← Extend Podcast with Darshan Shah, MD
Extend Podcast with Darshan Shah, MD
167. Dr. Amie Hornaman: The Thyropause Problem: Why So Many Women Feel Off in Midlife Despite "Normal" Labs
00:55:59
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- [00:03]
A
Welcome to xtend with me, Dr. Darshan Shah. A podcast dedicated to cutting edge science research tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. In a world where normal lab results often mask profound suffering, Dr. Amy Horneman, the thyroid fixture, shares her transformative journey from being a misdiagnosed patient herself to to now leading the thyroid and hormone charge as a specialist. This episode uncovers the critical flaws in conventional thyroid testing. It reveals why many individuals, especially women, are left feeling dismissed and unwell, despite their doctors assuring them that everything looks fine. In their panels, Dr. Horneman emphasizes that thyroid dysfunction extends far beyond just weight gain and fatigue. It impacts everything from mental health and cognitive function to chronic disease risk. Dr. Horneman, who built a nationwide clinic after her own six misdiagnoses, passionately advocates for a comprehensive approach to thyroid health. She explains the crucial differences between TSH T4, T3 and reverse T3. And relying only on TSH is a dangerous oversight. Listeners will gain a deep understanding of how stress, aging and other hormones can profoundly affect thyroid function, leading to conditions like like thyropause. This episode is a must listen for anyone who suspects their thyroid might be the root cause of their persistent health challenges, offering hope and a clear path towards true optimization. Dr. Amy Horneman, thanks for joining us today on the XTEND podcast. So fantastic to have you here.
- [02:19]
B
Thank you so much for having me.
- [02:21]
A
Yeah, so we don't get to do a lot of episodes on the thyroid. So I'm super excited to be diving deep into this with you. And you have a nationwide clinic that treats thyroid disorders, right?
- [02:31]
B
Yes. The advanced thyroid hormone clinic was really birthed out of my own pain to purpose story of being misdiagnosed six times. So I thought to myself, okay, so if this girl in Pittsburgh, Pennsylvania just got misdiagnosed in a major medical system, how many other people are suffering? So I really wanted to build something where we could Treat people across the United States.
- [02:55]
A
Wow. Okay. And so what do they misdiagnose you with, if you don't mind me asking?
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B
Just. I got the normal. You're normal. Everything is fine. Nothing to see here. Eat less and exercise more, why don't you?
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A
And that was based on your labs? They said everything was normal.
- [03:10]
B
Right. I mean, we're talking 25 years ago. So I would love, love, love to go back and see what labs they actually ran on me. Of course, we can guess that they probably just did one marker, tsh, and that was tsh, and that's it.
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A
But you'd be so surprised. I mean, I think it's still happening now in most of mainstream medicine, where you complain about, can you check my thyroid? And there's only one marker checked, right?
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B
Bingo. Exactly. It is still happening. And that's the crazy thing is, like, 25 years later, I'm seeing the same thing in our patients that I went through. They're coming in with their panels and TSH is on there, maybe a free T4, but nothing else. None of the other important markers that we really need to see.
- [03:52]
A
Yeah, yeah. And so I wanna get into that a little bit later. But first, let's just talk about the symptoms you are experiencing, because I'm sure there's a lot of people out there listening to this. And for men and women, these are symptoms that are often either completely ignored or, you know, with basic blood tests, you don't see anything wrong. Like you said, go home and eat less and exercise kind of a thing. Or they are even gaslit into saying, you know, this is all in your head.
- [04:19]
B
Yes.
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A
You know, go, go de stress or something. Right. And so I see that a lot. And a lot of people come to us with the same kind of complaints. And one of the things that we check deeply with every single patient when they come in is a thyroid panel, you know, including reverse T3 and some of the markers we're going to be talking about. But tell me what your symptoms were and what do people experience as, you know, just so the people listening can say, aha, I have that. You know.
- [04:46]
B
Yeah. So for me, it was the weight gain. So I was doing all the things. I was actually an athlete. I was a fitness model. I was doing competitions, figure competitions, bodybuilding competitions, and the scale just kept going up. So when I say I was doing all the things, I was really doing all the things. £25 went on that scale before I just stopped getting on it. I didn't want to become any more depressed than I already was, but it was really, it was the weight gain, the crushing fatigue. I mean, I was in my twenties, I shouldn't have had to be drinking five cups of coffee to get through my day. Crushing fatigue, hair loss, to where I thought, like, okay, well, it's time for extensions or I'm gonna go bald here. And that's just. Those are just a few of the symptoms. Obviously, the weight is what I really focused on. But now what I see, people come in and I'm sure you see the same thing. There's the anxiety and depression. Like you mentioned, they'll be prescribed an antidepressant, but. But nobody's looking deeper to see, well, what's the root cause of that depression that they're experiencing? The brain fog, constipation, joint pain. I mean, it really extends outward to the entire body. I always say with a thyroid from head to toe, it runs the show.
- [05:59]
A
Yeah, that's so true. And so, you know, you said something critical there too. Depression is often treated as a diagnosis, like, this is the primary thing. Wrong. But there's a root cause many times of why someone is depressed. Right. And so rather than subscribe to a lifetime of antidepressant medications that need escalating dosages, if you get to the root cause, you can get off of it, which is, you know, so much better, obviously.
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B
Right.
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A
And so, yeah, I think, I think it's really important that these symptoms are addressed from a root cause type of mentality rather than just accepting it's the way it is and you need a medication.
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B
Absolutely. And one of the things I talk about in the book and that we're seeing more emerging evidence on functional psychiatry, is actually starting to use thyroid hormone replacements, specifically T3, not just T4 only, but specifically T3. In their treatment of like the extreme mental health conditions, bipolar schizophrenia, we're seeing massive changes in that patient population without the use of antipsychotics.
- [06:58]
A
Wow. What about things like attention deficit also? You know, a lot of people, the reason I ask about this, a lot of people are self medicating. Right. And so could the thyroid also be involved in those types of things?
- [07:09]
B
Oh, definitely. Because with that, that attention focus, memory, that's all thyroid related. I've had patients come in who are in their 40s and 50s and they're like, do I have early Alzheimer's? Like, I'm starting to forget things. I can't recall words that I need to say. And it's like, no, it's just that your brain has thyroid receptors, thyroid hormone receptors on it. And it's just not firing. You don't have Alzheimer's or add. You don't need Adderall. Like, we just need to fix your thyroid.
- [07:38]
A
Yeah, yeah. Every cell in our body has hormone receptors, right. And so you really, like you said, the thyroid runs. What was the thing he said? The thyroid runs the show from head to toe.
- [07:47]
B
It runs the show.
- [07:48]
A
Yeah. So really it can affect any part of the body. So symptoms can be occur in the brain, it can occur throughout every single organ in your body. So it really should be checked, in my view, on everybody if you're experiencing symptoms for sure.
- [08:00]
B
Yes, yes. Yeah, that's. That's my view as well. Everybody.
- [08:04]
A
Yeah. And another way to think about it, and you and I were talking about this is, you know, a lot of times, especially when you're older, the symptoms are attributed to either menopause or andropause. Right. Testosterone or estrogen. Testosterone for men, estrogen for women. But really, like, it could also be the thyroid or it could be the thyroid causing the same symptoms.
- [08:24]
B
Right, exactly. So as we move into perimenopause, menopause or andropause. And here's the thing, we're all gonna move into it, right? As long as you're aging forward, we know your hormones are going to decline at some point. So that is actually a stressor on the body and those hormone shifts. And for women, my gosh, we go in this estrogen rollercoaster for a while in perimenopause. Crazy, crazy, stressful. That's enough to flip that Hashimoto switch, that autoimmune switch that may have been hanging out in the off position for years, maybe decades, that stressor of hormone changes flips that switch to the on position. So now these people, I say women mostly because women get hit the hardest, but now these men and women move into thyropause and they don't even know it. So they have the declining thyroid or the presentation of Hashimoto's and they have low hormone function. It's like, well, no wonder they want to just quit and throw in the towel because they, they're gaining weight rapidly, they're depressed, they can't think. I mean, all the things their sex drives down. They don't wanna do anything. No motivation. And it really is that combination, like you said, of that intersection between thyroid dysfunction and low hormone function called thyropause.
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A
Got it. And can pretty much everyone expect to go through thyropause or if you're pretty healthy and you don't have Hashimoto's. Does the thyroid keep chugging along throughout your life?
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B
You know, it can. I'm estimating around 80 to 90% of women and around 60% of men will get hit. We know men are, well, more protect with their testosterone against all autoimmune conditions. So women having lower testosterone levels, just in general, more fluctuating hormones, we're gonna get hit harder. Right now, the stat is 1 in 8Americans, but we're not taking into account the undiagnosed or the misdiagnosed. So really, it's about one in four that will get hit with a thyroid problem or thyroid.
- [10:22]
A
Yeah, yeah, yeah. And, you know, I think this whole concept of misdiagnosis is really important for people who are listening to this podcast, because the problem with the misdiagnosis is that doctors aren't really not checking for this in the correct fashion with their blood tests, basically. Right. And so we have all sorts of markers that we can look for with not just the thyroid glands function, but also how the brain and the thyroid are interacting. And we can also check markers for Hashimoto's, which is autoimmune attack on your thyroid gland. Right. And I just want to highlight one more thing that you said, is that stress can cause this autoimmune attack on your thyroid gland.
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B
Yes.
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A
Yeah, yes. So hormone declining or other forms of stress can cause this to happen. And who isn't stressed out there?
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B
Right, Exactly.
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A
So can we talk a little bit about the markers around thyroid? Like, what is a real thyroid plan and what should that include? And how do we check for Hashimoto's.
- [11:17]
B
Yes. Okay, so when you go into your doctor, if you go in and I mean, you can even speak to this, right. Back in your days in the Mayo Clinic, you were probably told, listen, all we can Check here is TSH and free T4, because if we go further than that, the insurance company, they're going to be all pissed off. So we don't want to anger them. So let's just. Let's keep to the basics. And it's really. It's not the doctor's fault. That's what they're told, and that's what they're taught in med school, that if you just check TSH and that TSH is above 4.5 is now the cutoff with LabCorp. At least if it's above that 4.5, they got that little H next to it. It's flagged high. Just give em T4 and tell Emil we'll recheck in six months, you'll be good. But now we know it's so much more than that. We have to look so much deeper because TSH is a brain hormone. So, yeah, let's look at the free T4. That's your inactive thyroid hormone. Let's check that out. I like to look at that because what I'm looking for is if that free T4 is too high, I know that that person's probably on way too much levothyroxine or Synthroid or that reverse T3 is gonna be high too. They're just not converting that. So I like to peek at the free T4, but it's not the be all end all. My two favorite markers, free T3. So we're checking that active thyroid hormone, that hormone that's ready to attach to your cell and do its job. And then we're looking at reverse T3, which is the active antithyroid hormone. I like using analogies so people can understand my analogy. For reverse T3 is like a bouncer at the club. So you got too much reverse T3. That bouncer standing outside your cell door, looking around, looking at the T3, trying to come in, going, yeah, you're not getting in tonight. Yeah, you're not getting in either. You can't come in and do your job. So if reverse T3 is too high, it's gonna block that beautiful active thyroid hormone from getting to the cell to do its job. So that's where we really see that tie into the symptoms. Now, we also look at, like, you mentioned, the antibody markers. We look at thyroid peroxidase and thyroglobulin. And by the way, you have to check both. Have you seen people come in with panels where they check one?
- [13:28]
A
Yeah.
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B
And it's like, there's two. Just write the other one down and check them both. So we want to look at both. And with those. And I know we can talk optimal versus normal. But just to mention, with those antibodies.
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A
Right.
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B
I want them at zero.
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A
Yeah. Zero is optimal.
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B
Zero. I don't want you to have any antibodies attacking your thyroid. So that is the full thyroid panel.
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A
Got it. So let's track this for people. So you have the tsh, which is a brain hormone.
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B
Yep.
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A
And the TSH goes up when your thyroid has decreased function because your brain's trying to tell your thyroid you need to make more thyroid hormone. Why are you not making it right?
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B
Yes. Yeah. It's like yelling at your kids who aren't doing their job. Like, your voice gets louder as they start. Stop doing what they need to do.
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A
Exactly. Okay, good. So then your thyroid gland is making T4 and T3. There's two different types of thyroid hormones, right? And T4 converts into T3, right?
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B
Yes.
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A
And then the active form of T3 is just T3. Right?
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B
Yeah.
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A
But then there's reverse T3 also. So that's the little piece. I think I want to dive in a little bit deeper with you. Can you explain the physiology from T4 to T3 and reverse T3?
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B
Yes. So to break down really simply, it's like T4 is at the starting gate.
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A
Right.
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B
And when those gates open, it has two paths that it can choose to go down. We hope it goes down that path of conversion of properly becoming T3. And it's just the removal of one of the iodine atoms attached to it. So remove the iodine becomes T3. Cool. Ready to go. Except it could go down this path instead, and that path is the reverse T3 path. So people who are insulin resistant, estrogen dominant, low in magnesium, low in vitamin D, low in selenium, low in iodine, stressed out, high cortisol, sometimes even genetic SNPs can interfere with that conversion. So T4 gets pushed down that reverse T3 pathway. I always say that conversion of T4 to T3, it's hard for your body to do, especially in this day and age. I mean, we have, like, an onslaught of toxins and stress that we didn't have 20, 40 years ago. So if it does become reverse T3, now we have a problem. Now we have something that we need to address. Figure out why it pushed down that pathway, but also look at the treatment, too. And now that plays into, okay, how are we gonna fix this situation that we see?
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A
Yeah. And so what's really important to recognize here is the traditional treatment that we give for thyroid, for hypothyroidism is Synthroid, and Synthroid is T4. Right. So if all these other things exist, like you were saying, stress and hyperinsulinemia and metabolic health issues, that T4 is still gonna go down the reverse 33 pathway.
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B
Yep.
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A
And be like the balancer, like you were saying, not letting the good T3 in.
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B
Exactly.
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A
Right.
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B
Exactly.
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A
So why do we give people T4? Why do we give people Synthroid? Like, what is. Why is that even a thing? Why not go to just giving them active T3 hormone?
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B
I get that question all the time. All the time. So, first of all, that process of thyroid optimization is so nuanced. It's so beautifully personalized to each person. So, yes, you might have an individual that only requires T3. I'm actually one of them. So I only can tolerate T3. I do have a genetic SNP that makes me. That gives me a propensity to not convert. Well, it turns out I don't because if I take any amount of T4 in a week, I'll be 10 pounds heavier and clinically depressed. And I've tried it, so I know, but not everyone is T3 only. The reason why we give T4, it's like having a savings account. No one wants to just have money in checking and always be spending out of the checking. You want to have some in a savings account that you can pull from on a rainy day. So that's what T4 is. It's like your savings account. It's in the bank.
- [17:20]
A
It's a really good analogy.
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B
Your body can pull from it, move it into checking, move it into T3, spend it, and then all is well. But the reality is not everyone can have a savings account. Some people just need to live off their checking.
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A
Got it. And so sounds like the optimal. Is if you can convert T4 to T3 is to have a little bit of both. Right. Like T3 and T4, savings and checking. And how do you get both together?
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B
Well, that's where the thyroid hormone replacement comes in. And I'm calling it that and not thyroid medication because I don't want people to get that in their head. That medication equals bad.
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A
Yeah.
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B
So let me clarify that for a moment. Medication that we want to avoid. Those are the band aids that you could very easily get. If you go in and you say, I'm depressed, I'm just not sleeping well. Okay, well, here's an antidepressant, here's a sleeping pill, maybe a statin, a blood pressure medication. Those are the medications we don't want. The medications that we do want are hormone replacement. So, yes, that could be testosterone, estrogen, progesterone, but that can also be T3 and T4. Thyroid hormone.
- [18:29]
A
Yes.
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B
Now that thyroid medication comes in a variety of different forms. I mean, we have T4 separated out. You already mentioned Synthroid. Levothyroxine is the generic. We have T3 in the form of cytomel or lyothyronine. And then we have the middle category, as I call it, the NDT, natural desiccated thyroid. That's your NP Armour REN thyroid. And that's the combination of T4 and T3. They're all derived from different sources. But I also want to go one step further and I'll get your opinion too. I'll turn the table and ask you that. T4 and T3, the Synthroid and the liothyronine. I actually rephrased the term and pulled out synthetic. I call them biosynth. Because when you use the term synthetic, what do people do? They go, oh, that's bad. It's like they're thinking of hormones like progestin, a bad hormone. It's like, okay. In this case, though, when we're talking thyroid, we wanna find that right combination for you. And if it takes a biosynth here and a biosynth there, or we can pair up T3 with NDT to change the ratio in your body. Let's do it. Let's keep an open mind when we're looking at treatment and thyroid hormone replacement.
- [19:41]
A
Also, you're creating bespoke protocols. And to be honest with you, most of the time I'm just giving people NDT because I feel like that's what's going to cover all their bases. But I do have some patients like you that don't convert T4 to T3. And so then we just go straight T3. But you're right. I mean, why not give them the two synthetics? Because then their insurance will pay for it. Because those are also, like, actually medications you can buy from your pharmacy.
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B
True, true. But I love the NDT too. But sometimes with. With a person that maybe has a middle of the road, reverse T3 will throw in some of the lyothyrenine to change that ratio. Because NDT is 80, 20, basically.
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A
Yeah, that's true.
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B
80% T4, 20% T3. So if someone's getting 80% T4 and say, well, the reverse is like a 17. So let's just put on a little bit of T3. Now what they're actually taking in is more of a 60, 40 ratio. And that might do a little bit better with their. With their body.
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A
Yeah. That's why it's so important for someone to really see someone that understands this because it's very nuanced. It's not as simple as putting someone on one medication because they're tshsi.
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B
Right, right, right.
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A
Yeah. And you see that all the time. And that's kind of like the way it's done 90% of the time. This concept of hormone replacement versus medications. I would love to dive into that a little bit more because we. We meaning men and women, humans, make hormones naturally in our body. Right. This is something that we're born with and make them our whole life. And because we're living longer than humans used to live, we're going through menopause. Andropause. Thyropause. Right. And so this is a consequence of just outliving our glands ability to produce hormones.
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B
Right.
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A
And so the reason I mentioned all this is because replacing them with is not giving you a chemical that can, like a statin, for example, that changes your biology. This is your natural biology.
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B
Yes.
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A
Right.
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B
Yes.
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A
So I just want to emphasize that to people because I think that there's a couple ways you can do medicine. One is a synthetic that does something that's not naturally biological, or you can have biological signals that you're just giving later in life when you're actually, you know, going through the normal aging process.
- [21:56]
B
I always say to patients, if I have that one person that's like, oh, I just don't want to take a medication, I'll say, okay, we are replacing hormones that your body is just no longer making in the right amounts. It's just, you know, it's slowed down. So I say, okay, if you had a child, and we test your child and we find out your child has type 1 diabetes. And doctor comes in, says, you know, I'm sorry, Mrs. Smith, we need to put your child on insulin, which is a hormone, and they're gonna be on this the rest of their life. But you know what? It's gonna save their life and improve their quality of life. And it's needed, it's a needed hormone. Their body's not producing it in adequate amounts anymore. At that point in time, you wouldn't say, well, you know, doc, I wanna avoid this medication thing. Cause the doctor's gonna be like, well, then your child's going to die because you need insulin to start survive. Now, do you need thyroid hormone to survive? Well, kind of, yeah. I mean, you're not going to die immediately, but it's going to be a long, slow death filled with different disease states that we kind of talked about off air before we jumped on. And so I just want to position it that way, that it's. We are replacing hormones that are no longer being properly made by your body.
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A
Exactly. And you know, I think it's important for us to talk about this. The connection between low thyroid hormone and low thyroid function and chronic disease. So you were mentioning some studies earlier. Can you talk about those?
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B
Yes, absolutely. You know, I know we all wanna focus on the aesthetics. I mean, that's what I did. I, I focused on the scale going up. For goodness sake, at 25. I wasn't thinking about heart disease. But the reality is when your thyroid function is low, you are at a greater risk of all cause mortality. So a recent paper came out that was presented to me last week that showed that low thyroid function or just even non optimized thyroid function. So this could even be the people that are on T4 only that we know just doesn't work to optimize you.
- [23:48]
A
Right.
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B
It just doesn't that you are at a greater risk of Parkinson's disease if you have low thyroid function and specifically that low T3. Because we know the T3 receptors in the brain, the dopamine connection with T3, activating the thyroid, activating dopamine, that's tied to Parkinson's cancer. A lot of, you know, people use clickbait a lot. A lot of IG influencers will put out a hook that you're like, what? And I've been seeing this a lot lately. Well, T4 causes cancer or Synthroid causes cancer. And it's like, wait, wait, wait, wait. It's not that the medication itself is carcinogenic. Your Synthroid is not going to give you cancer. The connection is, is that if you are on T4 only, we know that you're not going to be optimized. You have a greater propensity for your reverse T3 to be high. Your free T3 isn't going to be adequate to get to every single cell in your body. And your immune system just isn't surveying the situation like it normally would. So when our immune system is on high alert and it's doing what it should be doing, it's looking for those cancerous cells, it's looking for the mutations, it's going out and destroying them. I mean, we all have cancer in our body. You just might not know it because your immune system's doing a darn good job. Well, if we're on T4, only if our thyroid's not working properly, our, our immune system's not working properly, our lymph isn't moving properly, our circulation isn't moving properly. So yes, that is the connection to that greater risk of cancer because your body can't even find and destroy the cancerous cells.
- [25:22]
A
I see what you're saying. Yep. So it's not that the Synthroid cause a cancer. The problem is that your thyroid is just hypofunctional and that's what's leading to a higher risk of cancer.
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B
Exactly, exactly.
- [25:32]
A
Yeah. I think it's really important that this whole concept of optimization, right, like if you want to avoid chronic disease, avoid an early death, one of the best ways you can optimize is by looking at your hormones, and not just your sex hormones, but also your thyroid hormone. And, you know, our hormone replacement program here addresses both. Because I don't like to just talk about just. You know, a lot of people think hormone replacement is just estrogen, testosterone, right?
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B
Yes.
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A
And the thyroid has to be brought into it. It's all so synergistic.
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B
They play together. I know. I mean, there's. I've seen this as well. A lot of clinics that will only do hormones or only do thyroid. I'm like, oh, my goodness. No, they go together. They have to be put together.
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A
So does your clinic also work with testosterone, estrogen, and also. It's more than just thyroid fixing.
- [26:17]
B
Love me some hormones.
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A
Yeah, yeah. What else do you make part of the program when you're trying to help people with this?
- [26:25]
B
No, obviously, pulling in all of the functional medicine aspects. So looking at nutrient function, nutrient levels, looking at their diet, their nutrition, their lifestyle, sleep, all of that plays a role.
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A
Right.
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B
Because you have to have that foundation. If you're building your house on a dumpster fire, it's just not gonna work. You know, we can't just throw thyroid hormones at you and expect them to land and work in a body that's a disaster. So you have to start with that. Now, we will bring in some peptides here and there as well. Thymosin alpha. I love. For autoimmune, for Hashimoto's microdosing. Glps. I have a whole chapter on glps, Jekyll and Hyde medication. Seriously? We can go down a rabbit hole there. But microdosing, I have found that it will help to lower inflammation, lower antibodies, sometimes even lower the medication dose that someone needs.
- [27:16]
A
Yeah, yeah. And I think it's really important that when you start seeking out some of these alternate ways of reducing inflammation, that you keep monitoring the dose of your thyroid and your hormones because they will change as your need changes, right?
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B
Oh, yeah.
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A
But I think it's also important to recognize that, you know, a lot of times people ask me the question, am I going to be on this forever?
- [27:37]
B
Yep.
- [27:37]
A
Right. I'm curious, what is your answer to that question?
- [27:41]
B
I always say you're going to have to pry my thyroid hormone, my estrogen, my progesterone, and my testosterone out of my dead cold hands before I go off. Here's the thing. These hormones give us life. And we already talked about chronic disease, but quality of life, I Mean, who wants to say that? You know what? I don't want to take this little pill. Forget it. I'm just going to get fat, lay on my couch, have no motivation, never have sex again, never go out again, be depressed, you know, lose money, lose my marriage, lose my relationships, lose all my friends. It's cool. Because I don't have to take this little pill like, no, it's giving you back your life. That's what I would say.
- [28:20]
A
That's such a great response because I always get very surprised. I still get surprised when people ask me, am I going to be on testosterone forever? Well, yeah, you should be on it
- [28:28]
B
forever because are you aging like Benjamin Button? Like, have you figured that out? Like, if you do, then we can pull you off that testosterone. Right. Because you're. You're going to be 10 years old in the next, you know, 10 years.
- [28:38]
A
Exactly.
- [28:38]
B
Yeah, I know. It blows me away.
- [28:40]
A
Yeah, yeah. It's just a reset of your mind, of your framing of this whole thing. Right. Like, your mindset needs to be reframed around hormone replacement therapy first so that you understand, like, this is vital for you maintaining your health span. Right? Yeah, yeah. There are some therapies coming out, you know, like, they're talking about ovarian regeneration using stem cells in the ovaries. And that could be something really interesting. I could see that also being something that could potentially help men as well. And maybe, maybe for the thyroid, who knows?
- [29:09]
B
You know, down the line, maybe you never know. Yeah.
- [29:13]
A
I think the one place where maybe people can get off thyroid hormone is if you're young and you have Hashimoto's and we treat and cure your Hashimoto's, then I think you can get off thyroid. But thyroid pause is a real thing, right?
- [29:25]
B
Yeah.
- [29:25]
A
Like, as you age, you will reduce your thyroid hormone.
- [29:28]
B
Oh, I love what you said there. I love it when, when I'm interviewing or being interviewed by somebody that says something that I always say, then I'm like, yeah, yeah, yeah. Bingo. Bingo. So I always say that too. If we can catch you in that early stage, that early stage where you're gonna report your symptoms as not so bad, like, oh, maybe I have five to ten pounds to lose, but that's all. Yeah. My energy's a little bit low, but it's not that bad. Okay. At that point in time, we probably can put it into remission. But if you're 10, 20 years down the line, five years down the line, and you're suffering with symptoms, probably not gonna do that naturally.
- [30:06]
A
Yeah. Yeah, absolutely. This episode is brought to you by Momentous. So, as a doctor, one of the questions everyone always asks me is, what supplements should I really be taking? And honestly, before you even pick what's the right supplements for your body, you always need to think about whether you can trust the brand that you're buying or not. Here's what most people don't really take into consideration. The supplement industry is barely regulated. Brands don't have to fully disclose every ingredient in their formulas, and most products are never tested for purity or accuracy. That means a lot of the products that you buy online, you're not actually getting what's on the label and that's absolutely not acceptable. And it shouldn't be acceptable to you either. That's why I partnered with Momentous. Momentous is a brand I really believe in. Why? Because they created their own standard which exceeds what the industry normally talks about. The Momentus standard means they source the highest quality ingredients, they use clinically validated formulations, and they test every single product in every single batch. Every Momentous product is also certified by NSF for Sport. This is a gold standard of third party testing. It checks for contaminants, heavy metals, banned substances, and verifies what's on the label as exactly what is actually in the product. And they publish those test results directly on their website, so you can see it for yourself. You'll see there's no unnecessary fillers, there's no artificial additives. So you don't have to guess if your product is high quality or not. You know it is when you pick Momentous. If you're going to invest in your health, trust the supplements you're taking. And Momentous is built on trust. Go to livemomentous.com and use the code Dr. Shah for up to 35% off your next order. Can we talk some numbers here? So, you know, I think a lot of times people will ask for the test and then they'll get the test, which is great. But then, you know, the numbers on that piece of paper when it's marked as abnormal are not necessarily the optimal numbers that you and I are aiming for.
- [32:16]
B
Right, right.
- [32:17]
A
And so just because you have the test and just because you have the piece of paper don't go based on the ranges that are on that piece of paper.
- [32:23]
B
Right, Exactly.
- [32:24]
A
Yeah. So let's, let's talk about this for men and women. What, what are some of the numbers they should be looking at for TSH if they want to optimize? And then let's go down and look at T4 and T3 as well.
- [32:34]
B
Yep, let's do it. So, tsh. I just like it below 2. And I actually don't have a problem if it is zero because we have to. Again, it's nuanced. We have to look at. Okay, are you on thyroid hormone replacement? If you're on NDT or you're taking any amount of T3, it's probably gonna drop below zero. So just less than two. Free T4. This is where I differ from a lot of, let's say people online that'll post their optimal lab sheet. I like free T4 between a 0.8 to 1.2. Where do you like it?
- [33:03]
A
Yeah, I would say around that is like, I would love to see it.
- [33:06]
B
You know, I don't like it too high.
- [33:08]
A
Yeah, I don't like it too high.
- [33:08]
B
I don't want it at 1.5.
- [33:10]
A
Like, I always worry about the conversion as well, so. Yep, exactly.
- [33:14]
B
Yep, yep. Free T3. Upper quadrant of the range. So that makes it a little bit more universal.
- [33:19]
A
Right.
- [33:20]
B
For any lab, wherever you are in the country. Take that standard lab value range, cut in the four. I want to see you in the upper quadrant of the range. Reverse T3 is pretty universal as well. Less than 12. I'll accept less than 15. If your free T3 is looking good and you're asymptomatic, then we'll be like, okay, we're not going to panic about the reverse T3 of a 15.
- [33:41]
A
Yeah.
- [33:42]
B
And then like we mentioned already, TBR and TG antibodies. 0. 0.
- [33:46]
A
Exactly. However, I will say don't freak out if it's. If it's a little bit high. Over time that will get better. This is not something that is like a one time lab result that all of a sudden like you have a TPO antibody and now you have to start going crazy, you know, looking at immune suppressant medications and things like that. This is just. This is something that we check over time. And I normally don't treat it unless it's like super high. And then I. We talk about all the lifestyle stuff first. Right. Once you get your lifestyle in order, your autoimmune numbers come down.
- [34:17]
B
Mm. Yes.
- [34:18]
A
It takes time for that to happen. Doesn't happen like right away.
- [34:21]
B
Exactly.
- [34:21]
A
Do you agree with that?
- [34:22]
B
Oh, I totally do. I always say don't hang your hat on your antibodies because you'll have that patient that freaks out.
- [34:26]
A
Yeah.
- [34:27]
B
That their antibodies move by like 20 points. It's like, it's. Oh, it's okay. Maybe you Got gluten at a restaurant. Like it's a big deal.
- [34:32]
A
Right, right.
- [34:33]
B
Like it'll fluctuate. It'll fluctuate. But the reality, the bottom line is, how do you feel? And I always say, listen, when you're working with a practitioner, whether it's conventional, functional, whatever, they better be asking you those four most important words, how do you feel? Because that really does dictate what we're going to do next.
- [34:50]
A
No, that's so true.
- [34:52]
B
Yeah.
- [34:52]
A
You know, you said something interesting, which is that Hashimoto's. You said 80 to 90% of people with hypothyroidism have Hashimoto's.
- [35:00]
B
Yeah, it's actually about 95% is the last stat that I saw that when we're looking at all hypo low and slow cases.
- [35:06]
A
Yeah.
- [35:07]
B
95% is Hashimoto's. 5%. Are those okay. Chemotherapy, chemother, radiation, eating disorders, those kinds of things that'll tank the thyroid?
- [35:18]
A
Yeah. I mean, that's a huge number. So is it true that if you have Hashimoto's that some people, their antibodies will still show up as zero, or will that be caught in the antibodies?
- [35:28]
B
Yes, yes, they will be. So it's funny, a friend of mine, Cynthia Thurlow, and I were doing a podcast and we were talking about the same thing, and she goes, you know, I know I have Hashimoto's because I even have other autoimmune conditions, but mine are always there. I'm like, right, that's. Cause of how you take care of yourself. Same here. I know I have Hashimoto's. My antibodies are always zero because of the lifestyle that I lead. And I'm taking black cumin seed oil every single day. I'm taking LDN every day. So, yeah, I mean, I'm probably gonna walk around with zero antibodies, hopefully for the rest of my life.
- [35:59]
A
Yeah, yeah, that's. And I asked you this question. Cause I interviewed Cynthia a couple weeks ago and we were talking about this. This is. It was kind of like a leading question. Yeah, I knew. Yeah, I knew where you're going to go with this. But I think it's important for people to have the answer is that just because your antibodies are zero, it means you're doing the right thing, but doesn't mean that you don't have Hashimoto's. Right. So you have to be constantly vigilant. Let's talk about LDN and. And what was the other thing?
- [36:23]
B
Black cumin seed.
- [36:24]
A
Black cumin seed. Okay.
- [36:25]
B
Where do you get that from that supplemental form?
- [36:27]
A
Yeah.
- [36:28]
B
So the LDN's prescription, obviously, the black cumin seed, I actually put that into my fixer formula supplement line because of the research behind it. When you look at black cumin, it's working the same way as ldn. Lowering inflammation, lowering antibodies. It helps with the symptoms like hair regrowth, weight loss, insulin resistance. So there's a lot of powerful things the black cumin does.
- [36:52]
A
Wow. And that is a supplement that you take every day?
- [36:55]
B
Yeah.
- [36:55]
A
Okay, got it. Are there other supplements that you recommend for this?
- [36:59]
B
So, yes, in the book I talk about this list of no duh supplements, meaning, of course duh, we're going to take these every day. I know I'm dating myself back to like the 80s. Right. But yes, they are vitamin D, magnesium, selenium, B complex. In my no dust supplement list, I have iodine. I know it's controversial, but I have that in there. And I do have black cumin C because I think that's great for everybody.
- [37:24]
A
Okay.
- [37:24]
B
So those are the core. And then from there you branch out, you start targeting whatever's going on with you. If you have insulin resistance, okay, let's throw in berberine. Right. And then you get more targeted. But those are the core supplements.
- [37:36]
A
Great. And I think it's worth mentioning low dose naltrexone, or LDN as its shortened version is called. Can you talk about how that works and the prescription and why that's like such a game changer for Hashimoto's?
- [37:49]
B
Yeah, yeah. So naltrexone, when it's prescribed in a higher dose, used for opioid addiction. I think they're even using it for alcoholism as well. Not sure. But what they found was at a microdose, so normal dose would be 50. We're using 1.5 to 4.5 milligrams. So a very much a microdose. And at that level, it's taking down inflammation, it's lowering antibodies, and it's doing a lot of what the black cumin seed does too, helping with the symptoms as well. So we'll see an improvement in insulin sensitivity, weight loss, all of that with LDN as well. So if I have a patient that, let's say, has antibodies in the thousands, it's like, let's just throw both. Let's throw both on them. So let's do the black cumin seed and the LDN at the same time.
- [38:38]
A
Yeah, it's such an interesting drug. Right? I mean, it is binds to the opioid receptor just for a Few minutes or seconds and unattaches.
- [38:48]
B
Yeah.
- [38:48]
A
And somehow that reduces inflammation. I need to dive in more into the science of that because I just don't. I don't understand really how it works, but it works for sure. I mean, so many people with autoimmune disease that are not on low dose naltrexone, they've never tried it. I always tell them to ask their doctors about, can I give this a try?
- [39:07]
B
Oh, yeah. Now we're even seeing it with cancer, too.
- [39:09]
A
Yeah, that's true too.
- [39:10]
B
Yeah. So lowering that, that inflammation and obviously lowering insulin. Anything you can do to lower your insulin is going to improve just your overall prevention of cancer. You know, your overall protection of, of cancer since cancer feeds on glucose.
- [39:25]
A
Yes.
- [39:26]
B
So we're actually seeing both black cumin and LDN in, in cancer therapy too. And prevention.
- [39:32]
A
Oh, incredible. Yeah. Let's talk a little bit more about the, like the workup of the thyroid. So when do you get an ultrasound of the thyroid gland?
- [39:40]
B
When someone has Hashimoto's. We do like to get an ultrasound just to even get that baseline. Because, I mean, you see in your clinic, when a woman comes in her, she has positive antibodies. We don't know if it's been there a year or 20. We don't know if her thyroid is still plump and healthy and spitting out adequate amounts of T4 and T3. Obviously, we can see that in the labs too, but with an ultrasound, we can actually see it getting smaller. It's starting to look kind of jagged. We're looking for nodules on the thyroid as well. So I like getting that as a baseline. And then obviously if there's a problem that we have to follow, then we'll do ultrasounds more frequently.
- [40:17]
A
Okay. So you're using ultrasounds pretty liberally, it sounds like for your patients that come into the clinic that need to have treatment done.
- [40:24]
B
I wouldn't even say liberally once in a while.
- [40:27]
A
Once in a while.
- [40:28]
B
It just depends on the case. If someone has a history of nodules, goiters, things like that, or even a family history of cancer will do that if the antibodies are through the roof. But if I'm seeing antibodies like, all right, this person has TPO of 100, we're not going to send them out for an ultrasound right away.
- [40:43]
A
Good. Yeah, I think that's a really good nuanced approach. Yeah. So I think I probably use it pretty liberally. Like if I'm putting someone on thyroid hormone, I just want a baseline. But everyone does it differently. And I think I think, you know, maybe I am over utilizing it, but, you know, I think everyone has a different way of approaching.
- [40:58]
B
The reason I see, though, you know,
- [41:00]
A
why I do that, is because I did a lot of thyroid surgery when I was a surgeon. Took out tons of thyroids and thyroid nodules and, you know, half thyroids. And I just saw so many bad things. And I just want to know, you know, if there's something going on in there.
- [41:14]
B
Definitely.
- [41:14]
A
And a lot of my patients now are getting full body MRIs, too. And that also takes a look at the thyroid.
- [41:19]
B
That's right, yeah. Yeah.
- [41:21]
A
Is there anything else you put into the thyroid workup that we haven't mentioned yet?
- [41:25]
B
You know, I mean, the total T4 and T3, not as important because we have the free. But if they get thrown in, that's totally fine. A lot of people will ask me about T3 uptake. Really don't look at that that much.
- [41:37]
A
Okay.
- [41:38]
B
I mean, again, if it's. If it's on a lab because another practitioner ordered it and they're bringing their labs from elsewhere, it's like, all right, we'll take a peek at it. But it's not necessarily part of our normal routine. Yeah, hormones really are the big thing. Like, it's all the other markers. It's the CBC, the CMP, the hormones, the insulin, the A1C.
- [41:54]
A
Absolutely.
- [41:55]
B
We want to look at that in totality because all of that plays with the thyroid.
- [41:59]
A
Yeah. When someone begins thyroid hormone treatment with you, how long before they feel a result?
- [42:05]
B
Yeah. Big question. So nuanced. It's so personalized. Right. I always like to tell patients, listen, in the first month or so, you're gonna feel that fog lift. So maybe your energy will get a little bit better. Maybe you'll just kind of notice, like, okay, something is shifting in my body, but really a full four to six months to move the needle, to start seeing the scale go down. And I'm not even talking, oh, your scale is going to go down £20. No, if it goes down 2 to £5, that's a win. Because ultimately I'll have that woman to be like, I only lost £2 this month. I'm like, really? Only. How's it going? A couple months ago, wasn't still going up. Yeah. So that two pound loss is actually a win because we have changed your body's metabolism now.
- [42:51]
A
Yeah.
- [42:52]
B
And it's going in the other direction. So it really can be. It's a long game. It's not. Thyroid optimization is not linear either. And I like to set the expectation for patients that it might go like this. Like you'll get better and then a little bit worse and then better and a little bit worse. But ultimately the trajectory is up. You know, we're headed in the right direction. But certainly didn't take you three months to get here. It's not gonna take you three months to get out. So, you know, give me that full four to six months to really start to move the needle.
- [43:21]
A
Yeah. And now with this whole world of GLPs, I'm sure you're also prescribing GLPs. How has that kind of modified your protocols or tied into your protocols now?
- [43:30]
B
Well, oh, gosh, GLPs, man, they are just such that. I keep calling it the Jekyll and Hyde medication because to this date, I don't think we've ever seen a medication that does such miraculous, beautiful, life saving things on one side. And on the other side, people are taking it the wrong way and losing their precious muscle. It's crazy. We use them in a microdose form the right way. Now, obviously, if we have a type 2 diabetic, then we'll use a standard dose and we'll work with them while we're doing all the things. I do have a story on that as well. Because GLPs won't work. Your thyroid's in the toilet. But we will use them in a microdose form to lower that inflammation and just to improve that insulin sensitivity, which is gonna lower their reverse T3. Now, there's a lot of people that are. I'm sure you've heard it too. They started on a GLP and it's not working. They're not losing weight. We had one patient come into the clinic. She was a type 2 diabetic. I mean, full blown. Her A1C was 11.9. She was well over 300 pounds. And she had Hashimoto's for 15 years on guess what? T4 only. I know. Shocking. No one tested a reverse T3. Poor woman's reverse T3 is A22. Yeah, she was on a GLP for a year and a half. It didn't budge. It didn't budge her a1C. This miraculous drug, right? Didn't budge her a1C. So we start actually optimizing her thyroid, getting her on T4 and T3, lowering the reverse, all of that. Finally the GLP starts working. Her A1C is now 5.4 and she lost £150. So I hear this all the time. I'm spending money on this glp, it's not working. It's like, well, yeah, check your thyroid and your hormones first, then we bring in the glp, we don't start with the glp.
- [45:17]
A
Yeah, that's a great point. I think, on the GLP topic too. I think what happens with a lot of people is they go, they're overweight, they want to lose some weight. Right. No one's checking the thyroid, no one's checking estrogen, none of that's checked. But they're just given a GLP and they're giving this piece of paper to tell them how to escalate the dose and they go home and no one's checking in on them and they inject the glp and then a couple of weeks go by, they escalate the dose and just keep going all the way to the top. You see, you're nodding your head yes because you've seen this a million times. And by the time they get to you or me, they've lost a ton of muscle. The metabolic health is actually worse. Right, Yep. And their thyroid condition can sometimes be worse too. Can be worse, exactly. Yeah. And so I think, you know, you never want to give any medication, especially a glp, one with no follow up and just an escalating dose algorithm that. With no kind of stop guards in place. Right. And so we do a lot around, you know, we're very closely monitoring our patients, their skeletal muscle mass or hemoglobin A1C, their thyroid hormones, their sex hormones. We're monitoring everything.
- [46:25]
B
Yes.
- [46:26]
A
And we really believe that the GLP dose should only be accelerated to where you're losing a healthy two pounds a week at the max. And then we stop. And a lot of people don't even need more than the minimum dose of GLP to do that.
- [46:37]
B
Oh, yeah, right, yeah, absolutely.
- [46:39]
A
Why would you go past that? Then you get all the complications of gastroparesis and gallbladder and et cetera. Right, right.
- [46:45]
B
And just that whole premise of the starvation theory.
- [46:50]
A
Yeah, right.
- [46:51]
B
Which, which we haven't talked about since like the 90s, but it still holds true that when you reduce your calories so much, and that's what a GLP is gonna do when you go up, up, up in that dose. Listen, you're gonna look at that beautiful rib eye and you're gonna take two bites and push it away, you're not going to get in the protein nor the calories that your body needs. Now that will affect.
- [47:13]
A
Or the nutrients.
- [47:14]
B
Or the nutrients. Absolutely. That will affect thyroid function because your thyroid is a canary in the coal mine. It's gonna downregulate when it senses that this body is in some type of a famine state. Like, what is there. Is there scarcity in food now? Okay, so we're gonna hold on the fat. We're going to downshift thyroid. We don't want this person to have a high metabolism. They're gonna blow through their energy stores. So let's downregulate that free T3. Let's increase reverse T3, because we know if somebody is in this Crisis mode, reverse T3 is gonna go up to protect them. Reverse T3 is gonna say, listen, this person is starving. They're dying. There's something wrong. They don't need to burn fat. They don't need to make major decisions. They don't need to grow their hair. They don't even need to poop every day. They just need to survive this crisis that they're in. And so, yeah, we see thyroid symptoms get worse, but we actually see the thyroid get worse too.
- [48:10]
A
Yeah, it's so important in this age of, like, so many people are in GLP1s and no one's checking their thyroid and they're struggling with it. And this could be the real key to that problem. Yeah, it could be.
- [48:22]
B
Yeah.
- [48:23]
A
What else is in your book that people should know about the thyroid fix?
- [48:27]
B
So I wrote this book, you know, Darshan, I looked at everything that was out there for the thyroid, and I've read all of the books, and what was missing was a guide to what a person actually needs, thyroid hormone replacement wise. And I know that's kind of going fringe because it's like, are we really going to teach people what medication they need? But yes. So I built this. Do you remember the choose your own adventure books?
- [48:52]
A
Yeah, I love those.
- [48:53]
B
I love those books.
- [48:55]
A
We're truly from the 80s, right? We really are.
- [48:57]
B
We keep doing throwbacks left and right, but I wanted to build it so that someone could follow, so that they could actually read their labs and understand where they need to be, like, the optimal ranges like we talked about. And then it's like following this graph of, okay, I'm here, and I am taking T4 only. Yep, that's what my doctor has me on. This is my reverse T3. So over here, here's what I need to do. I need to lower my T4 a little bit and bring in some T3. Now I can change over to NDT because that's gonna give me T3 and then maybe do what we said. Add in a little bit of T3. Or maybe I'm here not on thyroid medication at all. And these are my numbers. So where do I start? And then they can go over to this path. So I wanted to guide the reader along so that they can literally know what they need. Then we take it one step further, and we go, okay, now here's how you're gonna find a doctor that's gonna listen to you and have that conversation. Cause the reality is not everyone can work with you or I. Not everyone can come the next doctor.
- [50:02]
A
There's too many patients out there. Right?
- [50:04]
B
There's too many. There's gonna be that patient that needs to use their insurance and go to their doctor. So this gives them that fighting chance.
- [50:11]
A
That's awesome.
- [50:12]
B
If they go in armed the right way. And as you know, like, you gotta go bulleted list of your symptoms. Don't write down your life story since 1988. Like, it's not gonna be read. Like, you got a short amount of time. And there are targeted things that you can do to bring your doctor in as a collaborative team to work with you. But you having that knowledge first, that's what empowers you. That's what gives you that edge in that room. When you have that five to seven minutes with your doctor to get your message across, that's what's gonna give you the edge.
- [50:44]
A
Agreed? Yeah. Going in with information is critical. And this book is not huge. So it's not like people need to invest months and months and months reading this. I mean, you can really. The minute you get diagnosed or you feel like you have symptoms, picking up this book and going through it, in a few hours of reading, you're fully armed with the information you need.
- [51:03]
B
I wanted to make it so that it was like girlfriend talk, like. Like us sitting here, chatting, having a coffee. I didn't want to get it too clinical because we already have the clinical. I wanted people to feel comfortable reading it. Now there probably will be, like, a revised version down, because already, before it's even out, I'm already thinking of more things I want in it. But, you know, the publisher says you got to keep it a certain amount. I'm like, okay, I'll wait for version two to put more in, but this is a great start.
- [51:30]
A
Yeah, no, this is fantastic. I really congratulate you on getting this out there. I know how hard it is to write a book. I'm in the middle of it right now. It's a lot of work. So, I mean, and this is going to help a lot of people and keep it simple for people. I think education is the key to your health and if you don't have it readily available, like in this format, it's really difficult to really know what to even ask for. Right.
- [51:51]
B
Definitely. Definitely. Well, thank you. Thank you for saying that.
- [51:54]
A
Yeah. Where can people find you and learn more from you?
- [51:57]
B
Absolutely. So you can go to dramy.coM-R-A-M I e.com from there you can connect with us at the clinic. You can find my podcast, all the things, all the links, all the social links on there. I have a great Facebook group. It's called Just Fix youx Thyroid and Hormones. And in there, I'm actively in there. My nurse practitioners and coaches are in there. You can post your labs. You can say, hey, do I have a thyroid problem or not? Here's the medication I'm on. What do I do? And we're in there supporting, loving on you. It's totally free. You don't have to become a patient to join. I just wanted a place where people could get real information and interact with and get that knowledge and that power to move forward with their health. So that's a fantastic place to connect. The book you can buy anywhere books are sold. You can go to ThyroidFixbook.com, if you're listening to this before May 16, we're doing a live all day launch and so anyone that pre buys the book before the 16th or when it comes out on the 12th, they get a ticket to the Zoom Room. So in there you're going to be interacting with me. You're going to be able to ask your questions live. We're going to be hanging out for five, six hours that day. So I'm going to encourage people go to thyroidfixbook.com to get it.
- [53:09]
A
Fantastic. We'll make sure to get this podcast episode out before then so people can join your Zoom session.
- [53:14]
B
Thank you so much.
- [53:15]
A
I love it. Well, thank you so much for joining us today and can't wait to get this out there for people and hopefully one day we'll have you back to talk about the next thing you're doing.
- [53:23]
B
Absolutely love it. Thanks.
- [53:25]
A
Thank you. Here's my top five learnings from this episode on the thyroid. Number one, normal thyroid labs are often very misleading. Many doctors only test tsh, which is a brain hormone, not a direct measure of thyroid function. Comprehensive panels including T4, free T3, reverse T3 and thyroid antibodies are essential to uncover true thyroid dysfunction. Number two, thyroid dysfunction impacts your entire body. Symptoms extend beyond just weight gain and fatigue to include anxiety, depression, brain fog, hair loss, constipation and joint pain. These are often dismissed or misdiagnosed as other conditions and it leads to inappropriate treatments. Number three reverse T3 is the true crucial indicator of your thyroid gland. Reverse T3 acts like a bouncer, blocking active T3 from entering cells and this leads to symptoms even with sufficient T4. High reverse T3 indicates conversion issues often caused by stress, inflammation and nutrient deficiencies. Number four Hormone replacement is not medication in the traditional sense. Replacing thyroid hormones and even your sex hormones is about restoring natural biological signals that your body is no longer producing adequately due to aging or other stressors. It's about maintaining health span and quality of life, not just masking symptoms. And Number five Optimized thyroid function prevents chronic disease. Low or non optimized thyroid function significantly increases the risk of serious conditions like Parkinson's disease and various cancers. Proper thyroid management is a powerful tool for longevity and disease prevention. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medicine medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.