Kim Vopni (00:01.25)
Hi, McCall, welcome. I'm excited to chat with you about thyroid. This is a topic that I have covered a little bit before. I've talked about it from my own personal journey, but I always love to dive deeper into the topic with experts like yourself. So thank you so much for joining me. I'd love to just have you introduce yourself. Who are you and how did you get into this world of thyroid health?
McCall McPherson PA-C (00:24.608)
Yeah, absolutely. Thank you so much for having me. It's always delightful and informative every time we connect. So I'm excited to reconnect. My journey in thyroid really began as a pain to purpose story. It was my own journey as a practicing PA. I was already in what I thought was my dream job. It was not my dream job, but I thought it would be, and was debilitated with thyroid symptoms already on Synthroid.
had moved from levithyroxine to that in an effort to get better and really was dismissed and rejected by my clinician, told my thyroid labs were fine. In fact, if anything, he needed to reduce my thyroid medication based only on my TSH and I was already.
was 27 and spending about 17 hours a day in bed. Any moment I wasn't at work, I was literally in my bed trying to rest enough to recover from the day and prepare enough for the next day. And that went on for the better part of a year. And it was terrifying when you're that young and that disabled, essentially. Life came to a screeching halt. And...
I advocated for myself, I did research, I asked for a full thyroid panel after six months, was rejected again, and eventually sent on my way crying, leaving the doctor's office, got on the wait list for what was back then one of the only people probably in the state of Texas that knew about progressive ways to deal with thyroid dysfunction, waited three months to see him, saw him, and began getting my life back very, very quickly. He became a mentor to me.
and I absorbed everything I could from him. From that point forward, I absorbed everything I could in research about thyroid conditions and kept building on my knowledge. Strangely, I just used it in my own practice, which was integrative and functional psychiatry. And eventually I had helped enough people with treatment resistant depression that actually just had a thyroid issue. They took my information and...
Kim Vopni (02:23.373)
Hmm.
McCall McPherson PA-C (02:25.966)
spread it across thyroid advocacy platforms everywhere and built this entire thyroid practice that I never intended to have. And eventually when the first person flew in to see me from out of state, I was like, gosh, I think I'm totally doing the wrong thing here. This is what I'm supposed to be doing. And from that modern thyroid clinic was born. now we, I'm so excited about this chapter in our journey. It's been almost 10 years and now we are almost in 50 states. will be maybe even by the time this interview is aired.
Kim Vopni (02:32.621)
You
McCall McPherson PA-C (02:55.448)
helping allow people to have access to like real good progressive thyroid care from people who also have a thyroid condition and believe you, see you, hear you. And it's just, it's been a sacred journey. Yeah, yeah.
Kim Vopni (03:08.095)
Wow, that's amazing. Yeah, so many people even in the world of pelvic health, most of us have some sort of a pain to purpose story. I find a lot of people in in in health functional health spaces definitely have that that story with with regards to and the reason why I like to talk about this is because I feel like it's a it's so underdiagnosed yet. So so common and for for myself.
Anytime I, you know, I remember reading, I don't even remember what book it was. I think it was, why do, why do I still have thyroid symptoms when my labs are normal? Okay.
McCall McPherson PA-C (03:41.804)
Yeah. Yeah.
Kim Vopni (03:44.046)
And I remember because I didn't present as the typical person. I wasn't lying in bed. I had decent energy, but I did struggle with a few symptoms, but everybody kept saying there's you can't have hypothyroidism. There's no way you could have hypothyroidism. The more I read, I'm like, I'm pretty sure I have hypothyroidism. And then I found out about Hashimoto's and then it was like that was literally checking every single box. And when I when that was happening to me, it was during perimenopause and a lot of the symptoms.
Are exactly the same. so things you can ex you can explain certain things away, but never really getting to the root. So why do you think this under diagnosis of thyroid conditions is so common?
McCall McPherson PA-C (04:15.886)
Mm-hmm.
McCall McPherson PA-C (04:25.874)
yeah, that's, whoo, that's a big one. So there's a couple things. know, six, seven years ago, medicine was really headed on a trajectory.
to begin to address this issue in a way that serves people. And at some point, a couple studies came out. We took a hard 180 turn and started deviating even further from the hope of people getting proper diagnosis and treatment, sadly. And now we're farther now than we were 10 years ago. So there's a couple of limiting factors. One is the tendency that medicine grossly and negligently oversimplifies thyroid dysfunction in every possible way.
away from, hey, you just need to check someone's TSH. That's enough. That is negligently not enough. it just, yeah. And then using that mechanism to determine specifically if someone's medication is right is impossible. Like once someone is on a standard medication like levothyroxine, their TSH becomes completely invalid. So that's two part. And then using really
Kim Vopni (05:15.821)
Totally agree.
McCall McPherson PA-C (05:36.402)
non-standardized lab ranges. There isn't a standardized normal range for these labs. So it's not checking enough labs, not checking a full panel, not looking at optimal lab numbers. We are simply dealing with normal, which I was normal and I was disabled. People can basically be on disability from hypothyroidism and be within normal range. It's a travesty. And then three, I think,
We expect for people to get better if they're on love with Iroxine, and that's the end of it. And we don't look any further in medicine for better options. And it's not serving people. We don't operate like that in other aspects of medicine. But we have sort of accepted that this is the approach to thyroid, and we're not going to evolve it any further. And women are suffering because of it.
Kim Vopni (06:26.123)
Yeah. So what would you, what, what is a full thyroid panel for those? Because there are so many people I hear every single day, even like when the topic comes up in my community, well, my TSH is fine. My TSH is fine. My TSA and they might have maybe like a T four checked as well in there if they're lucky as well. So what would be a full thyroid panel?
McCall McPherson PA-C (06:47.478)
Yeah, so I'll list them first and then I'll kind of talk about the importance and what they mean. obviously you do want TSH. It's a valuable number when you look at the full picture. So TSH, free T4, free T3, not to be confused with total T3, and reverse T3. That is your thyroid function. And then women need to be screened for Hashimoto's. If you're having thyroid symptoms, if you've been diagnosed with a thyroid issue,
Kim Vopni (06:51.383)
Mm-hmm.
McCall McPherson PA-C (07:13.73)
Many women are never being screened for this, but those are screened by TPO, or thyroid peroxidase antibodies, and thyroglobulin antibodies. So if we back up a little bit and we talk about thyroid function, TSH is a brain hormone. It is not a thyroid hormone. It's the hormone that your brain sends to your thyroid to regulate and stimulate it to determine how much output hormones it will create, OK, in a perfect world, right?
that TSH should receive feedback from your output hormones and adjust itself accordingly. Meaning, if you have plenty of output hormones, your TSH should lower and be like, you know what, we don't need as much production, reduce the TSH, we can coast a little bit. Inversely, if our output hormones are low, our TSH should increase to stimulate our thyroid. That's what it means, thyroid stimulating hormone to produce more output hormones. The problem is, that does not work.
a huge percentage of the time. Research shows it doesn't work about 35 % of the time. My practice is filled with women whose TSH does not correlate with their output hormones, full stop. So that is your brain hormone. Your output hormone are the following. So TSH stimulates your thyroid. Your thyroid secretes this hormone called free T4. Free T4 is a completely inactive, inert hormone. I give an analogy of crude oil.
We don't put crude oil in our car to make it go, but we need that crude oil to produce gasoline to put in our car to make it go. If someone gifts you unending amounts of crude oil and you can't convert it to gasoline, guess what? We're not really going anywhere in our car, right? We have to activate it to make it usable. Women very commonly don't do that. So T4 is inactive. It has to be activated into T3, your gasoline hormone.
Okay, that is what influences our metabolism, our energy, our libido, our hair, our skin, our digestion, all of these mechanisms, our metabolism. But if we can't convert that T4 to T3, it's not gonna do us any good. Okay, so lastly, there's another hormone called reverse T3, and we can go as far into this as you'd like, but reverse T3 is an inhibitory hormone. It actually blocks the absorption of T3.
McCall McPherson PA-C (09:39.754)
If you've got a lot of reverse T3 and someone's checking your T3 and it looks great, but they're not checking this, you're not absorbing a huge amount of your active hormone. So again, there's an issue. Sadly, if we're going to pick two hormones, TSH and sometimes T4 to check, those two hormones grossly, they correlate with one another. So it just doesn't give us a good picture, especially for example.
if someone is on levothyroxine, if they're on Synthroid, if they're on T4, so inactive hormone, the worse they are at using that levothyroxine, the less of it they're activating and converting. So guess what? The better their T4 will look, the more feedback goes back to their brain to lower their TSH. So it's crazy, but the worse you are at using
the standard approach medication to thyroid dysfunction, the better your labs will look if your doctor is not doing a full panel.
Kim Vopni (10:42.003)
That's crazy. That's bonkers. So the yeah. Yeah.
McCall McPherson PA-C (10:43.37)
It is crazy, it's so sad. And that's the reason why they told me I needed to reduce my thyroid medicine, right? Because I had all this T4, I wasn't using all this crude oil that I was stockpiling in my garage. Meanwhile, my gas tank was on empty.
Kim Vopni (10:57.333)
Yeah, so interesting. what would be, I want to get into optimal ranges, but before we go there, what would be some of the reasons why somebody would not be a good converter? The T4 to T3 conversion, the crude oil to gasoline conversion.
McCall McPherson PA-C (11:08.642)
Yeah, such a good question. Yeah, such a good question. our bodies are really smart. They do things on purpose, right? So when we are sick, when we are inflamed, when we're stressed, when we're micronutrient depleted, when we're not sleeping well, when we're pregnant, when we're breastfeeding,
Our bodies try to make us rest. They try to make us lay down, rest, and recover. And one way of doing that is by making you tired by not allowing you to activate your thyroid hormones. So in a perfect world, we would all live in a society filled with micronutrients and low inflammatory food and low stress and good sleep, but that's not really the society that we live in. I think there is
a degree of poor conversion that's inherent with being a human in modern day society. And that degree is enough to keep people from being able to function their best and keeps them from being able to activate enough of either A, their endogenous T4 or B, their Synthroid and Levothyroxine, which again is all dependent on your ability to activate it to ever feel well.
Kim Vopni (12:31.543)
So when you're, looking at the labs and like, what would indicate, well, you mentioned reverse T three. So if reverse T three is high, then that could, that can be a sign that, again, we have it that we were it's inhibiting that conversion process, if I understood that correctly. So what would, I guess maybe similar answers to what you just said, but what would make the reverse T three be high? I've heard a lot of it is stress, but same things. Yeah. Okay.
McCall McPherson PA-C (12:58.412)
Same. Yeah, same thing. So it is, it's this choice in your biochemistry. Is this T4 going to sit there in an inactive form and stockpile crude oil in your garage, right? Is it going to activate into gasoline or is it going to shunt to an inhibitory hormone? So in those situations that we just talked about, either A, it will sit with T4 and accumulate.
and increase that T4, or B, it will shunt to reverse T3. Inherently, those two things are interconnected because when we are not creating T3, when we're not activating our hormone, we are stockpiling crude oil in your garage. That crude oil is the source for your reverse T3. It's the only thing reverse T3 comes from. So think about it. We are supplying people
with levothyroxine, synthroid, levoxel, t-racin, unithroid, with all of basically 99.999 % of people's medication on thyroid hormones, we are supplying them with direct access to reverse T3 under these situations. And 99 % of people are living in these situations that would facilitate poor hormone activation or increases in reverse T3.
Kim Vopni (14:17.217)
Yeah. And so, as you said, if people, if we had practitioners looking at this and understanding that full picture, the medications would be significantly different and not, because Levoh and all the others that you listed, it is a T4 only medication. And some would benefit from maybe some T3 or maybe just T3. And I know that that people have alarm flags, alarm bells going off and
McCall McPherson PA-C (14:35.457)
right.
Kim Vopni (14:46.539)
Practitioners will deny and say that no that's not possible and but so what would be some optimal ranges that we would want to look for if we are doing this we have asked now we've been able to get this full thyroid panel in Canada where I am I can tell you that our our free health care system will not check you even if you ask your doctor and even if they put it on the requisition the labs will not test it unless
something is flagged to show that you might have an issue somewhere else. So basically they're waiting for something catastrophic. Then we're going to go a little bit deeper. You can pay privately. So I just have ordered this. Uh, I do a full thyroid panel at least once a year and it's 200 bucks. So my free healthcare system is not really my healthcare. It's my sick care and I will use it if I have something catastrophic to have, have, have happened, but healthcare. No. So what, what are the ranges when you say optimal?
McCall McPherson PA-C (15:22.286)
Mm-hmm.
McCall McPherson PA-C (15:41.09)
Yeah.
Kim Vopni (15:42.369)
that we would want to be looking for for each of those things on that test.
McCall McPherson PA-C (15:46.754)
want to compare and contrast this situation. So I can speak to American health care, which is different than Canadian, but seemingly still operates under similar paradigms. So what happens in America that I don't think people realize is that there is no firm standard range that is accepted as good for thyroid. Clinicians, doctors, et cetera.
Simply, and I'm grabbing a little piece of paper here to give you an example, they simply screen your labs and look for things that are in bold or off to the side. So that means whatever this lab says is normal is what they accept. The problem is in America at least, every lab's definition of normal is different. Even the same lab varies between locations two miles apart. Yes.
Kim Vopni (16:31.681)
Mm-hmm.
Kim Vopni (16:37.345)
Really? Wow.
McCall McPherson PA-C (16:40.12)
Quest Lab by my office is not the same as Quest Lab by my house. And those labs create normal ranges by selecting a bunch of patients in their databases and maybe weaning out the very top and the very bottom and then formulating averages. Well, there's several layers of issues with that. One is, you know, who is going to the lab, first of all? Like, is it people who feel so great? They're like, gosh, I feel amazing today. I wonder what my thyroid function looks like. Let me go to the lab and check it out.
No, right, they're going to the lab because they're looking for answers for their fatigue and their brain fog or maybe they're already diagnosed with a thyroid issue. So we are now basing normal optimal ranges on sick people. We are not excluding people with the condition that we are trying to rule out from being lumped into those data sets to create those averages. And then thirdly, there is no standard range. So I tell people this and it's a little weird to wrap your head around, but.
There can be two patients in a doctor's office. One walks into the doctor's office, the doctor looks at their TSH and maybe it's 4.5 and they say, yeah, no, this looks great, you're normal, come back in a year, no thyroid problem. The next patient can walk in with a TSH of 4.5 and that lab says the upper limit is 4.2 and the doctor says, well, you have a thyroid problem, let's go ahead and put you on some levothyroxine because we are inherently trusting that somehow these labs are now dictating how we should practice medicine.
which is terrifying, OK? So I want people to understand the context of when someone tells you your labs are normal, there is no standard normal. There is no true normal. So at Modern Thyroid Clinic, over the last almost decade, we started with more functional medicine ranges, where you wean out the top and the bottom percentages, and we start with a more narrow range. Every 12 to 18 months over the last decade,
Kim Vopni (18:07.595)
Yeah, wow.
McCall McPherson PA-C (18:33.09)
we have analyzed and reanalyzed from our patients' data, where do these people feel good? Where do they still have thyroid symptoms? And we have narrowed those, normal margins down every year to 18 months until, yeah, now we're left with ranges that are this wide compared to normal, which are as wide as the rooms that we're both sitting in right now. And we found, look, if we can get people into extremely precise, perfect thyroid function,
Kim Vopni (18:45.601)
Wow.
Kim Vopni (18:49.675)
Yeah.
Yeah. Yeah.
McCall McPherson PA-C (19:01.272)
they get their lives back. It's like a light switch comes on. So those ranges I actually freely share and I can send you a link to this, but we have a free thyroid lab guide where people can download what labs they need and what they mean, our optimal ranges that we use. if you're frantically in the car searching for a pen driving down the highway, please don't do that. You can find this in the show notes. I'll be sure to pass it over to Kim. But TSH is ideally less than 1.8. T4 is 0.9.
Kim Vopni (19:13.837)
That'd be great.
McCall McPherson PA-C (19:30.254)
to 1.2. T3 is ideally between about 3.6 to 4.2 for the bulk of your day, which is a little nuanced. And reverse T3 is between ideally about 8 and 12, can easily be up to 8 to 15 if your T3 looks really good. Antibodies, TPO should be less than 34. Thyroglobulin should be less than 1.
Kim Vopni (19:53.294)
So I've heard mixed things on the antibody side of things where some people say if there's any antibodies at all, automatically means Hashimoto's. And you're saying if it's under the 30, and I'm sorry, I didn't catch the second number there, but so your view is you don't have to be a complete zero, but we want them under those ranges.
McCall McPherson PA-C (19:56.686)
Mm-hmm.
McCall McPherson PA-C (20:15.832)
Totally, and studies vary on what is the threshold where someone actually has the autoimmune attack on their thyroid versus not. Like, is creating this damage to their thyroid gland? So in a perfect world, sure, it would be less than one, but no, certainly less than 34 with TPO antibodies, which is still a narrow margin more than you would think is perfectly reasonable.
Kim Vopni (20:39.917)
Mm-hmm.
Okay. So now we've highlighted hypothyroidism and now also screening for the autoimmune version or like autoimmune thyroiditis or Hashimoto's. Are they the same thing? Autoimmune thyroiditis and Hashimoto's, is that the same thing?
McCall McPherson PA-C (20:58.958)
Hashimoto's is a type of autoimmune thyroiditis. You can also have other types, like you can have Graves' disease, which is another form of attack on your thyroid that instead of eliciting hypothyroidism, it elicits hyperthyroidism.
Kim Vopni (21:09.367)
Got it.
Kim Vopni (21:13.877)
Okay, okay. So when you, on the hypo side, what differentiates symptom-wise, so we can do the testing, but symptom-wise, would somebody feel differently if they had Hashimoto's versus hypothyroidism?
McCall McPherson PA-C (21:28.302)
Good question. Very good question. So I want to, so people tend to lump these two things together, right? I want to separate them and tease them out as one is low thyroid function, which is hypothyroidism, and one is an autoimmune condition where your body is attacking your thyroid gland. It is eroding away that hormone secreting tissue, which then in turn leads to hypothyroidism, right? Largely,
hypothyroid symptoms that sometimes people think is Hashimoto's is just the manifestation of hypothyroidism. It's not the inherent autoimmune attack. So I would say most symptoms that we think about, like fatigue and brain fog and weight gain and hair loss and low libido and poor digestion and cold intolerance and all of these sorts of things, those are hypothyroid symptoms. A lot of people with Hashimoto's have them because they have hypothyroidism.
Now, if we wanted to further tease those things out symptomatically, I would say there's a couple things that I notice in the category of Hashimoto's people. Number one, they often will have a goiter, like they have a swollen thyroid gland that looks like almost a little fat pad on their lower neck. And the reason is because autoimmune thyroiditis, Hashimoto's, triggers inflammation, and that inflammation makes things swell in the same way that if we sprain our ankle.
It swells. So you're seeing that manifestation of inflammation. I used to have an enormous goiter in my own thyroid Hashimoto's journey. I don't have Hashimoto's anymore, but did very severely for a long time. And so that's one aspect of it. The second that I notice clinically a little difference in is Hashimoto's people, they tend to have anxiety more than plain old hypothyroidism. You can certainly still have anxiety with hypothyroidism.
but I see it very, very commonly and almost the higher someone's antibodies are, the more anxious they tend to be.
Kim Vopni (23:35.47)
Got it. Yeah, I definitely experienced major anxiety out of the blue. Never experienced it before in my life. And it was, it like halted me in my tracks. That was what it wasn't so much fatigue, but the anxiety was overwhelming and so frustrating. So frustrating. what, what in your experience, people who are, well, let me ask it first. Another first question. Do you see that these manifest or present?
at specific phases of life compared to another. Like I'm going to make an assumption, but you can confirm with me that perimenopause is a very popular time for these conditions to show up. Would you agree?
McCall McPherson PA-C (24:17.29)
I would agree. And then hypothyroidism creates this worsening of perimenopause symptoms. it's.
Kim Vopni (24:22.625)
That was my next question was, will it exacerbate? Yeah. Okay.
McCall McPherson PA-C (24:26.226)
Absolutely, because hypothyroidism drives hormone dysfunction, which can create earlier perimenopause, worsen symptoms in perimenopause. certainly perimenopause research certainly backs up as well menopause, like menopause is a prime time to get an autoimmune disease postpartum. So postpartum, we are at our highest risk as women for autoimmune disease because of changes in the way that our immune system is functioning from a low functioning state to trying to swing back into gear.
And often it goes into overdrive and we become autoimmune prone. And then also I find too, in our 20s as women, we're living our best life. We're not really health conscious. We're eating bad. We're drinking bad. We're stressing bad. All the things that prime us for an autoimmune disease when we're not really invested in our health is a very common time that I see as well. And those women are grossly dismissed.
Like they are like, nah. You know, also postpartum. Postpartum women are, well, you just have a new baby. You're just tired. You're breastfeeding. you're perimenopausal. There's always an excuse or reason for medicine to dismiss women with thyroid dysfunction. And so it's so important that we learn how to navigate this complex landscape because it is our ability to get our lives back, get proper diagnosis, get on proper medication.
is it's patient driven. It is dependent on us being informed and empowered consumers of our health. It is not passive. Sadly, you cannot just rely on your clinician to navigate this for you because in all likelihood, you will not land in the hands of someone that knows how to do that.
Kim Vopni (26:11.533)
1000%. 1000%. I've once I, so in my perimenopause, but like hypothyroidism Hashimoto's journey there, I didn't know. didn't had never heard the term perimenopause, never heard the term Hashimoto's and it was just through my own research. I figured these things out and, then started asking for these tests. but
So to your point, we need to be able to, we need to be informed and have the information to be able to advocate. And something that once I learned about this full thyroid and how many women are diagnosed with hypothyroidism just in general, but also then how many of those people also have Hashimoto's but are never diagnosed. I recommend to people, even in your twenties and thirties, get a full thyroid panel as a baseline and maybe do it every couple of years. Is this something that you would recommend?
McCall McPherson PA-C (27:06.954)
Absolutely, so I am not really in the business of saving insurance companies money, like that is not my top priority. So I am like, listen, get it done as often as you possibly can because data is powerful. The more data you have, the earlier you're going to realize if your numbers are shifting, if you are headed in not a good place. And so,
Kim Vopni (27:13.805)
Yeah.
Kim Vopni (27:20.417)
Yeah.
McCall McPherson PA-C (27:32.012)
Yeah, I mean, I even tell women who have kids with hypothyroidism and Hashimoto's especially, look, screen your kids starting at like age five or six. At the latest, every few years, they need to be screened as well for both Hashimoto's, which is not uncommon in children and hypothyroidism.
Kim Vopni (27:48.686)
Yeah, that's it's interesting because I have thought of that for my kids. I'm actually just but they're now like almost 21 and 18. So I'm a little I'm a little late, little late, but never too late. Right. So I will be getting them both screen. But so I'm going to come back to some of the symptoms you you listed off. One of the biggest struggles I had was constipation, where again, I hadn't changed anything. I had always been regular, super regular, never thought about it. Can eat whatever I want. Did what I just.
McCall McPherson PA-C (28:00.226)
Never too late.
Kim Vopni (28:17.645)
It was not a problem. And then all of sudden it was a big problem. What is it about hypothyroidism and or Hashimoto's that slows that slows? Is it literally just that it slows things down? Is that why we become constipation constipated? And is there a hormone piece in there as well?
McCall McPherson PA-C (28:36.78)
Yeah, so mean, T3 specifically, like your active thyroid hormone, is responsible for metabolism, the breaking down of your food, choosing whether we're going to store it as fat or use it for energy, the mechanical breakdown of your food. So if we wanted to think about this really simply, is with hypothyroidism, everything slows down and dries up. So a perfect storm for constipation, right? The mechanical nature of our.
small intestine, large intestine, moving things through slows down, which then leads to dehydration of the stool in our bowels, which leads to more constipation. Also, we tend to hold on to fluid. Most people listening can probably remember at some point if they have a thyroid problem, they're puffy. Again, pulling water away from our intestine into our tissues, which is going to in turn create more constipation. It's a big and very common problem.
Kim Vopni (29:34.7)
Yeah. Yeah. And in my community, that is a, it's a very common problem and it's a very common contributor to pelvic floor dysfunction as well. so always on, on the top of the list of what I'm working on with people. I want to talk a little bit about the medications before we get into some of the other ways that we can now, once we have the knowledge and once we have seen our ranges and we've become informed now, what do we do about it? So you've mentioned a list of the T four only medications. What are some of the.
other options, what would be T3, common T3 medications, and when would somebody benefit from a combo T4, T3, or just a T3 only?
McCall McPherson PA-C (30:15.128)
Good question. So, you know, first of all, the examples of pure T3, so only active thyroid hormone medication is Cytomel is the brand name. The generic form is lyothyronine. They're the same interchangeable medication. We're simply discussing brand versus generic. I use that very often when people come into me already on high doses of levothyroxine or synthrate or T4, and they simply don't have enough T3, right? So they have this
If we're thinking of a scale, the weight is really heavy on T4, really light on T3. Instead of removing all of this T4 and starting over with a combination, I just want to tip the scale and make it quickly and effectively balanced without redoing everything from the ground up and taking them off all their medication and transitioning.
So that is something that I very commonly do when people come in already existingly on T4. The other medication option that includes some form of active thyroid hormone or T3 is a form of what's called natural desiccated thyroid. You can see it abbreviated as NDT. These are medications like Armour, NP, and there's a new one coming out that I'm very, very excited about called Renthirate. It's actually coming out now this month.
And those are called natural because they are pig thyroid gland that is broken down and it's inherently has a combination of T4, mostly T4 and some T3. There's also some co-factors in there, T2 and other things that come with getting a whole gland of a pig made into a medication. So they can be really, really great, especially for people who aren't on thyroid medication, who...
are on low amounts of T4 that could easily transition to something like this. I like layering in some of this for people post-thyroidectomy because it has those co-factors that they're inherently endogenously missing. My favorites are certainly ARMA and REN thyroid out of that category. There is a lot of old wives' tales in medicine that are perpetually propagated about these meds.
McCall McPherson PA-C (32:27.444)
Armour, for example, is the oldest thyroid medication. It was around for about a half of a century before levothyroxine came around. And when it was first around in the 1920s until about 1983, it was very unstable. It was unpredictable. It wasn't well controlled. Medicine continues to say that about Armour. It is, in fact, quite stable, very predictable, very controlled, and has been since the 80s. But we continue this to propagate the narrative that it's not.
Kim Vopni (32:31.437)
Wow.
Kim Vopni (32:55.979)
Right.
McCall McPherson PA-C (32:56.622)
It has a reasonably narrow margin for error. Ren Thyroid has an extremely narrow margin for error and I'm working closely with that brand because they're going for FDA approval for the first time in desiccated thyroid history, which is really exciting for the thyroid community. So I would use those very often in those cases. I love them. I use them every day. I'm on armor. I'm transitioning to Ren Thyroid this month. So there's something I'm a big believer in for sure.
Kim Vopni (33:08.513)
Hm. Wow.
Mm-hmm.
Kim Vopni (33:25.663)
And REN is also sourced from pig thyroid.
McCall McPherson PA-C (33:29.11)
Ren is also sourced from pig thyroid. It is the only desiccated thyroid that happens from source to completion in America. So the pigs are from America. There are very rigorous standards involved in that process. Everyone else sources pigs from, Armour recently, I think, moved to Germany. And then I think NP thyroid is from China, but various places. So yeah, it's a unique aspect, but it is also pig thyroid gland.
Kim Vopni (33:58.158)
Okay, so if somebody was hovering around, like I've always kind of hovered around for TSH around the two, you mentioned ideal in the narrow ranges you have 1.8, would you do anything for somebody at a two?
McCall McPherson PA-C (34:14.198)
I would. So honestly, I find that anything above 1.8, people usually show up symptomatic. now, and the problem is women will come and they'll be like, well, no, I actually feel good. Like, I think I'm good enough, McCall. We've done all this work and I'm so much better than I was. Women don't know how they're supposed to feel. Like, we lose touch and context with what having a high sense of vitality feels like because we've pushed through for so long.
Kim Vopni (34:34.708)
So true. Yeah.
Kim Vopni (34:42.689)
Yeah.
McCall McPherson PA-C (34:42.934)
we don't have the relative ability to compare. it's my mission, honestly, that until everything is perfect, thyroid, hormones, adrenals, inflammation, until globally all of these things are so tightly controlled, I can't confidently send a woman on her way and be like, okay, this is what optimal feels like. I think that they don't know still. And so if I encounter someone with a TSH of two, I worry that they've accepted their new normal as optimal, and it's probably not quite good enough.
Kim Vopni (35:02.498)
Yeah.
Kim Vopni (35:12.757)
Yeah. Yeah. Yep. I need, I know I need a little tweaking there. So that's meds. The, the one thing that I have helped that has helped me, from more so, I would say the antibody perspective is LDN low dose naltrexone. Is that something that you use in your practice?
McCall McPherson PA-C (35:25.944)
Mm-hmm.
Absolutely, all day, every day. So I'll talk a little bit about that. I'm on it myself as well. So know, low dose naltrexone or LDN is a microscopic amount of a medication called naltrexone. Naltrexone strangely is used as an opioid blocker, a pain medicine blocker in cases of too much or addiction, et cetera. When you compound it, meaning you can make it into smaller doses,
usually starting at about 1.5 milligrams, working up to 4.5 milligrams. Standard dose really starts at 50 and goes up to several hundred. Something really strange happens. And it blocks a little bit of our own endogenous opioid receptors. And that sends a signal to our body that says, gosh, we don't have enough opioids. Can we increase and make more? And so we end up surmounting that depletion and end up in a state of excess opioids.
And uniquely, when you're walking around with a little bit of extra opioids, it reduces inflammation and autoimmune diseases of any kind. I've seen someone's TPO antibodies, for example, drop 500 points in three months with no other lifestyle changes just from low-dose naltrexone. It's something that I use very often in my Hashimoto's patients, in my inflamed people. I use it in 100 % of my Graves patients. It's incredibly life-changing for them.
Kim Vopni (36:40.182)
Bye.
McCall McPherson PA-C (36:53.614)
So I'm a big, big advocate. has also a lot of, I know you know this, but longevity benefits. Anti-aging, it can prune off some weak cancer cells, just slow, it reduces inflammation, which is largely what drives aging.
Kim Vopni (37:06.913)
Yeah, yeah, I know, I don't remember, I think I was talking to my naturopath about it, but saying that, know, metformin for a period of time was kind of the, long, a lot of people were taking it from a longevity perspective. And I said, I think LDN is going to surpass that and be the, one of the new things. think GLPs are also jumping in there too. Yeah.
McCall McPherson PA-C (37:22.988)
Yeah, yeah, yeah. LDN used to be my very favorite anti-inflammatory. I estimate GLPs to be 100 to 1,000 times more effective at reducing inflammation than even LDN. It's pretty crazy. Yeah.
Kim Vopni (37:39.394)
Wow, interesting. Okay, so I'll go on a sidebar. This isn't necessarily a topic we're gonna go down, but there's like a concept of microdosing GLPs, which is that like, are you looking at people using the kind of prescribed doses from a GLP perspective, or are you nuancing it for various people and seeing the same results even if it was in a microdose amount?
McCall McPherson PA-C (37:44.14)
Yeah
McCall McPherson PA-C (38:02.604)
Yeah, I have been microdosing people on GLPs for three years. Before the word even came out, we were already doing it in our program and absolutely have measurable data. probably, we probably at Modern Thyroid Clinic have the largest data set in the world for people on GLPs with thyroid dysfunction, period. So we have been mining data that no one else was collecting for years on these people.
Kim Vopni (38:06.658)
Wow.
McCall McPherson PA-C (38:29.01)
Absolutely, inflammation reduces not only with a microdose, after a single microdose injection, measurably on lapse. You can see a difference in CRP. I saw it reduce over 50%.
Kim Vopni (38:39.329)
Hmm. Does it have to be injected? Sorry, I interrupted you. What did you say?
McCall McPherson PA-C (38:44.238)
We would see reductions of CRP of over 50 % after one microdose injection after a week. I do not have data on oral or sublingual doses yet. We're starting our own beta to understand the data with those people. I'm very, very curious about the anti-inflammatory effects of sublingual versus injectable. And maybe we'll have another conversation soon when I've got some data.
Kim Vopni (38:49.494)
Wow.
Kim Vopni (38:56.191)
Okay. Yeah.
Kim Vopni (39:11.755)
Yeah, is the GLP injection, is that something that somebody would do daily?
McCall McPherson PA-C (39:17.71)
No, largely the ones that are out now are for weekly injections. We do often twice a week, smaller dose injections because the anti-inflammation, the anti-inflammatory effects will peak and then it will trough as the week goes on. Same with hunger, curbing, et cetera. So we use less dose more often. Red Etrutide is more of a daily and there are other meds that are daily, but right now we just do the weekly or bi-weekly injections.
Kim Vopni (39:27.597)
Mm-hmm.
Kim Vopni (39:38.743)
Got it.
Kim Vopni (39:47.403)
And that's something people can administer on their own. Once they, they're familiar, don't need to come into the clinic for that.
McCall McPherson PA-C (39:50.954)
Absolutely. Yeah, no, we do it entirely telemedicine. And we just teach people how to do it. It's a little video of me just injecting NAD. So it works.
Kim Vopni (39:57.282)
Yep.
Yeah, that's so interesting. Good for you. that's, you know, it's, you were ahead of the curve and you saw the potential of there and there's, we don't always have to go with exactly what is, what, that standardized dose is. And there needs to be this nuanced personalized approach so many times, so many times. Yeah.
McCall McPherson PA-C (40:22.766)
Absolutely, and I think you know all the side effects we hear about Blasted in the media all the time is literally because people are overdosed on these meds mean we are trying to apply diabetes dosing to people who don't have diabetes And that's just not really a winning game plan. I do think it's inevitable that
Kim Vopni (40:30.667)
Yeah, yeah.
Kim Vopni (40:36.065)
Right.
McCall McPherson PA-C (40:41.656)
pharma companies will start looking at smaller dosing. More tailored dosing is always hard in medicine because it requires a lot more touch points, but I think that the standard dose won't be the dose forever.
Kim Vopni (40:49.793)
Right.
Kim Vopni (40:54.445)
Yeah, yeah. The one that was alarming to me, which I have not gone anywhere near down a rabbit hole about, was bone loss. that is, are you seeing anything to do with that when you're looking at the microdose levels?
McCall McPherson PA-C (41:07.74)
no. In fact, there's bone protective mechanisms in GLPs themselves. I think when you're starving yourself, when you're not eating enough micro and macronutrients, your body, again, it's smart. It goes looking for resources to use. Muscle, bone, hair, collagen. When you're not overdosed and not eating, when you're eating enough micro and macronutrients, inherently, GLPs have a muscle protective component.
Kim Vopni (41:11.725)
Hmm.
Yeah.
McCall McPherson PA-C (41:37.484)
and a bone protective component that actually can help facilitate the reversal of bone loss and bone preservation, muscle preservation, but it's all about the poisons and the dose. And so we can take something that's so incredibly good for people and make it really bad for people or vice versa.
Kim Vopni (41:48.715)
Right, right.
Kim Vopni (41:53.708)
Yeah, yeah. And that was the whole thing is the, is not eating, of course you're be nutrient depleted, but they're blaming, they were blaming the medication and there's a lot of shame around this GLP, which I think is not warranted. And I think that this is such an incredible tool that's being used now. I'm hearing from you and several other people using it in all these different ways. So thank you for doing that. Now, away from the medications, what would be the lifestyle factors?
There's going to be the basics. You can list those basics off because we can't hear them enough times. But what else in that category of lifestyle recommendations would you be making to this hypothyroidism and Hashimoto's population?
McCall McPherson PA-C (42:35.692)
Yeah, so if we go back to facilitating the activation of your thyroid hormones, right, and we want to reverse engineer that lack of activation. So it's low inflammatory diet, micronutrient dense diet, getting enough sleep, getting enough calories, trying to reduce inflammation, trying to reduce stress. So meditation, those sorts of things, healthy amounts of exercise.
All of those things, not only do they facilitate the activation of your thyroid hormones, they also help to prevent Hashimoto's, right? Because Hashimoto's is a parallel that can happen and occur, and we don't want that. Anytime you have one autoimmune disease, you're at a risk of developing another of over 30%. So whatever we can do to mitigate that is enormous. I think a couple other things that I always emphasize on is these women are often told,
to eat less and exercise more and they get into these precarious situations of, sorry, my little, my daughter's epilepsy dog just showed up. Okay, so they get into these precarious situations where they're over-exercising to try to manage their weight and they are depleting their body and their adrenals further and it can quickly spiral and get to be.
Kim Vopni (43:44.801)
No problem. no problem.
McCall McPherson PA-C (44:03.174)
really, really negative. And in fact, some of the only people that we can't fix when they come to us are these over-exercisers that think, I'm just going to exercise and eventually it'll happen. And they are exhausted after they exercise. Then it's like three days of exhaustion and it very quickly spirals and they lose the ability to heal their body in a meaningful way in a small amount of time. as far as exercise goes, a big, big thing for me and a rule of thumb is never exercise to the degree that you feel
more fatigued later that day or the next day. Keep it under the threshold where you still feel as energetic or more energetic later that day. My favorite types are walking and strength training, but allowing your heart rate to come down between sets and circuits, not blending strength training with cardio, basically. Separate those things, build your muscle mass, increase your basal metabolic rate, increase how we're going to age with our muscle mass.
but don't do it in a way that compromises taxing your adrenals and your physiology so much. And then I always do, as far as diet goes, try to emphasize, incorporate in really good micronutrients, macronutrients. Find creative ways to get the good stuff in. And of course, leave out processed foods, et cetera. But oftentimes when you have such a nutrient-dense diet, you're not looking.
for energy and resources in this crappy food that we tend to eat when we're tired. So finding creative ways to flood your body with micronutrients is key. One of my favorites is green juice, not smoothies, but juice, where you get a lot of veggies in a tiny little package. You can get it almost any city in North America, and you just flood your system that way in a really easy and convenient way that doesn't cost a lot of energy expenditure for tired people.
Kim Vopni (45:55.884)
I don't remember who first said this to me, but it was a light bulb moment where, which is what you've just said, where a lot of the reasons for hunger is because we could eat a lot of food and not like feel full to an extent, but we still feel hungry because we haven't met the nutrient demands that we.
that our body needs and so it's still sending out signals and saying I need more, I need more because I need more nutrient. And just like it was this light bulb aha moment. I always feel like I've been, you know, healthy, healthful, but.
McCall McPherson PA-C (46:18.967)
Absolutely.
Kim Vopni (46:26.903)
for a long time, especially when I was struggling in this perimenopause and I also was dealing with with erectus, a type of pelvic floor dysfunction, a pelvic organ prolapse. I knew exactly what would make me gassy. I knew exactly what would make me have just one perfect poop in a day because I didn't want a second because then I would get symptomatic and I had a very limited diet and I felt hungry a lot of the time and I would be overeating certain times because I was nutrient devoid depleted. Yeah.
McCall McPherson PA-C (46:53.026)
depleted. Yeah.
Kim Vopni (46:54.909)
And so it's such an important point. I'm so glad you brought that up. This has been amazing. I absolutely love the work that I'm, you know, it's like we have these pains, but the purpose that we get to is really awesome and you're helping so many people. So thank you for your work. Where can people find out more about what you do with the modern thyroid clinic and potentially work with you?
McCall McPherson PA-C (47:11.736)
same.
McCall McPherson PA-C (47:17.196)
Yeah, so you can find us on.
all social media platforms under Modern Thyroid. You can find me at probably my favorite is TikTok at McCall McPherson or Instagram, McCallMcPhersonPA. And of course, like our clinic's website is Modern Thyroid Clinic. We're in about, I think, 44 states right now. Just pending on the last like six or seven, we're really excited. So of course, we're always here to help people in that regard as well. Our plan is to hopefully extend into Canada next. So fingers crossed for that.
Kim Vopni (47:39.49)
Yeah
Kim Vopni (47:47.405)
Yeah, I was going to say, are you coming to Canada? That's amazing.
McCall McPherson PA-C (47:49.568)
Yeah, we have to conquer the states first and then we're headed your way. Thank you so much. This has been amazing. Thank you for having me.
Kim Vopni (47:53.951)
Yeah, okay, okay, I'll be waiting for you. Thank you so much. This has been amazing.
