Fertility and Hashimoto's with Dr Christine Maren DO

If you've ever wondered what normal thyroid labs look like from a optimal functional, I feel like my best self-range versus a conventional range. This episode is for you. Today, I have on a very special guest, Dr. Christine Marin. She's a board-certified physician and founder of a virtual functional medicine practice based in Colorado, Michigan, and Texas. She's also the co-founder of HeyMommy, a platform dedicated to helping women navigate a healthy and happy motherhood. She was introduced to functional medicine after struggling with pregnancy complications and recurrent miscarriages. So she first-hand knows what she's talking about in this episode, ladies. She has a functional medicine approach which has helped her address her own underlying health issues associated with gut infections, hypothyroidism, hormone imbalance, and multi-execity. Does that sound familiar? We're definitely going to dive into mold in this episode as well. She's a mother of three. She devoted her professional life to helping women optimize her health, before getting pregnant, which is very important, to thrive postpartum and to get back to themselves. Dr. Marin is board-certified by the American board of family medicine, and she's also a certified practitioner through the Institute for Functional Medicine. Enjoy this episode, ladies. Get a pen and paper. Take notes. It is a powerful episode. Let's dive in. Dr. Christine Marin, welcome to Thyristorung podcast. Super excited to have you here to break down all the basics that a lot of women with Hashimoto's don't know. Yeah, I'm super excited to be here. So why is Hashimoto's very commonly underdiagnosed? Because people are not looking for it all the time. I think what we initially find is this immune system component of Hashimoto's, which is this auto-mean destruction of the thyroid gland, and eventually it causes hypothyroidism. But generally what happens in the conventional paradigm is people aren't just measuring TPO and thyroid-globaling antibodies. They're looking for hypothyroidism sometimes. If you go to your doctor and you are having fatigue or anxiety or some other sort of non-specific symptoms, they may or may not look for hypothyroidism. And if you have Hashimoto's, you may or may not have hypothyroidism. And if you don't have hypothyroidism, they're probably not looking for Hashimoto's. If you do have hypothyroidism, they are maybe looking for Hashimoto's. I was trained in family medicine. I'm bored certified by the American Board of Family Medicine. In my residency, it wasn't really sort of focused on. That's not thought to be something we can really do anything about that immune system piece. And so it's not necessarily all that important for some doctors in their opinion. So I would obviously disagree with that because there's this whole other kind of way that you can manage that immune system component. But for women who might have only had TSH tested, can you share what the other lab values would ideally be tested? And in a really basic way, share what those lab values would tell a patient. For sure. So TSH is a measure of your brain talking to your thyroid, essentially. It's like, as it goes high, it's like knocking on thyroid's door to try to stimulate the thyroid. So it's this negative feedback loop. If you have hypothyroidism, primary hypothyroidism, you would have a high TSH potentially. However, there are other causes of hypothyroidism. Central hypothyroidism or secondary hypothyroidism is one in which somebody might have a normal TSH but a low-free T4. So they're not making enough thyroid hormone, but their TSH isn't going up to tell them that. It's always really important to look at free T4, though it's not always done. In primary care, what's done a lot is called a TSH with a reflex to free T4. And what that means is only if TSH is outside of the normal range, will they check a free T4? I would always check at the very minimum TSH and free T4. And if you have to really negotiate with your doctor on thyroid labs for some reason, and they don't want to check things, at least insist on a free T4. But TSH free T4, free T3 is what's converted from free T4. So free T4 is like your raw material. You have to convert it, strip off an iodine molecule to make free T3, which is your active thyroid hormone. That is rarely checked in conventional medicine. I check it all the time because it's an indicator of how people are converting between T4 and T3. You can also check a reverse T3. That's not like a deal breaker. I like to look at it because sometimes it explains why somebody might have thyroid symptoms, even if they don't have technically hypothyroidism. That's a little bit in the weeds there. But if somebody has a problem converting T4 to T3, so they might have a normal free T4, but a really low free T3, they've got a conversion issue. That doesn't happen in the thyroid. It happens outside of the thyroid. And then we have to go hunting for these other kinds of things that are going on. There's a lot of digestive issues that are linked with hypothyroidism. So generally, I look to the gut when I see a high reverse T3. But reverse T3 would be like the brakes, whereas free T3 would be like the gas. And then I always like to check thyroid antibodies, thyroid peroxidase, and thyroid globulin. I can't even tell you how often I see those come up high in patients who have non-specific symptoms like bloating, anxiety, fatigue, hair loss, whatever it might be. So run down, TSH, free T4, free T3, plus or minus reverse T3, thyroid peroxidase, and thyroid globulin antibodies. That would be like the full thyroid panel that I would recommend. What's the difference between the two antibody tests? So thyroid peroxidase antibodies are more commonly elevated than thyroid globulin, but they can both be elevated in autoimmune thyroid disease. Usually it's thyroid peroxidase, that's checked. So if you saw like an endocrinologist, and they were being pretty comprehensive, they would probably check a TSH of free T4 and thyroid peroxidase. Have you seen where one antibody is positive, but the other isn't? Oh yeah, for sure. Yeah, I definitely see that a lot. I don't have any specific numbers, but I'm not surprised at all when somebody has positive thyroid peroxidase antibodies, but not thyroid globulin antibodies. Less often, people have positive thyroid globulin antibodies with the normal thyroid peroxidase, and somewhere in between that would be people who have both thyroid peroxidase and thyroid globulin antibodies. What would be ideal thyroid lab values, according to you? Because a lot of women, right? They're like, oh, my doctor said I'm normal. And I was told that as well. Like when I was first diagnosed, my TSH, I think is 3.2, which is within conventional, but outside optimal. So what are the lab values you use in your practice? Yeah, that's a really important question. And it is also a bit controversial. I see both sides of the coin, and that's part of the reason I really appreciate my training in conventional medicine, because it sort of like brought me a little bit back to them to the middle. But with a thyroid stimulating hormone or a TSH, I like to see it between 1 to 2, less than 2.5 is preferable. For somebody who is trying to conceive conventional literature, this is not a functional medicine or alternative or complementary approach. But if you're trying to have a baby or if you're pregnant, your TSH should be less than 2.5. When you look on the lab values, you know, it says normal ranges. It doesn't typically say that, because the lab doesn't know that you're trying to conceive. So that's just an important one for people to acknowledge. But from optimal perspective, I like to see TSH close to 1. There is definitely like some controversy out there among endocrinologists. I would say by and large, you know, American thyroid association and the American Academy of Clinical Endocrinology, they are as well as the American Academy of Family Physicians, like they're not recommending treatment for thyroid disorders unless TSH is quite high, unless your pregnant are trying to conceive. But TSH around 1, you know, 1 to 2 would be optimal. I like to see a free T4 1.1 to maybe 1.4, 1.5. And I like to see a free T3 3.2 to 3.8. I like to see a reverse T3 just like eyeballing less than 12. That number, you can calculate ratios and it sort of depends like if you have a high reverse T3, but you're on too much thyroid medication, that makes sense. So it's not totally straightforward. And then thyroid lobbying antibodies, I just like to see them as low as possible, but definitely in the normal range. Reverse T3, I think, is also controversial within conventional medicine, right? So can you explain why? Because I think some patients might think, oh, I have to like really fight hard to get a reverse T3, maybe from a conventional doctor. Can you kind of talk to why it is controversial? Yeah, I mean, there's just there's not enough literature to really support that it makes a difference in treatment. I think from the birds I view, if I see a big reverse or like a very high reverse T3, it's just telling me like, okay, I got to start looking around for other stuff that's causing us to drive all of our resources to the brakes. If you're a conventional doctor, like if I put on my conventional doctor hat, I don't know what I'm going to do with that number anyways. I think there's a lot of recommendations too, like the other recommendations are sort of like don't check a free T3 either. I don't really know why they feel so strongly about that because it's not an expensive or invasive test. And I tend to think about these things in terms of risk and benefit. It's just some more information. It doesn't expose you to radiation and it's not like it's $5,000. It's like $5. Let's talk medication because I know you're very, very good at dosing your medication and helping your patients feel optimized. Can you speak to just the different kinds of medication and then maybe what are some of your go-to's? - Yeah, for sure. So when we think about thyroid medication, the number one, and really one of the number one, prescribed medications, and then all of America is levothyroxene. So levothyroxene is a generic synthetic T-for medication. So there's synthetics, and then there's things called natural-desicated thyroid. Of course, I'm all for natural, I'm all for holistic medicine, like that's what I do, that's how I treat myself, and at one point in my life, I was even on natural-desicated thyroid, I no longer am, I am on synthetics. So I'll just tell you a little bit about the difference with synthetics, we've got synthetic T-for. Leverothyroxene, I mentioned, there are some brand names, and I always prefer the brand name one specifically. So, scintorade is a brand name, unithroid, at the one that I use, and recommend a lot is called tyrosent. I like that one because there's very few acceptance. It's like, levothyroxene water and glycerol, just there's not a lot of ingredients in there, so you're not gonna react to a lot of it, it's just clean. So better absorption for many people. So those are the synthetic T-for's. There is also a synthetic T-3 called cytomel, or lyofyronine is the generic version. So the levothyroxene and lyofyronine, that's the T-4 and the T-3 in the generic terms. So, cytomel is a synthetic T-3, sometimes all dose is synthetic T-4, plus a synthetic T-3. Sometimes people take too much synthetic T-3, so we'll come back to that. I like them separate because you can titrate the dose. People don't generally need a ton of T-3 support, and they don't always need T-3 support. It's not like a general sort of recommendation that I have, where everybody with hypothyroidism needs T-3 medication. Some people with hypothyroidism need T-3 medication. So, then you go to natural-descited thyroid. Natural-descited thyroid always has T-4 and T-3 in it. It's combined. And so if you increase the dose, you always increase the dose of both. So the trouble there is what I tend to see with a natural-descited thyroid is not enough T-4 and too much T-3 that doesn't apply to everybody. Some people do great with it. Some people need more T-4 support, and they're getting too much T-3 in relationship to T-4. And so they might feel anxious or jittery or techacartic like high heart rate. And the other kind of complicating factor with natural-descited thyroid is that there have been a lot of recalls. The recalls are because of subpotency of T-4. So they don't generally have enough T-4. Those medications are armor, WP, things like that. - What's your go to? - Teracent and cytomel. So Teracent synthetic T-4 and it comes in a solution and it also comes in a gel cap. And then cytomel is synthetic T-3. And so then I can titrate the dose. Like most people just need five micrograms of cytomel. Occasionally I see people, I have like a few patients who need more. And just remember too, like cytomel shortacting, the T-4 medications are longer acting. So they last for a day, you'd only take them once a day. There's no reason to take them twice a day. Cytomel, the half-life of medications, it's shorter with cytomel. So sometimes I might dose it twice a day, not super often 'cause it's a pain, but. - Right, because it's shorter acting. - Yeah. - How do you feel about compounded thyroid medication? - So I have a few patients on compounded thyroid medication. I don't find that it's generally necessary. What I always make sure with compounding pharmacies is you're using somebody super reputable. Because these are made by somebody in a compounding pharmacy, what if they mess it up? There is always that risk. So you always go with a reputable compounding pharmacy, you don't just like pick somebody off the street, it's kind of like when you find a doctor, like you really wanna do your homework and go to some place, somebody that's reputable. So, you know, there are a few instances where I've used compound thyroid hormone. I just, it's generally not necessary. - Let's talk about women who've potentially been overmedicated with T3, which is, in my experience, you feel like you're on speed. But for women who might feel this constant anxiety that comes on of nowhere, like, there was no correlation to an event, you see this a lot. - I do. I do see this a lot. I see, I have these like handfuls of patients, like the ones who didn't get thyroid treatment when they really needed it. And instead, they're like on United Press and medication, but really they need a thyroid medication. And then I see these patients who are on like, way too much thyroid medication. Now they're anxious and now they're on like an anxiety medication because they're on too much T3. There's kind of both sides, you know, and I see these, so the patients who come to me with a really suppressed TSH in a high T3, that's where the risks come with thyroid medication. With everything, every decision, supplements, medication, diet, whatever, it's always a risk-benefit decision for me. So, you know, the risks of thyroid hormone treatment are very low if it's used appropriately. When it's over-prescribed, we have to think about things like arrhythmia or palpitations, bone loss. So, yeah, I definitely do not like to bring T3 too high because it comes with those risks and then also some symptoms like anxiety. I can't sleep it and I feel like, you know, it's just, it is like tired but wired sort of thing. I mean, it is, it's a stimulant. And so for people who take too much T3, it doesn't feel good. But I think a lot of people are sort of convinced that they need it because some people do. I mean, some people definitely need it, but some people take too much of it. - Is there something in terms of the timing of the lab draw such that it would throw a practitioner off to over-prescribing T3? - Yeah, for sure. So, or under-prescribing it. So what I like to do in order to titrate the dose of T3 is have somebody take their medication. If I'm treating a patient who's on a T4 and a T3 medication, whether that's natural-descrated thyroid that contains T4, T3, or it's synthetic T4 and synthetic T3 combined together, I'll have them check their labs four to six hours after they take their medication. That's the only way I know how high their T3 is getting. And if they check their labs four to six hours after they've taken that medication and their T3 is 4.9 or 5.3 or whatever, I'm gonna take them off T3 or at least reduce the dose because that is too high. And it's just this bigger roller coaster. It's like you go up way high and then in the morning, you're like, crash and burn. So I try to just like smooth things out, just like with blood sugar, you know, you want to smooth things out and keep it stable. So yeah, I always like to time my medication draws afterward. Don't take your medication and go to the lab an hour later. It's all gonna look high like your T4 and your T3 aren't gonna be very useful. If you're not on a T3 medication, I generally have people check it first thing in the morning before they take their medication or late afternoon when their medication has metabolized. And if you're on a T3 medication and you check your lab's first thing in the morning, you just don't know how much do you need more T3? I don't know because it's been 24 hours. Like it's just harder to dose. - How often do you check labs when you're kind of trying to titrate that optimal dose when you're first working with a patient? - Like every four to six weeks. I think if you change your thyroid medication, you should always check your labs like six weeks later anytime. I'm always surprised by that because patients will show up in my office and they'll say, "Oh no, somebody changed me to this." Like, well, what was your follow-up lab and they're like, nobody checked it. I don't get that part. (laughing) - So why not? I don't know. - Yeah. Whenever women come into thyroid strong, my online program, we talk about working with a practitioner to feel like you're best self in terms of labs. And I don't talk about labs, but I say find a practitioner that will help you optimize your labs because especially if you're struggling with waking and fatigue. In my opinion, and I would love to hear your opinion, it is an uphill battle. I would say probably you're impossible to lose weight and have energy if your thyroid hormones are optimized. - Yeah, for sure. I totally agree. I mean, I think it can be, I would say the majority of people feel much better clinically when they're on optimal levels of thyroid medication. I do have a handful of patients who don't necessarily feel better. And when that's the case, it's like, "Well, what else is going on here?" We gotta keep digging because it's not usually just thyroid. - Yeah, so when do you keep digging? So obviously there's the genetic predisposition, there's intestinal permeability, there's environmental factors. You wanna get the thyroid hormones optimized, have someone feeling better. When do you start to look at other factors? Is that like within the first second appointment? Is that, you know, waiting to know? - Yeah, I mean, I'm always doing it. Like if I know somebody has positive thyroid antibodies or Hashimoto's, I'm always trying to figure out what, what's the underlying cause of the immune system disruption? Because if you have Hashimoto's, I know that the underlying cause of your hypothyroidism is Hashimoto's, that's very common. But there's also other things at play sometimes, you know? Sometimes it's like, it's Hashimoto's and you took way too much iodine 'cause you thought you were gonna help it, but you actually heard it. Or you know, you had mold exposure or you know, there's just all these other factors. So I'm basically always looking at all of it, but I sort of take it patience-ly because I can only dig as much as they want to. You know, so, you know, I have a few patients who, you know, they have hypothyroidism. I have one patient in particular I'm thinking of, he has really significant hypothyroidism. He does not have Hashimoto's. And so the big question is like, well, why are you hypothyroid? If you don't have Hashimoto's, there's other kinds of causes that we need to look at, like radiation, even hemochromatosis. Like there's all these other causes that can cause that, you know, fluoride exposure. But if he doesn't want to dig on that, there's, you know, I can just kind of help him, like lead the way and work on detox and replacing specific nutrients and things like that. But generally, the patients who come see me are the patients who have Hashimoto's who want to figure out why and what happened to their immune system and why their immune system is attacking their thyroid. - Yeah, who would it want to dig deeper? - I know. I mean, I've come, I've come, I've come, I've come, I've had enough patients also who are like, it's usually, it's usually none. And, you know, their wife is like, you need to see Dr. Marin, you know, because I see them and they don't really want to dig that. Like, it's just, it's just such a personal kind of thing. And I, I don't know. I mean, I know that it's, there's, there's different things that are going to motivate people. But like, I've always been really motivated to dig deeper and to just understand why. So. What are some dietary solutions you would bring in for someone you're treating with Hashimoto's? Uh, yeah. Number one would be gluten free. Um, I do strongly advocate for gluten free diet for anybody who has autoimmune disease. Currently, I'm digging through some literature on that and the literature doesn't necessarily even support that, but clinically, for sure. And also, what's the risk? Like, what's the risk in trying gluten free for three months? And I would just warn people like, going gluten free doesn't mean like you're going to feel all better. And I've had lots of patients who were like, well, I did go gluten free, but then I didn't feel better. And it's probably because there's other things. There's like all these different logs in the fire and you have to start taking them out. And generally, gluten is one of the big logs in the fire that can affect intestinal permeability. That's all about Zonulin, which is a protein that increases intestinal permeability and then increases this autoimmune reactivity. So gluten free diet for sure, generally I recommend like dairy light, sometimes no dairy. It sort of depends on the patient. At one point, I was really like dairy free until I considered like all of these ingredients in my dairy free cheese, which I didn't eat a lot of anyways, but like oatmeal and, you know, all these dairy free substitutes are great for you either. So I generally, more than not, my recommendation is like no, yo, play and like all this, you know, mozzarella cheese and like these heavily processed dairy products. If you want to do maybe like a goat milk kefir, I don't even do that, but like a Montego cheese or like our Parmesan or Regiano or some sort of hard cheese and a goat or sheep's milk cheese that will change the casing and the lactose component rather. So it's better tolerated, but in general, I'm not, I'm advocating against processed dairy. I'm not telling anybody to drink milk. That's not on the table. So I don't really think there's like a huge problem with soy. I think if it's organic, it's actually can support some detoxification. So it's a little bit controversial, but I don't know. I don't also want anybody eating a bunch of processed soy, like soy protein isolate, like the Debra recommend. Tomari, like a gluten free kind of soy sauce, I generally think it's fine. I tend to be on the bandwagon of eating a whole food low processed diet, low in crap and high in nutrients. And from there, every once in a while, somebody benefits from like an autoimmune paleo diet. If they're super reactive and they're thyroid proxidacinabodies or through the roof and they feel terrible, might be worth a try. I just always emphasize this is a short term approach. This is not a long term solution. The point of doing an elimination diet is to figure out what you're reacting to so you can remove the food and then eat more diversity. I think the sort of trap I see is like these patients will be autoimmune paleo for two years. And then they've taken out so many foods and they can't get them back in and their got microbiome has changed and shrunk because they don't have enough diversity in their diet. Now they're reacting to the other foods that they were eating all the time and it just creates more stress. Are you making these recommendations through an elimination diet or are you having patients do like an IgG food test, sensitivity test? I usually on elimination diet sometimes they'll do food sensitivity testing. I don't put a ton of stock into them, but I do find them sometimes helpful. Sometimes we'll do food sensitivity tests. The big ones I'm looking for, I didn't mention egg. I think gluten dairy egg are the big reactors maybe soy. And sometimes if you see like nuts coming up, it's like, oh, okay, that person might need to do AIP. So if I did a food sensitivity test and I saw that they were super reactive to gluten, dairy, eggs, nuts, then I probably would recommend AIP for a short course. But my general recommendation is like sometimes people really want to do food sensitivity testing. And I tell them like, we can do it. Just understand it's not perfect. There's false positives, there's false negatives. It is not a perfect test, but it can give us a guideline and we can start there and kind of, you know, see how things look. I would not do that test in somebody who is already AIP because if you've eliminated the foods, you shouldn't be reacting to them anyways. So generally, it's more of an elimination diet. Like whole 30 love it. I think it's great. Like for somebody who hasn't really like done a lot of work and like knows how to read labels, I think that's a great way to sort of dive in and understand like, what am I reading here? And like, you know, if somebody is shopping at like Kroger or King's supers or wherever. And they're buying a bunch of conventional products with high fructose corn syrup and things like that. Whole 30 is great. A lot of women, I think they default to changing diet because it's something that's accessible within their control. And then they don't necessarily feel better. And then you have to dig deeper. Is there some sort of infection? Do you have SIBO? Do you have H.P. Lori? Do you find that to be super common? Like women are like, I changed my diet. Why are they feeling better? 100%. Yeah. I also see that people are like, I changed my diet and I felt better, but no, I don't feel better anymore. It's like they have this initial sort of transient response, but it doesn't last. And so when we treat gut, it's remove and replace like that's step one and step two and remove. People are always removing a lot of foods, but they don't remove the infection. So there's a really high correlation between gut infections and Hashimoto's that goes back to the intestinal permeability piece. That also goes back to the thyroid gut connection because your thyroid guides basal metabolism in your gut viscera, meaning motility, stomach acid, digestive enzymes, like all of that really relies on healthy thyroid function. And if you have hypothyroidism, that's going to affect your ability to do that. And that's going to increase your risk of gut infections. And then once you have more gut infections, that increases your risk of autoimmune thyroid disease. So there really is this like vicious cycle that can happen. So it can get complicated. There's just so many different inputs. And it's like, I don't, there's people sometimes ask, which are vertical? I don't have a vertical. Which one? Like, it depends on the patient. Like, I'm looking for gut infections. I'm looking for environmental triggers, like by the way, pregnancy can be one of those. So like, I really go through this whole timeline with patients, like literally birth, like we started birth. And then I understand like, okay, in your childhood, you got a lot of antibiotics. That makes sense. Sounds like you have intestinal dysbiosis. That goes hand in hand with having Hashimoto's. Then you moved into a moldy house and you know, shit hit the fan. Like, I get it. It's interesting. A lot of women will ask me like, what's your supplement? Like, what's your daily supplements? And I'm like, depends on the day. And depends on what we're working on. Yeah. Let's talk about fertility because you do specialize in this. So for women who might have had multiple miscarriages have not been diagnosed with hypothyroidism or Hashimoto's, can you tie the pieces together to bring clarity for women who maybe they feel there's something wrong with them in terms of having multiple miscarriages or fertility issues? I think if your intuition is telling you that you're probably right. And I say that because that is the exact feeling I had when I had multiple miscarriages. I remember laying in bed with my husband and saying like, there's something wrong with me. And he's like, no, there's nothing wrong with you. It's fine. It's not your fault. I'm like, no, no. This is my intuition speaking. There's something wrong. Like, I know there's something wrong. And I was having massive digestive issues. Of course, there's something wrong. The point when it comes to thyroid is there is a huge player. And having hypothyroidism in Hashimoto's definitely increases the risk of miscarriage. And it is easily negated with proper thyroid hormone replacement. It is just overlooked. And what I see is that a lot of patients who are trying to conceive are not seeing a reproductive endocrinologist because they don't want IVF. Reproductive endocrinologist generally know this information, but who they're seeing as a primary care doctor or an OB/GYN. And they don't always know this information. And so what's important is that if you're trying to conceive your TSHs less than 2.5. If as soon as you get pregnant, your TSHs above 2.5, that were in thyroid hormone replacement. Now if you've had a history of miscarriage and you have Hashimoto's, you might consider thyroid hormone replacement because that is shown to maybe decrease your risk. The literature is a little bit out there, but I think again, risk benefit, like why not try it? It's a really low risk intervention. If you've had miscarriages, have your thyroid checked. Like 100%. The problem is just people don't always do it. And this is again, where it comes back to like you have to advocate for not just a TSH. You need a TSH, free T4, thyroid peroxasianobodies. I would love to see a free T3 in thyroid globulin as well. But at the minimum, you know, TSH, free T4, a TPO. That is an indication to test TSH and TPO antibodies. If you look at the literature, it's just again that people don't know it. But like you just go back and look at the conventional recommendations. They are there. The American Thyroid Association. Like nobody's recommending for universal screening of hypothyroidism. It drives me crazy because I'm like a TSH is like $4. It's so cheap. Why aren't we just screening everybody? Like why are we screening for syphilis, but we're not screening for hypothyroidism? I mean, why not? I don't get it. But there are so many different reasons why we should screen. And so if you look at like American Thyroid Association, they weren't, I think the literature, the language that uses like aggressive case finding. But there's like so many different reasons why you should check that and miscarriage. So miscarriage is one in fertility, irregular periods, having a family history of somebody who has an autoimmune disease, having an autoimmune disease yourself. Like there's so many different risk factors for Hashimoto's. And it's just incredibly common. Do fertility treatments affect someone who is on thyroid medication? Yeah, it's a great question. The best way to know is just to check your laps. And so if you're going through fertility treatments, generally a reproductive endocrinologist knows to like, okay, let's check thyroid a lot. They just don't always know how to treat it. A lot of their reproductive endocrinologists don't necessarily treat it. Check your thyroid hormone. If you go on estrogen or any sort of hormone, including birth control pills, and also hormone replacement therapies, like outside of pregnancy, if you're trying not to conceive and you're on birth control pills or your postmenopausal, check your thyroid labs, especially if you're on thyroid hormones. It's a similar mechanism to what happens when you get pregnant. And it is also, why if you're on thyroid medication and you get pregnant, you check your labs right away because most women on thyroid medication who get pregnant need an increase of 25 to 30% in their thyroid dose. So that's a really important one. And the reason is because when you have all these hormones on board, your body makes more thyroid binding globulin. And you'll see that sex hormone binding globulin goes up. And so you can just measure a regular lab, SHBG. And those binding proteins bind up free thyroid hormone. And then you need more of it. So you just have to pump in some more thyroid hormone. I have a few patients who've needed to increase their thyroid dose by like 50% or more, but generally 25 to 30% increase is adequate. Sometimes people don't need that big of a increase. But if you're on fertility treatments, you probably need a slightly increased dose. A lot of women will get diagnosed with Hashimoto's at Poise Factor. Why is pregnancy such a stressor and trigger on the body? That's a great question. And we don't really know. It's absolutely a risk factor in developing an autoimmune disease like Hashimoto. So in my postpartum panel, I always check for thyroid antibodies. Again, even if you had them and they were negative two years ago, I'm going to be checking again, postpartum because I know that pregnancy is a risk factor. Lots of different theories there. I mean, here's one theory. Like you're not sleeping in your breastfeeding, your nutrient deplete, your stress, you're not sleeping. We know stress can impact thyroid function and develop in Hashimoto's. So maybe that's one of them. There's another theory. Like you have somebody else's DNA inside of your body is your immune system confused by that. I mean, you're carrying a human, your partners DNA, right? And so like what happens to your immune system when that happens? There are some other theories related to X chromosome. I think the reality is we just don't totally know. I don't know if we'll ever know, but we just have to know it is a trigger. There is a potential for postpartum thyroiditis, which is typically like resolves after 12 months postpartum. So I think sometimes women get confused. Do I have postpartum thyroiditis? Do I have a little blown autoimmune condition? Yeah, that is a it's a confusing one. It's even confusing for practitioners. Like I have a patient like that. And I just happened to see her postpartum. She had positive thyroid antibodies. I thought it was Hashimoto's or antibodies went away. I'm like, okay, your Hashimoto's is in remission. She had another pregnancy had postpartum thyroiditis. And I'm like in retrospect, I think that was postpartum thyroiditis. So yes, women with postpartum thyroiditis, typically their thyroid function resolves. It doesn't always. It can just be a presenting symptom of Hashimoto's and they can go on to develop Hashimoto's. It's complicated, but it's just where like, yeah, follow labs. And if you're not feeling well postpartum, get your labs strong. Don't assume it's because you haven't slept or because you know, you shouldn't be anxious and revved up and enabled to sleep postpartum. For women who do have known hypothyroidism, a lot of them fear getting pregnant. Like, am I going to have a healthy baby? Am I going to have a healthy pregnancy? Can someone have a healthy pregnancy with hypothyroidism? Absolutely. Just check your labs. 100 percent. I had two healthy pregnancies with hypothyroidism. One of my pregnancies wasn't great. The one after my miscarriages. But absolutely, I think what's most important is just that your thyroid hormone is in a good spot. And namely, that you're really replacing T4. What I sometimes see is people who are pregnant might be on armor. It's not an absolute contraindication, but the most important thing is that you have enough T4. It's not that you have enough T3. The fetus C is T4. You can totally have a healthy pregnancy. It's just about a appropriate thyroid hormone management. Yeah, let's take a shift because we touched on that it's a genetic component. There's the intestinal permeability. And then there's this environmental factor. You and I have both experienced different aspects of this environmental factor. One of them being mold, which is like my kryptonite. Another one that you shared with me is also childhood trauma. Yeah. Can you speak to that? It's so fascinating. So I believe this study was from 2018. There was a really large cohort in Sweden and a long story. They basically looked at having a big stressor and found that, indeed, psychosocial stress is a very big risk factor when it comes to developing autoimmune disease. It was sort of like a theoretical thing, I think. Like we thought that stress probably maybe impacted the immune system, but we didn't know. Now we know stress indeed impacts the immune system. And I just think that is so fascinating. I don't think I fully really appreciated it in the past. My thought was sort of like stress. Let's maybe the straw that breaks the camel's back. I mean, certainly plays a role, but it's like there really is a lot there when it comes to psychosocial stress and childhood trauma. And I think what really got me on this bandwagon is Gabar Mate's new book, The Myth of Normal, I'm familiar with it. I'm familiar with him and I've heard him on a couple of podcasts. I haven't read his book yet. His book is great and he talks a lot about the personality behind autoimmune disease. And so I've really been watching this in my patients. Like what he describes is women who are hypercapable, hyper-responsible, maybe have like excessive social responsibility, tend to be self-criticizing when like hard on themselves. Basically women who can get shit done and put their needs aside sometimes. And I'm like, oh, that rings a bell. I know someone like that. Who is she? It really resonated with me because it just strikes and courts my own childhood. And I was like supercapable from a really young age. I was like the fourth kid care for myself when I was like nine or eight or seven even. Just looking at your childhood, I think in general, of course there are people who have experienced the big T trauma. And I am so sorry for those people who have gone through that. And I think the remainder of people who have the little T trauma, which I really believe we all have to some degree passed through our genes and just history, I didn't appreciate that myself until really kind of diving into this. So I think there's this like little T trauma that really does influence the way that our immune system develops. What's really interesting is looking at like metaphysical medicine and energy medicine and chakras, the root chakra where your immune system develops. It's the first one to develop has a lot to do with sort of like where you see yourself in your family. And it's interesting with Hashimoto's because there's that root chakra where the immune system is and then through chakra, which is like where we speak our truth. And as women, women are often like kind of shushed right? You're like, don't say that. Especially 20, 40, 50, 60 years ago, 80 years ago, right? Like it's just, there's just it's just different. Like women aren't always allowed to like speak their truth or say what's on their mind or be really direct in their communication. And if they are, they're called themes sometimes. So it's just interesting to think about like how does that hypothyroidism that chakra around your neck that with your like heart chakra and that like feeling of self compassion and then the root chakra and like the immune system piece. It's like I just think there's something there. And it's super interesting in one of these days. I'm going to do some sort of energy medicine certification so I can learn more about it. But I definitely think that is a piece of the puzzle. Yeah, I love it. I mean, there's so many different factors, right? So like gut and test your yeah, the ability. Like I feel like so many different environmental factors, right? We'll be one of them. There's many more. Yeah. Where is a practitioner? Because I think a really good practitioner creates a hierarchy of what to treat first then next, then next. Whereas I feel like a beginning practitioner kind of just treats everything at once and kind of barrage is the patient and overwhelm some. I know it's independent for a patient, but create this hierarchy of this is a step. This is the next step. Yeah. Yeah. Yeah. Yeah. I mean, with my patients, I generally like day one, I'm like, okay, here's the deal. We've got to get some test done. So we have the data and here's your homework. I want you to get rid of the toxins in your house and start filtering your air in your water. It doesn't always have to start at once, but we got to get rid of like chemicals. Like if you're using like blade plugins and like, yes, I don't know, a little janky candle or whatever, like any of those like fragrances or you're cleaning with conventional cleaning products or you know that there's mold in your house. Like obviously these things can't be solved in three weeks, but like at least start going down that kind of pathway to like that low tox living. So we don't re-talks, right? So like that lifestyle component is really important. Let's get the testing done. And then I really start working on the gut. So it's always like let's, you know, we got to fix the gut piece that has to do with the simulation of nutrients, gut infections are just going to perpetuate that. So I usually start with gut that, I mean, the dietary piece sort of comes next, you know, so it's diet and then gut. And then I often start to work on detox sort of after that. But at least we're not going to detox. We're going to detox and by then they will have already like started down this pathway, like getting rid of some of their house with chemicals. I mean, many patients who see me are already like doing that, you know, and they've seen like a bunch of other practitioners sometimes. So it just kind of depends on where people are at. And I just try to meet them where they're at because you know, I also tell patients like this is your plan that mine, I can't overwhelm you. That's going to lead to nowhere. So we just got to like start pulling out one log at a time, like whatever it is. And by the way, like, when it comes to those patients who are trying to conceive, it's generally like, well, I'm not going to work on detox all that much because we just want to keep the toxins where they're at. So it really does just depend on the patient and like how much they can and are willing to do. I think generally it's like, let's start with, yeah, lifestyle nutrition, gut detox. Yeah, I love it. For someone who's lived in mold, you as well as myself, I'm always curious, do you, what's your belief in terms of like, can someone heal or live their life while living in a moldy home? Because sometimes financial is very challenging to remediate or to move, right? Not everyone can do that. That's challenging now. And it feels like the world is closing in, because you're like, oh my god, I'm in this moldy home and I can't get in the home. Do you think someone can heal or maybe not fully, but at least function? I think you can get better for sure. I mean, I was sort of in that situation where like we knew we were moving, but by the time I realized I was in a house that had mold, like, it took some time to like, okay, what's the next step here? You can do things like use binders and glutathione and help your body detox and you can definitely start to feel better, but I do think it's pretty important to get out of the exposure. It does depend though. And about as the exposure and how much are you reacting to it? Some people are super reactive. And then some people have a little bit better tolerance. It's a hard one. I usually tell patients with mold like, hey, this isn't something that's going to get better overnight. And wow, I mean, it's a tricky one, because it's like, well, you can get a hepa vacuum and you can get like an awesome air doctor or austenair or some sort of great air filter. But then if you move, you're going to need to get new ones. Once my house was remediated, like, there's air doctors or austenair all over the place. I've got this fancy melee vacuum that's like, hepa and all the things. It's hard, because you don't want to like invest in all that stuff if you're going to move and then drag it with you. And then you've got something that's potentially spewing out some mold. I mean, for me, when I did remediation, I was like, I don't want to have to second guess this. I don't want to wonder if those books are full of mold. I'm just going to get rid of them. If it's cheap to replace an easily replaceable and or I don't really want it long term. And I'm not going to miss it in a year. Like, I just got rid of it. Yeah. Did you go out of bed? Everything? Because I think there's this assumption in the mold world. I have to purge the house and you like leave in a car with nothing. Yeah. Yeah. That's too much. I think it's too much too. No, I didn't get rid of everything, but I did regret in one time not getting rid of my mattresses. Because I'm like, that's where we spend like our 10 hours or eight hours or whatever it is. That's a long time. I did get rid of mattresses this time around. I've done more than once, unfortunately. I got rid of books, you know, I just really tried to pair down like there's just like my crawl space is all like these plastic like your tight like, you know, um, stairlock things or whatever, stairlight. Yeah. And stuff. So no, I didn't get rid of every single thing I owned, but like everything was like wipes down or in the washer. And if it was like porous, like wouldn't bring this so far with me or mattresses and stuff like that. But I don't know. I mean, this most recent time actually, we did have mold exposure. I've worked with this for mold remediation people. And they used a special solution and a hepavak on my sofa and on my bed frame. They were pretty confident that I was going to help. And I've had like army testing and stuff and it looks fine. So it really is, it's like a tricky one, you know, I don't know. Yeah. Yeah. The answer is I didn't get rid of everything and it can be super stressful. And it can be like a huge trigger for like PTSD and like really just like a lot of trauma associate with mold. This stuff is no joke. It sucks. Yeah. Do you have any tips on how to heal that trauma? Girl, I saw therapist and she, I don't even know the technique she is, but she had me tell her the story of when I found my house flooded in water, which I was taught. If I was talking to you like a year and a half ago, I'd be crying right now. I, it was like my worst nightmare. I walked into my house, which I had already gone through mold and was already like hypervigilance about water damage. And my three year old plugged a sink upstairs and filled up the sink with water. And the outflow drain, I didn't realize it of course, but like it went to the floor. It was a house that we had purchased and the sink was part of the original house. And it just like hadn't we just hadn't remodeled that that part of the house yet. But it did, you know, meet it. But anyways, this pedestal sink, the water went to the floor, seeped through the ceiling, went down the walls into my basement. I found it a couple hours later, I walked into the house and I heard dripping, which literally dripping gives me like a fast heart rate, like water immediately, like, like I'm on high alert with water. And I ran around the corner and I saw water coming through the ceiling and I actually slipped because there was like an inch of water on the floor on our wood floor. And I fell back and was like looking up at the ceiling and water was like dripping on my face. And I'm like, oh my god, oh my god, it was just a terrible thing. So anyways, I recounted that story to her in tears. And then she had me tell it to her backwards. And then she had me tell it to her backwards and fast. And then backwards and slow. And then forward, I don't know what that's called, like therapists know what this is called. I don't know. I believe it is some way to sort of work through PTSD. I don't know. The woman I saw is like fabulous and she knows a lot of different techniques. So I don't know. You'll have to share her contact so I can get it on PTSD. I got you. Thank you so much. Where can people find you? I know you see patients in Michigan, Colorado and Texas. I just sent you so much. Yeah, very good. But where can people find you? You can find me at drcristinemarin.com. So also on Instagram at dr. Christine Marin. Those are usually the places I hang out. And I do all virtual kind of telemedicine for patients in color to Michigan. And Texas, those are the states I'm licensed in. My husband was military. So we had like a turquoise route. Well, thank you so much. I'm sure the Hashi ladies have taken a page of notes just like I have. And you know, you sharing your wealth that you're super active on Instagram. I always learn something new every time your Instagram pops up on my feet. So yeah, thank you for having me.