In this episode, I am speaking with Dr. Amie Hornaman, also known as The Thyroid Fixer. She’s the founder of the Institute for Thyroid and Hormone Optimization, an organization with transformational, proven approaches to address thyroid dysfunction and support people in returning to optimal health. We will talk about the root causes of Hashimoto’s, testosterone, hormone replacement therapy, and more.
Table of Contents
In this podcast, Dr. Hornaman and I discuss:
- The common misunderstandings conventional medical doctors have about thyroid health
- The environmental triggers that affect thyroid health
- The link between gluten and thyroid health
- Why testosterone is critical for both men and women (and the accurate levels)
- Should you go on thyroid replacement therapy?
Listen or download on iTunes
Listen outside iTunes
Ari: Hey, this is Ari. Welcome back to The Energy Blueprint podcast. With me today is Dr. Amie Hornaman, who is also known as The Thyroid Fixer. She’s the founder of the Institute for Thyroid and Hormone Optimization, which is an organization with transformational, proven approaches to address thyroid dysfunction and support people in returning to their full optimal health. We cover a lot of interesting, novel stuff in this podcast.
I also ask her take on this landscape of opinions of different thyroid experts with different hypotheses and different approaches, different paradigms of how to fix thyroid dysfunction and improve thyroid function. I think you’re going to get a lot of insights from this podcast, particularly if you are someone who has or maybe has early stages of hypothyroidism. Even if not, I think this is definitely worth listening to, because you may eventually have it.
You’ll get a lot of insights here on how to help prevent it, as well. Dr. Hornaman is a wealth of knowledge and I think you’re going to really enjoy this. With no further ado, here is the podcast.
Welcome to the show Dr. Hornaman. Such a pleasure to have you.
Dr. Hornaman: Thanks, Ari. I’m happy to be here.
Ari: First of all, tell me how you got into teaching about, and helping people with hypothyroidism. Is this personal for you or how did you end up becoming the thyroid fixer?
Dr. Hornaman: Like so many of us. Pain to purpose story, going through our own set of health circumstances. If we rewind about 25 years ago, I used to compete in figure competitions, NPC Figure Fitness. I also did some powerlifting. I did some fitness modeling, very active. I had done many, many shows. For those listeners who don’t know, you are on a strict diet, you’re doing chicken and broccoli and asparagus and you’re tracking all your food and you’re hitting the gym twice a day because you want to present basically a lean, tight, muscular physique on stage and then you’re being judged. Sounds crazy. I think we are a little bit crazy who do that too.
I had done many of these before. I did not approach a show prep lightly because I came from a family with obesity and I was a chubby kid when I was younger too. I would always fight the bulge but as I started to grow up, and that’s why fitness and nutrition became such a key component of my life, I knew the things to do to change my physique and to overcome my genetics that was given to me so nicely by my family.
I had done many shows before this one show I was doing, I had put on 25 pounds. Now biologically it didn’t make sense. It didn’t make sense to be eating chicken broccoli and asparagus and going to the gym twice a day and the scale to be going up, even if you don’t believe in calories in, calories out, I was eating clean food to put on 25 pounds was ridiculous. I did what we all do. I first went to my family doctor and I said, this is what’s going on. She said, no you’re fine. Everything’s normal. Then I kept going because I’m like, no, no, it’s not normal. This isn’t right. I went to doctor number two, eat less and exercise more. Number three, you’re just getting older. I was 20-something. Really seriously?
Then it took doctor number six is where I cried in my car. I remember putting my head down on the steering wheel and praying to God that something was just wrong, because if something was wrong, we could fix it. If you’re telling me that I’m normal and this is life, am I just going to keep gaining weight? Am I going to gain 50 pounds, 100 pounds? I was tired, I was losing my hair and I was in my 20s. My life was going down the toilet as we speak.
Finally, the seventh doctor diagnosed me and I got that diagnosis of Hashimoto’s and I left the office with a pill, Synthroid. I thought, yes, there’s an answer and there’s a pill and now I’m going to lose weight and I’m going to get my life back and everything’s going to be fine. I gave it five months and there was zero change. There was not one pound lost, there was no energy gained, my hair was still falling out, so I did the Dr. Google thing like y’all do. I got on and I started researching a little bit and I saw this thing called T3 and I didn’t know at the time. I was newly diagnosed, I wasn’t in this functional space either.
I go back to my doctor and I say, “Hey, there’s this other medication that we can add on– This other thyroid hormone that we can add on to my Synthroid. Turns out it works really well together because this is the active thyroid hormone and Synthroid’s inactive, so I don’t even know why I’m taking it, but can we add this on?” She goes, “No, I don’t do that.” I go, “Well, I’m going to find somebody who does.”
That’s what led me into functional medicine. There was when the universe gives you a name a couple of times and you’re like, I keep hearing this person’s name, I need to reach out. I kept hearing this gentleman’s name over and over again, and he was integrative. We didn’t even have the term functional back then. He was integrative medicine, he was a natural pharmacist, and he saved my life.
To this day, I would love to ask him like, “What tests did we do?” We had to have done all the tests that I do now. He did all the testing, we did the right thyroid hormone replacement, we did the right diet, and the right supplements to support my body through the whole process. I finally lost weight and then he became my mentor.
I completely changed my career trajectory, went into functional medicine, started obviously diving into, because I thought, well, if I am dealing with this, obviously a ton of other people are, and they’re just walking away going, “Okay, well I guess I’m getting older. Well, I guess maybe I need to starve myself and work out three hours a day to get this weight off.” That’s not the case at all. That’s what led me into specializing in the thyroid.
Why thyroid health is often misunderstood in conventional medicine
Ari: Beautiful. Why is this so misunderstood within conventional medicine?
Dr. Hornaman: Well, first of all, it’s the standard of care. What most conventional docs are taught in med school is to check the TSH, the thyroid stimulating hormone. If that is actually flagged high, then you treat for hypothyroidism and you give T4, you give Synthroid, it’s standard of care. There was one time I was actually talking to a group of integrative wellness physicians on this very topic, on the testing, how we need more testing and on the treatment, how we need to think outside of the Synthroid box that I call it because there are so many different things that we can do with a thyroid patient to get them well besides this one pill.
The doctor raised his hand and he said, “Well, that’s all we’ve learned.” I was like, “Well, thanks for being honest, but we have to break out of that.” That’s the point. How do we get conventional docs to break out of what they’ve learned and it’s ingrained in them that they learned in med school? We have to really break out of that. That is the problem with conventional medicine. Just misdiagnosing or mistreating hypothyroidism and Hashimoto’s.
Ari: Got you. I’ve had over the years many thyroid doctors on the podcast, and it’s interesting to note some of the differences in paradigm. Obviously, if I had a conventional doctor on here the sort that you’re describing there that you went to personally see many of they would have their own very different paradigm that’s very TSH centric as you just described. Even within functional docs, there’s some pretty significant differences. I’m curious how you conceptualize what are the key causes of Hashimoto’s hypothyroidism.
Dr. Hornaman: With the general term hypothyroidism, in that term, low thyroid function, we have Hashimotos and then the 5% of the other. 95% of all hypothyroidism is Hashimoto’s, which is the autoimmune form of hypothyroidism. It’s where your body attacks your thyroid gland and your thyroid gland stops producing the proper amounts of thyroid hormone that it once produced and it starts to become damaged. We can actually see it on an ultrasound where it looks like it’s been attacked. It looks all jagged and edgy.
Whereas in the other 5% of hypothyroidism, that is usually caused by either over-exercising, undereating, extreme dieting, certain medications, cancer with radiation, or chemotherapy near the site. Those causes of hypothyroidism where the thyroid gland itself just goes, “No, I’m not working well anymore.” That only really accounts about 5% to 10%. The rest is the autoimmune form.
Now we know that autoimmune is on the rise through the years. We have increased exposure to environmental toxins and pesticides and all the things that are endocrine disruptors that we hear so much about these days. We have increased stress. You can even go before 2020 and pick up on increased levels of stress to income households. People are trying to do everything all the time. It’s go, go, go society.
Now you add the last couple of years on it. Now we’re definitely seeing an increased incidence of all autoimmune diseases, but definitely specifically Hashimoto’s, because Hashimoto’s with autoimmune, you have to have a trigger. That trigger for women, since we see how Hashimoto’s more in women than men, that trigger can be low testosterone. It can be something that we all– Pregnancy, pregnancy is normal, but it’s also a stress. Perimenopause, puberty, menopause, hormonal shifts, all of those things in addition to the stressors in the endocrine disruptors, just it’s like set up for autoimmune to present itself.
How your environment affects your thyroid health
Ari: Very interesting. Let’s say you’ve got exposure to various kinds of environmental intoxicants, let’s say you’ve got stress. How does that actually translate physiologically into the thyroid not working well?
Dr. Hornaman: With that autoimmune– I always call it a switch. It’s like a light switch that turns on. That’s why you’ll hear so many women say, “It was after I had my first baby, it was after my second baby, it was after I hit 50 and I went into menopause. It was after my husband lost his job and we had to move all in that same year.” It’s like the switch turns on.
Now you always have that genetic predisposition. With any autoimmune, and Dr. [unintelligible 00:10:04] talks about the three-legged stool. I think he’s the first one that started the three-legged stool analogy. With the three-legged stool, you have that genetic predisposition component that says, genetically you have autoimmune in your family. It could be that mom had Hashi, but gram had lupus and your sister has type-1 diabetes. There’s just that autoimmune component.
Now the question is, what is your body going to do with it when that switch turns on? Is it going to turn on Hashi? Are those– I use the analogy of soldiers. Those soldiers, are they going to go out and attack your thyroid? Are they going to attack your joints and you have RA? We don’t know. That switch goes into the on position with one of the legs of the stool, the trigger, the stressor, the whatever it is. It can even be we see a large tie back to Epstein-Barr virus, which many of us have. EBV is a huge precursor to Hashimoto’s.
Now, why the body chooses the thyroid, why is it why those soldiers say, “Hey that thyroid gland that looks like a really good gland to go and attack and just destroy,” why autoimmune presents itself differently in certain people? I’m not really even sure.
We do know that lower testosterone levels, which if you look at males and females, males have higher– Even though females have more, testosterone is the more abundant hormone, actually in females, men have more of it. When we’re looking at total testosterone levels for a guy, obviously we’re going to see 900, 1,000, 1,100. For women, we’re going to see 50, maybe 40, maybe 60. With that, lower testosterone too, testosterone is very protective against autoimmune.
That’s another reason why in addition to our hormonal shifts that women have all the time, we also have lower levels of testosterone, which protect against autoimmune. I think that’s why women get hit harder with the Hashimoto’s component of autoimmune versus men. It’s that switch turning into the on position.
Do thyroid antibodies cause the immune system to attack your thyroid
Ari: What do you make of this immune systems role in actually destroying and gobbling up the thyroid gland tissue? I’ve seen different opinions on this one. One take on it is more what I just described that’s like, “Hey, the immune system starts to recognize this self tissue of the thyroid gland as non-self, and therefore starts attacking it and gobbling it up. Therefore, and as you have a smaller and smaller thyroid gland, less hormone naturally results from that.”
Alternatively, I’ve seen people say it’s not so much that the immune system is targeting the thyroid gland tissue itself. It’s more that there are toxins, maybe heavy metals, maybe infections, viruses, things like that, that are being stored in that tissue and the immune system’s trying to get to them. Then destruction of the thyroid gland is unintended side effect of that. Then I had Dr. Eric Balcavage on my podcast recently, and he really brushed off all of the notions of the idea that the immune system that these antibodies, antithyroid antibodies, anti-TPO, and what’s the other one?
Dr. Hornaman: TGA, thyroglobulin.
Ari: Thank you. Really, those antibodies are not, he cited research saying that they’re not actually driving destruction of the tissue of the thyroid gland. I’m curious where you land on that spectrum of those three different views.
Dr. Hornaman: Dr. Eric he’s brilliant. We agree and disagree on many different things. This would be one component that I see his theory of the cell danger response. I feel him on that because I think there is something to that. I would also tie back to the research that shows that, let’s say gluten. Gluten is a molecular- in molecular structure it is very similar to the thyroid gland. We call it molecular mimicry.
We know that gluten consumption has been on the rise and we can’t say, there’s more gluten-free foods out there. People are eating– No, they’re not. The gluten-free foods are just as inflammatory. We can take the denatured wheat, the increased gluten [unintelligible 00:14:39] exposure through the years. I tie that actually back to why the immune system attacks the thyroid gland specifically because it looks like the thyroid gland.
To break it down, an easy understand analogy, your soldiers, so your antibodies, you look at your lab tests, those TPO and TGA antibodies are antibodies to the thyroid gland, thyroid peroxidase, thyroglobulin. Let’s say you look at yours and you have, we’ll say 600. You have 600 TPO antibodies, you have 600 soldiers that when you eat gluten or all those years that you’ve been exposed to gluten, and maybe you didn’t even know that you had Hashimoto’s because that can go undiagnosed for a good decade or more. Maybe you didn’t even know that you have Hashimoto’s. Nobody’s tested you properly like myself. There’s been destruction all along.
You didn’t even do any research or talk to someone that said, “Hey, you might want to even just eliminate gluten.” That’s so simple. Just take it out. You’ve been eating it all along. Every time you eat that gluten, your soldiers go, “Hey, there’s an invader that looks like the thyroid gland that we like to destroy.” Let’s go kill the invader and then we’re going to move over,” because it can’t really tell the difference. The soldiers can’t tell the difference between your thyroid gland and the gluten molecule, and they’re just destroying everything. That would be, that’s one of my theories as to why Hashimoto’s itself is on the rise. I also think that because Hashimoto’s antibodies can come back as a false negative quite often, and it’s also not tested enough because many conventional doctors will say, oh, we tested it and it’s zero.
Now, I always say an antibody is an antibody. You might have, let’s say the range for TPO, and it varies from lab to lab, but let’s say one range is less than 34. You have to be over 34 antibodies before you actually get flagged high, and before your doctor pays attention to it. What if you have 24? You’re going to be told that you don’t have Hashimoto’s then. I completely disagree with that because those are 24 soldiers and they will continue building their army.
As you continue to eat gluten and as you continue to be exposed to different stressors and toxins, and like you said, heavy metals and the underlying infections like Epstein bar virus and Lyme. As your body is battling all of this, it’s building its army too. 24 soldiers–
Ari: I have heard someone’s some people say, I don’t know if I remember exactly who I had this conversation with, but someone saying that some level of those antithyroid antibodies is normal. Are you saying that you think zero is the only healthy amount, anything above that is indicative of beginnings of Hashimoto’s?
Dr. Hornaman: It is the beginning. Any antibodies are the beginnings of Hashimoto’s for sure. Now, does that mean that it requires immediate treatment? No, I think it’s just knowledge. You have to look at it in context with the rest of the thyroid labs and the thyroid, the free thyroid hormone values and how the patient feels.
If you have somebody that’s coming in and you happen to run a full thyroid panel on them, and you see those couple of antibodies, let’s say you have 24 out of 34, but their free T3 is great and their TSH is below a two and their reverse T3 is below a 12 and they say, yes, I’m pretty good. I really don’t have any symptoms. I’m not struggling with waking or fatigue or hair loss or constipation, then we just use it as knowledge.
We say, okay, this is some data. We’re going to look at it down the road. If you ever start to feel wonky or you start to get some symptoms, we’re going to retest this and see where these are going. Maybe we do some lifestyle and nutritional and supplemental interventions to reduce those antibodies that are there, because that can be done, it can be pushed into remission.
I wouldn’t blow it off though. Flip side is, someone has 24 antibodies, their free T3 is at the lower end of the range, but still in the normal range, and they’re suffering with symptoms, then we pay attention to that. It’s not necessarily going to change the way that I treat, but we have to do something because that person should not be suffering with symptoms and be told that they’re normal, just because they have some antibodies. Maybe that’s normal to have.
A breakdown of thyroid hormones
Ari: You’ve mentioned a number of different hormones in passing here. I want to make sure that people understand some of the key different hormones here. There’s T4, T3, free T4, free T3, reverse T3, and T2. Does that cover it? Can you maybe go over which of those are the most critical to measure? Oh, and TSH. I forgot. TSH.
Dr. Hornaman: TSH is thyroid stimulating hormones. That’s produced by the pituitary gland, and that sends a message from the pituitary to hypotha–No, I’m sorry, the pituitary. Here’s how I like to say that about TSH, and it’s the HPT axis, the hypothalamus talks to pituitary, pituitary talks to the thyroid. It’s like a feeler. It’s sensing, is there enough thyroid hormone in the system, or do we have to poke the thyroid gland and tell it to wake up and produce more thyroid hormone? That’s TSH, good measure, but we can’t rely on it because I have seen hypothyroidism with TSHs of one. Even in functional, it’s optimal. You have to keep going and look at all the different hormones.
Now, the thyroid gland does produce T1, T2, T3, T4. We only have assays for T3 and T4. We do not yet, unless it’s in an experimental study situation where they do test T2 levels, because there’s been a lot of studies on T2, we don’t have it in the general population to test T2. T1 is pretty just– it’s just there and it’s not really important. It doesn’t do anything.
When we’re looking at T3 and T4 on a lab, yes, we can look at the total and we can look at the free, and the free is ready to be taken up by the cell.
When we’re looking at free T4 and free T3, and we’ll tie in reverse T3 in a second. Free T4 and free T3 because your thyroid gland produces those hormones, we really want to look at the T3. T4 is inactive. There is not a single receptor site on any cell in your body for T4. There are, however, multiple receptor sites on every single cell for T3, including your heart and your brain, everything. Your body needs T3 to stay alive. That’s the active thyroid hormone.
Now, T4 will convert over to T3. In doing so, I always say it’s like running 10 tough mutters. It is really hard for the body to do, even though it is built into us, and that is what the body is supposed to do, there’s many factors that can interfere with that conversion, estrogen dominance, insulin resistance, heavy metals, underlying infections, a genetic snip on the DIO1, DIO2. There’s so many different things that can interfere with that conversion.
That’s where we want to test reverse T3. I want to know how much active thyroid hormone is in your body, free, unbound, ready to be taken up by the cell and attached to that cell receptor site. I also want to know your reverse T3 level. Now, reverse T3, it’s beautifully built into us as a survival mechanism. If you are laying in the ICU, the ER, you are fighting an infection, you are fighting for your life, your reverse T3 is going to go up because it says this person needs to live and needs to heal. They don’t need to be burning fat. They don’t need to have energy. They don’t need to poop every day. They don’t need to grow their hair. They need to survive. Reverse T3 goes up to shut down bodily processes.
Now think about that. If your reverse T3 is high on a day-to-day basis where you’re not trying to survive and you’re not trying to heal a traumatic injury, you’re trying to live life, and work, and take the kids to school, and do your job, and clean the house and go grocery, you don’t want that high. You don’t want to be in a survival state as you’re walking around trying to live life. If that reverse T3 is high, that’s telling us that that T4 hormone, the inactive hormone that really has two paths to choose, it has chosen the reverse T3 path. Instead of converting the free T3, it converted to reverse T3, and it basically put your body into survival mode.
Reverse T3 is the antithyroid hormone. I always use the analogy of a bouncer at a club standing outside the cell door, arms crossed, telling T3 it can’t get in, can’t get in, can’t get in. It’s not that when we really look at the studies at the very base way of explaining, but it makes it understandable. There’s been some debate on, does it actually block the cell? Does it really block the receptor site on the cell? No, it attaches to it. Just reverse T3 looks like T3 and it comes along and pops into that receptor site. When the T3 is trying to look for the receptor site, there’s no receptor sites open. They’re all clogged with reverse T3, but it’s an easy way to understand it.
Ari: Got it.
Dr. Hornaman: Oh, T2. I didn’t go into T2.
Ari: T2. Thank you.
Dr. Hornaman: We can’t measure it, but it’s powerful. When you really start looking at the studies of T2. T2 is in natural desiccated thyroid. For those of you taking Armour Thyroid, NP, Nature-Throid from days past, that is desiccated thyroid. Like I said, the thyroid gland does produce T1, 2, 3, 4. When we make it into a pill for thyroid hormone replacement, it contains a little bit of T2, but it contains a very small amount. We estimate about 9 micrograms in every 60-milligram tablet of Armour that can even be less than.
In the studies, they’re using 150 to 300 micrograms. What it shows is that T2, I call it the forgotten thyroid hormone, increases basal metabolic rate. It does so with no thyromimetic effects, meaning it’s not going to change your thyroid lab values for good or bad. It’s not going to convert into reverse T3, and you’re not going to be told that your hyper. It’s not going to push down that TSH to where your conventional doc says, “Oh my gosh, you’re hyperthyroid.” No, you’re not. You’re not.
It will have an effect on brown adipose tissue. You’ve talked a lot about this on your podcast, just activation of brown adipose tissue through cold exposure, ice baths, even fasting, and talking to that all activates brown adipose tissue. We want that activation because when you activate brown adipose tissue, you’re actually protecting yourself against disease. You’re improving your insulin sensitivity, you’re lowering insulin resistance, you’re burning more stored body fat. That’s what we want.
It increases based on metabolic rate, activates brown adipose tissue, and it works at the mitochondrial level to increase ATP production without even cardiovascular side effects. Now, why do I say that? Because many doctors are scared of giving T3 as a thyroid hormone replacement because they will say it’s going to increase your heart rate and give you AFib and cause a heart attack. If you take it in large amounts, if you overdose it, if you take too much, if you abuse it, yes, absolutely can do that. Now, there’s a benefit to using T3 in thyroid hormone replacement therapy when we’re actually doing treatment.
For those who maybe they can’t tolerate T3, they get that anxious feeling and their heart rate goes up and they’re looking at their Apple watch and they’re like, “I’m 120.” No, we don’t want you to be that. We don’t want that cardiovascular side effect from thyroid treatment. We can use T2 and get the benefits of, get the weight loss, get the energy production without stimulating the cardiovascular system as well like T3 can. That’s the last thyroid hormone worth talking about for sure.
How testosterone affects health
Ari: Got it. What about testosterone? That’s something that you mentioned earlier in passing. Also, a little-known fact is that it’s the most abundant sex hormone in women as well as men, though we’re all trained to think, oh, testosterone, that’s in men and women have estrogen, but they even– most people think they either don’t have testosterone or they have very low levels of testosterone relative to estrogen. Testosterone’s really important for women too. Tell us about that.
Dr. Hornaman: It is. That’s my second love/passion in talking about. Testosterone is so vital. It cracks me up that we have now put testosterone, or our government has put testosterone into the category of opioids where you have to have a DEA license to prescribe testosterone. Now let’s look at the benefits of testosterone, male and female. Very cardioprotective. We know that low levels of testosterone increase your risk of cardiovascular disease.
It also decreases the need for antidepressants because it does enhance your mood. I call testosterone, our GSD hormone, or get stuff done hormone, because without it, you’re not going to want to do anything. You’re not going to have that motivation and drive, you’re not going to want to go to the gym, you’re not going to want to work, you’re not going to want to do anything. In addition to the cardiovascular component, you have the quality of life component.
Low testosterone will increase fat deposition, it will reduce muscle mass. You’ll have a really hard time putting on muscle. A lot of my women and male patients, they’ll say, “I’m hitting it hard at the gym. I’m doing the lifting heavy thing, cut back on my cardio, and I still can’t build muscle. I’ve been doing this for a year.” That could be low testosterone. Obviously, there’s going to have some effect on the libido, although libido isn’t just solely testosterone. There’s many different components to libido, but testosterone is just so– it’s such an amazing hormone for both men and women, but it’s overlooked, it’s underappreciated, it’s under-tested, and then we can get into the lab values, which are horrendous.
You think thyroid lab values are bad in the standard lab value range versus what we look at in functional medicine as the optimal range? Testosterone is worse. Women, your total testosterone level will get cut off at a 45. I don’t even want you below a 50 for total testosterone. Your free testosterone better be in the upper half of whatever lab value range you have, and that can vary from lab to lab. Men, in general, your testosterone range goes from 250. Now it’s getting cut off at 1,000.
I wouldn’t even let my 76-year- old father be below a 600 in testosterone because of the cardiovascular effect because I want him to have quality of life. I want him to feel strong. I want him to be healthy. I want him to have low body fat so it doesn’t bring on the diseases of aging. That is testosterone. You will actually be told that you are normal and everything is fine as a man if you’re coming in with a testosterone of a 280, a 300, which is pitiful. You’re not even going to want to get out of bed in the morning.
Testosterone is such a passion of mine because it does so much for both sexes and it’s such a vital hormone in addition to what we talked about in the beginning of it being very autoimmune protective. One study showed that when we give men and this was a study done in men, not women but when we give men testosterone, their incidence of autoimmune specifically, this study looked at Hashimoto’s their Hashimoto’s incidence goes down and those men with Hashimoto’s their antibodies went down to with TRT.
Ari: That’s interesting. What’s the mechanism behind that?
Dr. Hornaman: Now you’re putting me on the spot. I think I have to look that up.
Ari: I don’t know either. It’s okay. If you don’t know then you’re in good company. [laughs]
Dr. Hornaman: That’s a good question. Now you got my brain piqued. Now I’m going to have to look because we just know that fact that it’s protective but what is the mechanism? I’m going to have to look that up.
Thyroid hormone replacement therapy
Ari: Let’s talk about practical interventions here. Let’s say I come to you, I have hypothyroidism and let’s say my pattern is you’re seeing moderate to low T4, T3, and then the free T3 is considerably low out of range. TSH let’s say it’s a seven. You’re seeing that pattern that is saying you’ve pretty much got Hashimoto’s. What are you going to do with me?
Dr. Hornaman: This is just another area where Dr. Eric and I disagree in and many other functional practitioners and I disagree. I am all for thyroid hormone replacement because here’s the thing. If you’re coming in and we can do all the things, we can do all of the nutrient interventions. I am a fan of iodine, magnesium, a little bit of selenium, not too much. All of the things that support the thyroid gland, we can go gluten-free. We can make sure that you’re sleeping. We can make sure that your diet is on point. We can heal your gut, we can make sure your adrenals are fantastic and you don’t have some wonky cortisol pattern.
Even after we do all of that the chances of us bringing a T3 level from a 2.3 to let’s say a 3.7 or a four which is where I like to see it, 3.5 or above or the upper quadrant of that range is very, very slim to none unless we add in some thyroid hormone replacement.
Now there are some cases that we can do this naturally, the numbers that you presented, Ari, they’re a little bit further gone. If someone’s coming in just right on the border of everything and like I said their symptoms aren’t debilitating yet, then we can do some natural interventions that will absolutely help. If they’re in the basement, if they’ve been dealing– I get the people that they’re on their last leg. They’re like either you help me or I’m a goner. That’s it.
With them they’re so low in everything that we have to use thyroid hormone replacement. I try to reshape people’s outlook on this because a lot of people will say why don’t I go on my medication the rest of my life? I say listen, I get it if that’s a statin or if it’s a Band-Aid medication like an antidepressant or a sleeping pill which is what most doctors give to Band-Aid the symptoms of hypothyroidism. We can take away all those Band-Aids and you can replace your thyroid hormones. I rephrase it as thyroid hormone replacement.
Just like when you go into menopause the smart thing to do would be to replace those hormones that are no longer being made.
They’re not coming back no matter what we do. That’s called aging. You can’t beat the decline in hormones but we can reverse it by replacing hormones. If you were a type-1 diabetic you wouldn’t say to me I really don’t want to go on medication so you can keep your insulin. I’ll be like,”Okay. I’ll be at your funeral in the next year because you’re going to literally die without that hormone.”
Same thing with thyroid. You’re not going to die. You might after a long, long time after all the organs start to be affected but nothing to be scared about. You are not going to have good quality of life unless we replace those hormones that are no longer being properly made by your body. In the case of Hashimoto’s when the thyroid gland has been reduced to a pea or it’s all jagged and messed up that’s certainly not going to be able to produce the proper amount of hormones that it once did.
In those cases, I am a fan and I have seen it work multiple times including myself in replacing those thyroid hormones that are no longer being properly made in addition to doing all the other things. We can’t just throw thyroid hormone at you. I say this over and over again to my patients on my pocket, everything, we can’t just throw thyroid hormone at you and you’d be eating at McDonald’s and not sleeping and not taking any of your vitamin, not supporting your nutrient status. It has to be all done in conjunction. When it is done in conjunction it literally gives someone their life back. Their symptoms reverse. They’re like this is how I’m supposed to feel.
Ari: Is there any concern with the exogenous thyroid hormone causing a further acceleration of the thyroid gland destruction in a similar way, let’s say to many other hormonal feedback loops in the body, the classic example of course being the use of exogenous testosterone steroids causing atrophy and shrinkage of testicles and testicular production of testosterone. Does something like that occur with exogenous thyroid use?
Dr. Hornaman: To my knowledge, we haven’t seen a shrinking of the thyroid gland like we do with the testicles and testosterone intervention but there is that negative feedback loop. There is the probability that when we start using thyroid hormone replacement– We don’t use it unless you need it. We’re not doing this thing of abuse just to help you lose some weight. We’re actually using it because we can see that you have low thyroid hormone production in addition to all the symptoms.
There’s going to be some negative feedback that occurs where your thyroid gland is naturally not going to produce the hormones that it is producing in the same amount that it once did. Here’s the thing, if your thyroid gland is already not producing the right amount it’s already not doing its job. It’s like keeping an employee on and still paying him a really good salary and he is sitting at his desk looking at IG all day. It’s still not doing its job. You have a choice.
Ari: What if you put an app on their computer to block their access to social media?
Dr. Hornaman: I love it.
Ari: I’m saying that jokingly but also the analogy here is like what if you are helping facilitate the thyroid gland to function better through let’s say heavy metal detoxification or improving your sleep, decreasing your stress, improving your circadian rhythm, improving your nutrition, et cetera.
Dr. Hornaman: You can and it all depends on how far gone they are. How far gone is that thyroid gland? Again if it’s shrunk down, if it’s destroyed, if your free T3 has come back at a two, a 2.3 something like that then we’re probably not going to see that gland, your natural production of thyroid hormone kick into the level that it should be. Now if we can do it, we can do it. Like I said there are those cases where absolutely all of that works.
Heavy metal detox, you improve the gut, you make sure that their cortisol pattern is perfect. It’s in that half-bell curve where it’s high in the morning and then goes down throughout the day. You check that because you don’t want high cortisol day that’s going to push up reverse T3. You get their insulin in check, you get their hormones in check. You make sure that they’re not estrogen dominant. You make sure that there’s adequate amounts, optimal amounts of testosterone on board. A 100% it can be done but it’s a case by case.
Thyroid treatment in general is so nuanced. It is so individualized. This is really where personalized medicine comes in and needs to come in even stronger because you have to look at each individual uniquely. There is no blanket treatment for anyone. Some people might just need a little bit of thyroid hormone replacement for a short amount of time and we can get their thyroid gland back on track. Some might not need any and we can do all the different interventions.
Some might be like I am not getting better unless you do this and this. That was my case. There was nothing. I was living the perfect life. I was clean eating. I did all the things but it still didn’t produce a result until I brought on thyroid hormone replacement therapy in the right amounts and found the right medication and dose that worked for me and what I needed and what my body needed. Now you couldn’t pry it out of my dead cold hands because it’s giving me life and it’s optimizing me.
It’s so unique and personalized. Now there are supplements so we can use some thyroid glandulars, we can use T2 which is 3,5-Diiodothyronine. We can use those in replacement of thyroid hormone replacement to see if that’s going to help the symptoms, to see if that’s going to help get the basal metabolic rate up and get the person feeling better and maybe avoid the use of thyroid medication. I’m open to all of it. I am not opposed to using thyroid hormone replacement because it has saved lives in some cases.
Supplements that are potentially harmful for the thyroid gland
Ari: Are there any things in, let’s say nutritional things or supplementary things that people think are healthy or are good for thyroid function but you find that they’re actually harmful?
Dr. Hornaman: Then one thing that comes to mind as soon as you ask that is high doses of selenium. These poor thyroid patients they’re so desperate and I get it. They’re on Dr. Google and they’re on the forums and they’re in the Facebook thyroid groups and you always hear like, use magnesium and selenium cause that’s great and that’s all your thought already needs. A lot of people will take 200 plus milligrams of selenium a day, and then I’ll see an elevated selenium level and then I’ll see an elevated reverse T3 level. Overdosing and really this kind of can apply to everything. Even iodine. Iodine is the Goldilocks, well element really. we want it.
Ari: I’m glad you brought that up because I wanted to ask you that given I’ll let you get into your thing, but I definitely want to talk about iodine.
Dr. Hornaman: About iodine. absolutely. That’s one thing that can be underutilized or overutilized. If it’s overutilized, it can absolutely produce harm. That’s where it really got a bad reputation in the Hashimoto’s thyroid space is because many practitioners were using it in very high doses. Now, Dr. David Brownstein, he’s kind of the father of iodine he was using in his practice in Michigan, which is the Goiter Belt, and was seeing a decrease in the need for thyroid medication. Also a decrease in the incidents of hypothyroidism in general. If you use over 50 milligrams per day, you absolutely can trigger a thyroid storm. This is where kind of the fear of iodine and Hashimoto’s came into play.
If we look at biology, if we go back to science, every cell in your body needs iodine. Your thyroid needs iodine, low iodine produces high reverse T3, low iodine spurs on goiter and nodules. Your thyroid gland needs iodine to convert that T4 to T3 molecule to convert T4 hormone to T3, you need iodine. If we totally eliminate it and we’re scared of it, that’s going to have its own set of issues, just like overusing it will have its own set of issues.
I believe in the right amount, the proper amount of iodine used every day that’s going to support your immune system. It helps with hair growth, it helps with conversion. It decreases nodule size. It lowers reverse T3. It does so many things, you just don’t want to overuse it and abuse it.
Ari: Are you familiar with Alan Christianson’s book on this? I think it came out a year or two ago from. I don’t want to misrepresent his position but my sort of very succinct summary of it and from my many personal conversations with him is he’s of the opinion that iodine has a very tight Goldilocks zone. Much tighter than, most other nutrients, most other vitamins and minerals, certainly. That outside of sort of overtly nutritionally deficient diets like let’s say you’re in Africa, somebody’s eating 90% of their diets cassava or something like that. They just don’t have a good mix of foods to get adequate iodine levels.
Outside of that, I believe he’s of the opinion that pretty much all of us are getting sufficient amounts of iodine. We’re all sort of in that window of the Goldilocks zone. He seems to be very concerned about then using additional iodine, pushing you up out of that Goldilocks zone, and then getting thyroid toxic effects that are actually causing Hashimoto’s. He cites a lot of literature saying that iodine restriction helps those with Hashimoto’s. I know you just kind of explained that, but I want to introduce that viewpoint for context. What’s your take on that?
Dr. Hornaman: I love Alan. I do. I want to get Alan and Brownstein on my podcast and just have a big debate between the two of them. Because I respect the hell out of both of them and I’ve interviewed Alan too, and I see his point. I think, again, we’re getting into an extreme. If we start eliminating all the foods like don’t eat sushi and all this, we’re eliminating all the foods that naturally contain iodine then what?
Anecdotally just in my practice, been doing this for 26-27 years now, anecdotally, when we just use a little bit of iodine and I see low iodine levels, and I know that could be a whole another podcast as to how to properly test iodine. What’s accurate, what’s not? No, putting it on your skin is not accurate. When I do blood on someone that has not been taking it, it’s low. It is flagged low each and every time.
Now once they start taking it, you’re going to get a flagged high. When you test that blood just from bare bones, nothing, it is flag low. Again, anecdotally when I just add in a little bit, and I’m not talking about overdoing it maybe five milligrams, maybe five, maybe 25 is as high as I’ll go. 12.5 is really nice, five is a fine starting point. You just kind of find that person’s sweet spot. They will say to you, once I started taking this, my symptoms improved. Because we know it’s also antiviral. World War II soldiers carried iodine for pretty much everything. You got a wound, here you go, you’re getting sick, here you go. You don’t feel good, here you go.
Ari: You got a broken leg. Let’s rub some iodine.
Dr. Hornaman: Some iodine on it. We know your mom rubbed it on you with every wound that you have, there’s some very beneficial properties to iodine, I think used in the proper amounts, it’s just a beautiful thing. I have to respectfully disagree with Dr. Alan saying to eliminate everything from your diet containing iodine. I do agree with him in that you don’t want to overdo it because you can. Absolutely. Yes, you can go thyroid storm where you go into hyperthyroidism or you can actually make your hypothyroid symptoms worse and go deeper in the hole.
I mean we biohack, right? We experiment on ourselves a lot. There was a point in time years ago where I said, what, I’m going to keep increasing my dose of iodine every other day, every third day to see what happens. I got to a very high dose. I want to say I hit maybe 75. I definitely went hypo, I started gaining weight, I started being sluggish. I was like, okay back off. You really have to find that sweet spot and not go over.
Ari: Interesting. Amy, this has been extremely insightful. I’ve enjoyed it a lot. Are there any final thoughts you want to leave people with?
Dr. Hornaman: My message that I try to give everyone is to have hope. Because many of your listeners might have a thyroid problem right now. They might resonate with being on T4 only. They might resonate with all the symptoms that are not being improved. Maybe they’re not being tested properly, but there is hope. I went through seven doctors. I’ve had some patients go through 10, 15 doctors before they find that answer. There is an answer.
Whether it is not using medication and really dialing in all of those nutrients and dialing in all the other, like balancing your hormones, making sure your insulin isn’t high, all of those things, doing a heavy metal detox, checking for everything, we can go that route or we can go the medication route. Either way there is an answer. You do not have to hold onto the words of you’re just getting older, this is how you’re going to feel. This is as good as it’s going to get.
If you do feel a little bit crazy, so I call it medical gaslighting. If you do feel like, gosh, is this me? Maybe it’s me. Maybe I’m doing something wrong. Maybe I’m just crazy. Maybe these symptoms are all in my head. No, they’re not. Your body giving you symptoms is a beautiful gift because that tells us we need to look deeper into something. I don’t know what the answer’s going to be. It might be thyroid it might not be, it could be hormones, it could be something else. Don’t give up. You have to have hope that there is an answer and you just can’t stop. You can’t stop. You have to have that hope.
Ari: Beautiful. I love that. Where can people find your work and follow you, get in touch with you, work with you?
Dr. Hornaman: Absolutely. dramiehornaman.com is my website on there. You can book a call free discovery call if you’re interested in working together. My podcast is the Thyroid Fixer podcast, which RA was on as well. You can find me on all social channels, IG, YouTube, Facebook, all that good stuff under Dr. Amie Hornaman as well.
Ari: Wonderful. Thank you so much, my friend. I really enjoyed this conversation with you. You have a lot of wisdom.
Why thyroid health is often misunderstood in conventional medicine (06:20)
How your environment affects your thyroid health (10:45)
Do thyroid antibodies cause the immune system to attack your thyroid? (13:30)
A breakdown of thyroid hormones (20:32)
How testosterone affects health (28:28)
Thyroid hormone replacement therapy (32:45)
Supplements that are potentially harmful for the thyroid gland (41:50)