← The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
588. Unpacking the Peter Attia-Antonio Bianco Hypothyroidism Episode: What Was Missed, What Was Truth, What Was WRONG
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I know the trends. I know the numbers. We know thyroid like it's the back of our hand. We can optimize someone blindfolded, with our hands tied behind our back. We can do it in our sleep. So what they're saying, as I was listening to this podcast, quite honestly, made me want to stab my eye out. Welcome to the new and completely reimagined Thyroid Fixer podcast, a podcast that refuses to sound like every other health show out there. We're here to disrupt this entire space, and now you are part of that disruption. If you're listening right now, it's because something inside you finally said, I'm done being ignored. And I'm here to tell you. Good, because this is where everything changes for you. This is where you say, no more. No more being dismissed by your doctor. No more being told your labs are normal. No more recycled medical advice. No more recycled biohacking advice. No more being told you accept what you made know isn't right here. You'll get truth. You'll get clarity. You'll get information you can actually use, tools, strategy, and guidance you can apply right now to take back your energy, your hormones, your metabolism, and your life. Every episode will give you something real, something that moves you forward, something that reminds you that you were never the problem the system was. This is the Thyroid Fixer podcast. This is your turning point. This is where you rise. Get ready. We're about to disrupt everything you thought you knew about thyroid and hormone health. Let's go. You have questions about your thyroid, about your labs, what they mean. What about your hormones? What about insulin? Why are you gaining weight? Why are you so tired? Why are you losing your hair? Why won't my doctor listen to me? Why won't my doctor test these things? All of these questions that you have running around in your brain, and you know that if you just had the answers that that could push you over the edge into optimal health, that you could be that badass human that you are meant to be. Well, I got you covered there because I am going live every single week in the just fix your thyroid Facebook group. That is my Facebook group. A beautiful community just filled with amazing people. Where I am in there, my nurse practitioners are in there. My health coaches are in there. There are patients in there that have been with me for so long, they're experts in their own right, and they answered just the way that I would. So we have you completely covered in this group. So not only can you post your question every single day, every single hour, if you want you can mark your calendars for our weekly live Q and A sessions. We where you get to ask your question to me and I'm going to answer it live on air. And not only that, we are doing product giveaways. We're doing working with our team giveaways. You're going to want to be in there and actually be live on that call. If you're at work going in the closet, just shut the door. Take minutes for yourself. Take a half an hour for yourself. Take an hour for yourself so that you can get the information that you need to to bring yourself into optimization land where you're not looking sideways at a brownie and gaining weight at the same time, where you can feel amazing every single day. Because that's my goal for you. You know that I love, love, love to answer your questions and this is the place where you can get them answered live. I completely and totally hear you and I see you and I understand you and I know exactly where you're at. You're gaining weight. You can't lose. You have all the symptoms that no one's listening to. The fatigue, the hair loss, the brain fog. You can't remember why you walked into a room. You don't want to get dressed and go out because you know if you have that glass of wine with your friend, if you have that dessert with your husband or even order an appetizer, you're going to be five pounds heavier the next day and your clothes are already tight. Every single doctor is telling you that you're normal and everything is fine. You've been to multiple conventional medicine doctors trying to use your insurance, hoping to God that somebody has an answer. Then you've dropped thousands of dollars on functional medicine or integrative medicine because you keep hearing how functional medicine gets to the root cause of the problem. But not every functional medicine practitioner knows the thyroid and knows the hormones and can treat you as a nuanced, personalized individual, a unique person. That is exactly what my team and I do. We specialize in thyroid problems. We specialize in hormones. You can't do one without the other. You cannot just see someone for your thyroid and have them ignore your hormones or have them half ass your hormones. They better be a hormone and thyroid expert. If you are going to spend your time, your energy and your money, if you are going to invest in functional medicine, they need to be a thyroid and hormone expert and treat you as an individual. They can't have a cap on how much T3 that they're going to give you they have to personalize your treatment plan to get you feeling your best, no matter what that looks like, so that every system in your body functions at the very top, at the very best. And that is exactly what we do. I made it my mission because I went through this. I was dismissed, I was gaslit, I was misdiagnosed, and I dropped thousands of dollars before I found an answer. That is why I made it my mission to be able to treat people in all 50 states so we can prescribe via telehealth, thyroid and hormones and peptides. Yeah, the GLPs as well, to all 50 states, most of Canada and now Puerto Rico. That is my mission to be able to help you wherever you are, because I want you living your best life. I want you to join me in optimization land, where you can go out and love life and go out with your friends and go out with your partner and not gain weight looking sideways at a brownie. Yes, we do have financing options available. I'm talking like 0% or 12 months, the whole thing, based on your credit score. We got you. And our programs are affordable. They're completely and totally affordable. And they will get you from point A to point B. They will bring you into optimization land. So please don't waste another moment struggling, please. I want you living here with me, a great, happy life in optimization land. So go to my website@dramy.com, click the Become a patient button so we can have a chat. Let's talk it out. Let's hear what you've done, what you haven't done, what's worked, what hasn't worked, and let's get you on the right path to feeling your absolute best. If you can imagine the best life ever, that is absolutely possible for you. I'm not BSing you. I am not BSing you. I was in your shoes. Many of my patients have been in your shoes. We will get you there. And that is my promise to you. Before I dive into the deconstruction of The Peter Attia, Dr. Antonio Bianco, hypothyroid episode on Peter Attia's podcast, I want to make something very clear. I deeply admire and respect both of these individuals, Peter Attia and Antonio Bianco. Peter is brilliant. He's thoughtful, he's evidence driven. He's been one of the strongest public advocates for hormone therapy out there on 60 Minutes. He even said that withholding bioidentical hormone replacement therapy and the black box warning triggered by the flawed Women's Health Initiative study was one of the biggest Medical catastrophes in modern female health. You go, Peter, I love you for that. And he's right. That study produced decades of fear that kept women from receiving life saving hormones. It directly contributed to today's skyrocketing rates of heart disease, cancer, Alzheimer's in women now in their 60s, 70s, 80s. My mother was one of them. And then Antonio Bianco, someone I've interviewed myself on this podcast, was one of the only researchers I came across during my doctoral work who articulated the true importance of T3. His work has genuinely advanced the scientific conversation. Now, why are we doing this episode? This interview between Peter Attia and Antonio Bianco is going to be consumed by the public as factual thyroid education. And that's the problem. And while parts of it are correct, other parts are deeply misleading or incomplete. And that can be dangerous for real thyroid patients out there like yourself who might be listening to this, who are trying to understand their bodies. So here's the thing. If you're a long time listener of my podcast, if you're in the just fix your thyroid Facebook group and you've been there for an extended period of time, reading, posting, joining me weekly on the Facebook lives, asking questions, educating yourself, then you already know that a normal TSH does not mean that you're fine. You already know that symptoms absolutely matter. You know that free T3 runs the show and is so important. And the reverse T3 is clinically necessary to see whether or not you are converting your T4 to T3. You've learned these truths and they've changed your life. But the newly diagnosed, the ones that have all the symptoms, that are desperately seeking answers, that are being dismissed and ignored by their pcp, their OB gyn, the next pcp, the next endocrinologist, five endocrinologists, a functional medicine practitioner and a naturopathic doctor, and they're being ignored and dismissed and ignored and dismissed, and they're seeking real advice and real information. They don't know all of that. They don't know that yet. What about the women and the men just entering this space of thyroid and hormone dysfunction? What about the scared, exhausted, confused patients that we see every day entering our just fix your thyroid Facebook community who don't yet know what their labs mean, what optimal ranges are, or why they feel so terrible even with normal labs? What if they listen to this interview and walk away believing that a TSH of 3 means you're perfectly healthy, that symptoms, they just don't matter, that it can be anything, a multitude of of problems, that a free T3 of a 2.5 is just fine. What if they walk away believing that reverse T3 is irrelevant unless it is catastrophically high? What if they walk away believing that a 2.5 microgram of T3 is somehow dangerous? All of which is false and all of which is stated in that interview. So this episode is not about attacking anyone. I'm not about that. I know there are influencers out there. They're influencers that have attacked me. I think that they have Little man syndrome. They have issues. I don't do that, but I will deconstruct. And this is about protecting thyroid patients from misinformation that sounds scientific but is incomplete or outdated and therefore harmful, or that is not properly understood by an individual who treats thyroid patients, but who also has a thyroid problem himself or herself. And I think that that's important because, you know, and I'm not tooting my own horn, but it's just the truth that, yes, I have treated, we have treated in the Advanced Thyroid Hormone Clinic. We have treated thousands, thousands, thousands of patients. Thousands. I know the trends, I know the numbers. We know thyroid like it's the back of our hand. We can optimize someone blindfolded, with our hands tied behind our back. We can do it in our sleep. So what they're saying, as I was listening to this podcast, quite honestly, made me want to stab my eye out because I thought about all of the work that I've done that my colleagues that are of like mindedness have done to educate you on the thyroid, on the symptoms, on the testing, on the treatment, and then this. So we have to keep going because it's about giving these newly diagnosed patients the clarity and the truth. And if you're one of them, then you deserve this, the clarity and the truth that you need to be able to advocate for yourself. So with utmost respect for both Peter and Antonio, let's break this down section by section. Okay, right in the beginning, section one, let's go to physiology. T4 versus T3 diodinase normal ranges and reverse T3. That's we're going to be talking about in this first section. So what do these guys get? Right? Number one, T4 is a pro hormone. T3 is the active hormone that binds receptors and deodinized enzymes. Convert T4 to T3 or they can come in and this is discussed in the podcast, they can convert T4 to reverse T3 so the body does shift toward reverse T3 under stress or illness. All of those statements are true. And there is a Little bit of love and a light shined on the importance of T3 being the active thyroid hormone and activating at the cell level. And yes, he is correct and also says, I give credit, that T4 is inactive. It doesn't do anything. It can't do anything. It cannot have an effect on a cell. Now, here's what they miss entirely. Actually, nowhere in that episode do they discuss normal versus optimal. They repeatedly use the phrase normal range, normal range, but never once explain how those ranges are created. Now, we've gone over this in previous episodes, but let's just explain and clarify. Those Lab reference ranges, LabCorp Quest, or your hospital, they come from basically sick hospital populations, not optimized healthy individuals. If you want to dive deeper into labs, listen to my podcast episode with Dr. Ken Barry as we talk about his book, Common Sense Labs. Great episode. And this is where he breaks down exactly how we got those standard lab value ranges. And in a nutshell, we went to a hospital, we tested a bunch of people, and we said, well, here's where most people are coming in at. Whereas functional medicine comes in and says, give us your badasses. Give us your healthy individuals. Give us those people that are living their best life and who are asymptomatic. Let's test them, because that's a much more narrow range. Now, these lab reference ranges, they include people with undiagnosed thyroid dysfunction as well. They reflect statistical averages, not functional wellness. So when Antonio says TSH is normal, TSH is normal, he means normal in that standard lab value range. For a data set filled with sick people, this is not the same thing as optimal or healthy. A normal TSH does not mean. And when I say normal, I'm referencing what Antonio says in this interview. Normal. Normal. Normal. Normal means that you could have a TSH of a 4, and that's considered normal. Functional medicine says, no, no, we want you below a 2. That's optimal. So everywhere in this episode, when they say normal, TSH, normal, free T4, they mean within that standard lab value, sick reference range. So a normal TSH does not mean you have adequate tissue level, thyroid hormone. It does not mean that your metabolism is functioning. It does not mean that your brain is functioning. It does not mean that your symptoms are irrelevant. Normal is a setting on the dryer. It should not be used to describe any. Any. Any set of labs. Okay, reverse T3. Antonio claims reverse T3 only matters at astronomical levels. That's a quote. This is absolutely false. And we know this. Reverse T3 becomes clinically relevant well before it becomes astronomical. Ask the woman that has a reverse T3 of a 19 whose doctor keeps giving her more T4, more natural desiccated thyroid. I've talked about my patient over and over again, Amanda, who has seen other thyroid practitioners who ignored her reverse T3. That in my eyes was astronomical. I don't know if it would be astronomical in Antonio's eyes, but she was in the 30s and the 20s with her reverse T3. And you know what they kept doing? They kept giving her more T4. They kept giving her here, here's more T4 with a baby dose of T3, which we're also going to get into today. Or here's more NDT, more NDT. Well, NDT contains 80% T4. So her reverse T3 was being completely and totally ignored even in the functional community. Ask the woman whose reverse T3 is a 16 that falls completely within the normal range, using air quotes here. Normal range. And she is sick and all she's on is T4 only, which Antonio also says is okay, so we're going to talk about that as well. Who is on T4 only, whose reverse is a 16. Her body is in total complete shutdown mode. Ask her if she wants to wait around until it becomes astronomical in functional medicine and in reality, boots on the ground. Thyroid care from a woman who has had a thyroid problem. Me. We have seen thousands of patients treated, thousands of patients. And I get it at a very personal, deep level, experiential level. Reverse T3 above A12 already signals metabolic dysfunction. If we wait for the levels that Antonio is referring to, the patient will or you will already be in what the literature calls human dormancy syndrome. Now what is this? So there's actually a patent, it's a published work describing this state. Reverse T3 is basically the central feature. So when someone has an elevated reverse T3 and mimics fibromyalgia, chronic fatigue and mitochondrial dysfunction, so it puts your body into a human dormant dormancy, dormant, shut down survival hibernation mode. It makes you like a bear in the winter. This is documented, this is tested, this is written about. Why is it ignored then? The physiology punch line. Reverse T3 is not dead and it is not insignificant. Physiology. Let's look at basic physiology. Reverse T3 is not dead. Antonio refers to it as dead. It's the break. It's the brake pedal on your metabolism. It's not insignificant at all. And when it rises even moderately, the body is signaling. I can't convert T4. I'm conserving energy. Please stop increasing T4, that's what the body is saying through reverse T3, increasing. But we don't have, have to wait until it gets to astronomical levels, in fact, and one thing I teach my patients and, and one thing that you always hear me say is that everyone's body is unique. Thyroid optimization is a nuanced art. Again, it's one that we can do with our hands tied behind our back, eyes blindfolded in our sleep. Like, honestly, it, it's that simple for us. However, it's nuanced and it is an art form. When you do something over and over and over again, it becomes very easy. It's like fine, it's a no brainer, that's fine. But if you're not doing something correctly over and over and over again, then that behavior and that way of doing it, the incorrect behavior gets ingrained as well. So I believe that that's what's happening to a lot of these functional practitioners out there. They learned a certain way or they came from conventional medicine and they are trying their best to practice functional medicine or they're using it as a marketing term, either one. But they just haven't done it enough for it to become second nature to them. This is why I always say you have to go to a thyroid hormone expert to treat your thyroid and hormones. You can't just go to a functional medicine expert because it can be a jack of all trades, master or not. But I'm, I'm diverting right now. When you and, and I know Antonio sees patients, he used to, maybe, I don't know if he still does, but he references seeing patients in the interview and in his book. But why would you wait for a reverse T3 to go astronomical? Okay, well, he also talks about testing. So now we're going into the next section of ignoring T3 and reverse T3 assays because the assays vary. Assay variability does not justify ignoring the hormone that actually runs your metabolism. If we discard every test with variability, we would diagnose nothing. We look at patterns. We look at the person. We don't look at isolated numbers. Those numbers give us data. They give us the connection back to the answer to the most important question that your doctor can ask you or any practitioner working with you should ask you, and that is, how do you feel? Those numbers, whether perfect or not, tie back to an overlay on your symptoms. So you come to us, you say, listen, I put on £30 in a couple of months. I'm doing all the things I can't take it Off. My hair is falling out. I'm really tired. I'm constipated. I have brain fog. I'm losing the outer corners of my eyebrows. I'm cold all the time. Well, those symptoms pretty much point to hypothyroidism. Now, let's just look at your labs to confirm or deny that. And that's where we overlay your labs on top of that. Now, let's just say you had all of those symptoms. And by the way, I am also on 125 micrograms of T4. Great. So T4 is not working, because if it did, you wouldn't have all those symptoms. And, oh, look, your reverse C3 is a 19. You are on way too much T4, and you have conversion issues. That's what that 19 tells us. Now, if the assay isn't perfect, who cares? All right, let's do some margin of error. Person has a reverse D3 of a 19. Maybe it's a 16, maybe it's a 25, maybe it's a 15. Don't care because it's still high. Person's on T4 only, which we know doesn't work. Their doctor keeps increasing it, and they keep getting worse. And they have all of the symptoms of hypothyroidism. How hard is it to just say the reverse T3 is freaking high? Maybe the assay isn't perfection, but it's definitely giving us feedback to be able to then help the patient. So when we look at reverse T3, we look at free T3, we look at TSH, we look at free T4, we look at the antibodies, we look at the symptoms, and we look at trends over time. This is how you diagnose thyroid dysfunction accurately. This is how you diagnose a conversion problem. By listening to the patient. Listening to the patient. And then when we add the optimal ranges like we already discussed, then that brings another layer to that puzzle, because now we have where you should be. And if you are way outside of that range, the optimal range, then we know that something is wrong and that that outside of the range number ties back to your symptoms. All right, next section. When they're talking diagnosis, their diagnostic criteria actually excludes millions of people. And this is the problem that we see every day in our practice, every day in the Facebook group, people being told that they're normal, that they don't have a thyroid problem because their TSH is within normal limits. It's within that standard lab value range. Now, he does a good job at explaining that TSH is not a thyroid hormone. It is a pituitary hormone. Yes, it is. And it is the signal that is given to the thyroid when the brain detects that the thyroid is not doing a great job at secreting enough thyroid hormone for the body. But it doesn't measure tissue level. Hypothyroidism. So, as we know, as I have said so many times, and many of my functional colleagues out there have this on repeat as well, that you can be profoundly hypothyroid with a normal TSH. Now, Antonio also goes into T4 and he says how we diagnose hypothyroidism is by an abnormal TSH and a low free T4. Low free T4. That's it. I'm thinking of at least five different lab panels that I've looked at in the last two days that have a TSH easily below a 2. Check that box for functional medicine. Check that box with a free T4 that is not flagged low. It's actually coming in at a 1.4. What if we stop there with Antonio? According to this interview, if you had just those two numbers, you would be told that you are normal and that you do not have hypothyroidism. How is this better than our conventional model where people are being misdiagnosed left and right? Now, I give Peter Atia credit that he does bring in the functional medicine belief system to a point. He brings it in when they talk about natural desiccated thyroid medication. He also brings it in with a little bit of a, maybe a shadow on it that, well, you know, the belief is that everybody is hypothyroid. Here's the thing. A lot of people actually are because the thyroid gland, head to toe, runs the show. We know that a dysfunction of the thyroid gland will affect the entire body. We know that the thyroid gland is pummeled by toxin. Exposure by heavy metals, by mold, Epstein Barr virus, various infections, fluoride, chlorine, bromide, the toxic allergens, iodine deficiency, elevated cortisol, elevated insulin, inflammation in the body, dysregulated hormones. That's what thyropause is. Ladies, after the age of 40, as your hormones go on a roller coaster ride, you enter thyropause, or your thyroid gland craps the bed and you start getting symptoms. Now, this can also happen after pregnancy, because pregnancy is also a hormonal roller coaster. Autoimmune is on the rise. So is it wrong to say that 90 to 95% of the population over the age of 40 has a thyroid problem? And half of them don't know it. Yeah, absolutely. There are so many people being misdiagnosed. And if we go by only looking at TSH and low free T4, my God, how many more people will go misdiagnosed and suffer? Now, again, this is where I feel like in listening to this interview, I'm either bipolar or schizophrenic. Like, I'm. I'm back and forth, back and forth, going, okay, I agree with that. But then you say this. The struggle is real when it comes to losing weight. Listen, I know because I've been there. You're trying all the things. You're doing the diet, you're tracking your macros, you're getting to the gym, you're going to the Pilates, you're doing all the things. But it's not working. It's not working. And this is independent of a thyroid problem. Maybe you have a thyroid problem. Maybe you have low hormones, or maybe you don't, and you're just like, I just have a really crappy metabolism that I am putting on weight or I can't lose weight no matter what I do. Then you need some help. But what you don't need is a stimulant fat burner of the old days where you literally thought you were having a heart attack. You need something that is actually going to work to increase your metabolism without jacking up your heart rate. Enter Thyroid Fixer. Yes, I know it's called Thyroid Fixer, but I named it after myself and the brand because it's my baby. It's my child. And it's a product that I have been studying for 15 years and using it on patients for 15 years before I brought it to you. Thyroid fixer contains T2. And what this does, I call it the forgotten thyroid hormone. No, there's no tests for T2, but your body does produce T2 in small amounts. T2 will increase your basal metabolic rate, literally the amount of fat that you're burning at rest. It's also browning white adipose tissue. So this is why you jump into cold plunges. Or maybe you're like, I don't want to jump in a cold plunge to brown your white adipose tissue. That helps with insulin resistance, it helps with metabolism, it helps with inflammation, helps with overall health. So that's a good thing as well. And here's the other thing. With T2, it's not going to affect your thyroid. So many of you know, if you take T3, if we give you T3, or if you abuse T3, when you're not supposed to, it will have a feedback loop, a negative feedback loop on your thyroid. And you're going to either look like you're hyperthyroid or you're going to shut down your own Thyroid Production. T2 doesn't do that. It's working at the cell level to just simply increase your metabolism. That's a win all the way around, because now you're gonna burn fat, now you're gonna lose those extra LBs, and that's ultimately what we want. It also bonus, helps with ATP production at the mitochondrial level. This means steady energy through the day. No highs, no lows, no caffeinated red bull spikes. Just really nice, steady energy through the day to keep you going. So you want to add in thyroid fixer and just literally watch your body change over the next couple months. Because, listen, I mean, it's. It's time. Well, it's time all year long. I mean, there's no good time of year to lose body fat. We want to be in shape. We want to look, feel, and perform our best. Add in thyroid fixer, and your body will absolutely thank you, and then you'll come back and you'll thank me. So Antonio will state in this interview, and again, I give him credit for this. He will state in this interview that people are being misdiagnosed. He will state that only relying on the TSH is incorrect. But then he dismisses the free T3 and the. And the reverse T3. So it gets very confusing. Which is exactly why I needed to deconstruct this for you so that I can help unconfuse you. Because when I was listening to it, it felt like my brain was literally being pulled into different directions where he contradicted himself and not a blatant contradiction. It wasn't. He'll say this and then said the opposite, but. But to the point where you go, wait, wait, wait. What? How can you say XYZ here and yet say XYZ over here? And it's like two different belief systems. Okay, I'm gonna keep going here. So T4. So Antonio does say that we are looking for a low. Free T4. Oh, wait, wait, wait, wait. We have to go back. Oh, my goodness. Back to the patient that I was just saying. So let's go back to that person, that patient with a TSH below a 2. A free T4 of a 1.4. Okay, now since that patients with us, we're going to keep going. Free T3 of a 2.5, reverse T3 of a 19 what does that pattern tell us? Okay, so if we stop at the TSH and the free T4 person is told you're normal, everything's fine, be on your way. Antonio said it's fine. But now we look deeper and now we look at those two assays that they say are not accurate, not entirely accurate. So just because a Test isn't a 10 out of a 10, LabCorp and Quest, we're going to just throw it out, we're going to dismiss it, we're not going to look at it and use our scientific brilliant minds to piece this together with a person's symptoms. I think we can do that. And I don't believe that a test would exist throughout multiple nationwide healthcare systems and through nationwide lab testing like LabCorp and Quest, that was just willy nilly all over the place. Has no accuracy. Yeah. Nothing. It's pointless. It gives a different. No, no, they, they wouldn't even be offering it like that. That's ludicrous. There has to be some standard to which these lab Companies run free T3 and reverse T3 to guarantee some level of accuracy, because it was all over the place. It wouldn't even be on an order form. It wouldn't even be tested. So when we look at that full pattern, then we can see, okay, well, reverse T3 is telling us that this person is taking so much T4 because their doctor keeps increasing it. Yeah, their free T4 on paper looks good. It's actually in that beautiful, shiny normal range that Antonio wants it in and the TSH is normal. But now we go down and we can see the answers with the low free T3 and the elevated reverse T3 along with the person's symptoms. So if we throw out reverse and free T3, that person continues to worsen with their symptoms and can actually be detrimental. Another prop I will give Antonio is that he does state in this interview the dire need to address hypothyroidism and how it can kill you. You know, I have said over and over again that you're not going to die without thyroid hormone. But realistically, you can. If we remove your thyroid gland and we don't replace it, you will die. I mean, you absolutely will die without thyroid hormone because it runs your entire body. If you don't have adequate thyroid hormone replacement at that point of time, you are at a higher risk of cardiovascular disease. Which he does touch on as being of vital importance and being one of those things that we see quite often when the thyroid gland is not being properly treated. Various heart conditions, various cardiovascular conditions, as well as an increased risk of Alzheimer's and dementia, it starts affecting the brain. I have done podcasts on this as well that you can certainly go back and listen to, especially the one on Does Synthroid cause cancer? And in that, I'm explaining that it's not the medication itself causing cancer. It is the elevator reverse T3 and the lack of proper thyroid hormone replacement that is putting a person's body into a low immune which we know that the immune system is what protects us from cancer. Because our immune system is always looking for those mutated cancer cells invaders to go out and attack and get red and clean house. But if we don't have a properly functioning immune system, if our thyroid is struggling so badly that our bodies can't work properly, then yes, you are going to be at a greater risk. So I give Antonio props for shining the spotlight on the severity and the dire need for people to wake up and address hypothyroidism. But here's the thing, Antonio. We got to address it the right way. We got to address it the right way. Okay, so treatment. Antonio claims that 80 do well on T4 only. I will say wholeheartedly, with a stat from the Academy of anti aging medicine, a 4M, and with anecdotal evidence from the Advanced Thyroid Hormone Clinic, and what we see every day, and what I have seen for the past 30 years, is that 0 to 2% do well on T4 monotherapy. T4 monotherapy is standard of care. Now, like I said in the beginning, Dr. Bianco is one of the only researchers who has written published literature on T3 being the active thyroid hormone and being used in treatment. But yet he makes a statement like 80% do well on T4 only and minimizes the amount of people that require T3 completely. Minimizes, if not eradicates the people that need T3 only. And here's a T3 only listener, me listening and saying I'm one of them. Then I have a couple other patients that I know. So that makes it way, way more than like the point 5, the 1% of the population that you're talking about that are on T3 only. No, T3 only is a real thing and has helped a tremendous amount of people. And again, you take that T3 only girl, you take me and you give me T4 and you will see me go hypothyroid in a week. You will see me gain weight because that is my physiology that requires T3 only. And again, we have to get back to personalized medicine. And stop treating people like a lab marker. Stop treating everybody like everybody else. Everyone is so unique and different. If that person needs T3 only, then they need T3 only only to live their best life. That should not be withheld from them. We should not keep pumping more and more NDT in them and cross our fingers and wish on a rainbow that 80% T4 and 20% T3 will work in a person with a conversion issue. It's not going to. It's going to make them worse. And this is the point of the podcast where I really got fired up, if you can't tell already. So. So in real clinical practice, 100% of our patients are on T4 and T3 combined or T3 only. And we do it in a way that is personalized and individualized and works with their body and their physiology and their labs and yes, their labs containing Pre T3 and Reverse T3, both of which have been blown off as insufficient assays and they don't test real well. And you know, the numbers are all over the place. Okay? But the numbers give us a sign. And I can tell you wholeheartedly that that person that is on 112 micrograms, that went to 125, that went to 150 because their conventional doctor just kept increasing their T4. And we can see the trend in their reverse T3 again. Who cares if the reverse T3 is off by 1 or 2 or 3 or 4? We can see the trend. It keeps going up with each increase. It keeps going up. And oh, by the way, it also matches their symptoms and getting worse and worse and worse with each increase. So I will give the economy for anti aging medicine the benefit of the doubt and say, okay, we'll give you that 2%. Because I'm sure there are people out there, they're just not in our practice. I'm sure there are people out there on T4 only. They're living their best life, they're thriving. That's fine. They're not coming to see us. So for us It's a hundred percent. T4 requires conversion. We've said this before. T4 is the inactive thyroid hormone that is discussed on the podcast. And it has to go through a conversion phase to become T3. It's the removal of one iodine molecule from the structure to basically make it into T3. There's a lot that goes into conversion. There's a lot that gets in the way of T4 to T3 conversion, nutrient deficiencies which most of us are, stress, which most of us are elevated cortisol, elevated insulin, estrogen dominance, progesterone deficiency, iodine deficiency, a DIO1 and DIO2 SNP, which is genetics saying, basically, you don't convert very well per your genes. There's so much that can get in the way of that conversion that patients will end up with a low T3 and high reverse T3. Okay, but Antonio is looking at that or paying attention to that. This is where I go bananas. They also discuss treatment with T3. So Antonio says that even 2.5 to 5 micrograms of T3 can cause issues. And Peter actually jumps in. Oh, yeah, yeah, we've seen that. It's ludicrous. And who. Yes, of course, there is that subset of our patients who are very sensitive. So if you're listening to this going, oh, my God, Dr. Amy, 2.5 micrograms of T3 gave me heart palpitations. Right? Yeah, but you're sensitive, okay? You're. You are. I love you, but you're very sensitive. We just have to go slower with you. I get it. But most of the other people over here, they're doing pretty good. So in dosing reality, I would say, and I get this question asked all the time, what's the average dose of T3 that you give your patients? It's very individual, because what works for you might not work for someone else. So, again, going back to my favorite phrase, my favorite thyroid medication is the one that works for you, and the combination that works for you and the dose that works for you, whatever that is, that's our job to figure out. But I would say Most are between 20 and 100 micrograms. I know that's a big range, but I'll explain why I'm saying this. And some need more something needless. You're always going to have those outliers, right? Whenever you have a range, you're going to have the outlier and have the person that's on 10 micrograms and is optimized. You're going to have the person that can't even take 5 micrograms or they're freaking out. You're going to have the person that's 150 or 200 micrograms, and that's what keeps them optimized. So you're always going to have the outliers. I would say, in general, between 20 and 100 micrograms to fully optimize. That's about right. We have plenty of patients on these doses, and they're doing just fine. They are living Their best freaking life. No one's dropping dead of a heart attack afib. Nobody's losing bones. Nobody's going hyperthyroid. So Antonio says that we need better treatment, but then defends T4 only. This is. See, this is where my brain being pulled in two different directions, like I feel schizophrenic. What are you saying? What are you saying here, Antonio? You cannot say we need better treatments and then defend the exact outdated model that has failed the very people that you say need help. We need treatment to be whatever that person needs. Whatever that person needs. Maybe it is natural desiccated thyroid medication. I'm not saying that's the be all, end all. And I do appreciate Peter Attia for shining the light on functional practitioners really heavily relying on and almost kind of dying on the sword that, oh, my gosh, this is all we need. All we need. All we need is ndt. That's it. Those synthetics are bad. Now, this is where I agree with Peter and Antonio. Antonio says, you know, there's nothing wrong with the synthetics. Thank you. You're correct. I call them biosynth. Antonio, Biosynthetics. This is your levo. Your centroid lyothyrenine. This is the T4 and the T3 separated out. They call them synthetic T4 and T3. And then, you know, people out there with tinfoil hats and that hug trees, they're all like, well, I only want a medication that has the word natural in the title. Okay? So, side note, Peter and Antonio didn't talk about this, but I'm gonna let you in on something. Um, it's still made by a drug company. Your ermur thyroid you got right there. Your NP thyroid. It was dried from a pig. That's the only natural part about it. The rest, fillers made by big pharma put into an orange bottle that you then have to pick up from a pharmacy. It's really not that different from the levothyroxine or the lyothyrenine that was created to mimic the T4 and the T3 that your body makes. And guess what? Your natural pig thyroid. Wilson, if it's working for you, then I'm all about it. I am not anti ndt. I am pro whatever the hell is going to work for you, to give you your best life. But I don't understand and cannot wrap my mind around people who believe that natural desiccated thyroid is the only way. And there are many functional practitioners out there, like Peter shines a light on which I love him. For four that will only prescribe ndt. And that's doing as big of a disservice to the thyroid patient as the conventional doctor prescribing T4 only. It's still putting you in a box, and it's not taking into account your individual physiology and your ability to convert T4 to T3. Next section. TSH normalization isn't enough, but they still rely on it. Okay, so they say that TSH normalization isn't the whole picture, but. But everything they recommend still hinges on tsh. They never say, just throw TSH out like we do. Like, at some point, it's like, you know, you don't have to test tsh. It's okay. Like, if it was an expensive test, I would totally leave it off of the panel. Like, why even waste your money on it? But they rely on it. The most important question that I ask is, how do you feel? So labs inform the story. They don't override the story. We cannot hang our hat on normalizing tsh. And this is what Antonio keeps coming back to in the podcast, is getting the TSH in the normal range. Well, what about the TSH that drops below normal, but yet the free T4 and the free T3 are optimal? They never reference optimal, but I'm saying it. Then what would you say? You know, would you say that that person is. Is finally optimized on their thyroid hormone replacement? Yes. And they never discuss the basic premise, the basic physiology of what occurs when you give T3. Because T3 is fast acting, which they mentioned in the interview. It is. And it has a very short half life. Yes. I mean, yes, you do have to dose it a couple times a day, but big freaking deal. I mean, if you are a blob of mush sitting on your couch watching game shows and eating bon bons all day, you're probably, probably not going to be listening to this, but you're probably not really caring about anything. And you're going to be the one that complains that you have to take T3 twice a day, right? No, you're going to stay the blob on your couch eating bon bons, watching game shows. That's fine. That's your choice. But the people over here want to live an active, healthy, vibrant life, feeling their best. They can set an alarm. They can remember to take their T3 twice a day. I promise, it's not that big of a deal. Because when you tell the woman who hasn't been able to lose weight, who has put on 40 pounds, who has lost half of her hair, who can't get off the damn couch that she has to take this life giving medication twice a day. You think she's going to be like, no, you know what? Just go me that T4 because it's really slow acting and I only have to take it once a day. I don't, I don't care. I don't care how I feel. I don't, I don't care about gumball. No, she's going to take the T3 twice a day. It's not that big of a deal. So we need to treat properly. And please, if you listen to that interview, do not get sucked into that standard of care is okay with T4 monotherapy. It's not. And that baby doses of T3 are okay because they're not. Now, I do want to pause here and go over a couple things that I loved that he said in the interview. Number one, when he was talking about hyperthyroidism, he did point out the fact that just because the TSH is low or suppressed does not mean a person has hyperthyroidism. They have to have an elevated free T3, an elevated free T4 and, and a suppressed TSH. And that you will be able to tell. It'll be that person that comes in, their hands are clammy, they're shaky. Like you can tell their whole countenance is anxious and amped up. That's your hyperthyroid patient. I give them credit for that. And that is true. So it's not just based on TSH being suppressed. You're hyperthyroid, you're over medicated, your TSH is suppressed. No, it has to have all of those factors combined. The other thing they get right is talking about radioactive iodine versus surgery. This is fantastic. They bring this in to the conversation for when a person does need to have their thyroid gland removed. This is where Antonio is 100% correct. I'm so glad he brought it up. That whole discussion around radioactive iodine versus surgery. So historically, radioactive iodine was the default because surgery was invasive. There's anesthesia, there's recovery, it's surgery, there's a big scar. But today they have come so far. Surgeons are specialized in this. They do hundreds of cases a year, hundreds of surgeries a year. It's. It's a microscopic scar. It's easily done, safe, precise way. Safer than radioactive iodine because radioactive iodine does increase cancer risk. Listen, if there's a treatment that makes you avoid your friends, family, children or pets because you yourself are Radioactive, Maybe that's not something that you want to put in your body. If you've already had it done. You've already had it done. Make sure you're taking iodine. But if you had that choice. I love that Antonio and I agree on this. We agree wholeheartedly on that statement that you definitely want to go toward surgery and away from RAI if you have that choice. Okay. Elevated tsh, but feels fine, Case. Yes, some people do feel fine with a mildly elevated tsh. Great. But that tiny minority should not dictate how we treat the millions who feel horrible. With a normal tsh, you're always going to have outliers. You are always going to have those random numbers that are wonky. And this is where we have to ask you, how do you feel? So if we're looking at tsh, okay, yeah, easily. You could be walking around with a TSH of, let's say a 5. And I would go, oh, my goodness, this person is so hypothyroid. Oh, how do you feel? And that person goes, yeah, I feel great. I'm good. Like, I really have no symptoms whatsoever. And I've had these discussions, too. I've had these discussions with people, so I know it exists. This. I've seen their labs. I've. I've had the discussions. You know, I feel fine. I have no symptoms whatsoever. I go, really? Really? So no waking, no fatigue? I go through the list. Really? No, I'm. I'm maybe, you know, maybe a little fatigued. That's about it. Okay, so we're just going to leave that alone, because we also know that sometimes when you take iodine supplementation, that can bump up tsh. Maybe you were exposed to a virus. Same thing with antibodies. Those can increase and decrease. You got gluten. Something happened. Okay. It's random. And at the same time, you could have someone with. I have said this before. L. Russ and I have talked about this on a podcast before. You could have someone with a free T3 of a 2.9, and they feel great, too. Like, you go, no. Really, Sally. Or any. Any symptoms whatsoever. Because, you know, we can change your medication here based on this. No, I feel great. But then you could have another. Another. I could have two women the same age, the same body weight. We'll make them. We'll make them all the same. Same, same, same, same. And the one woman has a. Has a free T3 of a 2.9. It feels like garbage. And can't get rid of any of her symptoms because she needs more T3 and the other woman feels fine and has zero symptoms. It's very unique. That's why we look at the number and then we ask you the question. We look at the number and we ask you the question. Question with an elevated tsh, of course we're going to ask you how do you feel? Because 9 times out of 10 an elevated TSH is going to result in a person saying that they are symptomatic, whereas that small percentage will say that they're fine. Okay, the conclusion we're almost at the end here. Antonio ends by saying that 20 million Americans have hypothyroidism but we need better treatment. So he is absolutely right. But the T4 only model the fear of T3 or increasing it beyond that 2.5 or 5 microgram dose. The dismissal of reverse T3 reliance on TSH. These are the reasons that patients are suffering and begging for better treatments. If we truly want better outcomes, the treatment paradigm must change. Most patients need T3. Most patients do not convert T4 well and TSH does not tell the whole story. The science must evolve to match clinical reality, not the other way around. The information shared on the Thyroid Fixer Podcast is intended solely for informational and educational purposes. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with your physician or other qualified healthcare provider with any questions you may have regarding a medical condition treatment or before making changes to your healthcare regimen, including medications, supplements, or other therapies. Use of the information provided in this podcast does not establish a doctor, patient, or client provider relationship between you and the host or between you and any other healthcare professionals feed featured on the show. Any medical opinions or statements made by guests are their own and do not necessarily reflect those of the host or affiliated parties. 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