inflammation, to feel better, heal your gut, add in a multiplicity of other things, I think it is worth considering. 

[00:52:54] And to your point, you're not saying that every single person listening who has an underactive thyroid needs to remove these five things, the power of the N of 1, do a food diary and see what makes you feel good and what makes you feel bad. I have a son who has nut allergies and he's figured out eggs make him feel terrible and so he doesn't eat eggs anymore. And he was actually saying, “If they're cooked in something like a baked good, he will be fine.” But he said, “If I just try to eat an omelet? Forget it. It's a disaster.” So, again, honoring that bio individuality.

[00:53:24] Our last question is from someone who wants us to talk about the DUTCH. McCall is the only person I've ever heard say the DUTCH testing is a sham. No, she's not. There are a lot of clinicians that don't like the DUTCH. And I say this respectfully and we can all agree to disagree on certain things. I would love to hear a deeper discussion on this between the both of you. I'm over five years out from breast cancer, and I've done several DUTCH tests since watching the positive changes in my pathway. She's referring to estrogen detoxification with the lifestyle changes I've made has been incredible. I just don't understand why she doesn't like them. So, again, it can be personal preference, but I would love to get your take on-- And remember, McCall is viewing this very much as someone who is, you know, working with thyroid patients, also working with patients that have got complex hormonal dysregulation. And all of us have differing opinions. You could ask 10 clinicians. They may all have differing opinions about different tests. 

McCall McPherson: [00:54:16] Right. And I think if it's working for you, what's the harm? If it seems to be working for you, go for it. Now, my viewpoint is this, and we're being very candid here. [Cynthia laughs] So, I started using DUTCH testing, I think, in about 2015, 2016, maybe through 2017. And I compared it to blood labs. So, I've spent my hundred thousand hours at this point analyzing blood labs. I understand them with nuance when it comes to hormones, and I know this blood test result correlates with this clinical picture, and it tracks. What I would find is there was a big discrepancy between the DUTCH test and blood tests, and they were not matching. And I saw it over and over and over again, and so I quit doing it. 

[00:55:05] And again, maybe they've changed it in the last 10 years or so, but I will almost try most things as a clinician that have a good reputation, that people are like, “Hey, you should look into this.” If it's not working, if it doesn't seem like it's tracking, if it doesn't seem like the information provided is lining up to look at the clinical picture and correlate, then I'm going to ditch it and that's ultimately what I did. And it also boils down to my toolbox. I am perfectly equipped to manage women's hormones in an extremely nuanced way with labs that are covered by their insurance, that aren't cash pay and get the same effect. 

[00:55:44] And I think initially, dare I say, when DUTCH test came out, it was the only hormone lab test that people who are not providers could use. So, it was being used largely by nutritionists and health coaches and they did a very good job marketing it to those people. And then it made its way into practicing clinicians practices, as well. And so, for me, cost benefit analysis, the information I'm getting, if it's really tracking with the clinical picture, it wasn't worth it. 

Cynthia Thurlow: [00:56:12] Thank you for that. So, what I can tell you is I've been probably working with this since 2018 and when we're looking at hormones, you can test hormones with blood, you can test hormones with urine, you can test hormones with saliva. There is so much opinion, and I say this across the functional integrative medicine space. Some person is like pro urinary metabolites, another one is pro saliva and I think saliva for me I think is particularly helpful for cortisol if we're trying to look at a 24-hour distribution like you see on the DUTCH and then serum labs. But I'm a serum labs person, I always lean that direction because it's foundation of my training. With that being said, what I find transparently with the DUTCH, yes, a lot of non-licensed people interpret the DUTCH. I think the bigger issue I have is that it's an expensive test. 

McCall McPherson: [00:56:58] Right. 

Cynthia Thurlow: [00:56:59] If the person that's ordering the test does not know how to properly interpret it. And let me be clear, I have taken two classes to interpret the DUTCH. I have a binder that is this thick? 

McCall McPherson: [00:57:10] Yeah.

Cynthia Thurlow: [00:57:10] It's like three or four inches thick. It is that nuanced. That is the investment I made in my knowledge to be able to interpret it properly. And I think it is probably the most, at least to this point, the most challenging test I've ever had to work with to interpret properly. Meaning I encourage someone to purchase the kit, I get the results and then I can comfortably sit down and say these are the things that I'm seeing. So that's number one. A lot of clinicians order the test, they don't know how to interpret it. Ends up becoming a very expensive for the patient, it's not covered by insurance. 

[00:57:44] And then sometimes, I get consulted to interpret other people's tests with the patient's permission and the clinician let me be clear. And that's both good and bad. But it also speaks to the fact that in the integrative medicine space for the most part, I think people order tests because they see clinical efficacy, they see the need for utilizing the test and they're not just doing it, just order tests because you have to think about the utility of a test all the time. I mean that's always where my mindset goes. If I'm asking someone to spend a couple hundred dollars, is it going to tell me something that's going to be helpful? 

[00:58:14] So, for me personally, what I like the DUTCH for, I like to see a 24-hour distribution of salivary cortisol. I like to see that with some DHEA. I like to see the estrogen detoxification piece. Especially, for someone who has had breast cancer or any other types of cancers. I think that you have to look at it-- the lens of-- what information are you looking for that you can't get from somewhere else. I think that has to be the decision-making piece. So, when I hear clinicians that aren't pro, there can be a multiplicity of reasons. Some people are just, “I'm allopathic trained, I've never had that training, I don't believe in it” and I respect that. 

[00:58:50] But I've seen enough really good information. I've had women that have had poor estrogen detoxification, Poor Phase 1, Poor Phase 2. So, we're talking about the liver and we've figured out ways to support their gut health and really work on metabolism and that can be helpful. But I think the context is always if you're ordering a test, you better make sure you know what to do with the information, number one. Number two is, “Are you seeing utility?” And obviously this individual is and that's great. And I would say I would not discourage someone from continuing to do that. 

[00:59:20] But if anyone has had a test and they feel like it has not been valuable, I mean I think that's when we go back to just being conscientious, thoughtful about tests that you're ordering, making sure it's really something that's going to make a difference in the quality of care that you're delivering to a patient. 

McCall McPherson: [00:59:35] I totally agree. And it's also at the end of the day too, it's like people will come and they'll ask us for it. And I'm like, “You don't want me interpreting your DUTCH test.” Like, you don't want to spend X amount of dollars. It used to be through like $350 when I ordered it. And then having me, this is not my set of tools. You want me as a plumber, to work as an electrician, and that's not going to work for you, and it's not going to beneficial. So, I definitely think, it can be very useful in cases of breast cancer, etc., ovarian cancer. And also, if it's useful for you and it's helping, do it. But it's not something that we incorporate into our practice. 

Cynthia Thurlow: [01:00:13] Yeah. And I think, I respect when someone says, “I don't do that.” There are specific types of testing I do not do. And I will say, “You do not want me looking at a test that I have not seen in three years to interpret it comfortably.” I would say that would not be what I would do. And I think a good clinician will identify that. The other thing that I would say is I get concerned, and I'm not going to call anyone out when I say this, but there are people online that you don't even have to ever be a patient in their practice. You can go online, you can order your test kit, and then someone from their practice is going to meet with you. And it's probably not a licensed provider. 

[01:00:48] I think that's always like one of those things, in the context of the greater good, what would be of the greater good? Just be conscientious about where you're receiving care, where you're getting information, because I think ultimately it does not make a big difference. 

McCall McPherson: [01:01:04] Oh, absolutely. Absolutely. 

Cynthia Thurlow: [01:01:07] Well, my friend, as always, thank you for your time today. This has been a truly invaluable conversation. As always, please let listeners know how to connect with you. We know Modern Thyroid Clinic and Modern Weight Loss Clinic is available nationwide, which is really exciting. So, if you're listening, you love what McCall has to say, which, of course, why would you not. You could reach out to her and her team and decide to work with them. 

McCall McPherson: [01:01:30] Yes, you can find us at modernthyroidclinic.com, modernweightloss.com. I love hanging out on social, @mccallmcphersonpa on Instagram and @mccallmcpherson on TikTok. And then I too have a podcast, Modern Thyroid & Wellness. And you can tune in there if you want to go deeper in conversations like this. Yeah, I'd love to see you around. 

Cynthia Thurlow: [01:01:50] Thanks so much. 

McCall McPherson: [01:01:51] Thanks for having me. 

Cynthia Thurlow: [01:01:54] If you love this podcast episode, please leave a rating and review. Subscribe and tell a friend.

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