Well, hello ladies and gents. Robert Sykes, Keto, savage.com.
And today I've got special guest Doctor Amy Horniman on the line
and we do a deep dive into thyroid health and function.
This is a topic that I get a lot of questions on from both
clients and just the general community.
Maybe they're doing everything right.
Nutritionally speaking, their training's dialed in, but
they're not seeing the results they want and they think it may
be hormone related or thyroid related.
And I really wanted to just peel the curtain back on what the
thyroid is, what it does, how to medicate properly for thyroid,
thyroid function if need be, what test to get done, how
frequently get those tests done, and just all things proper
thyroid health and function. So if you are in that category,
if you have got everything dialed in it or not seeing the
results that you want, that may be the reason.
So grab your pen and notepad, take some notes, take this
information and act upon it if need be.
I've got no doubt that you will take something from this so that
for the delay, sit back, relax and enjoy the conversation with
Doctor Amy Horneman and we are live.
Doctor Amy Horneman, how are you today?
I'm good, Robert. How are you doing?
I'm doing wonderful. How was your Christmas?
We're recording this like couple days after Christmas.
Oh yeah, it was low key, low key.
So I didn't have a bunch of people bringing cookies over,
which is always good for for the nutritional aspect as you know.
Yes, yes. The temptation of the holidays
gets a lot of people and just simply bypassing that, keeping
it low key and staying on top of your nutrition is makes
everything much easier going into New Year's.
It just does. It really does.
So I want to do little back story here.
I've had several people on the podcast.
I've been on your podcast. Many of the people that I've
brought on have been, you know, experts in hormonal health, both
male and female and many of which have background in thyroid
health. And The thing is, like, I've
recorded so many podcasts, I don't even know what episode
this is going to be, like 600 something.
But people, clients, people I talked with, they asked me these
questions about thyroid health specifically.
And I I say yeah, I had talked about it a little bit on this
podcast with so and so and a little bit on this podcast with
so and so I would love for this recording that we're doing right
now to be like my stand alone, go to like if anybody has any
thyroid questions I just simply say check out Episode X with Amy
and you'll all, all your questions will be answered.
So can we do that? Yes, let's do it.
I love it. Perfect.
Before we dive into all things thyroid, what makes you an
expert in thyroid health to begin with?
Well, we can go back something like let me see, 30 years and at
one point in time I was competing.
We talked about that on my podcast as well with you and I
was competing in fitness and figure competitions and as you
know, as your listeners know, it's rigorous, it's it's a
strict diet, you're going to the gym.
Back then, it was twice a day, cardio twice a day.
And I had done plenty of these. I'd I'd done plenty of shows.
I had done photo shoots. I was doing fitness modeling.
So I had dieted down over and over and over again and I knew
how my body was responding or should respond.
And this one particular show, I was getting ready for the Mr.
Pittsburgh and checking in with my coach, you know, stepping on
the scale, giving the weekly updates.
And I would step on the scale and it would be up 5 lbs, ten
pounds, 15 lbs. As you know, you start going,
wait a minute, I'm not doing anything wrong here, you know,
do we have to change the diet? Do I have to be more strict?
Do I have to go to the gym three times a day?
It didn't biologically make sense.
Even if you don't believe in calories in, calories out,
which, you know, we don't. But there still is an in general
rule that when you're eating chicken, broccoli, asparagus and
a sweet potato and hitting the gym twice a day, the scale
shouldn't be going up. So I was, I mean just, I was
really frustrated. Obviously.
I was perplexed, but I did what we all do.
I went to my doctor and I said, you know, here's what's going on
with me. I'm also very tired, but the the
scale going up is just it's it's driving me crazy.
This shouldn't be happening. And they did some tests and they
came back with your normal, everything is fine.
So if you saw me, I'm just doing air quotes right now.
Normal. Everything is fine.
Then I left there and of course I was frustrated.
I'm like, wait, this doesn't. No, I'm not.
Normal things aren't fine. This isn't right.
And I kept plugging away, getting more and more strict
with the diet, and got on the scale again. 25 lbs now, 25 lbs
heavier while I'm in competition prep mode did not make sense.
Now I'm becoming depressed. Now I'm actually starting to
lose hope, and I kept going to different doctors.
So Dr. #2, it's all in your head.
Dr. #3, eat less and exercise more.
That one I love. So I'm like that.
Yeah, it's not even possible at this point to eat any less or to
exercise any more than what I'm already doing.
Then doctor number 456, all within the medical gaslighting
terminology, right? It's in your head.
You're just getting older. I was in my 20s.
Everything's fine. You're normal.
Finally, one doctor touches my
throat and says swallow, This is Dr. #7 touches my throat and
says swallow. And she says you have
hypothyroidism, you have a goiter, you have a nodule on
your thyroid. We're going to, we're going to
do an ultrasound. And we also found out that yo,
you have Hashimoto's, the autoimmune form of low thyroid
function. So I was pumped up.
I'm I I left the office. I'm like, yes, I have a
diagnosis. She gave me a pill that I
thought, this is it, I'm going to lose the weight.
I'm going to feel better. This is awesome.
And I gave it five months and did not lose a pound.
Did not lose a pound. I was think I'd be more and more
depressed. I mean, just, you know, you you
go to the gym, you start to wear sweatshirts because you feel
like everyone's judging you. Oh yeah, she used to compete and
she used to do fitness modeling. And now look at her.
She's hitting those doughnuts a little bit too hard.
She couldn't do it and that wasn't the case.
And so, you know, a lot of just self loathing and blaming and
and shame came with that. And you know, I dealt with it
for five months and I kept hearing the name of this
functional practitioner. Back then it wasn't even we
didn't even use the term functional.
It was integrative alternative, whatever the terminology was
back then. And I kept hearing the same name
over and over and over again. I'm like, OK, maybe I need to go
see this guy. This is a message.
So I went. He sat with me for 90 minutes.
That was crazy. I mean, every other doctor spent
5 minutes with me. He sat with me for 90 minutes
and he did all this tests, all this testing, and he had it all
out in front of him, laid out. And he's going through my
symptoms and asking me how I'm feeling and pairing that up with
the testing. And he's saying, well, here's
what we need to do. You know, you're on Synthroid,
which is T4 only, and we'll talk about that.
You're on Synthroid and that's the inactive thyroid hormone,
and that's all you're on. And here you have a conversion
problem. And so we need to change up the
medication. We need to add in some
supplements, let's change up your diet a little bit.
And it worked. And the pounds came off.
I mean, it took, took time. It took like 6 months to a year.
But I got back to being me and back to being myself.
Now. At the time, I was in
Pittsburgh, PA, a major medical hub for for, you know, UPMC
health system. It's huge, huge.
It's like, you know, Mayo Clinic, Cleveland Clinic, UPMC.
And I thought to myself, if I'm in this large town with a major
medical system, all of these specialists that I went to go
see metabolic specialists and no one can give me an answer.
How many other people are out there suffering?
How many people are stopping at doctor number 2345?
After five doctors, you're like, well, you know, probably right
there, I mean five different doctors are telling me that I'm
normal. Maybe I'm normal, maybe it is my
fault. And and that's what changed my
career path because I thought, you know, this is unacceptable,
first of all. And in if I am in this on this
roller coaster, how many other people are as well.
So that's why I changed careers, got multiple degrees, and I'm
here doing specializing in thyroid hormones.
I love it. I love it.
So when you were able to recover over that six month year span,
did you change anything else? Like, did you change your
nutrition, your training? Or was it pretty much just
exclusively shifts in thyroid function?
Oh gosh, that was so long ago. I remember doing some changes to
my nutrition, but since I had that pretty much on points,
there wasn't any, there wasn't major changes that that needed
to occur. And I get patients like that all
the time because they're really, they normally come to see me on
a really good diet. You know, sometimes we have to
tweak it, especially if we're seeing some insulin resistance
or whatever change up the carb content, the macros.
But but I was pretty good. It really came down to getting
my thyroid optimized and doing some nutrient support, some
different supplements to do nutrient support that he put me
on as well that that move the needle.
So if somebody is going through something similar, they've got
let let's say they've got their macros dial in, let's say their
training is optimized. What would be some telltale
signs that hey, it's beyond that, it's somewhat hormonal,
it's thyroid related, like is it going to be mostly just them
seeing the weight not coming off?
Is it like a certain phenotype with how they feel?
It it, it can be a multitude of symptoms or it can just be a
couple. So the big thyroid red flags
are, yes, weight gain or just the inability to lose.
A lot of people will stay stagnant at a higher weight that
they've they've put on the weight, they're staying
stagnant. They're doing all of the things
that should really work, the diet, the exercise, the
biohacking, the whole thing. And and it's not coming off.
There's also fatigue and this is kind of more like a you can't
get through your day fatigue, that crushing fatigue.
It's it's where you're staring at the couch at 2:00 in the
afternoon going please like if I can just have 1/2 an hour to lay
down, like I can't get through my day.
Constipation, hair loss, low libido, just loss of motivation
in general. And it it becomes really hard to
work out when thyroid problems go for a really long time and
they're not caught. A lot of times I'll hear people,
my patients will say, you know, I really try to work out, but if
I do a 1520 minute hard workout, I'm done, I'm done for the day,
I'm done for the next three days.
Recovery times are really low, dry skin, brittle nails.
I mean those are the big ones you have to think of when we're
talking hypothyroidism, think hypo, low and slow.
So if you think of all the different processes of your body
slowing down South gastric motility, IE Constipation,
energy down, mitochondrial function low and slow ATP
production down, metabolism down, hair growth down, mood,
depression. Low mood is a big one too.
And a lot of times people will be prescribed antidepressants
instead. Again, that's another symptom of
low and slow thyroid. What are Is it like an age
demographic where this seems to be more prevalent, or is it just
across the board, all all different ages?
There's a little bit of a of a demographic component to it, so
it does hit women more than men, Although whenever I see my men
get hit with hypothyroidism, Hashimoto's, it always effects
their testosterone levels. So we can go down that rabbit
hole and talk about that, but women more than men.
And it's because testosterone is actually very autoimmune
protective. So testosterone can reduce
antibodies. So whether we're talking about
Hashimoto's autoimmune thyroiditis or we're talking
about different autoimmune conditions like celiac or
Crohn's disease or rheumatoid arthritis, testosterone is very
protective. So men in general, even if
you're a male with low testosterone, you still have
more than a female with low testosterone.
So as our testosterone levels drop and we just have less in
general that makes us more prone to autoimmune conditions to that
Hashimoto's light switch turning on.
And then the other things that we'll see is pregnancy, hormonal
shifts, big life stressors that will turn that switch on as
well. So it tends to hit women more
than men and I would say it tends to show up more in late
30s to 60s. But I mean believe me, I will
get patients in their 20s, I'll get patients in their in their
70s, they just finally want to be optimized.
So you know, those are the outliers, but I would say mainly
between if we had the baby, I'd say between 40 and 65.
For the for the guys you know their testosterone's likely for
for many of them is going to start declining at a gradual
rate as the age not near the drop off that women around
menopause see with that slight drop off in males over time.
Any issues that they experience with regards to fatigue, low
energy, low recovery, things of that nature, low libido, they
can most likely attribute that to that drop in testosterone.
Not so much thyroid related. There may be thyroid function
there, but their their first bets probably going to be
testosterone related, right? Definitely.
But we always want to check the thyroid because, yeah, as you
know, as you've talked about, I mean low testosterone, it it
goes down just as we age. But then just all the
environmental and lifestyle factors that can plummet our
testosterone further, you know, food quality, the whole deal.
We can go into again, a whole rabbit hole there.
But we always want to go back and check thyroid function
because what if the thyroid being the master gland, it's at
the top and it's regulating sex hormones.
What if that's low And then we just start piling on TRT, which
I have no problem with. I love testosterone replacement.
We start giving that guy TRT testosterone, and you know, he's
just not getting better and that number just isn't going where it
should. Let's go back and look at the
thyroid and make sure that there's not an underlying
problem. I think sadly, a lot of these
new TRT clinics that are popping up are just simply prescribing
testosterone and they're not looking at thyroid function at
all. So if you're going to get any
any hormone replacement therapy, I would recommend getting a full
gamut of tests across the spectrums that you can tease out
any variables there. And and I'll add to that too,
the other thing that I've heard from my male patients that have
gone to the the clinics, like you say, they'll actually be
told they'll they'll they'll be tested and they'll be an obvious
thyroid condition, low thyroid function.
But then they're told all you need is testosterone that will
take care of your thyroid. I'm like, wait a minute, great,
Can we rewind? Can we do both so that we can
help this guy? I mean, just giving testosterone
is great, but it's not going to automatically bring up your your
free T3 to an optimal level. So that's the other thing that I
want your listeners to be aware of if they hear that.
Totally, and it makes sense with the female demographic.
If testosterone is protective towards thyroid function,
they're going to have significantly lower levels at
baseline even in the younger demographic.
So that can be just an easier gateway for that thyroid
malfunction to take hold. Exactly, exactly.
And even hormonal shifts, Puberty.
You know, sometimes that Hashimoto Switch will turn on
during puberty. Sometimes it'll turn on the the
PS puberty, pregnancy, hairy menopause, and then menopause.
That's when we'll see a large majority of of symptoms start to
resent themselves and women because of those hormonal
shifts. What do you think the the
primary catalyst is for this thyroid malfunction in society
these days is coming from? That's a great question.
I've I've thought about this a lot actually and and especially
with autoimmune and we're seeing a almost a a surge of autoimmune
conditions in general Hashimoto's and and the like.
And I really think it comes down to we are living in a world now
where we've lost control of the quality of food.
I mean, I'll even go so far as to say unless you're landing it
and farming it yourself and if you can, God love you, right?
That's the only way you have total control unless you're
you're you're raising your cows and you're going out and killing
deer, which you know we do to. But to a point, you know, I I
still have to buy organic fruits and vegetables, 'cause I'm not a
good gardener, I'll I'll kill everything.
So I have to rely on the fact that that is labeled organic and
that there's no overspray from the farm next door who uses
pesticides and you know that it that it really is organic.
And I I think we just the soil composition, we're losing
nutrients, we're we're losing micronutrients that are required
for thyroid function and for overall protection and support
of our body and our immune systems.
So I just think if we, if we just look at the quality of our
food right now, I mean there's a huge answer right there that's
going to spur on a ton of autoimmune conditions, the
toxins in our environment. I mean, come on, we all know the
stats. We've heard these stats that we
can look at an umbilical cord and find what is it, something
like 150. I might be low, maybe it's 250
different toxins in in the umbilical cord before the baby
even enters the world and gets exposed to the air and the water
and the the Glade plugins that mom and dad have in the house,
they're already loaded down with toxins.
I mean, what is that going to do to our bodies?
What's that going to do to our immune systems?
It's going to throw everything off.
So yeah, I would say food quality, toxins, stress levels
nowadays, lack of sleep, EMF, exposure, all of the things that
that your audience hears you talk about.
Just put that all in a bucket and there you go.
There's your answer as to why we're seeing more thyroid
problems and autoimmune conditions.
Yeah, we definitely live in a pretty toxic environment.
You have to yeah, once. Once you start diving down the
rabbit hole, like you often times start with nutrition that
leads you to all the environmental exposures, the the
shampoos, the conditioners, everything that you're putting
on your body with the skin being the receptor to all that.
I mean it it the rabbit hole goes very deep for sure.
If somebody is aware of all those things and they're doing
everything quote UN quote right and they're still experiencing a
lot of these issues with autoimmune hyper hypo, what what
gives? There's just simply a imbalance
in the dosage that they're taking in.
Or what would be the fix if they're still experiencing a lot
of this chronic fatigue? You mean if they're already,
let's say they're already diagnosed and they're being
treated kind of like I was, I put on some kind of thyroid
treatment? Yeah.
Is it just simply incorrect treatment patterns on on their
prescriber's part or what's going on there?
Yes, many times it is. So like I told my story, I was
put on on T4 and now T4 is the is is inactive.
So your thyroid gland makes 2 thyroid hormones T4 and T3T4 is
inactive. T3 is active.
So T your your receptor sites on your cells only have a
connection for T3. They do not have a a lock and
key mechanism for T4. So that T3 has to get to the
cell and make a connection and turn it on, whether turning on
your metabolism or your. Your mitochondria, your energy,
whatever it is, you need that T3 at the cell level to turn it on.
So if we give someone T4, and in my case, I had what was called a
conversion problem, meaning that T4 has to become T3 in order for
it to get to the cell and turn it on.
I didn't convert well. So multiple things come into
play when we're talking about conversion, insulin resistance,
estrogen dominance, underlying infections, micronutrients,
deficiencies like magnesium, iodine, selenium, vitamin D
there's a a slew and even genetic snips can can be present
that impairs the conversion of T4 to T3.
So when you're not converting very well, you need a dose
change, you need a medication change.
And in my case, I needed to add in T3.
And actually ultimately during my journey I found out that I
don't convert at all. So I am actually on T3 only.
I just take the active thyroid hormone T3.
If you give me T4, bad things happen, all the symptoms come
back. So it could be that you need a
dose change, a Med change, a complete overhaul.
We need, you know, we might meet, need to bring you to T3
only or maybe use a little bit of T4 with T3.
It's very unique to each individual, but it's about
sitting down and finding out why are these symptoms still
present. If you're being treated, why are
they still present? And then that leads us to are
you being treated properly? And if not, let's change that up
so that we can give your body the hormones that your body
needs. But at the same time, of course,
look at nutrient deficiencies and what you're eating and
nutrition so that you're doing it all together.
Because we certainly don't want to fall into that mindset of,
OK, well, just, you know, give me that T4 and T3 and I'll be
good to go and I can eat whatever I want, 'cause now I'm
going to have a good metabolism. No, it has to all work together.
Right. Totally.
What? What are some like when when
someone goes into a clinic, they're getting these these labs
drawn. What do they need to make sure
they're testing for so that they can cover the full spectrum and
ensure that there's not any blind spots?
This this is the important part exactly.
So the testing is the key. And in my case, like I said, I I
wish I could see what tests they actually did on me.
Back then when I was seeing doctor doctors number one
through 7 who all told me I was fine, My guess is that they only
tested TSH. Now TSH is a thyroid test, but
is it is a pituitary hormone. It's thyroid stimulating hormone
and it's released by your pituitary and it signals the
thyroid gland to produce more thyroid hormone, more T4 and T3.
See, because your thyroid gland will produce both.
It'll produce the inactive and the and the active form.
And if TSH goes up, it's kind of like it's it's screaming at the
thyroid. It starts talking louder and
then it gets even louder and then it starts screaming at the
thyroid. Hey, you're not doing your job.
Let's do this. Let's produce T4 and T3.
Come on. So when we're looking at TSH and
it's high, that's a no brainer. OK, Obviously this person has a
thyroid problem. The brain is signaling the
thyroid to make more, and it's not listening.
But if TSH is in the normal range or even in the functional
medicine optimal range, we still have to test further.
So we want to test the free T4, Free meaning unbound it's ready
to be. In T4's case, it's ready to be
converted to T3. We want to test free T3.
We want to test the unbound form of the active thyroid hormone
that is present in your blood ready to attach to your cell.
We also want to test something called Reverse T3.
Now Reverse T3 is the anti thyroid hormone.
It acts like a bouncer at your cell door and if Reverse T3 gets
too high, and I don't mean flagged high on your labs, I
mean high per functional medicine optimal ranges which we
can talk about. But if Reverse T3 goes up and
starts climbing, now you have these bouncers right outside
your cell door telling T3 that it can't get in.
No, you can't come here, you can't attach to the cell, you
can't do your job. And and that's a test that it's
very interesting for me to hear this over and over again from,
from my patients and from my community.
Their doctors will tell them it's not needed.
Oh, that's only needed in a clinical setting.
Meaning like if you're dying in the ICU or the ER, then we'll
test your Reverse T3, to which my argument is, well, OK,
Reverse T3 is a survival mechanism built into our bodies.
Thank God we have it. Because when we are injured or
or biting for our life, Reverse T3 will go up because our bodies
are so smart and our bodies know that when you're trying to
survive, you don't need to burn fat and you don't need to feel
good and you don't need to grow your hair, you need to survive.
So Reverse T3 will shut down all of those other systems to funnel
the body's energy to healing and survival.
But here's the problem, and here's what I would argue with
these docs that say that it's not needed.
What if you're walking around trying to live life, raise a
family, do your job, you know, do some errands, whatever, and
your Reverse T3 is high. So you're walking around in
survival mode, your body thinks it's dying, and you're going to
feel like you're dying because that Reverse T3 is too high.
So we always, always, always have to test that.
And then we want to look at TPO and TGA antibodies.
These are the markers for Hashimoto's.
This just tells us, do you have an autoimmune condition?
Do you it? Does your body think that your
thyroid gland is a bad guy, is an invader and regularly sends
out soldiers to destroy the invader?
Do we want to know? We want to know if your body is
kind of just a little bit confused and thinks your thyroid
is a bad guy and it cracks me up.
I will. I will actually see those that
get tested. I'll see doctors test one out of
the two Hashimoto markers. I'm like, you know, there's two
markers for this. Let's test both of them.
So you really want to get that full testing, that full picture
of your thyroid in order to properly address and treat?
So just to just to clarify, there's six tests total TSH,
free TS3, free TS4, what were the last two?
Reverse. T3.
Yeah, so free T4, free T3 and then yes reverse T3 and then TPO
and TGA antibodies those are the main ones.
Some some practitioners will test total T4 and T3 which is
fine. I mean, those are just add-ons,
but it really it's the free versions of those thyroid
hormones that are most important.
So if you're getting any type of initial HRT treatment, or if you
have any issues with your thyroid whatsoever and you're
not testing those six, then you need to really suggest to your
doctor that you need to test for those or find a new Doctor,
basically. Exactly.
And that's actually my rule. So if your doctor says no to
testing, it's time to find a new Doctor.
Because if they won't even test you as their patient to really
see what's going on inside you, and especially if you have
symptoms that you're like, hey, this is reducing my quality of
life and ruining my life, they should care enough to dig deep
and really figure out what's going on with you.
And if you don't test, then you don't know.
Totally. And these are all tests that
people could also get through third party like LabCorp or
Quest Diagnostic Center if they wanted to go totally outside the
realm of a family doctor, correct?
Absolutely, Yeah, you can order your own labs.
The problem is, and it's a great place to start, just to kind of
get that snapshot and see, you know, do I have something going
on. The problem is if you what if
you do what? If you do have something going
on, well at least you know. Now I have to find someone that
can address what I'm seeing in these labs and address the the
low function properly. And you mentioned a few times
within the the range of functional health care, ideal
optimal range. A lot of people don't realize.
But the when when they go get a lab test and it says OK, you're
in range and doesn't flag it red unless it's out of that range,
That range is oftentimes totally skewed by what the general
populations range is, which shouldn't take much convincing
to know that the general population is not a very healthy
demographic anyways. Bingo, exactly.
So when we when you look at your labs and you see that that range
off to the side, if you are below that range or above that
range, you'll get, you'll get the little L, the little H it'll
be red like you said. And that standard lab value
range was taken from the general population, no one at any point
of time weeded out the obese, the sick, the diabetic heart
disease, nothing. They just took a general
population standard lab value range.
And in functional medicine we say give me your fit, your
healthy, your badass people that are rocking life at the age of
50. Sixty 7080.
Let's test them, see where they're at.
And that's where we want everyone else to be.
So that's how we get the functional medicine optimal
range. It's It's more narrow than the
standard lab value range. Is that range available to the
public? Like, can they go somewhere
online and figure out what that ideal range is for their
demographic? I've never seen it just kind of
put out there except from functional practitioners.
Like we have a a free guide that gives all the tests that you
need to get and and then here's the optimal ranges where you
should be. I mean even including, you know,
testosterone and SHBG and estradiol for women and getting
into the hormones. But yeah, it's not like a widely
published thing that you could Google.
You'll have to get it from a a practitioner, A functional
practitioner. Gotcha.
Now when people get these lab tests back, they see that
they're out of the optimum range.
They start incorporating some form of thyroid medication, HRT
in some form or fashion. What delivery vehicles for that
do you find to be the most beneficial for the, the, the
masses? Like there's all different forms
of medication now, different delivery vehicles, different
modalities for administering it. What do you find to be the most
consistently you know on track and effective?
The one that's going to work for you, So the one that's going to
work for you and the combination that's going to work for you.
So I I I'll answer that but I have a little story to to
preclude it. So I gave a talk to a group of
integrative Wellness physicians and it was we, we were talking
all about the testing and why it's important to do all the
testing, why we need to look at reverse T3, why you need to
incorporate that in every time you test the patient.
And then I talked about being in the Synthroid box, meaning the
T4 only box. That's what I got.
I got, I got my T4 sent on my way.
It didn't work. And I said my, my argument to
these practitioners was, OK, if someone comes in and they're
depressed and you'll give them an antidepressant and if that
one doesn't work, you'll give them another one.
If that one doesn't work, you'll tag on another one and they'll
be on two or three and then plus an antipsychotic and a sleeping
pill. But you won't do anything but T4
for a thyroid patient. And we have so much more out
there. We have the natural desiccated
thyroid medications that those are derived, they're they're pig
thyroid gland dried up. They have around 80% T 4 and 20%
T three meant to mimic our own thyroid gland and mimic our own
thyroid production. We have T3 through those, thank
God people like me that don't convert, or people that just
need a little bit more T3 because they have a low free T3.
We have that available in addition to the T4 medications.
Why aren't we finding what's going to work for that person
and using all of these different modalities and the one doc
raises his hand and goes? That's all we've learned.
And I said well cool, thanks for being honest.
But can we now branch out and really help these people.
And so it's a really about finding what's going to work for
that individual person. I honestly I will combine
anything based on what I see in their labs based on maybe their
past experience. So if they didn't do so well on
one type of medication, we'll go over here and we'll try this one
and we'll combine it and we'll look at the numbers.
And so it really is, I mean I all the thyroid meds are
basically in pill form. So if we're talking you know,
injectable or trophy or something like that, like we can
talk about with hormones when we're talking about thyroid
medication, it's it's pretty much all oral pill form.
It can be compounded, but it doesn't have to be.
It just depends on the sensitivity of that person to
different fillers or whatnot or if they have celiac disease.
But but yeah, it's all oral forms, but it's just about
finding what that blend is that's going to work for you.
Now for branching into the hormones, that's where we can
go, OK, testosterone. I love injectable.
I love. I don't love cream, but I I love
injectable. For men and women, cream is kind
of hit or miss. It's based on the patient.
Not really a big fan of pellets 'cause it tends to Jack your
hormones up too high, especially my ladies.
They'll go into a male level of testosterone and lose their hair
and then they'll crash down the other side.
Estradiol. Injectable's fine.
Most people can't tolerate it. I like the patch or cream,
progesterone, oral or cream. I mean, we can really get even
more nuance when we get into the hormone world.
But Thyroid World is mostly just oral pill, but there's a bunch
of different blends we can do. Now in regards to the thyroid
medication, how often should someone be like, say they go in,
they get their initial labs drawn, they get prescribed a
certain dose and form of this oral medication.
How often do they need to be testing to see what that's doing
to their levels going forward, at least initially?
Yeah, Yeah. Initially, initially we want to
test minimum every 90 days because hormones kind of take
that long to shift. Now in some people we might test
the six week mark once we start them on a regimen and we want to
see are we moving in the right direction, then we'll we'll test
a little bit sooner, but minimum has to be 90 days because we're
still tweaking. You know we're still building up
those hormones. We're making sure that the
numbers are moving in the right direction.
We're making sure that the patient is getting symptom
relief at the same time and then maybe making some dose changes
along the way just to tweak it. Once a person is optimized then
we can start spacing it out. So really, once we get them
optimized or close to optimize, we'll do once every six months
for a little while and then maybe even just once a year once
they're really just kind of floating on their own.
And once that person is optimized and they're not going
through any drastic life change like massive change in stress or
pregnancy or anything of that nature, is it realistic to
assume that they're likely going to be pretty even keel for the
most part or will that shift quite a bit going forward as
well? Because I've got some clients,
one in particular comes to mind, and it seems as though she's
constantly going back between Hyper and Hypo, and everything
seems to be relatively consistent from an environmental
standpoint. So it seems as though they just
don't have the medication dialed in.
Yeah, well, it kind of does come down to what you said it Are
there are there stressors going on, you know, emotional,
physical, even just over exercising different things like
that. Are there, is there something
going on that throws them off? Because I do find most of the
time once you kind of hit that optimized state, you've hit your
stride until just like you said Robert, until something happens,
a hormonal shift or a woman goes into menopause or you know a big
life stressor occurs for the most part where they land in
optimization land is kind of where they can can stay for a
while. So for your client, gosh, I
don't know I would we would have to look at everything like what
about hormones? Is she?
Is she maybe shifting and moving into that paramenopause,
Menopause state that That's kind of throwing her off or cortisol?
And I'm sure you're looking at all this, but I'm just
spitballing off the top of my head to think of different
factors. I would say it has to be
something. Yeah, yeah.
Are you seeing like in your female demographic that once are
you seeing a lot of the issues resolved once you get the
thyroid fixed up, so they don't have to necessarily use HRT in
tandem with that? Are you pretty much seeing a
benefit from HRT in tandem with thyroid medication across the
board? It's hard to say across the
board because everyone's going to be different.
But I guess a better way to phrase the question is do you
have are most of your clients that are taking thyroid
medication also on some form of HRT or the HRT issues often
times resolved just because of the thyroid the thyroid fix?
Most are on HRT as well, because here's the thing.
And I just got this question earlier today too.
You know, what do we fix first, the thyroid or or the hormones?
I say we both, we're doing both. So in optimizing the thyroid
that can have an effect on the hormones, it absolutely can
improve hormone production. So if we're looking at someone
who's 35 years old, her thyroid's in the toilet, she
still has, you know, decent amounts of progesterone,
estradiol, still cycling and and maybe her testosterone is
slightly on the low side, We can do thyroid and her testosterone
will probably come up and progesterone, estrogen will will
balance out a little bit and possibly even move into the
optimal range. And she won't have to even think
about hormone replacement until she gets closer to
perimenopause, Menopause. But then if if we're looking at
someone that's really over the age of 40, I mean I I would
place money on the fact that if someone is suffering with
symptoms and they have a thyroid problem, if if you're over the
age of 40 and we only do thyroid, we're we're missing the
mark and we're not going to get you to that fully optimized
state that we could if we brought in hormones.
Hormones give us life and they have such a variety of of
different effects on the body including longevity and
protection too. So we have to think about the
immediate effect of reduction of symptoms.
So whether it's, you know, hot flashes, vaginal dryness,
insomnia, even progesterone helps with T4 to T3 conversion.
We talked about testosterone's effect on on antibodies.
Testosterone gives us the libido, protects our muscles,
protects our heart. There's so many benefits to
hormones, it almost seems silly to just push those aside and
say, oh, we'll just let thyroid do everything.
Yeah, we know you're 45 years old, but the thyroid will just
take care of it. No, it is the master gland.
But let's also address the low hormone function with the tools
that we now have. We have bioidentical hormone
replacement therapy that mimics the hormones that were once
being made properly by your body.
So let's do that, because we have that option now to really
get you feeling your best. It's funny, there's this big
push, as there should be, for us all to kind of return to some
degree of what human existence was like before all the chaos
ensued before the the foods that we have, the environmental
factors, the toxins. So we're a lot of people that
are in the know are moving towards kind of like this, you
know, traditionalist view of, you know, homesteading, tapping
into your local community for food, growing your own food,
hunting for food, getting outside more, trying to be more
in line with your circadian rhythm.
So we're doing all of those things, but yet within the
biohacking sphere in which those are all popular, there's like
this equally strong push to incorporate HRTTRT thyroid
medication, which is very counter to what we as a species
were doing, you know, 500 years ago.
Is that ever, I mean, is that simply just a result of us
having more knowledge and truly being able to optimize more?
Is there any chance that you see that the the need for that
declining as we become more conscious of our environmental
factors and toxins and nutrition?
Or is it simply a matter of, look, we now know so much more
than we ever did. If one truly wants to optimize,
eat all the right foods. Put yourself in the right
environment. But your best bet is going to be
to include HRT to some extent and thyroid medication to some
extent, pretty much across the board.
I had a couple different thoughts as you were talking.
So the the initial thought that popped into my mind was we're
living longer. You know what, we we have a
longer lifespan. So we're having, we're actually
getting the opportunity to experience low hormone function
where our ancestors didn't because they were dead before
menopause. But at the same time, yes, we
are living longer. But yes, I do agree with you
that if we really dig deep and if, if you are capable of doing
all the things that you just said, you know, growing your own
food, hunting for food, harvesting, living off the land,
getting out in sunlight, getting out in nature, resetting your
circadian rhythm, it's possible that you won't need the hormone
replacement therapy as early as those who aren't doing those
lifestyle changes. But you're still going to live
longer. And and really, it comes down to
a personal decision. I really don't like the idea of
aging. I don't know if you've known
that you're we're about the same age, right?
So you start looking at these stars, you know, like, like the
stars that we grew up with. And you look at them and you're
going, man, they look old. Oh, wait a minute.
They're my age. Crap.
And you, you know, you start thinking like, OK, I'm getting
older. I want to look, feel and perform
my best till the day I leave this earth.
And if that means hormone replacement, I'm going to do it.
But that's my choice. I mean, you might have someone
that that says, you know, I really just want to be fully.
I'll use the word natural. I don't know how how
encompassing that is, but I want to be natural and age naturally
and if my hormones decline, so be it.
I'm just, you know, moving along like my ancestors did.
Then yeah, by all means, do all that you can to improve your
quality of life. And maybe that doesn't involve
hormones and that's your choice. But I I do.
I think it comes down to a a personal choice.
I think you have the potential to stave off hormonal decline if
you're doing all the things and you're and you're doing it at an
early age. You can't just start like at 45,
like you have to start in your 30s really making these changes
to stave off that hormonal decline.
But it's one of those things that's going to happen if you're
going to live past the age of 50, I mean it or 40, it's going
to happen. Yeah.
I mean, it makes sense to me that one is going to be able to
perform more optimally with these exogenous therapies.
And I think it really just boils down to when you want to make
that shift, if you want to make that shift.
And then if you do decide to make that shift, to do so with
all of the data and truly test from a full spectrum standpoint.
Because so many people are are kind of going into this
haphazardly and it's causing them more long term issues than
not. But I think if everything's
truly dialed in, it's got more of a protective effect than an
adverse effect. Yes, yes, yes.
And if it's dumped properly, just like you said, we're not,
we're not just throwing hormones at you, not testing.
I I had someone the other day and she posted in my in my
Facebook group, my public Facebook group and she said
well, I'm seeing this. She used the term integrative.
I'm seeing this integrative practitioner and you know she
has me on all these hormones, but I don't know, I don't think
they're working and we haven't tested them in like 6 or 8
months. Wait a minute, you can't throw
someone on hormone therapy and then not check their hormones.
Like that really has to be done. And I answered earlier about
thyroid. Yes, thyroid we can kind of push
to maybe once every six months once you're optimal.
But hormones, no, we need to stay on top of that.
We need to make sure that you're on the right dose, in the right
combination and and really continuously kind of tweak that
for individuals. So that's the other problem is
you really don't want to just throw the hormones in and then
call it a day and not be testing and and be overseen by someone
that knows what they're doing with hormones too.
And most of these experts in the field that are truly taking a
holistic approach and looking at everything, looking at the
environmental factors, having a conversation around nutrition
and not just simply writing a script, they're probably, I
don't want to generalize, but I'm going to a little bit.
They're probably not going to be your standard of care.
Typical family doctor that people are getting from their
insurance providers. Right, exactly.
And and I'm glad you brought that up.
We kind of do have to address that now.
If if you're lucky enough to be with a PCP and OBGYN that is
open minded that will test all the things that will treat you.
However the believes and is knowledgeable in the thyroid and
bioidentical hormones, that's awesome.
But it's so rare. It is so rare because when we
look at what doctors are taught in Med school about the thyroid,
it's it's a very small amount of time.
It's about the same amount of time to get on nutrition in Med
school, a very small amount of time.
And then they are. And you have to remember this as
a patient. They are also driven by the drug
companies, whether you like it or not.
There's an amazing movie out on Netflix.
I think it's called like pain, pain hustlers or painkillers.
There's a series and there's a movie and they they both go into
the the opioid epidemic and really where it started and how
these these drug reps were being pushed back in the day to
incentivize doctors and doctors would follow that.
They would, they would literally prescribe only that drug because
hey, they were getting massive kickbacks.
Now that's kind of died down a little bit through the years,
but it's still present. So we still have Med schools
being funded by the makers of Synthroid and then it becomes,
you know, wink, wink. You know that that's all you
have to do is prescribe Synthroid to your hypothyroid
patients, right. But that's the only therapy that
they need, right. And so that's what they're being
taught. So yes, you get that, you get
that rare doctor that thinks outside the box, awesome.
But most of the time what I see and and what my patients bring
to me their experience and when they when they get to me is that
they've had that five to seven minute insurance based provider
visit and they were told that they were normal and they were
told that they, you know can't test reverse T3.
We don't do that. Oh, no, We don't give T3 because
it'll, you know, 'cause bone loss or whatever falsity that
these docs still believe, You know, same with hormones.
We don't give hormones because it'll cause cancer.
OK, How many 16 year olds do you know with cancer?
Right. So it's unfortunate that yes, in
order to get really good treatment and get optimized, you
probably will have to pay out of pocket for that.
I think as a society, we've been so conditioned to believe that
our insurance will do it. Our insurance will pay for
everything. I have insurance, I pay my
premiums, and therefore I should get amazing treatment.
Well, no, because those docs are run by the insurance company
too, and they are told what to do and they have a coda and
they. My sister's a conventional Dr.
she's a geriatrician. She is overbooked all the time.
That hospital or whoever runs her practice books her schedule.
And you have these old people coming in for a 5 minute visit.
They can barely get in the room in 5 minutes and she has 5
minutes to spend with them. They are.
These docs are driven by the insurance companies whether you
like it or not. So I'm glad you brought that up
'cause it kind of does come down to you need to find a specialist
and you might have to pay out of pocket, but is your health worth
it? Yeah, it's definitely a broken
system. So if somebody's listening to
this and they're convinced that their underlying issues are
thyroid related, hormonal related, what is the best next
step for them to find this well vetted specialist?
Do they do they, is it like a a resource, a website that they
just need to type in, you know, functional health, integrated
medicine in my area, Like what? What is the best plan of attack
for them? That's a great question.
Yeah. I mean, I would say, honestly,
this sounds cliche, but almost listen to podcasts, right?
So you bring on experts like myself, like other hormone
experts, listen to them and see if you jive with that person and
and then maybe go that route because you'll you'll actually
be able to hear the beliefs of that hormonal thyroid expert
instead of just going to a a person because they have the
term functional or integrative in their name.
That doesn't always mean that they're an expert in thyroid and
hormones. They might be a gut expert.
They might be a mold expert or heavy metal expert.
And then they say, Oh yeah, we can fix your thyroid too.
And I've seen this as well. In my practice, I've seen
patients spend thousands if not 10s of thousands of dollars on
functional medicine because they have the term functional but
they didn't specialize in thyroid and hormones, so they
didn't even test thoroughly. And you know, I mean the
functional world, it's great. It's great that we have it.
It's great that we have all these experts.
But as the consumer, as the patient, you also have to be
very careful, do your due diligence, ask questions, I
mean, you know, get on the phone with the office or or do you
know a discovery call. Most people have discovery calls
where where they talk to you for a while, where's the questions
ask. Do you, do you believe in T3
therapy? Do you do all of this testing?
Do you do bioidentical hormone replacement and and if any of
those anything that we talked about if they say no to reverse
T3, no, I only do armor thyroid, no, I only do T4 then then
that's not right for you then then you got to run and you got
to keep going. Yeah, totally.
No one's going to care about your health as much as you, so
you have to do the due diligence for sure, not just expect to
rely on your PCP to be like the one stop shop.
The cool thing about a lot of these functional health and
Wellness clinics that are, you know, jumping on podcasts and
putting themselves out there and and really taking the time to do
it the right way. They have done a really good job
of removing a lot of the barriers to entry.
Like they accept patients from all over the place that you
don't have to have a physical location.
Like how is your, how is your clinic set up?
Like how how do you typically see clients?
What's your typical avatar look like?
It's all telehealth and yes, just like you said, we can
prescribe to all 50 states including some some of Canada as
well. So that really allows us.
And that was my ultimate goal when I started my practice was
to not just be able to treat locally to to build the team up
so that we can help everyone because you know it's it's tough
when you're well. I was going to say it's tough
when you're in a small town, but it's tough when you're in LA and
you can't even find a a decent functional practitioner that
knows the thyroid hormones. So we do all telehealth, doesn't
matter where you are. You sit, sit at home, sit in
your living room, jump on a call, and we do everything for
you. Your meds are sent to your
pharmacy, shipped from a compounding pharmacy, the whole
deal. So that's really what I that's
how I like to practice, because that just allows us to help so
many more people. Do you feel like you lose
anything by it not being in person?
Like, are you able to get all the information you need with
that telehealth, you know, conference call?
No, definitely, definitely because I mean you're you're
face to face with them so you can even see their, I mean with
thyroid we can see like the swelling in the face, the edema,
the edema in the neck. You know, you can kind of see a
person's behavioral patterns. Are they more on the anxious
side, are they more on like the slow depressed side?
I mean you can tell a lot from from a video conference.
And I think, you know, COVID really brought the the ease of
being on Zoom to the masses where it used to be.
That belief system of I need to find someone in my town that I
can walk in their door and sit down and talk to them face to
face. And it's like COVID came along
and we were forced to break out of that mindset and break out of
that mold. And now I think a lot of people
of all ages are are more comfortable doing telehealth
consultations. I have patients in their 80s.
I had one. I had one woman.
She was 82 and she's like, that's it.
I want to live the rest of my years the best I can possibly
be. I'm tired of being tired.
I'm tired of this. I'm tired of all the symptoms.
And so yeah, we treated her and she's she's rocking life right
now. That's awesome.
Good for her. Good for her.
So where do people go to find out more about you and and your
clinic and just dive deeper. Like, if they're wanting to move
to the next step, get their thyroid checked, get their
blood, blood work drawn, and just dive deeper into this fear
you you're working with male and female, right?
Definitely. Yep, male and female.
So you can go to Doctor Amy horneman.com.
On the website you will see a book, a call button, and so you
can fill out the application book, a call.
We'll go over everything that you've tried and been through
and and what you're doing now and whether you're diagnosed,
undiagnosed, your symptoms, everything.
And we'll really, you know, figure out the best approach for
you. And then you can listen to me on
the Thyroid Fixer podcast. Robert was on my podcast too and
we have over, gosh, 370 episodes now.
So I dive a lot into thyroid and hormones.
Obviously having other experts on as well as is talking about
it myself. So you can hear me talk even
more about thyroid and then the Girl Fix Your Thyroid Facebook
group that is an open group for the public.
You can even jump on there and post your labs if you're like,
you know, I ordered these labs for myself.
Everything that Robert and Amy talked about and I'm just not
sure, go ahead and post them in there with your symptoms.
And I'm in there. My nurse practitioners are in
there. The community is amazing.
I mean some of my, my patients who are optimized are in there
answering too and they answer just like I would cause they've
been trained basically by me. So they're in there answering as
well. So if you just even want to jump
in there and get kind of an idea of what's going on with you, you
can do that. Awesome.
I'll certainly link that to that.
One more question for you. What would you say is good
preventative care? Proactive care, if someone is
not really experiencing these issues, don't necessarily have
any, you know, markers out of range.
This is a kind of a selfish question because I'm asking it
in part for myself. My my hormones are all out of
whack right now post competition prep.
But in general, I've got a pretty good solid baseline.
Are there, like some common denominators with just nutrient
deficiency that you see? And it's kind of a little
question too, because there's a lot of deficiencies with our
modern diet. But like for me, for instance,
who is eating all the right foods?
What are some preventative things that I can do to just
ensure my thyroid stays functioning at a high rate going
forward? Iodine, magnesium.
So if it wasn't you before you brought you into the to the
equation, I would say you got to be gluten free.
So the general population you have to be gluten free.
And then I I really do believe in in a lower carbohydrate
lifestyle because as you've talked about many times
overconsumption of carbs, highly inflammatory, high insulin will
will inflamed the thyroid, it'll bring up reverse T3, it'll cause
all kinds of issues. We know that gluten is an
autoimmune attack Mimicker. So when we eat gluten we kick up
those soldiers, we we build those antibodies to further go
out and attack the thyroid. So that's that's the in general
answer. Now we move a little bit further
into you. I know you're already doing
that. So now we have to go deeper.
So I would say iodine is fantastic.
Iodine gets a bad rap in the thyroid world because there are
practitioners out there that overused it and they sent people
into a hyper stage and it wasn't good.
So we definitely want iodine in the mix because it's very
supportive. Every cell in your body needs
iodine just like it needs T3, and you use just enough for
support. It supports the immune system,
it kills viruses, it helps convert T4 to T3.
It helps support your thyroid. Magnesium is another big one
like a multi mag, not just mag citrate, that just helps you
poop every day, not just mag listening, you know you want
that that multi spectrum magnesium that helps with T4 and
T3 conversion. Selenium gets overdone quite
often by the thyroid community because they'll they'll read in
a blog that selenium is amazing for the thyroid and it is.
But then they end up taking 200 to 400 milligrams of selenium a
day and they push it too high which can also push up the
reverse T3. So we want you know just enough
selenium like 100 micrograms a day.
That's pretty much all you need. Iodine, magnesium, selenium,
keeping up your vitamin D levels.
I'm trying to think of anything else really that's those are the
main things controlling stress. Obviously we want, we want to
look at insulin and cortisol, but for you I would I would just
get into those those nutrients too.
I've got a little hack for iodine, so I've been, you know,
as as I've been eating less with this prep and reverse, I've been
trying to find ways to keep my food interesting.
And I bought several bags of this freeze dried bulk help.
So it's just seaweed, but it's like an incredible source of
iodine and I'll just sprinkle that like as a seasoning on top
of my food. It's getting got a nice crunch
to it, but it's like one of the highest sources of naturally
occurring iodine and it tastes really good.
So let's sprinkle that on everything.
Oh, that's good. I do like that It it does taste
good. You're right.
So it's a good little snack. It is.
Well, Doctor Amy Horneman, I've
learned a ton. I've always enjoyed chatting
with you. I come out of the conversation
much more enlightened as a result.
And I I truly do think this is a great episode for me to just
point people to that have questions on thyroid.
Because like I said, I've got little bits and pieces of
thyroid discussion sprinkled throughout the 600 plus podcast
episodes I've done. But having just a one stop shop
where people can go know what test to get, know what they can
do pro proactively and reactively if necessary is key.
So I can't thank you enough for taking the time on the deep dive
here. My pleasure, my pleasure.
Thank you. I will definitely link out to
your site Your social. Did you say your social earlier?
Oh, social is, you know, all social platforms on at Doctor
Amy Horneman. So you can you can find me
anywhere under Doctor Amy Horneman.
Well, I will certainly do that. I'll send that to everybody and
you have a wonderful 2024. Do you have any big, big plans
for 2024 or just keep grinding like you are?
Now keep grinding. I'm doing a a big move.
I'm moving to Iowa to be closer to the deer that I hunt.
So yeah, doing a doing a big move.
But other than that, just, you know, keep rocking this.
I love. I love talking to people like
yourself. I love doing my podcast.
I love being on podcast. So yeah, we're just going to
keep doing what we're doing. Well, let me know when you get
so, because the Iowa deer are much bigger than the Arkansas
deer, so I'm going to have to come up there and and go hunting
with you. You are more than welcome to,
absolutely. Awesome.
Well, until next time. Until then, you take care and
have a great 2024. Sounds good.
You too. Bye, bye.