Why Thyroid Treatment Isn’t Working | McCall McPherson PA-C

If we can get warning signs intervening earlier, this is absolutely what we want to do. Medicine is really only checking one hormone, your TSH, your brain's hormone, and we need to look deeper. You're talking about changing the trajectory of your entire health journey here. You can absolutely be debilitated in "normal" lab ranges for thyroid. If you can't treat what you don't know. These women deserve better when they're on their fertility journey. People don't need to be on excessive amounts of thyroid hormone to feel well. Why wait for it to fail completely before we pay attention to it? Welcome back to the As A Woman Podcast. I'm your host, Dr. Natalie Cufford, and today we're talking all about the thyroid. If you've ever struggled with fatigue, brain fog, weight changes, irregular cycles, infertility, anxiety, or just feeling off, and your thyroid labs were brushed aside and told everything was fine, this episode might be for you, because thyroid health influences everything. Your metabolism, your ovulation, pregnancy outcomes, mood, and long-term hormone function. Yet, it's often reduced to just a single number. So today, I'm joined by McCall McPherson, thyroid expert, PA, and founder of Modern Thyroid Clinic. We're diving into what thyroid optimization really means, where conventional testing can fall short, how your thyroid hormones impact your life, and really how to advocate for yourself and your own care. We call "thank you so much for being here." Thank you so much for having me. I'm so glad we finally made this happen. I know. We've been trying for such a long time, and I just have to say from the start, I adore you. I adore your work. It really comes from a place of patient education and advocacy, teaching people how to really take agency for their own body for something that gets dismissed a ton. Absolutely. Well, thank you. I feel the same. I mean, it's our work mirrors one another, yours infertility. Mine with thyroid. We absolutely want to change the landscape, and evolve it a little bit for people. Let's start really, really basic, and then we're going to dive in. But if somebody is listening, and maybe they don't come to this with thyroid knowledge, do you want to give us a little thyroid gland one on one? Because we're going to be talking a lot about these different hormones and what they are. So do you want to set the stage? Absolutely. So your thyroid impacts literally every mechanism in our physiology, every large organ system, long-term health outcomes. It's this foundation for energy, vitality, but also long-term health in terms of cardiovascular disease, brain fertility, all of it. Arthirate sits on our neck, and it's influenced and stimulated by a hormone called TSH. Comes from our brain, stimulates our thyroid. Arthirate then largely releases a hormone called free T4. Okay? Free T4 is like crude oil. It doesn't really go in our car to make it run, but we need it to make gasoline to make our car run. That T4, what we want it to do, is convert to free T3, and I'm sure we'll dig into this more and more. Your gasoline hormone, your most important hormone. And sadly, kind of like you mentioned, medicine is really only checking one hormone, your TSH, your brain's hormone, not even a thyroid hormone, and we need to look deeper. So I love conversations like these. I love it. How did you get so interested in the thyroid? Good question. So I was 27, practicing medicine, had a long-standing thyroid issue on synthetic and I was depilitated. I was spending 16 hours a day in bed. I'm not exaggerating. I went to work, came home at 3.30, went to bed, rested enough to recover, and rested enough to prepare for work the next day, and was non-functioning. I mean, outside of work, I was in no relationships, limited friendships. It just dominated the landscape of my life. It was overweight, losing hair, puffy, inflamed. I knew enough. I was already practicing medicine. I'm like, "Oh my gosh, I just, I have a thyroid issue and I need to get my medicine adjusted. Went to my doctor, went to my clinician, told him my list of thyroid symptoms, and he's like, "Okay, we'll check your labs. Checked at TSH, came back and said, "Look, it's normal, it's fine. In fact, it's a little low. We're going to need to reduce your synthetic, but by the way, I can put you on lipitor because you have a cholesterol issue at 27. And I broke down in crytosis. If you take anything else from me, I will lose my job. I won't function. I won't function. I'll be on disability, right? And begged, came back with a little post-it note with a list of labs, asked him to run a deeper look. He said, "No." And I think like so many people who experience this, it just feels hopeless because your brain hardly works enough to function in day-to-day life, much less research. Find a new doctor. Get on a weightless advocate for yourself. All of it. Learn enough to advocate for yourself, right? And this was when information wasn't readily available. I got on the weight list for one of the only doctors I could find that specialized and kind of progressive complex thyroid issues, weighted some a few months later, and he completely changed my life. Became to very, very motivated to dive into every research study that comes out. Anything I could get my hands on, that physician became a mentor to me, and kind of naturally over years, modern thyroid clinic was born, and I'm so darn grateful for my journey because we've been able to impact so many other women. You've changed so many people's lives, and I love that it comes from that experience. It's terrible you had to go through it, but in a similar way for me going through infertility, set the stage to know how helpless and hopeless it feels, and how advocating for yourself feels like such an easy word to say, get very difficult in practice, and even just knowing what's right or what's wrong because when you get dismissed and gaslit, you then start to believe this narrative that maybe you just don't tolerate it well, or this is just how you are, right? And the thyroid, it's really interesting because the fertility field is so complex, we're going to dive into it, but you know, they've taken another swing where people are not even screening for it and not even looking at it, whereas, you know, you and I are big proponents of, look harder, look more, look bigger because you can't make decisions on data you don't know, so why not test for it? I don't feel like we should be the people who are keeping lab results from patients. Right. Amen. Like saving insurance like $65 and a gauge of you getting a free T-forged. Like, please make it make sense. Right. It makes no sense. And what's so crazy is in a world in a country where hypothyroidism is almost ubiquitous as we age, as women, especially if we have children, the higher, you know, the older we get, the more at risk we are, and the huge ramifications on our quality of life and long-term health outcomes, it is bizarre to me that we're not more invested in this mechanism, in the ability to help these people, and it's so bad, I share this pretty often, but in my practice when I see patients for the first time, and we review their labs, so they've been told over and over, it's not your thyroid. Your labs are normal, they come to see me on the day that we review their labs. I've even pulled my clinicians, they get the same answer, 90 to 95% of women say one of two things. One, so you're telling me, I'm not crazy, or two, so you're telling me this isn't all in my head. Isn't that tragic? It's terrible. It shows you what a complete failure we've done of taking care, I mean, of women, especially of this population, and that even when you seek care, you have to advocate an extra step because you're getting told so often that it's not something you just have to deal with it, or this is just what, I'm sure you just happens as you get older because we know the thyroid gland, just like our whole body, everything breaks down over time. So we see disease states increase as we get older, and just being dismissed and gaslit, that's why all that every single patient is saying, oh, it's not in my head, or I'm not crazy. Absolutely, and it's like in the world of thyroid, you cannot passively sit back and expect to get your life back, or expect to get a diagnosis. There are so many levels of failure of this system, what labs are they checking? What ranges are they using? What medication are they using to treat you with? You know, like there's so many layers where medicine has gone wrong, that if you're not empowered and informed enough to know, you're not going to be able to navigate that landscape. Okay, there's so much I want to dive in with you, and I can already tell you, can you talk forever, so much, try to focus on one important concept before we can dive into some specifics here, especially when it comes to the thyroid, I mean, truly for all labs, but especially the thyroid, the reference range that you see on the piece of paper, which is sometimes what providers are going by. The reference range is a population-based average, right? It is not optimal in any means, and especially for the thyroid, a different stages of your life or in clinical presentations, that's not the numbers we should be going by. Right, so usually they're based on lab ranges, like people that go to the lab, and they have their labs drawn, one, they're not excluding people with hypothyroidism when they're formally doing those averages. Right, right. It's population average. Right, whoever's going there. Who's going there? And who's who's going there? If we're going to base these labs off of that, is it people who feel so great, they want to take an afternoon off for the fun, right? Let's go see what my thyroid's doing. No, these people are sick, they're looking for answers, and now we're basing normal, quote, optimal ranges on them when they're not at all. You can absolutely be debilitated in, quote, normal lab ranges for thyroid. I was our patients are. Okay, for the basic definitions, I mean, I know this and I know a lot of my audience says, but this gets confusing because of some of the lab ranges. So let's just without giving numbers, hypothyroid versus hyperthyroid because when people are just screening for TSH, it confuses them versus D3, 2, 4, you want to kind of lay the stage there before we dive into it? Of course. So hypothyroidism means low functioning thyroid. Okay, usually that's correlated with an elevated and increased TSH. Why? Because your body is trying harder to stimulate your thyroid more. It's also associated with lower output numbers. So your thyroid gland is producing less, less free T4, less free T3. The inverse is what happens in hyperthyroidism or grades disease. Your TSH is low. Why? Because your thyroid doesn't need to be stimulated. Right. It's going where it gets hypercrecreting all these hormones and free T4 and free T3 are elevated. You know, 90% of the people are going to experience hypothyroidism. Hyper is much less common. When it comes to in your opinion, so we're going to go your professional opinion, obviously somebody who talks about the thyroid every single day of your life. When should we be screening for the thyroid? Is it certain symptoms that you recommend? Certain disease states? Should everybody get some generic screening? Like what if you could create it? I guess what would you say? Yeah. So every woman needs to be screened for hypothyroidism. But hypothyroidism often shows up in times of hormonal transition. So puberty, pregnancy, postpartum, parimenopause, menopause, those are like highlighted times where women should absolutely be getting full thyroid panels. Antibodies included because we're also at risk for Hashimoto's during those times. But every year, like when you go to your clinician for an annual checkup, you should be getting a full thyroid panel every time. I say it's about, and research backs this up. It's about 10 years from when people have symptoms to reach a diagnosis. And the more data points we get along the way during your life, the quicker we'll know when something starts to do. So why wait until you're debilitated? Right? Right? Right. And I think it's important for people to know that this is exceptionally important in certain circumstances, especially to your point when there's so much nuance in reproductive hormones and your whole body works together as a whole hormone communication system. So when energy is put in another area like growing a baby, postpartum, you're going to highlight other times when things are not going to function as well. But I think that for me, it's wild because the recommendation is for screening medically depends on which professional organization you want to go listen to, as to what a doctor may buy the books they do. And that's not very patient-centric always because in order to get into medical recommendations, something's got to be proven many, many times as to apply to the majority of people. And you're so big on this individualized approach, which I also love because I think, especially if we have unexplained infertility, irregular cycles, we were trying to get pregnant. We're going through IVF, for current pregnancy loss. The prevalence of having hypothyroidism or specifically Hashimoto's is going to be so much higher in those populations. Absolutely. Especially for women who are trying to get pregnant or trying to maintain pregnancy or about to go into IVF. And it is heartbreaking to hear you say that now at this point in time, they're not even screening everyone because research shows even subclinical hypothyroidism. Hypothyroidism that medicine says, "Guys, it's so mild, it's not bad enough yet. We don't need to treat it increases unexplained infertility risk by about 10 to 20%. Like it's a very big deal. It increases miscarid risk by almost double, especially in the case if you have Hashimoto's. These women deserve better when they're on their fertility journey, especially when it's something so easy as, "Hey, let's fix your thyroid. Let's optimize it before you move into this emotionally intense time, financially intense time." Like the cost of all of this is really a lot when we could simply treat your thyroid on the front end and minimize so much of it. And to be fair, it's relatively simple in the world of diagnostics because it's blood testing. In the world with the reproductive organs where a lot of the things we do are not simple to test. They're very invasive, they're really expensive, and that's a lot more of a complex decision-making because is it worth this expensive, risky test versus this is blood work, right? We shouldn't be the gatekeepers to it. And I absolutely agree. We see, especially with Hashimoto's disease, such a correlation with infertility and explain infertility, there's a higher prevalence of endometriosis, other autoimmune disease. I mean, chronic inflammation with autoimmunity plays such a role within itself. You might be shocked, maybe you wouldn't be shocked, but I am shocked at how many patients I see who carry a hypothyroidism diagnosis who, when I say, "Well, do you have Hashimoto's disease?" They say, "Well, I don't know. They've never had antibodies checked. That seems wild to me. Is that something that you see?" Oh, absolutely. It's, again, like for you to say that, it's especially disheartening because the implications are high in fertility, but the vast majority of people don't have their antibodies checked. If they do, they get them checked one time. Medicines, overwhelming view of Hashimoto's is, there's nothing we can do about it. There's no way to influence it. It doesn't really matter. We simply need to treat your hypothyroidism. I think fertility and pregnancy is such a canary in the coal mine because this is a group of people that can be representative of the larger population, but are more sensitive and manifest things earlier. If we know that Hashimoto's has huge implications for fertility, and we know that mild subclinical hypothyroidism, which I consider overt hypothyroidism, has implications in this population, hey, it probably also has implications in the larger population. Absolutely. Right? Yeah. You know, it's a little disheartening that we're not advancing our perspective of this still. Okay. I want to hear how you approach it. So Hashimoto's autoimmune hypothyroidism. So this means that you are thyroid gland, that butterfly shape gland in your neck, not keeping up with the demand to make those thyroid hormones because it's being attacked by antibodies. So you get this definition by essentially having positive antibody level. So the TPO or thyroid globulin antibodies. Right. And typically you'll have some lab abnormalities, right? But it not always. You can have positive antibodies and still have normal blood work. And it's still as important because so many patients will be told, well, until your thyroid gland stops making hormones, there's nothing we need to do about it. And I know your approach is very different. So will you lay out for us your approach to Hashimoto's and what you think about it? Yeah. So, you know, we've seen time and time again at modern thyroid clinic. And it also, you know, manifests in research that we can influence Hashimoto's. We can influence antibodies. I'm the perfect example. If you were to see a photo of me from 10 or 15 years ago, I had, no, 15 years ago, I had an enormous squater, a huge protrusion swollen thyroid gland. I was in severe Hashimoto's. My antibodies were over 600. I have not had positive antibodies in over 12 years. Look at that. So you can absolutely want achieve remission. And what that does is it protects the remaining plant from further being destroyed. Right. Why? You know, and even if you don't go into remission, simply reducing your antibodies is a manifestation of reduction in inflammation, less destruction of your thyroid glands. And you know this, but when you have one autoimmune disease, you're at an increased risk of developing another of over 30%. So if we could reduce those antibodies, we could extrapolate that that's a risk reduction for other autoimmune diseases. So it's like a win, win, win. And there's some kind of simple things that you can do to influence Hashimoto's. So what are they? How do we influence it? Because you're talking about changing the trajectory of your entire health journey here. If you can decrease this antibodies or this attack essentially on one of your organs. Yeah. So some ways that we like to use at modern thyroid clinic one is work on your gut health. So your gut is an inflammatory reservoir if you're inflamed, right? So that could be from food. So looking at, hey, what foods are driving inflammation for you? Looking for dysbiosis with the stool analysis? Are you having yeast overgrowth, bad bacteria overgrowth, not enough beneficial bacteria? Leaky gut. Looking at all of those things. So gut centric supplementing with salineum, 200 micrograms has been shown in research to statistically significantly reduce antibodies in 90 days. So something simple you can do, simple, safe, reducing iodine. I know so many people are like pump yourselves full of iodine, but actually that can worsen Hashimoto's and removing it can be an incredibly powerful way to reduce antibodies. And I don't know how much you get into this in the fertility world, but we use LDN or low dose now track zone. Yes. A lot for Hashimoto's. It is incredibly powerful. It manipulates your immune system in a way to lower inflammation, but not suppress your immune system. Because this win-win, super safe, very well tolerated, cheap, accessible. I've seen it reduce antibodies 500 points in three months. That's incredible. If you are not in the Hashimoto's world, you don't know. That's almost unheard of. What about thyroid hormones? What about thyroid hormone replacement? Yes. As a strategy here. You know, thyroid hormone replacement doesn't do a lot for antibodies, but it is pinnacle. It is key for improving your quality of life for being able to function, to thrive, to not be fatigued and foggy to influence your fertility. Thyroid replacement hormones are absolutely key. And they are the first thing we work at in modern thyroid clinic because people are debilitated with these symptoms. They can't function. They can't go and change their whole lifestyle. They can't become paleo for the rest of their lives when they can barely get up and put pants on every day. Yes. So you have to cover the basics. You've got to give back to living. Don't move. You can optimize. Totally. So that's what we focus on first is let's optimize hormones. Let's supplement these people with the hormones that they're missing and then turn their lives around and then work on lifestyle to reach out. do Sashi. I see some patients who are really resistant to thyroid hormones. Do you see this at all and why is that? I do, especially because we are what would probably be referred to as a functional medicine. Like practice, we take an integrated and alternative sort of viewpoint. Part of that is being able to influence Hashi motives. And so a subset of people come to us that don't want thyroid medication and they want to heal their thyroid naturally. And I think what's happening on social media, the world at large, there are lots of influencers, health people out there that maybe can't prescribe medication. You're being very health people, health people. Don't want to put any fingers. But you know, they're advocating for this concept of, oh, well, I can reverse your hypothyroidism, right? And to a consumer, to a patient, to a great, sounds great. And it's really confusing because we can reverse Hashi motives. That doesn't mean that you don't have hypothyroidism, right? Most people with true hypothyroidism, 90% of them have Hashi motives. They've lost thyroid gland tissue, right? It's no longer working anymore. And so even though I'm in remission, even though I haven't had Hashi motives in 12 years, guess what? I still take thyroid meds every day because I lost tissue that was supporting my thyroid hormones. So to those people, I specifically say, look, thyroid dysfunction is linked to even mild thyroid dysfunction is linked to cardiovascular disease, pre-diabetes, obesity, infertility, depression, cognitive decline, dementia. So supplementing those hormones protects you from all of that because if you don't, guess what? You're going to end up on lipitor. You're going to end up on a diabetes medication eventually, like all these sequela of having mild even hypothyroidism will add up to medications that aren't supporting your natural physiology. But if we can fix the thyroid, the root cause, it protects your long-term health. Because you're really thinking about a twofold approach, right? We have to replace what your body doesn't have. Like, hormones are necessary for life. So it's not just about medication or quick fix. You're trying to one replace what you don't have or what's not functioning well in a couple of minutes. And then two, how do you really optimize and decrease some of this inflammation and this attack that's happening on the thyroid gland? Absolutely. So for me, right, I see a lot of patients obviously they're trying to get pregnant and we manage thyroid in the first trimester. We know that having hypothyroidism is clearly associated with infertility, ovulation abnormalities, pregnancy loss, poor outcomes. And we even see this with subclinical hypothyroidism. So if you get a, we'll use TSH for the moment. So the hormone from the brain. Your brain is interpreting how much thyroid hormone you have, the T4 that's circulating around, saying, do I have enough? And sending out that TSH in response to it. So we know that your normal lab has this really big range for TSH. And for pregnancy, we want it to be in the low end of that. Meaning we want you to have some excess thyroid hormone circulating around because the moment you get pregnant, you need 30% more thyroid hormone because that baby is totally dependent on you. So we usually treat to get that TSH also in 2.5 if you're trying to get pregnant in the first trimester. Is that, and again, that's lower than what that reference range is going to tell you. Is that your approach to or how do you usually run? So I mean, we've developed our ranges for what we consider our patients in this. Right. Like, that's the thing is so for the last 10 years, we've analyzed and re-analyzed our data. Hundreds of thousands of pieces of lab data correlated them with symptoms. And over those 10 years, every 12 to 18 months, I narrowed those margins more and more based on that data. And what I found is if people get into these narrow, narrow margins, all within what medicine would define as normal, but if we can tighten and narrow them very, very intensely, people get their lives back, their health outcomes improve, their fertility improves. Right. So I want someone's TSH always less than 1.8. I love that. Ideally, closer to then to one, especially for people who are moving into pre-pregnancy planning, active pregnancy planning. Somewhere in that range, people are asymptomatic. They have pregnancy outcomes that are positive. They have reductions in their cholesterol, their blood sugar. All of these other markers start to align. I find people at 2.5 are perpetually symptomatic, even if they're output hormones are normal. What about when it comes to, and this is personally, I understand I'm in a unique sphere. So we want to reference this for people listening. I will tolerate people being overtreated because it's short term. So if you're trying to get pregnant and your TSH is really suppressed because I'm treating you as a little more and you're asymptomatic, I tolerate it with that knowledge that you're about to get pregnant and then you need this 30% more and then tie trade a little more when they're in the first trimester. But it's not good to be over-treated long term. We were even talking about before we went on air how being over-treated can actually be detrimental to your health. So is there a low end of the range you start to get nervous about? We'll say in the average person, not pregnant, not trying to get pregnant. Great question. So with TSH, no. Because we are not using TSH to indicate output hormones. We are not guessing what someone's free T4 and free T3 are by way of their TSH. Every single time we check labs, we get all the information. So we know, are these people hyperthyroid? And the definition of true hyperthyroidism is elevations in free T4 or free T3. It's not TSH suppression. So research shows about 35% of people have a mismatch between their TSH and their output hormones. So it makes so much sense because the brain is influenced by so many different things in our body. Your hypothalamus is interpreting your cortisol, your stress, your inflammation. Levels, so especially in this population or even in the infertility one, we're basing treatment decisions based on what your brain's outputting, yet half the reason you're in this position is there's a mismatch between brain and what's happening anyway. Amen. And I see that mismatch way more often than 35%. But the other thing that I think medicine hasn't caught up to yet is people on T4 base medications. So these are what 90% of people are on in the only thing. This is a centroid. They'll leave with Iraq's end. Yep. T. And once someone is on a T4 base medication and they don't use it well, which is a lot of people, meaning they're taking crude oil, but they're not converting it into gasoline. Okay. Essentially think about it like they're stockpiling crude oil in their garage, right? They've got a lot of it because they're not converting it to gasoline, which is what we want them to do. All that crude oil in their garage is sending a message to their brain saying, hey, we're good. We have so much thyroid hormone, lower their TSH all the while their T3 is their gastric is empty, right? And so once someone gets on a T4 base medication, TSH is incredibly unreliable and the vast majority of the time will not be reflective of T3 of even T4. Research shows actually TSH correlates to T3. Your most important hormone, less than 1% at the time. Oh my gosh. This is very validating because I'm always like ignore that TSH. You know, even though it's the number one screening thing we do or we're supposed to do, you know, in medicine and in the fertility space and they're even recommend doing it less. I live on the camp with you. That doesn't make sense to me by default. Anybody who walks into my office has a higher risk of having thyroid disease. And we took a full panel and with antibodies so that we can make decisions here. So it's validating because I'm always like ignore that. That, you know, if you're symptomatic or your other labs, that's a different place. That's totally different. That's what we're titrating to. And I do not advocate for overmedicating people. In fact, like we get criticized because we're so conservative, people don't need to be on excessive amounts of thyroid hormone to feel well, to have good health outcomes. They need to be narrowly controlled and not allowed to be too low to high, but they do not need excessive amounts of hormones. And that is it. It's not good for long term health outcomes. Whether it's T4 or T3 and infect a lot of research shows T4 is more problematic than excessive amounts of T3. It's so important that you say this because if you are struggling, if you are a woman and you hear this and you have, we'll say thyroid problems, there's this internal desire. Sometimes I think more is more. Like I must, like I don't feel good so I must need more hormone or more this or more that. And I think sometimes reflexively, people who don't understand the thyroid might just play into that. Instead of what you're saying is you need for you to be just very tightly controlled. Like we need to control all those factors we can, which medications are a huge part of it. There's all these lifestyle factors you mentioned in decreasing inflammation as well, but it's not just more as more. It's really targeting precision. Yeah. And you know, hormones are interconnected. So if you overdo thyroid hormones, you impact reproductive hormones. Like there's a cascade in the same way that your thyroid controls everything and can impact everything negatively about how you feel. When you overdo it, it also has implications for other systems of our physiology. So I agree more is not better. What are symptoms if we set back for a second that somebody should maybe be aware of like what hypothyroidism versus hyper. So you say these things are, I know you're about to listen to everything. These things are not normal. And there are things that you hear people coming in with yet have gotten dismissed so frequently. Yeah. The sad thing in medicine is we talk about so often how hypothyroidism symptoms are non-specific, right? Right. So that's not a bad thing. And to a degree, sure, that's true. But if you have fatigue, brain fog, weight gain, weight retention, inability to lose weight, hair loss, dry skin, brittle nails, brittle hair loss of the outer portions of your eyebrows, low libido, high cholesterol, high blood sugar, you know, these shifts and changes. And you have four or five, six of them. It's pretty specific. Like with pretty good accuracy, I can say, look, if it looks like a duck, it walks like a duck, it quacks like a duck, it's probably a duck. If you don't have anything but fatigue, it could be a slew of things. Right. But when the constellation of these symptoms start to arise, you probably have hypothyroidism. with thyroidism. And then hyperthyroidism over production of thyroid hormones leads to anxiety, palpitations, kind of trembling, heart racing, hair loss, weight loss, often the first thing that will show up for people if they wear like an apple watch or something is increased resting heart rate or they go to work out and they barely do anything and their heart rate is 190. Those are kind of the symptoms of hyperthyroidism. And most hyperthyroidism is actually from being overtreated or overmedicated. Is that right? Most hyperthyroidism right now? I mean, I would say yes, but true like significant hyper is gravestisies, which strangely we've seen an increase in the last few years post-COVID. It was kind of fascinating. I mean, all autoimmune disease has increased. Totally. Yeah. And ours is Hashimoto's and Graves. And Graves for us is such an important factor because we didn't see it very much before and now we see it, you know, every day. I guess we even talked about Graves for a minute here. But the management for Graves is different than Hashimoto's. Yeah. And Graves people have a particularly difficult plight, unfortunately, because they have too much thyroid hormones, medicines answer is to suppress those hormones. So they usually go from being hyper to hypno. Right. Go destroy the thyroid. Go either destroy it or suppress them with medication. Things like methamisol. And so they're living in these extremes. No one really hasn't offered for them where they don't have to. And that's really where modern thyroid clinic thrives. Couple of things we do for Graves is we immediately work to reduce their antibodies, which with Graves, the cool thing about it is the higher their antibodies, they're directly proportionate to the higher their hyperthyroidism. Their overproduction. So it actually goes together for this. They go together. It's really, really interesting. So if we can reduce their antibodies with lotus, now. Trexone, with these powerful mechanisms, you're going to lower their thyroid hormones. Lower their thyroid hormones. And then what we also do secondary, which is so important for these people to know, is if you have Graves, find someone who does what's called block and replace therapy. Okay. What that means is we put them on a little methamisol. We put them on a little thyroid blocking medication. We try to always spare their thyroid gland. And we make them hypothyroid to create stability just enough to just keep them from being on the Graves rollercoaster. And then we actually give them thyroid hormones. So they don't have to leave. So they're meeting in the middle. Yes. We have a better way to look at it. Yeah. Yeah. So they don't need to be hyper. They don't need to be hypow. And there's real hopes to keep their thyroid. A lot of Graves people, especially postpartum, will transition out of Graves and into Hashimoto's. And it will go away on its own. But if we remove their thyroid. It's a wild time for so many reasons. I totally agree. But if we can save their thyroid, it helps them long term so much. Nicole, you said this, find somebody who does this. Is that not something that's commonly done? The block and replace kind of a meet in the middle approach for Graves? I know one other person in the country that does it. Unfortunately. No. So this leads to the, how do you advocate for yourself? Right? Because if you say, I'm not feeling normal, I have a litany of symptoms. And this goes, it was like, even more if you also have, you know, a family history or anything like that. And you go to the doctor and you give them your symptoms and you ask about your thyroid and they say, okay, and they check a TSH only. And it comes back in the reference range. What do we do? We ask for a full thyroid panel. And if we're met with the slightest bit of resistance, we leave. We go find someone else. Why? Because the likelihood that you are going to change the way that this person practices medicine is, is pretty unlikely to. Let's say they oblige and they order a full thyroid panel. Just because you ask them to. Sure. They don't know how to interpret that. They don't know what to do with it. Right. And they don't know about progressive medications. All of these, these steps that you want to make sure that you're empowered with. If they're not on board with that and they're not already doing it, it's going to be hard for you to get to the end point that you deserve to be at. It's such a good point. It's partly due to training, due to interest, even due to health systems, things that are maybe out of the hand of that provider, even if they wanted to. They may not be in a position where they can care for you in that way or test or treat based on parameters that they have or restricted to them. So it's not always that people are bad or people are not interested. Sometimes it's the system is not set up for success. But you are an end of one and you're living in a population, right? So health care is meant for the population. So you owe it to yourself to go get another opinion. Really, really advocate for yourself and seek help. Absolutely. And you know, for women who I think have a harder time being heard seen in beliefs and medicine, I think it's just vitally important that we find people to partner with on our health journey that can actually move through this process with us, support us in the way that we need because it's incredibly valuable, especially for thyroid. And that's part of the reason, honestly, that now modern thyroid clinic is nationwide, right? Like in my lifetime, I want people all over the country to have access in one place. Right. That would have like been the need, but you probably had so many people reaching out who needed help in other areas. Gosh, yeah, we ended up it before we decided at the 9,000 person weightlust. Oh my gosh. Yeah. Yeah. Okay. I have a question that may be pseudo controversial. Love this. Okay. I'm good at gas, right? I'll say I love I'm I'm big on precision, I'm big on data. So to me, if we're replacing, we're going to want to manipulate multiple data points. So, you know, you have your T4 replacement, you have your T3, we're trying to get to the magic spot. What is your thought on, we'll say like, I'm a thyroid or people who are what is armor thyroid? What should people know about certain other options for thyroid hormone replacement? Yeah. So armor is a form of what's called natural designated thyroid. It's also the type of medication that NPS and run thyroid is. It's the oldest existing thyroid medication. It was around for a half of the century before Levy thyroxene based meds came into play. It's called natural because it comes from pigs. It comes from the gland, the thyroid gland of pigs. It is about 60-70% T4, 30-40% T3. I love it. It changed my life. I think it has to be used by someone who knows how to use it. Sometimes, you know, I get the comments in social media, oh, well, I tried armor. I tried when thyroid. It didn't work for me. That's kind of like a diabetic saying, oh, well, I tried insulin. No, it's got to be the right medication at the right dose at the right times, right in the right hands. It has to be done in a nuanced way. This is not one-size-fits-all medicine. It's actually way more complex than medicine realizes. And so you've got to have the knowledge of the provider that's on on board to do that, but they can be incredibly life-changing because they do in fact contain T3 in them, which I think the vast majority of women in our country need access to and hardly anyone has access to that. Is there a way to get T3 without? I go there are T3 isolated medications like there are T4. Absolutely. So a medication called Cytamel, the generic is lyothyronine for people who are on synthroid, libethyroxene, unithroid, who are on inactive T4-based medications. Adding T3, adding Cytamel to it is the quickest people. This is the quickest way these people can get better. Like, they're usually missing this hormone. They're not converting enough of their crude oil to gasoline. Let's give them some gasoline and really quickly it can change their lives as opposed to taking someone on a large amount of synthroid and then trying to convert them to natural desiccated thyroid, which is very complex. Adding T3 in can be incredibly powerful and some people honestly have such poor conversion the only thing they need is T3. So what I'm hearing here and I love it is that there's multiple approaches, right? So you can have this combined yet there's some maybe limitation depending on your unique state as far as giving them individually for somebody who's already on a high dose. They may feel worse before they're better. That may not be worth it for them versus trying to just add on. And a lot of individualization here, which big medicine is not good at, right? Because we like protocols and people trying to put you into a box and you're really talking about the opposite. Yeah. Really trying to individualize it there. Is there anybody, you know, pregnancies a unique time because we usually want to make sure people are on some type of T4 alone because of how it crosses the placina and really protects the baby in that aspect of it. Do you have patients who are on T4 only or do you put most patients or all patients on some form of T3 too? All of our patients are on some form of T3. So, you know, I think people that do well on T4 only, they don't really need us. Like they can see their primary care doctorate. So they can see an inter-conologist, right? Selection bias. So it's not that everyone needs T3, but they don't need us. And, you know, even our pregnancy patients are on some form of T3 most of the time. Yes. We just can't get off the T4. Right. Oh, no. And we emphasize T4 because T4 takes precedence. The baby's health takes precedence. Are you, but you know, you're special and unique in an expert and there's a lot of people who might treat people with T3 only and they tell, even pregnant patients, they don't need any T4. Yeah, that's scary for me. That's terrifying. I even think desiccated thyroid in the hands of someone somewhat educated about it is still dangerous because of the short-acting nature of the T4. Women who are pregnant need access to long-acting sustained T4, like levothyroxene, synthetic, unithrolythlovoxyl, T3, these are not to demonize these meds, especially in pregnant women. They need the T4. I love this. I want to reiterate it one more time. The placenta is the most fascinating organ in the entire body. And when we just want to think about medications or hormones, not everything can cross it, has to be stable enough and live long enough in your body to get metabolized and cross through. So the game has changed when you're pregnant. I think for thyroid patients, they sometimes get nervous because maybe they're on a regimen and yet we sit across from them saying, your hormones are going to change, your needs are going to change, but also our goal has to change a little bit. to because we also have this other life that we have to protect. Absolutely. So I love hearing you kind of frame it and I know, I mean, I knew your approach before I asked the question, but I think that's important to hear because people are going to be hearing this at all different stages. And yet if they're being told by somebody online that they, T3 is the only thing that they need or that matters because it's the gasoline, you don't need any crude oil, that narrative is dangerous in this case. And honestly, that narrative is dangerous in a lot of cases because what now kind of newer practices are doing is, are they are hyper elevating people's T3 suppressing their T4, which is not okay. Like your body needs consistent access to T4, T3 is incredibly short acting. It's incredibly, incredibly volatile. And so if you're running out between your doses overnight, in between doses, your body is going to be compromised in innumerable ways and that's just not the right way to do things. You and I both really blend like holistic medicine and, you know, evidence-based medicine. It's like the perfect place to be where there's not very many of us to be honest, but I'd love to talk just the last minute about some of these, you know, lifestyle recommendations that can really decrease inflammation. And when it comes to autoimmune disease or thyroid function that I know, you know, you talk about. So when it comes to certain things, you mentioned, you know, the gut microbiome, gut health, what type of other certain foods to eat, a certain type of dietary pattern, I have a feeling you're saying anti-inflammatory eating is going to be what's important here, but how do you counsel when it comes to let's approach diet for thyroid health? Yeah. So I want to kind of tease out the two mechanisms. One is autoimmune thyroid issues like Hashimoto's graves and the other is thyroid function. So for autoimmune thyroid issues, definitely there's a pattern that I see. So we test food inflammatory results. We do it via IGG inflammatory testing. And I just kind of have looked at that over the last 15 years to understand, are there patterns in this population, right? And there are like I don't like to put everyone on a one size fits all diet because not everyone needs to be on this specific diet. But when we think about foods from most inflammatory to least inflammatory for thyroid people, number one is dairy. I thought it was going to be gluten too. That's not. I see dairy like three times more than gluten, number two is gluten, number three is grains, number four is legumes, number five is eggs, and number six is nuts and seeds. And by the time you get down to nuts and seeds, it's like 5% of people. It's not very common. So most people do not need to get rid of all of those things. I would say, hey, maybe go dairy free. Check your antibodies on day zero, recheck them on day 90. If they reduce the owner of one experiment, right? Test and retest. Don't just guess, right? Same with gluten. If dairy doesn't do anything, try that. Try not to be over restrictive. Try to incorporate in micronutrient dense vegetables and fruits, protein, right? Those sorts of things. When it comes to exercise, don't overdo it, strength training, walking yoga, even Pilates, but stay away from CrossFit when you're early on in your journey. Stay away from high intensity interval training. Anything that's going to increase inflammation, essentially? Totally. Absolutely. And when we think about hypothyroidism, so much of the lifestyle modifications for this are tailored to the activation of your thyroid hormones. So we've talked a lot about the crude oil hormone becoming gasoline. That's the end goal. When your body halts that, when it stops the activation of your thyroid hormones, it does that on purpose. It's not like to punish us and make us suffer needlessly. Then our body wants us to go into recovery mode when it wants us to lay down the rest and recover. It makes us tired. So we do that. So think about it. It's caloric restriction. It's inflammation. It's stress. It's not sleeping. It's pregnancy. It's postpartum. It's overexercise. I've seen it severely with overexercise. So the things that your body is asking you to recover from are halting the activation of your thyroid hormones to make you tired. So you do so. Because it's one of your metabolism. It's trying to slow you down. So it halts this process. Exactly. On purpose. So if you reverse engineer that, you mitigate stress. You get enough sleep. You eat a low inflammatory diet. You don't overly calorically restrict. You nourish your body with protein and micronutrients. You don't overexercise. You can facilitate the activation of those hormones to a degree. I love you. I also just love, you know, the world is so connected here. And I feel like we're just bringing it together because, you know, I talk all this about inflammation and fertility. My life's self-factors that are going to help you get pregnant faster, anti-inflammatory eating, you know, not long periods of caloric fasting. We want to build muscle, not do the high intensity all the time. We want to sleep better, manage stress. We're all saying the same things. And it's not coincidence. It's really because of this underlying, how chronic inflammation or the physiology of your body, especially as a woman, your brain is made to send out hormones in response to your ability to get pregnant, which means it's waiting to make sure you're at a right state to do that. You're not encouraged enough, you're not stressed enough, you're getting the nutrients, you're getting the rest. And when you're not, your body is meant to protect you. So it will stop sending out the hormones to ovulate. It'll stop the conversion of your thyroid hormone to make the gasoline because it's trying to prevent you from getting worse. It wants you to slow down trying to get you to rest. It's fascinating. And I love it. And I love you for being here and bringing it all together, especially for the thyroid. I want you to talk about where patients can find you. But I also would love it if you would because it's, this episode will come out a little bit of time and you're going to be very soon pre-selling a book that you have coming. Do you want to tell us a little bit about it, like an exclusive pre-look at what that's going to be? Absolutely. I've never told anyone the name of the book publicly. So here we go. It's coming out on Penguin Rain of House or with Penguin Rain of House. It's called Take Back Your Thyroid. Love it. I know. I'm so excited. And basically it is everything that a person needs to know to be informed and powered to navigate this complex landscape in a way that allows them to get their life back. Like the thing about me is I don't hold anything back. Like I don't want the only people I'm able to impact are to be our patients. I want people to take the information I share and successfully navigate this at home with their clinician if they're able and willing, you know. And so this book does that. I also hope to a degree that it challenges a little bit of the medical paradigm. And I spent a lot of time looking at the research and analyzing it and included it there as well. So I think it can also support clinicians. So stay tuned. And early 2027. I love it. So it will be released early 2027. We'll be able to pre-order it soon. And I think it's so important. And I live in this space too. Change for the medical institution has to come from, you know, both within but also externally from patients advocating for better care for demanding that women shouldn't have to fail first before we get attention paid to us. We should have to feel terrible before we're eligible for testing or treatment. I love how you educate and advocate and thank you for spending time with us here today. Thank you so much for having me. Thank you for listening to this week's episode. I'm so glad that you are here. And if you're ready to take the next step in your reproductive health journey, my book The Fertility Formula is for you. It's a science-backed guide to understand your hormones, optimize your fertility, and owning your reproductive future. You can order your copy and receive immediate access to the pre-order bonuses that I made just for you. This includes the Hormone and Lifestyle Guide, the IVF course, and access to the exclusive book club with monthly live Q&As. The Fertility Formula is available for sale on April 14th and I can't wait for you to get your hands on it. Learn more at NatalieCroffordMD.com/book and as always, follow along at NatalieCroffordMD for even more because knowledge is power and your health deserves a formula made just for you as a woman. Do you enjoy listening to the As a Woman podcast? If so, check out the resilience factor brought to you by The Pinnacle Network.