Today, I am thrilled to reconnect with my friend and colleague, Dr Amie Hornaman. She is a popular and frequent guest on the podcast.
Dr. Hornaman, known as the Thyroid Fixer, helps 1000s of individuals optimize their thyroid and hormones. She joins me today for a mini thyroid master class where we discuss the miscommunication surrounding thyroid health, the role of empowerment, and the impact of hormone replacement, and we dive into the physiology of the thyroid, the effects of thyroid pause, Hashimoto’s, and autoimmune conditions. We explore labs you need, elimination diets, molecular mimicry medications, and why iodine is essential for those with thyroid health issues. We also look into various supplements, including vitamin D, magnesium, iodine, and creatine, and the research surrounding black cumin seeds and T2.
Today’s discussion with Dr. Amie Hornaman is invaluable as it will set you up for 2025 with all the information you require regarding the thyroid.
IN THIS EPISODE YOU WILL LEARN:
Why doing due diligence and understanding your body is essential for making informed health choices
How thyroid dysfunction impacts overall health
Why proper thyroid hormone replacement is vital to prevent long-term health issues
How hypothyroidism increases during perimenopause and menopause
The importance of regular thyroid testing and proper management
The most effective tests for thyroid function
The antibodies play when autoimmune conditions get diagnosed
How lifestyle and diet impact thyroid health
The various options available for thyroid medication and the need for personalization
What are the benefits of compounded thyroid medication?
Dr. Hornaman introduces her supplement lineccess
“Perimenopause and menopause, where hormones are declining, and as a woman moves into that stage of life, estrogen is literally on a roller coaster.”
-Amie Hornaman
Connect with Cynthia Thurlow
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Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
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 Dr. Amie Hornaman. She has been a popular and frequent guest on the podcast. Today, we did a thyroid mini masterclass. She is the thyroid fixer, helping thousands of people optimize their thyroid and hormones. And today we spoke about miscommunication, especially around thyroid health, the role of empowerment, the impact of hormone replacement, physiology of the thyroid, the impact of thyroid pause and the role of Hashimoto’s in autoimmune conditions, labs to ask, for the impact of elimination diets and molecular mimicry, medications including synthetic, non-desiccated thyroid and compounded, why iodine is so important if you have thyroid health issues. The impact of supplements including vitamin D, magnesium, iodine, creatine and more. And research surrounding black cumin seed and T2. This will be an invaluable way to start 2025 with all the thyroid information you need and more.
[00:01:41] Dr. Amie, so good to have you back on the podcast. Welcome.
Dr. Amie Hornaman: [00:01:44] Thank you so much. I love being here.
Cynthia Thurlow: [00:01:46] Yeah. It's funny, a few days ago, or maybe it was a few weeks ago, I feel with the holidays, everything's like rushing together. We were talking about misinformation on social media. I have to believe that individuals are well meaning but sometimes, Amie, it is so hard because it's so clear that these individuals, I'm not going to call them out, don't know what they don't know and they don't know what they're talking about. Let's talk about the basics. There are a lot of people that don't understand basic thyroid physiology. And I can imagine because that's such a huge focus of your work, that must be incredibly frustrating. So, let's start the conversation there today.
Dr. Amie Hornaman: [00:02:27] Yes, I also want to pull my hair out, and I talk about this a lot on my podcast too. Even going into and looking at the functional medicine, integrative medicine, alternative medicine, whatever category you want to put it under, we know that, it's hugely beneficial to people, especially in this day and age to have the opportunity to see a functional or integrative specialist or even to listen to biohackers who have dove into the science. And it's bringing us out of that conventional medicine model where one size fits all for the thyroid. All we do is test TSH. All we give is T4. So, it's breaking out of that mindset, which is fantastic.
[00:03:07] But when we're talking about the thyroid or when we're talking about hormones, those are so nuanced that you really have to know what you're doing to specialize in it in order to be able to have a full, accurate discussion or to give the world or everyone on Instagram information about it that is accurate that will benefit that individual. And too often I see in this world of biohacking of functional medicine, it's a one size fits all cover in the functional world where someone might be a peptide expert, but they're talking about thyroid and they're getting it wrong.
[00:03:48] And this is where I cringe and I'm like, “Oh, no, no, no, don't listen to this person with that, you can listen to them about peptides, you can listen to her about the gut, but don't listen to them when it comes to the thyroid because that very much is a nuanced art.” And you have to specialize to really know. And just like I don't sit here and claim to be a mold expert or a heavy metal expert or a parasite expert. I don't specialize that in my practice. I don't claim to be one. I don't talk about it because that's not my area of expertise. It's the same feeling that I have in this functional world of like, please don't talk about it if it's not your area of expertise. Because we want to ultimately give accurate information to help people, to help people move the needle, to help people with their symptoms, to anti-age, to protect their health long term, moving into perimenopause and menopause, we don't want to give them and I hate using this term, especially coming out of COVID, we don't want to give them misinformation, but we don't want to give misinformation because then people just end up very, very confused and usually paralyzed in making a decision for their own health. And they don't progress because there's too much info coming at them.
Cynthia Thurlow: [00:05:00] Yeah. So, it's interesting. My husband in the past six months started thyroid medication and he was listening to a male in the space talking about this individual's interpretation of how thyroid physiology works. And so, my husband, who's an engineer and for anyone that's listening, that has significant other, loved one that's an engineer, you understand what I'm saying? That they are very quantitative, detail-oriented individuals. And so, my husband came to me and showed me this video when I said, “That's actually not accurate and let me show you why and how this works.” And so that was number one, that was the first introduction I had to this individual's work. I think I texted you immediately because I was like, “What is this clown doing?”
Dr. Amie Hornaman: [00:05:44] Yeah.
Cynthia Thurlow: [00:05:45] And then it was multiple iterations of looking at other content that this individual wrote. What's interesting is there's another individual again who will remain nameless, was basically shaming women if they took hormone replacement therapy and this incorporates also thyroid replacement because if you're doing lifestyle right, “You shouldn't need it.” And all I could think of was what disservice are we doing to the health and wellness community if we don't understand what we don't understand, number one.
[00:06:21] And number two, we're propagating misinformation because there are many people, myself included and probably you as well. I would not feel as good as I do if I were not taking thyroid replacement, number one. And we were not doing HRT but how many other individuals listened to this information and either felt shame about wanting to take hormone replacement therapy in any capacity, or the other individuals who were being told by healthcare practitioners that they qualified for thyroid replacement, but then completely discounted what their provider said because this individual who doesn't understand basic thyroid physiology.
[00:07:05] And so, out of respect for these individuals who I have to believe are well meaning, I thought to myself, I was like, “I think it's so important to just encourage people to do their due diligence and to understand their bodies as much as possible so they can navigate making choices that make sense to them that are in alignment with their goals.” I had a guest on the podcast very recently and she said, “Hormone replacement therapy is not right for everyone and that's okay.”
[00:07:38] And so that always should be the message is that it might not be right for every body, but every body should be able to be counseled on the cost benefits with either choice if you choose to take it or don't choose to take it, understand what the long-term ramifications can be or not be. And that's what I hope and certainly with this podcast is exposing my community, certainly your community, to good information so that they can navigate good choices for themselves long term.
Dr. Amie Hornaman: [00:08:09] Yes, absolutely. There's so much I want to say to that. First of all, whenever I hear that information, I always ask, “Is it a male?” The reason why I say this is because-- [crosstalk]
Cynthia Thurlow: [00:08:19] Mm-hmm [unintelligible [00:08:19].
Dr. Amie Hornaman: [00:08:20] Because most men do not get hit with the amount of symptoms that women get hit with. Your husband is outside of the box. And men who have a thyroid problem are just near and dear to my heart because it's so rare and we know it starts affecting their quality of life and their testosterone. And so, I love helping the guys with thyroid problems. But when I see an individual speaking about thyroid issues and giving the message that you don't need thyroid hormone replacement, you have to fix your cells or you have to do better with your lifestyle.
[00:09:04] I go, “Have you ever gained 20 pounds in two months? Has your body ever totally rebelled against you to where you don't even know who you are anymore? Have you ever been so tired at 02:00 PM that you have to stop your day and lay down, even if it's for a 10-minute nap? Have you ever gone through that?” Because if you haven't, please do not stand up there and tell me that I don't need thyroid hormone replacement when that could make or break my quality of life and protect me in years to come from a variety of different disease states that can come when your thyroid is not functioning properly or when we're not replacing with hormones.
[00:09:43] That's always my first question is, “Have you walked in those shoes of having hypothyroidism?” Because if you have, then maybe you can speak, but if you haven't, I'm sorry, you don't know what it's like. I guess, number one is I would say to any of your listeners, always look at the source. And then we have to go one step beyond that too and I say this even with hormones too. When I hear someone say, “You don't need hormones,” just take XYZ supplement and do this lifestyle or do my XYZ program, I always go, “Well, maybe it's because they can't actually prescribe hormones.” That's not part of their program. Maybe they can't prescribe thyroid medication. So, for their business, basically they have to come up with a protocol and give the messaging that you don't need it because otherwise no one's going to come to them and do their program.
[00:10:41] Because there's not that thyroid hormone replacement involved. There's not hormone replacement involved. So, I also go one step further. And I go, “Okay, maybe your program, I mean, works fantastic for people with gut issues, but it's not going to magically bring back their thyroid. It's not going to magically turn on their ovaries to produce estrogen at the age of 50.” It's great for what it's great for but don't expand that and give people the false message that they're going to anti-age and magically produce more thyroid hormone or sex hormones from doing this program as well. So, it's almost like looking at studies. You have to go deep and you have to look at who funded that study. What's the motivation behind it? What's the motivation behind this message?
[00:11:27] And to your point, I'm sure that these individuals are very well meaning trying to get the message out to the world on different things that we can do to bio-hack and to improve our health. But we do have to be careful because some information can actually do more harm than good. And that's where we have to really be cognizant and look a little bit deeper even as consumers and listeners as to what that message is, who it's coming from, have they walked in those shoes that they're talking about and what's the motivation behind it? What are they selling? What are their programs? And do those programs contradict going on thyroid medication?
Cynthia Thurlow: [00:12:06] Yeah, it's such a good point. And it's interesting to me because neither of them can prescribe, number one. Number two, one of these individuals, we had a shared patient and I had been telling this patient for two years, it is time to start thinking about thyroid replacement, hormone replacement therapy. And when she finally went on, she was a different person. She felt so much better. And this is a really great example. And I'm all about being positive on this podcast and spreading good information. But this is a really great example of why second opinions are important. Making sure the individual, yes, the lifestyle piece is so important. That is foundational. There is no question. You're not going to do better on HRT if you still eat a standard American diet.
[00:12:52] You don't physically move your body, you don't manage your stress and your sleep is crap. Let's be clear. But on the other hand, I think that in so many different ways, women feel a sense of shame for taking medication. I know for myself, my nurse practitioner, like, this is probably eight years ago said, “You finally have declared yourself, I think it's time for thyroid replacement.” And do you know, for six months I was super stubborn, and I was like, “No, I don't need thyroid replacement.” And then finally, I was so tired, I was like, “I need thyroid replacement.” And I remember it was like within three days I felt like a light bulb had been turned on in my brain because I felt so much better. I had so much more energy.
[00:13:33] So, let's pivot and talk about what happens when we don't have enough thyroid hormone overtime. 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: [00:13:54] 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.
[00:14:37] 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 and estrogen and testosterone.
[00:15:27] 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.”
[00:16:15] 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. 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.
[00:17:11] 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.
[00:17:56] 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.
[00:18:49] 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 and 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, 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 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: [00:19:53] 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: [00:20:10] Thyropause, which may or 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, 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.
[00:20:57] And with autoimmune, there's this beautiful analogy that I absolutely love of a three-legged stool. Where is 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 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.
[00:21:50] 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 opposition to the opposition. And when that autoimmune turns on, that's where we will hear women say, “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.
[00:22:35] 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: [00:23:08] 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.
[00:24:02] And I had a woman DM me the other day that said, 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.” [Cynthia laughs] So, let's talk about optimal labs 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: [00:24:33] 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 access.
[00:25:23] 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 1 and you are dismissed. There's no way you could possibly have hypothyroidism because your TSH is within normal limits, WNL.
[00:26:12] 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. 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. So, let's break that down just like you said, reverse T3. It is beautifully built into our bodies as a survival mechanism.
[00:26:58] 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.
[00:27:44] That's why it's vital to test reverse T3. 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? So, this isn’t [chuckles] right--
Cynthia Thurlow: [00:28:55] [laughs] That's the truth.
Dr. Amie Hornaman: [00:28:57] Oh, 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 kind of 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 0.5%. You have that outlier that they're on T4 only and they're a rock star and they're fine.
[00:29:50] 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 begets autoimmune. Where we see one, we see more than one.
[00:30:29] 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 can really see how you are doing and how you are moving through midlife and whether or not you need thyroid hormone replacement.
Cynthia Thurlow: [00:31:10] This is like a mini thyroid masterclass.
Dr. Amie Hornaman: [00:31:13] [laughs] It kind of is.
Cynthia Thurlow: [00:31:14] I'm loving this. I'm loving this. So, for listeners understanding what you need to be advocating for, these are not weird labs, these are not unusual labs. I think that for every person listening, if you are optimized on thyroid medication, great. What I find is most women are not. They're struggling in the in between, meaning they're taking medicine, they see a scooch of improvement. They have hope that they're going to feel better soon, but they still feel like they've been run over by a car every day. They're tired and fatigued. And we talk about thyroid pause. I think this is important. Every hormone goes through this pause state. I've even heard adrenal pause. I think these are important to understand it's not just our sex hormones that take a hit.
[00:32:00] And so as someone who Hashimoto's that has never had a positive antibody, I'm going to say this again. Most cases of hypothyroidism are attributable to autoimmune Hashimoto's. You do not need to have a positive antibody. But what I find interesting about antibodies anecdotally is that for a lot of women, it is sometimes the kick in the pants they need to stop eating gluten. Because we talk about molecular mimicry. Let's talk about that. Because when we talk about gluten or dairy or soy, and that offsetting the receptor can help people understand like, we're not just being mean by suggesting you go gluten free. I think going gluten free for me prior to being diagnosed with hypothyroidism is what put my other autoimmune issues into remission. It is that powerful. You can do it, I promise. I thought it was harder to go dairy free to be completely transparent.
Dr. Amie Hornaman: [00:33:00] No, it's definitely harder to go dairy free. And do you know, I still reference one part of our conversation, whether it was on your podcast or mine, the last time we spoke where you and I were discussing antibodies, and we both currently have zero antibodies. Our antibodies don't show, but we both have Hashimoto's. And I always go back and I reference that because when you live that healthy lifestyle and you are gluten free, those antibodies continually come back at zero. You can literally put your autoimmune into remission. Now, that doesn't mean that you don't need thyroid hormone replacement, to address the actual thyroid hormones that we talked about and bring those into an optimal state. But you can put your Hashimoto's into remission. So, here's the analogy I love to give with Hashimoto's. And this will tie in the molecular mimicry.
[00:33:52] I talk about antibodies like soldiers. So, when you look at your TPO, thyroid peroxidase or TG, thyroglobulin, when you look at those markers on your labs, it will have a number. Now, if you have a less than 1, you can pretty much chalk that up to zero. If it has a number, let's say there's 9, let's say there's 30, let's say there's a thousand. Think of those as soldiers that are going out and beating up your thyroid gland. Because that's essentially what autoimmune is. It's your immune system, very, very confused, thinks that your thyroid is a bad guy and likes to go and start a war and beat it up. Those soldiers when they see a gluten molecule, so we have gluten-containing foods of that, the protein of gluten is gliadin.
[00:34:33] When we look at that microscopically, it looks in molecular structure very, very similar to the thyroid gland. So, you have these soldiers that are programmed to think that your thyroid gland is a bad guy. Now you eat gluten. Now those soldiers see this thyroid like thing coming in and they go, “I think we're under attack again. The invader is coming in, let's go start a war.” And they go out. You essentially launch your own attack on your thyroid. You are spurring on an autoimmune attack. Now, it might be something that you recognize and can feel. Oftentimes, I have had patients come back and say, “Okay, it was the holidays” [Cynthia laughs] and I eat gluten and man-- crosstalk]
Cynthia Thurlow: [00:35:22] And I feel like crap.
Dr. Amie Hornaman: [00:35:23] I mean, this actually just happened to me over Thanksgiving and it surprised me a little bit. It literally surprised me a little bit. By Thanksgiving Eve, so we went out, we actually went to this beautiful club. I didn't cook. We went with friends, huge spread of everything. I mean, everything that you can imagine. So, yes, I absolutely indulged in the stuffing. No, it wasn't gluten free. And yes, I had a glass of wine and yes, I had the desserts, and I tried one of each because it's Thanksgiving and I rarely do this. And it was a lot of fun. By that night, I thought I had mess. My entire body from head to toe was locked down. I mean, I was doing these weird stretches just trying to loosen up my muscles. I took boatloads of magnesium. I was like, I couldn't even believe how my body was responding.
[00:36:05] And then, of course, my sleep that night was probably the lowest sleep score in tracking my sleep that I've ever gotten. It can be an immediate effect that you feel. And actually, I find that a blessing because that gives you that immediate feedback to go, I will never do that again. But oftentimes, it's very, very slow and almost like insidious. I don't feel well two days out of the week, I'm on the couch, I'm in pain. What's going on? Was it something I ate? I don't know. In eating that gluten, you are spurring on that autoimmune attack, and your thyroid gets attacked. And not only that, but you start increasing the amount of soldiers. So, you might find that if you don't go gluten free the next time you test well, now you went from 100 to 500, now you went from 1,000 to 3,000. So, you're building your army as well.
[00:36:57] And I think when we put it that way to people, it gives them that kick in the pants that you're talking about to say, “Oh, okay, well, in that case, I will cut it out, because I don't want that to continually happen to me.”
Cynthia Thurlow: [00:37:11] Yeah. And it's so interesting, your experience on Thanksgiving, the degree of inflammation that must have been ongoing in your body. I went gluten free 13 years ago, and there were not nearly as many options as there are now. But I recall, and we have mutual friend Natalie Jill. I was doing one of her workout programs, and she was really big on no gluten. And I can remember the amount of inflammation that I felt like I got rid of almost instantaneously within the first week of not eating gluten. And the fact that I had to restructure a snack, if I wanted to eat a snack or a meal was life changing. And I say to my husband all the time, he doesn't eat a lot of gluten, but he does eat gluten. My boys eat gluten.
[00:37:54] The differentiator for me was so profound that I was like, I'm never going back. And when I'm outside the United States, I can eat gluten and I'm fine. I think it has a great deal to do with dwarf rehybridization, exposure to glyphosate, what that does to the gut. I think it's why many people will say, “I can enjoy gluten when I'm outside the United States, but I can’t enjoy it here.” I think it has a great deal to do with the way that we address wheat here in the United States in silos, so that it lives on forever. That's why this hybridized form of wheat has been created, so that it can sit in silos and not spoil.
[00:38:32] And, yeah, that's great, but it's also why so many of us don't even think about the way we eat and how it impacts the way we feel. We've just gotten so conditioned. I mean, I grew up in New Jersey. I grew up at the Jersey Shore. And, I grew up in a childhood where there was a ton of gluten everywhere. And, I think about this now. I remember I went off to college and I would come home, and my friends were like, “You eat weird now.” And I'm like, “No, I just eat something other than Italian food which is fine as a time and a place, but I think for so many of us, it's so much a part of our culture or our human experience that we eat exactly how we did as teenagers into middle age, and we start to realize it just really does not serve us.
[00:39:19] I would love touch on medications because this is another area that I think a lot of people don't understand. There's lots of options. It's like going to the grocery store. You have the conventional, you have the formulations that have more than just T4 in them. We'll think about that. As, you know, we're having an upgrade. And then you can have compounded. You can run the gamut. I've met plenty of people that have done really well or at least they tell me they're doing fine on Synthroid.
[00:39:50] I have others that have moved on to Nature-Throid, and that group of options. And then those of us that have graduated to graduate school, I always say, “It kills me. But it doesn't kill me that I have to have everything compounded now, because that's what works best for me.” We've tried everything else, and if the generic stuff works great, don't feel like you have to upgrade to the stuff that I'm using. But if it doesn't work for you, know that there's lots of options. So, let's talk about the options that are available. Both conventional, all the way up to compounded.
Dr. Amie Hornaman: [00:40:23] Oh, I love this because there are so many options. And when I get asked the question, “Well, what is your favorite thyroid medication?” I say, “The one that works for you in the combination that's going to work for you, in the dose that's going to work for you.” Because we have so many options. And that's really the message that gets lost definitely, in the conventional system with their T4 only approach. But even moving into functional and integrative, again, if they're not an expert in the thyroid, I see a tendency to only give NDT medication, which is natural desiccated thyroid. Natural desiccated thyroid medication, that's your Armour or your NP, and then we can even go into compounding T4 and T3 together.
[00:41:11] The problem with staying in that realm of thinking is that you could do a disservice to people, to your patient, because that NDT medication, it does contain T3. So now we're into that. 98% of us need T4 and T3 or T3 only. Okay. NDT medication does contain T3. It's around 80% T4 and 20% T3. Now, if we're taking someone that's on T4 only and we move them to NDT, they're going to feel the difference because you're giving them some of that active thyroid hormone. So, in the beginning, everyone is going to be like, “Whoa, this is amazing, yes.”
Cynthia Thurlow: [00:41:48] I couldn't sleep. That was my tell. I would get insomnia, terrible insomnia for the first week.
Dr. Amie Hornaman: [00:41:53] With the NDT or with the T--
Cynthia Thurlow: [00:41:55] With the NDT.
Dr. Amie Hornaman: [00:41:56] With the NDT. Okay. So, when you move into that, into NDT, sometimes you feel better, sometimes you feel worse, or you have symptoms that start appearing that you're like, “Wait, this isn't right, this isn't good.” So that's where, okay, we're not quite there. It's better, but we're not quite there. Now, the beauty of customization of thyroid hormone replacement is that we can start bringing things in to change the ratio. So, if we move to compounded. Well, we can tell that compounding pharmacy. You know what, instead of doing 80% T4 because this person has a reverse T3 that's kind of iffy, don't like it. We don't want to give them too much T4, let's bring that down. Let's do 40% T4 and 60% T3. So, compounding thyroid medication, we can make it however we want to.
[00:42:55] We can do any ratio we want to or for people that maybe don't want that, we'll say extra expense because their insurance is covering the medication that they pick up at the CVS, Walgreens, at the pharmacy. And again, there's nothing wrong with that. I'm on total generic T3 only, and it works for me. What we can do is take that NDT and bring in liothyronine or Cytomel, that's T3. So, liothyronine is the generic form of T3. Cytomel is the brand. Quite honestly, when it comes to T3, I like generic over brand because generic has less fillers than the brand T3.
Cynthia Thurlow: [00:43:29] Interesting. Yeah.
Dr. Amie Hornaman: [00:43:30] It's flipped with T4. T4, the generic has more fillers than. If you go up in the stratosphere of Synthroid and then Tirosint and Tirosint-Sol. It gets more, for lack of a better word, pure as you go up that T4 ladder. But over in the T3 category, we can throw in some liothyronine to that NDT. And now we've changed the ratio. Now, we've brought you to more of a 50:50, 40:60, whatever we want to do ratio to really tailor it to you. We can also move over here and say, “Okay, here's this person on Synthroid. They're doing okay, but their free T3 is low. So, let's leave them on that Synthroid that they're doing okay with. Reverse T3 looks good. Obviously, it's brought their TSH into the optimal range and that T3 is still low and they have all the symptoms still. So, now let's bring in some liothyronine to their thyroid protocol and adjust that as we go.
[00:44:36] And even to that, I get the question, well, what's the average dose of T3 that works for people? I have people that are optimized on 10 mcg. I have people taking 200 mcg and then everything in between. And this just speaks to the nuance effect. It so individualized and nuanced to you, but you can absolutely get to that optimized state once you find the right person to work with and the right combination of thyroid hormone replacement that you need.
Cynthia Thurlow: [00:45:10] I think it's so important that you stress bio-individuality rules, how critically important it is. You know, certain people have certain budgets, they'll say I need to use the synthetic options and there's no shame in that. Other people are like, “I've done the non-desiccated and that doesn't work for me.” I have tried everything. I actually did really well on Nature-Throid and then it became impossible to find. And I got put on Synthroid and Cytomel. Then that stopped working and they kept increasing my T3 and I was like, “Timeout. I don't think I need more T3.” Now I'm on compounded and that works really well. And because I've been stable for two years, I'm like, we're not going to mess around. It's everything-- I feel good, I have plenty of energy.
[00:45:52] I know that in the realm of co factors for thyroid replacements, there's a lot of controversy around iodine. What are your thoughts? Do you routinely test your patients for iodine deficiencies? Are you a fan of replacing iodine in appropriate patients?
Dr. Amie Hornaman: [00:46:10] I am. I am in that camp of being pro iodine and here's why. Number one, I interviewed Dr. David Brownstein I put him in the camp of the guru of iodine because he has been practicing in the goiter belt of Michigan.
Cynthia Thurlow: [00:46:27] The goiter belt, [laughs].
Dr. Amie Hornaman: [00:46:28] It's the great. I came from the goiter belt too, up in Erie, Pennsylvania, [Cynthia laughs] all on the Great Lakes. It is the goiter belt, it's the cancer belt. So, he's practiced for decades in Michigan and really dove into iodine. And this is decades ago when he was seeing a lot of his patients coming in with thyroid problems. And he'll say, “I have no problem putting these people on thyroid medication.” That's not an issue. But why, why are we seeing so many thyroid problems? Now, I mean, 20 years ago he was saying it was low iodine.
[00:47:06] Today, we could say, okay, low iodine and all the toxins and everything in our environment and the stress that triggers Hashimoto's or autoimmune. But going back to his research, he started using iodine with his patients and he was seeing an improvement in thyroid function, a decrease of doses of the thyroid hormone replacement that people would need. And you can go one step deeper and just really use basic biology, common sense. Every cell in our body has a receptor site on it for iodine. Iodine is amazing at being antiviral, antibacterial. World War II soldiers used to carry it basically for everything. Oh, you got a wound, let's put some iodine on it. Oh, you're sick, take some iodine internally. So that's why I can't wrap my mind around the other side who say don't use iodine.
[00:48:00] I think you have to use it responsibly. So, I really believe that iodine got a bad rap when doctors were or practitioners were overdosing it. “Yes, you need iodine. Here you go. Start off on, we'll say 25 mg of iodine.” And some individuals went hyper. They went into a thyroid storm and that's never good. But if you go low and slow with it and dose yourself very slowly to find your tolerance, then there's really no harm. You're only supporting your body. And I always tell my patients when we start them on iodine and they're slowly titrating up, say you will know the day that you go one drop too many because you will feel anxious, you will feel hyper, you'll feel over caffeinated, like you will feel it.
[00:48:47] But here's the good news, it'll go away in a few hours or by the next day. And now you know that your dose, you got to back that up and go one or two drops lower than that and that's your sweet spot and that's okay. Finding your dose of iodine is also very bio-individual. You have to play with it and go nice and low and slow to get to that level. Now I don't actually test for it and sometimes we'll throw in a test. But I always tell people if you're not taking it, your iodine's going to be low. If you are taking it's probably going to be flagged high when we get that lab back. But I interviewed Barton Scott years ago and we were talking about Hair Tissue Mineral Analysis. And I said, “Do you test for iodine in that HTMA?” And he goes, “No, because every cell in our body needs it. So why don't you just take it?”
[00:49:37] And I just remember that quote and I've hung onto that quote as it's so simple and so basic, like, well why don't you just take it? It's like, “Oh, okay, done. Put a pin in it.” So that's my take on iodine. I have seen and heard people improve in days. So, as we're working on optimizing their thyroid, they add in iodine and they're like, “Oh, my gosh, I have more brain function and more energy. It's great.” I mean, it can really turn the corner very quickly when you add in iodine, properly.
Cynthia Thurlow: [00:50:08] Fun fact. My mom and my aunt are both patients of Brownstein's, so I'm very aware of his work. I actually have his iodine book sitting in my bookshelf that I have skim read. But I do believe that depending on the individual, definitely a good option. Let's talk about what are you using that's new? I know that you've got an amazing supplement line. What are some of the new things that you are working on within your business to help optimize your thyroid patients? Not just the way they feel, but optimizing lives like making things simple. I know we're in agreement about keeping things simple or trying to keep things as simple as possible.
Dr. Amie Hornaman: [00:50:49] Yes, yes. The supplement fatigue supplement overwhelm-- [crosstalk]
Cynthia Thurlow: [00:50:52] [laughs]It’s a real problem.
Dr. Amie Hornaman: [00:50:53] I get it. So, what I do for my patients is I have what I call the Noda supplement. So, I term that from our days of childhood back in the 80s. Well, like, “Da, of course you're going to take that.” So those are the Noda supplements. This is your vitamin D, your magnesium. I put iodine in there, I put creatine in there, like we discussed on my podcast. And I also put in their black cumin seed oil. And for thyroid patients, I put in T2. So, I'll break those two down. So, black cumin seed oil, it is part of my line, it's in Hashimoto's fixer.
[00:51:30] But when I first released it, when I knew, okay, I know that black cumin seed has a boatload of evidence in lowering antibodies of all autoimmune conditions and lowering inflammation. So, done. It wasn't until I released the supplement that I went even deeper into the research. Usually, we do this before. It was good enough for me that it lowers inflammation and lowers antibodies, boom. But then I went deeper into the research and as you know, to be able to say anything is a cancer preventative or may actually protect you against cancer, you better have research behind it or all the alphabet agencies will come after you [Cynthia laughs] and shut you down. And black cumin seed is one of the only supplements, ingredients- [crosstalk]
Cynthia Thurlow: [00:52:22] Flew under the radar.
Dr. Amie Hornaman: [00:52:24] -compounds, right? That can actually say that.
Cynthia Thurlow: [00:52:27] Oh.
Dr. Amie Hornaman: [00:52:27] Yeah. There are a multitude of studies that show that black cumin seed oil is basically a cancer preventative, helps reduce your risk of. So, I have now put that because of it lowering inflammation as well, that extra benefit of being cancer protective. It's in my Noda supplements now. So, I take it every single day. And you believe me, I loaded up on that Thanksgiving Eve and all the next day too, because my body was so inflamed from the alcohol and gluten consumption that I did that three times a day just to lower the inflammation. So, black cumin seed for sure.
Cynthia Thurlow: [00:53:08] Not to interrupt you, but just out of curiosity, because I know low-dose naltrexone has some of those same properties and I know Dr. Pam Smith talks about, I take 4.5 mg a day and that's my therapeutic range. She takes 1 mg a day for breast protection. So, I'm curious, I'm sure that you work with both of them. Do you feel like one is more efficacious in your patient population in looking at reducing inflammation and low-dose naltrexone, let me just interject this. It's one of these weird drugs that you don't know if it's going to work until you use it. And some people, you can use it and they don't per se see an improvement in their antibodies. They may not have a reduction in their inflammation, but when it works, it works very well.
[00:53:54] And for me, it was the missing piece to get my thyroid optimized. We were like, “Okay, let's try this.” Just throw it up on the wall. So, curious for you, do you use them interchangeably? Do you feel like you're using more black cumin seed oil? I'm just curious.
Dr. Amie Hornaman: [00:54:09] I use them together often. So, depending on a person's antibody level and if they have multiple autoimmune conditions as well. So, normally where we see one, we do see more than one. So, if they have multiple autoimmune conditions, I'll stack them. So, we use LDN and black cumin seed at the same time. Where I see the difference between the two. They're both fantastic. They're wonderful. You'll have that subset of people on LDN who may experience insomnia no matter what time they take it. Sometimes we'll say, “Okay, pull it back, take it in the morning, don't take it at night.” They'll still experience insomnia or they will experience increased cortisol. And I've seen that in a couple patients as well as colleagues report back to me. “You know what? I can't take that because my cortisol increases.”
[00:54:58] So, that's the only downside with LDN or to your point, we won't see any movement with LDN whatsoever. And how they feel and inflammation, pain reduction, antibody reduction. So that's when we'll either move over to black cumin seed or we just use them together because it's a powerhouse together too.
Cynthia Thurlow: [00:55:15] So, interesting. And then you also talked about T2. Let's, for benefit of listeners, talk about the functions of T2. This is part of thyroid fixer, correct?
Dr. Amie Hornaman: [00:55:25] Yes, yes, yes.
Cynthia Thurlow: [00:55:25] Okay.
Dr. Amie Hornaman: [00:55:27] So, T2, I've been studying for about 15 years, researching for 15 years. It has 30 years of research behind it. And it is a thyroid hormone, but it doesn't work on the thyroid itself. So, what that means is you could take T2 and the mechanism of action is that it increases your basal metabolic rate. So, it works at the mitochondrial level, stimulates ATP and increases basal metabolism. So, the amount of fat and calories that you're burning at rest, it also browns white adipose tissue. So that's why we're jumping into cold plunges, is to brown that, that white, squishy fat and make it more metabolically active, make us more insulin sensitive. That's what T2 does. But it does it all at the cell level. The benefit of this is that, number one, it's doesn't produce that anxious effect.
[00:56:15] So, sometimes, even when we start someone on T3, or if you've ever taken too much T3, you get pretty hyped up and anxious. T2 does not do that and it won't change your thyroid lab values. So, you won't go back to your doctor and have them pull a thyroid panel and go, “Oh, my gosh, you're hyperthyroid now.” And you're saying they're going, “No, I feel great. Like, I finally have energy and I'm losing weight. So, no, I'm not hyper at all.” It doesn't affect. It doesn't have that negative feedback loop to shut down your own thyroid hormone production like thyroid medication does. And again, I'm not saying that to avoid medication that doesn't take the place of it necessarily. But if someone is on T4 only or if you are on any thyroid medication, you're like, “I'm not losing weight. I'm not feeling any better.” This might be something to add in because you can get that symptom relief without affecting your thyroid lab values.
Cynthia Thurlow: [00:57:14] So, interesting. I always love connecting with you and like I said, this is like a thyroid mini masterclass. Please let listeners know how to connect with you, how to listen to your amazing podcast, get access to your supplements, learn more about your work.
Dr. Amie Hornaman: [00:57:28] Absolutely. So, you can go to dramie.com, D-R-A-M-I-E really simple and on there you can book a call if you're interested in working together. We do prescribe to all 50 states and most of Canada because that was kind of going back to my statement in the beginning. That was very important to me to be able to give proper thyroid hormone replacement and not BS people letting them think that they can heal their thyroid naturally. Some people can, but most, we really love that thyroid hormone replacement. You're going to have to pry it out of my dead cold hands in addition to my sex hormones. [Cynthia laughs] So, we prescribed all 50 states, most of Canada and then yes, to your point, also the podcast, The Thyroid Fixer Podcast, Cynthia has been a guest on many times.
[00:58:11] We dive deep into this whole world of thyroid hormones and all the symptoms around it. So that's a great resource as well to dive a little bit deeper. And from that dramie.com site you can reach my store if you're interested in Hashimoto's Fixer, Thyroid Fixer like we talked about today, you can access it there or you can go to betterlifedoctor.com and go direct to the store.
Cynthia Thurlow: [00:58:33] Love it. Thank you for all the work that you do, my friend.
Dr. Amie Hornaman: [00:58:37] Thank you.
Cynthia Thurlow: [00:58:39] If you love this podcast episode, please leave a rating in review, subscribe and tell a friend.
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