Kim Vopni (00:01.186)
Welcome back, Dr. Amy Horniman. I am excited for another conversation with you about thyroid, but we're gonna go a little bit deeper this time and we're going to learn more about things that you have covered in the new book you have coming out, The Thyroid Fix, which I'm excited to read. I guess anybody who's listened before, I'll have that other episode linked, but for those that don't know you, how did you become, I remember hearing
Dr. Amie Hornaman (00:05.76)
with you.
Kim Vopni (00:31.118)
you on a podcast. don't remember, it was many, many years ago. And I remember learning about T2 from you. And ever since you have been my my thyroid guru, what brought you into this world of being my thyroid guru?
Dr. Amie Hornaman (00:44.292)
Well, know, Kim, mean, like so many of us here, you know, just like your own story, like so many of our friends, pain to purpose, you go through your own pain, and then you start looking around and go, you know, I don't think I'm the only one going through this BS. Like, who else is? And maybe I need to help these people. So that was me. I mean, 20-some years ago, I was being misdiagnosed over and over and over again. So I was getting ready for a bodybuilding show. And I was doing figure. It was the feminine side, not the...
not the manly looking bodybuilders, but the feminine side. And I had done plenty of shows before. I knew how to lose the weight. I knew how to get my body in show shape. But as I was dieting and going to the gym twice a day, the scale was going up and not down. And that didn't even make sense. mean, biologically, that should not be happening. When you are truly restricting calories and you're eating clean and you're hitting the gym and all that, your body should lose the weight. It should shed fat.
Mine was not. Mine was going up. And when I say going up, I mean the scale went up to like 25 pounds in a very short amount of time, a couple of months. So even that just did not make sense to me. I went to my doctor and I went to actually six of them. Six different doctors all told me I was normal, I'm fine. Just, you know, one of them was like, eat less than exercise. I'm like, dude.
You don't even realize the amount of calories that I'm taking in. I'm taking in about 1,200 calories. It's all clean food. I'm not eating donuts. I'm not eating pizza. Well, finally, the seventh doctor actually touches my throat, and she tells me to swallow. First doctor to lay hands on me tells me to swallow and says, have some nodules here on your thyroid. And based on your labs, it looks like you have hypothyroidism. Here's a pill. So I took that pill home. I was so pumped up.
so pumped up that I had a name for what was going on with me. And then I supposedly had this pill that was gonna be my answer. It was gonna fix everything. So I took my little pill. I took my Synthroid, which is what it was. It was T4 Synthroid. Took that every day for about five months. And I didn't lose a single freaking pound, nothing. Didn't feel better, didn't grow any hair back, didn't lose any weight.
Dr. Amie Hornaman (03:02.912)
So I start Dr. Googling because that's what we do when our bodies are basically giving us the burr. We're like, what's going on? Well, I didn't have chat GBT back then. I have my own gateway computer. So I'm on there on dial-up internet, Dr. Googling. And still finding great information about the thyroid, it turns out this pill that I was taking was an inactive thyroid hormone. It's T4, totally inactive. It has to convert and become something called T3.
Kim Vopni (03:13.838)
Ha
Dr. Amie Hornaman (03:29.576)
And turns out that there is a medication, there is a pill that contains the active thyroid hormone too. And then I'm reading these articles of how some doctors will put T4 and T3 together. And I'm like, well, that makes sense to me. Why not put the active thyroid hormone in the mix? So I went back to her and I said, here's what I'm finding. I did what you all do. I print out the studies, hand her the paper. And she looks at him briefly, dismisses me, and says, that's not standard of care.
That's not what I do. And I said, well, I'm going to find somebody who does. Now that led me into this world of functional and integrative medicine because I had to go outside of that conventional system that I was in. Seven doctors now have let me down in the conventional medicine system in a major, major health care system here in the US, and where the best of the best doctors are supposed to be. And I was still dismissed and medically gaslit left and right.
So that's what led me into the world of functional medicine where my mentor saved my life. I mean, he spent time with me. He asked me how I felt. He tested thoroughly. And then he actually put me on the right thyroid hormone treatment that my body needed. And it wasn't that little T4 only pill, which I know we're going to go into more today.
Kim Vopni (04:51.586)
Such a cool story. And then you ended up becoming, part of that, you weren't already in functional medicine as a practitioner, correct? Before then? Yeah.
Dr. Amie Hornaman (04:58.494)
No, changed careers, totally changed careers, went into functional medicine, got my master's, got my doctorate, got trained in functional medicine. And then just opened up this practice because I knew how important it was. I knew that I wasn't the only one out there suffering from all of these misdiagnoses with thyroid. So I really wanted to be able to help women everywhere that were in my shoes, that were experiencing the same dismissal.
And it was really important for me to be able to help women in every state too. So I was local at the time in Pennsylvania and we could only treat people that we saw in person, NPA. Now luckily when COVID hit that opened up the prescribing borders and now we're able to prescribe to all 50 states. I literally built a team so that we can do that so we can help women everywhere.
Kim Vopni (05:52.972)
Yeah. So when we think about the thyroid, one thing that you're highlighting in your book is that this will help people understand the labs. And it's important to know, first of all, what labs to get because conventional medicine does not do a full thyroid panel. So what would be a full thyroid panel and then what outline in the, or tell us what you've outlined in the book in terms of how people can self-interpret their labs.
Dr. Amie Hornaman (06:18.598)
Exactly. So if you think that you can't self-interpret your labs, you're wrong. It's very, very easy to teach you, and I will do this in the thyroid fix. So you start with getting all of the labs. And just like you said, Kim, if you go into your doctor and you just say, hey, doc, I want a thyroid panel, you're only going to get two labs, but that's not enough. So you're going to get TSH, which is thyroid stimulating hormone. That is a brain hormone.
It is not a thyroid hormone, it's a brain hormone. We look at that hormone, but we don't hang our hat on that. We do not hang our hat on TSH because TSH can lie.
Dr. Amie Hornaman (07:01.418)
So we don't want to just rely on that TSH marker alone. We have to go deeper. The second marker that your doctor might toss in is something called FreeT4. Now, I just got done saying I got a hand on that pill. T4, it's the inactive thyroid hormone. So when we're testing FreeT4, we're testing how much inactive thyroid hormone you have that is kind of pent up and ready to be converted.
So it's ready to convert and become T3, the active thyroid hormone. However, T4 can do something else that's a little bit sinister. It can become something called reverse T3. And reverse T3 is your anti-thyroid hormone. That's going to put your body into a hibernation state. So literally, your body is going to think that you are either dying or that you are a bear in the winter.
And it's going to shut down fat burning, shut down energy production, shut down growing your hair. Just everything is going to go into a hibernation state. So we want to test that. We want to know how much of this anti-thyroid hormone you have in your body. So reverse T3 is a marker that you have to ask for. Your doctor is not going to put it on a standard lab test. You have to ask for it. The other marker that you're going to have to ask for
is free T3. So T3 is the active thyroid hormone. We want to know how much is unbound, ready to get into your cells. And then we're going to test TPO and TGA antibodies to see if you have Hashimoto's. Do you have the autoimmune form of hypothyroidism? Have to have all of them. Every single time you get your labs done, you have to have that entire panel. And then what we're going to do is look at it through an optimal lens. So just because you get that panel,
You don't want to go off to the side and look at the standard range or the reference range because that range is actually taken from groups of sick people. And it's too big. It's not narrowed down enough. So we're going to look at your labs through an optimal lens as well, where functional medicine says, this is where you're going to feel your best. And then we're going to go from there for treatment.
Kim Vopni (09:20.878)
Yeah. One thing I heard recently, which I didn't know, and correct me if this is different, that also those reference ranges can also vary from parts of, say, in the United States, different parts of the United States, because they are taken from a specific population in that area. So if there's a sicker or healthier, you know what I mean? So it can vary even state to state. That's crazy.
Dr. Amie Hornaman (09:48.222)
Yeah? yeah, yeah, and it can vary lab to lab. So we have LabCorp, Quest, Access Labs, any lab test. Now, hospital systems. I every single lab you go into can be different and can have a totally different reference range.
Kim Vopni (10:04.962)
Yeah, so we get those numbers, now we understand where we fall within the optimal range. If we are outside of that, so let's say there's something, the conversion, the ratio between, is it T4 to T3 or is it reverse? I can't forget what that ratio is, but there's a ratio we're supposed to look at as well, is that correct?
Dr. Amie Hornaman (10:28.522)
You know what? I don't even look at the ratio. I just go straight for the numbers. I go right for the numbers. So when we're looking at those numbers, that free t3, I want that in the upper quadrant of the range. So when we say upper quadrant, that makes it very universal. And in fact, if you're listening in a different country, you can do this. So you're going to take the standard reference range off to the side. You're going to cut it into four. And I want you in that upper quadrant, that upper fourth, or even just a little bit over. That's fine, too.
Kim Vopni (10:30.731)
Okay. Okay.
Dr. Amie Hornaman (10:58.548)
but that's where your free T3 is gonna be optimal. Reverse T3 is relatively universal in that we want it less than 12. Most labs will have that reverse T3 anywhere from like nine to 25, five to 25, so we want that less than 12. So those are the two most important markers that you can get. And then with the other markers,
TPOTGA antibodies, we want those at zero. I don't want you to have any antibodies. TSH, we want below a two. Free T4 is the tricky one because there's a lot of influencers or thyroid peeps out there that they'll have their optimal reference range. They'll post it on Instagram. And I look and they'll have that free T4 at let's say a 1.5. I go, no, that's not where you want it at all. You actually want it a little bit lower. And here's why.
I like it between a .8 and a 1.2. So really at the lower end of that reference range. Because if someone has too much of this inactive thyroid hormone, whether they're taking T4 only as a prescription, maybe you're on levothyroxine, you're on Synthroid, Tiracin, and that's all you're taking. Or maybe you're taking something called natural desiccated thyroid medication, NDT.
That's your armor, NP, renthiroid, that's 80 % T4. If you're taking in too much T4, what's gonna happen is you have a much bigger propensity for that T4 to push down the reverse T3 pathway and put your body into hibernation mode. So whenever I'm looking at labs and if someone comes back with a T4 of like 1.5 or middle to upper range,
I immediately start thinking in my head, I'm like, I bet their reverse is going to be high. I bet their poor body is just in this locked down survival mode state. And that's why they're symptomatic. And sure enough, I'll drop down to look at their reverse. like, yep, there it is. It's a 20. It's a 22. It's a 24. So we really don't want that free T4 to be too high.
Kim Vopni (13:12.834)
Got it, okay. So you've highlighted the T4, T3, and as you said, initially somebody put you on T4 only medication and that is very, very common for a lot of people. But if it's getting pushed into the reverse T3, if it's not converting, it's not going to work. And so potentially they need some T3 and there may be T3 only. But I wanna highlight some of the reasons why that conversion may not be happening.
Dr. Amie Hornaman (13:41.522)
Yes, so that conversion process is really tough for your body to do. There's a lot of things that can get in the way. So number one, insulin resistance. Well, 93 % of all Americans are insulin resistant. So right there, you're kind of behind the eight ball when it comes to converting because your chances of you being insulin resistant are 93%. So insulin resistance, estrogen dominance.
High cortisol, like if you're really stressed out and you have anything going on with your adrenals, high or low cortisol. Low ferritin levels, low iodine, low magnesium, low zinc, low vitamin D levels can all play a role in T4 to T3 conversion. And then there are genetic SNPs. There are genetic variants in our DNA that can actually make us a non-converter or a poor converter. So it really is a.
tough job for your body to take all of that T4 and convert it properly into T3.
Kim Vopni (14:43.374)
Okay, I can, you know, lowering stress, optimizing hormones, optimizing nutrient deficiencies, you know, basically nervous system regulation, all of that is going to help favor a proper conversion. What would some, you mentioned when you went on T for only nothing changed, so you still continued to gain weight, you talked about your hair. What are some of the symptoms of
core thyroid function and I want to kind of highlight the buckets of hypothyroidism and you've also mentioned Hashimoto's which is the autoimmune side. So symptom wise, how do they differ and then we'll get into more treatment afterwards.
Dr. Amie Hornaman (15:27.486)
Okay, so symptom-wise, it's gonna overlap because Hashimoto's is just the autoimmune form of hypothyroidism. So when we're looking at all the cases of hypo, low, and slow function, hypothyroidism, when we look at all of the cases, 95 % of them are autoimmune-related. It's Hashimoto's, you have an autoimmune condition, your body mistakenly thinks that your thyroid is a bad guy.
and goes out and attacks it and starts beating it up every day. Only about 5 % of those cases are primary hypothyroidism, meaning maybe you went through chemo or radiation, you're taking a medication that downregulates your thyroid, like a beta blocker. Birth control, if you've used birth control for more than 10 years, you're at a 283 % increased risk of hypothyroidism.
Kim Vopni (16:22.562)
Wow.
Dr. Amie Hornaman (16:22.592)
So it could have just been being on birth control and using all those synthetic hormones for so many years. But that really only accounts for about 5%. 95 % is Hashimoto's. When we're looking at symptoms, they're all the same. The weight gain, inability to lose weight, the hair loss, fatigue, constipation. I always say with a thyroid, from head to toe, it runs the show. So literally, if you start at the top of your head, your brain function, your cognition, your memory, your mood.
Your eyes can get really dry if you're hypo. Your hair can fall out or break or just become really thin and brittle. Your throat can feel like there's something caught in it. Sometimes you feel swelling or you can visibly see swelling in your throat. Your face can have something called mixedema where it swells and actually looks like a moon face. So one thing that we can really notice in thyroid patients when we start them on proper treatment is that their face automatically thins out in a good way.
you know, not Ozempic face, but like in a good way where they actually look like themselves again. And then we just keep going, heart rate, body temperature, frozen shoulder is a weird wacky sign of hypothyroidism, but it's absolutely correlated. Bloating and constipation, irregular cycles, infertility. I mean, you name it, the thyroid has control over it in your body.
Kim Vopni (17:21.105)
You
Kim Vopni (17:43.053)
And all of those could also tick the box of perimenopause. So it's, I remember, I tell the story a lot with people in my community. When I, didn't know the term perimenopause at the time. This is, know, 14, 15-ish years ago when I started to go through it. I had no idea what was happening. And all of what you just listed off plus many other weird things happening. And I knew, like my instinct was there's something hormonal because I had such.
Dr. Amie Hornaman (17:47.241)
Yes!
Kim Vopni (18:12.226)
raging heavy periods and then going to the doctor, no, everything's fine, your ferritin's low. That was the only thing that came up flagged and it was very, very low, but no wonder, was like half my body weight and blood was coming out every month, like it was crazy. so my point being, in that process, when I was now, what's happening to me and reading all these hormone books, I start learning the term perimenopause, I start learning the term, well, I knew the thyroid, but learning about hypothyroidism and started to check all those boxes.
And I needed to be the one even working within, you know, a natural path, working with a natural, I had to be the one to say, could I get this, these tests over here, this full thyroid panel and sure enough, right. But all of those overlap and that is so confusing. And I recommend people get hormone testing, full, full hormone testing and full thyroid testing as early as they can to get a baseline. So from a hormone perspective.
How, so I guess let's say a lot of women are diagnosed within this perimenopause phase of life. Do you recommend going and looking at them together, attacking the thyroid first, attack, I don't mean attacking, that's a bad word, addressing the thyroid first or addressing hormone first, or address them all together? How do we tackle that? Okay.
Dr. Amie Hornaman (19:32.8)
All together, all together. It drives me bananas when I hear someone say to a patient, like we'll get a patient into the clinic of course and they'll be talking about their experience with another provider, maybe they've seen another functional provider. And they'll be like, yeah, so and so, they just wanted to address my hormones first and they said we come back and look at thyroid like in like three to six months. Like, why? Number one, the thyroid and hormones, play together.
Kim Vopni (19:56.718)
Why? Yeah.
Dr. Amie Hornaman (20:01.182)
The thyroid is at the top, it's the master. It's going to have some level of say as to whether or not your sex hormones are balanced. It can actually make you insulin resistant even if you're not eating a carbohydrate at all. I've seen carnivores have high insulin and high A1Cs because their thyroid is off. It's going to dictate your stress and your response to stress. Your cortisol can go all kinds of wacky.
if your thyroid isn't working properly or isn't optimized properly. So it's about looking at the full picture together and you address everything at the same time because it all interplays. So just like we said, okay, insulin resistance will drive up reverse T3. Estrogen dominance will drive up reverse T3. Well, let's just say we're only treating the thyroid and we're leaving the hormones alone. So now we're treating the thyroid.
and someone is over here in an estrogen dominance state and we can't figure out why the reverse T3 is elevated, well, no one's over here looking at the hormones. So yes, you have to look at everything together, same time.
Kim Vopni (21:07.778)
Yeah, yeah, makes sense. So from a treatment perspective with the thyroid, I want to go a little, like go deeper in this section because it can be confusing. So you started out saying you were given T4 only, the majority of people who have a diagnosis, often diagnosed hypothyroidism without having had a full thyroid panel, but that's another story. So they get diagnosed hypothyroidism, they're given T4 only and...
Lo and behold, it doesn't change anything. What are those T4 only medications? So people who might be feeling, hey, that's me, I don't feel any different or better, but I'm on thyroid medication, I thought this was the right thing to do. What would those medications be?
Dr. Amie Hornaman (21:51.68)
So that's gonna be Synthroid, Levothyroxine, Lavoxyl, Euthyrox, Tiracin, Tiracin Sol. So those are all under the category of T4. So that's your inactive thyroid hormone. And there are generic forms, there's brand forms, but if you're on any of those medications, then you are on T4 only, T4 monotherapy.
Kim Vopni (22:18.092)
And who would benefit from that?
Dr. Amie Hornaman (22:22.27)
Not many people. I gotta tell you, I mean, there was a stat, there was a stat given out at an A4M conference years ago, and it was that 2%, and they used the term do well on, which I always put in quotes, so I'll break that down in a second. 2 % do well on T4 only, 98 % of us need T4 and T3 or T3 only. And I love that stat because it still punches you in the face.
Kim Vopni (22:48.792)
Mm-hmm.
Dr. Amie Hornaman (22:48.928)
Right, it still is like, holy hell, mean 98 % of us need something other than what this standard of care treatment is. Yes. However, I would go one step further and I would say, what do you mean do well on? So I tell a story in the book about being on a plane. sitting next to a woman, you you do the chit chat, hey, hey, how are you? And what do you do? And she says, oh!
I'm on thyroid medication. I oh, know, what'd take? She says, synthroid, I'm on synthroid. And so I immediately go like, well, how are you feeling? Are you having any symptoms? And she's like, no, I'm doing good. Meanwhile, meanwhile, she's like really thinned out hair, like really struggling from hair loss. I mean, she was at least 70, 80 pounds overweight. I mean, I'm sorry, there's the body positivity movement, and then there's just being overweight where it's not.
great for your health, let's just be honest. And I thought to myself, my god, she literally thinks that this is normal. She thinks that this is fine, that this is doing well and thriving. I think so many people are so deeply gaslit by their doctor, and they're given that T4 pill and sent out the door and told, we don't need to test you again for six months. So they just believe, it's like they medically gaslight themselves then. They go, well, I have this pill that's working, so.
If I'm still overweight, it must be my fault. I must not be doing enough. I must need to work out more or restrict more or it's me or it's just part of getting older and I just have to accept it. And they don't even know that there's really, really good on the other side. Like there's something out here waiting for them that could change their life, but they're stuck in this bubble of literally believing, unfortunately, what their doctor tells them and medically gaslighting themselves. So I would argue that 100%.
need T4 and T3 or a combination of or T3 only. No one is going to do well on T4.
Kim Vopni (24:51.342)
Yeah, yeah. What is the benefit? You know, I keep thinking like, why do we even need, I know we need T4, but why would we need a T4 medication? So why wouldn't, in my mind, I'm thinking how the heck did they even come up with this as being a test in the first place and a recommendation when we want the active form, right? So why would anybody even need that little bit of T4 and T3 together? Why not go right to the T3?
Dr. Amie Hornaman (25:18.41)
That's a great, great question. It's one I get all the time too. So T4 is kind of like your savings account. And T3 is like your checking. So T4 is very slow acting in the body. And we know that it doesn't do anything in and of itself until it converts. So just like you can't use a debit card to pull from your savings account, you have to move that money from savings to checking. And then you can spend it.
So that's similar to T4 and T3, checking savings. We always wanna have some in our savings account that we can pull from on a rainy day if we need to. Now there's, there are certain people like myself that you can't have a savings. You have to live off of your checking. I can only take T3. If you give me any kind of T4, I'm going hypothyroid. My reverse T3 is going through the roof. I'm gonna gain 10 pounds in a week and become clinically depressed and I know this.
because I actually tried it on myself and it wasn't fun. So you're going to have that subset of people that they're gonna have to live off their checking or they're gonna have just a little tiny bit in their savings, but checking is going to rule. And it's all about finding what that ratio that, now you wanna talk ratios, more of like a T4 to T3 ratio in your treatment is more important because some people might need 80 % T3.
and only 20 % T4. Now the problem, and I know we're gonna talk about it with natural desiccated thyroid medication, is that it is 80 % T4. So yeah, you're getting 20 % T3, you're getting some T3 in there, but it still is 80 % T4 and not everyone can tolerate that.
Kim Vopni (27:02.562)
Yeah, I had somebody recommend to me this is several years ago when I was still kind of learning and, and she said, and I never did this, but she said, well, we could try you on an NDT national natural desiccated thyroid. It's, you know, predominantly T four, but she said, you might feel worse exactly what you just said, basically become more hypothyroid, put your reverse T three go even higher. then if it does, then we'll know to change. But I kind of thought, well,
I don't know if I really want to do that test and see if I feel worse. can I, can I, can I opt the, like, is there a way to know where to start with somebody and you know, does, would you always go T4, T3 first and play around with those ratios or is there ever time where you'd go straight to T3?
Dr. Amie Hornaman (27:46.228)
Sometimes you do go straight to T3. And this is the uniqueness of my book, of the thyroid fix. Because I have not seen any other thyroid book go into medications like I do and literally guide people on their journey. So Kim, do you remember the Choose Your Own Adventure books when we were little? I love those, I so love those. So that's how I built it.
Kim Vopni (28:06.574)
I love those, yes.
Dr. Amie Hornaman (28:12.576)
So basically as people get their labs and we teach them, here's what your labs mean, here's where you should be, then I kind of move them through this process of depending on exactly where they're falling with their reverse T3, exactly where they're falling with their free T3, and then are you on thyroid medication of any kind? So it's kind of like if yes, and then you're on T4 only, but your reverse T3 is high,
then what we're gonna do is lower your T4 dose and add in T3. If you're on natural desiccated thyroid and your reverse T3 is high, and I give different categories of what that high is, so we'll go reverse T3 like 12 to 16 and then 16 to 20 and then 20 to 24, so based on where you're falling, then maybe we lower your natural desiccated thyroid medication, keep you on it.
and then maybe add in some T3. If, I'll give you one more scenario, because you mentioned that one doctor said, you might get worse before you get better. Well, here's something that most practitioners never ever talk about. The fact that natural desiccated thyroid medication can actually turn on an autoimmune attack. It can instigate an autoimmune attack. Here's why. Because if you think about Hashimoto's, like we said, it's the autoimmune form.
You have these little soldiers that they are confused, just like in any autoimmune condition. Those soldiers think that whatever that body part is is a bad guy. So if you have rheumatoid arthritis, your soldiers think that your joints are bad. If you have celiac, your soldiers think that the villi on your small intestine are bad. Same thing, Hashimoto's, your soldiers think your thyroid's a bad guy. Cool, okay. So then we have these soldiers that are programmed to go out and attack what they believe is an invader, the thyroid.
Now, we actually ingest a portion of a thyroid gland, right? What are the soldiers gonna do? They're gonna see a thyroid glandular coming into the body and they're gonna launch an attack. So that's why a lot of people, when they start taking NDT, and these are the people that are like, they'll go to functional or integrative medicine and notorious and functional medicine.
Kim Vopni (30:21.166)
Attack it, yep.
Dr. Amie Hornaman (30:38.676)
If they're not a thyroid expert, they're gonna hand out NDT like candy, because there's natural in the title. Like they think that because they're prescribing natural desiccated thyroid, like they're the best practitioner ever. And it's like, wait a minute. If you're giving this NDT to someone that has Hashimoto's, they could get worse and not get better because you're just spurring on an autoimmune attack. So it really is about that personalization. If you're doing it yourself by following the book,
Kim Vopni (30:43.874)
Yep. Yep.
Kim Vopni (30:57.346)
Yeah, yeah.
Dr. Amie Hornaman (31:08.392)
It's about turning inward and really paying attention to how you feel and your symptoms. And I walk you through that. If you're working with a practitioner, it's about that communication piece and about them really looking at you as an individual and looking at your labs and really figuring out exactly what medication and what dose you need. And here's the thing with thyroid. There is no one size fits all whatsoever, but we have so many options.
that we can absolutely figure out what that best combination of dose is for you. No question at all, we can get you optimized.
Kim Vopni (31:43.298)
Mm-hmm.
Kim Vopni (31:47.215)
That is so interesting and makes complete sense and I've never heard that before. So let's talk, because we're on that, what is NDT, natural desiccated thyroid? I would put my hand up and say, I thought it was better because it has the word natural or it's more quote unquote, bio-dedical when we think about from a hormone therapy perspective. Oh, it must be better because it's naturally sourced. So what is it?
Dr. Amie Hornaman (32:02.09)
Right.
Dr. Amie Hornaman (32:10.718)
Right. Exactly. So it is actually the original thyroid medication. So back in the 1800s, that's how they treated thyroid was they dried out a pig's thyroid gland and gave people the powder, gave them the dried powder. And then actually NDT came into play, but it never got FDA approval. It just kind of existed in our system. Well, then in the, it was like the 1920s or 1930s,
T3 came about. Now, we have T3 in the form of lyothyronine and citamel. And that is biosynthetic. So that's the big thing. And just like you were saying, Kim, well, I thought that natural desiccated thyroid was better, because it's natural. It's naturally derived. Well, that T3 or T4, even if we're jumping up to the, I think it was like 50s or 60s or 70s, that T4 actually got FDA approval.
whether we're talking about T3 or T4, they are biosynthetic, meaning they are biologically identical to the T3 and the T4 your body makes. You don't have to be scared of them. We can't put them in the same synthetic category like we put birth control or a progestin. Like, no, it's not synthesized, it's not synthetic. It is still made in a lab, it's made by a pharmaceutical company.
but it really is identical to what your body makes. So with NDT, that's essentially what we're doing. We're still taking it from a pig's thyroid gland. But I also want people to know, number one, still made by Big Pharma. It's not like some organic farmer is growing your natural desiccated thyroid medication. And it still does have fillers in it. So it does contain certain fillers that some people can't tolerate. And then the third point is,
Kim Vopni (33:57.272)
Yeah.
Dr. Amie Hornaman (34:07.4)
It's 80 % T4, 20 % T3. Fourth point is exactly what we talked about about the autoimmune attack. So in some people, it's fantastic. Listen, there are listeners right now going, it saved my life. It's the best thing ever. I finally feel normal. Awesome, good. Then that is working for you. But if you're listening and you're like, my gosh, I am on NDT. And you know what? I think, yeah, I did get worse and it never really kind of turned around or maybe.
Kim Vopni (34:14.147)
Mm-hmm.
Dr. Amie Hornaman (34:35.722)
You know, I got better for like the first like two, three weeks and then not so much. You know, then, you know, everything came back, started gaining the weight again. I'm still fatigued. Okay, then that might not be the right thyroid hormone replacement for you. And we have to figure out what is gonna work for you.
Kim Vopni (34:53.283)
Yeah. Is there a T4, T3 medication away from NDT?
Dr. Amie Hornaman (34:59.744)
if it's compounded. So we can have compounding pharmacies, yeah. And then we can compound it in whatever ratio. We could tell the compounding pharmacies, hey, you know what, just sprinkle in some T4, like do like, you know, 10, 15 % and make the rest T3.
Kim Vopni (35:01.463)
Okay, so it has to be compounded.
Kim Vopni (35:06.404)
Yeah.
Kim Vopni (35:14.211)
Yeah, yeah, okay. And then you mentioned T3 only medications, Cytomel, was it, was why a Lyo, Liothyronine, are those the only two T3s? Okay, okay. Is there any, like from a compounding perspective to really personalize things, would you start there with somebody? Is that where you typically start? Like with, with,
Dr. Amie Hornaman (35:23.338)
Myothyronine. Mm-hmm. Yep. Those are the only two. Yeah.
Dr. Amie Hornaman (35:40.158)
with T3 only or compounded?
Kim Vopni (35:43.907)
with compounded T4, like if, cause you had mentioned that usually you would start with a T4, T3 and kind of titrate, so I'm assuming then you would go the compounding route so you can more accurately know? Okay.
Dr. Amie Hornaman (35:54.528)
Now, honestly, when we're looking at the pharmaceutical versions, if we go Synthroid and Tirescent, it gets more pure as we go up the chain. So, Levothyroxine, generic, has a lot of fillers. Synthroid is brand, has a lot less fillers than the generic. Tirescent is so pure. I want to say it has maybe one or two other filler ingredients, and then Tirescent Sol...
is the most pure, often not covered by insurance, but the most pure form of T4. So we can go up in the pharmaceutical ladder so that people do have a shot at that being covered by their insurance because compounding medications is not, it's just not covered. Yeah.
Kim Vopni (36:27.193)
course.
Okay.
Kim Vopni (36:40.867)
Yeah, so when you are doing a T4, T3 together, you compound, but you take one of either levothyroxine or that category that you just listed, and then one of cytomel or, I can't say that word, lyothyronine, thank you, got it.
Dr. Amie Hornaman (36:55.134)
Lyle's it, yeah, exactly. So I'll give you an actual real world example. So let's say, let's say Susie Q comes in, she's got all the symptoms, she's gaining weight no matter what she's doing, she's losing hair, she's literally, know, she's the one that comes in with a bag of hair that she counted out of the shower, just to prove to people that she's losing her hair, she's tired, she's constipated, the whole thing. And we test and we see, okay, Susie, you know, your doctor has you on 15 micrograms of synthroid here.
and your reverse T3 is an 18, your free T3 is low at a 2.3. So here's what we're gonna do. We're gonna take that T4 all the way down to like 12.5, maybe 25, but we're gonna go really nice and low with it. And then we're gonna bring in lyothyronine, and you're gonna dose this at five micrograms twice a day.
because T3 is very fast acting. And this is something else I go deep in in the book and really explain to you how to properly dose your T3 and then even how to properly test yourself the next time you go for labs. T3 is very fast acting. So you don't wanna like pop your medication in the morning and then go for your lab. You don't wanna just take it once a day, cause then by the afternoon you're gonna be out of your T3. So you dose it twice a day. Then as we titrate up in that T3,
we're kind of ladder stepping. So then you're go 10 micrograms in the morning, five in the afternoon. And then a week later, you'll go 10 in the morning, 10 in the afternoon. And then you'll go 15 in the morning, and then maybe 15 in the afternoon. And you're gonna baby step up until you reach that dose where your symptoms are eliminated and you feel your best. Now, in a perfect world, this is done by working with someone who knows what they're doing with a thyroid, but that's also what I teach in the thyroid fix is,
how to titrate up your T3 and listen to your body at the same time so that you know when to stop, when to hold, and maybe when to drop back down.
Kim Vopni (38:53.262)
And that's something I think in this world now, and you mentioned COVID being a trigger for more more people, more and more telehealth options, more and more people seeking care, working with people online. And I think that working with somebody in most cases is always going to be better, but for many reasons people can't do it, they can't find somebody in their area, they can't afford it, yada yada. And this book will be able to help people advocate for themselves.
within potentially still this conventional system or in the insurance system, but at least be able to have documented proof. And then they can take that book and they can say, hey, please read this book and take it to their care provider, right? Yeah.
Dr. Amie Hornaman (39:26.709)
Mm-hmm.
Dr. Amie Hornaman (39:32.96)
Well, that's true. Yeah. You can buy the book and give it to your provider. But in the book too, I also go really deep in a couple chapters of number one, how to find a doctor. So this is even how to find one in the conventional system, what to ask literally like the front desk staff before you even schedule the appointment or hand over your copay exactly what you're going to ask. And this is going to save you so much time and money.
Kim Vopni (39:45.583)
Perfect.
Dr. Amie Hornaman (40:01.182)
And then we even talk about functional, functional and integrative. And that's especially important because you're gonna hand over hundreds, if not thousands of dollars to them. So I have a list of questions that they have to answer correctly for you to move on to the next step. Then we talk about what you're going to do when you're in that appointment. And there are specific strategic things that you can do to get your doctor, your practitioner
to listen to you and to collaborate with you in your health journey. And it's funny, right, I mean, it was like right at the end of writing this book, right before it was ready to be submitted, I did an interview with Dr. Ken Berry, and he talks about this nuclear option. And I literally, it was just enough time to add it to the book. And of course I give him credit, because I love the guy. So this nuclear option is what you pull out at your doctor's office.
if you're just running up against the brick wall. If you're like, if your doc's like, nope, don't do that, that's standard of care, sorry, sorry, sorry. We have this like nuclear bomb that you can drop on your doctor that will basically scare the shit out of them so that they will either listen to you or they will basically shoot themselves in the foot by having to document it in your chart. So we talk about that as well.
Kim Vopni (41:23.917)
Yeah, that's huge. That's huge. Well, I'm super excited to read this. I'm super excited for my audience to read this. There's so many people in my community who, who have their own thyroid medication. Most of it is T4. They are still struggling with constipation. Of course, that's a huge issue in my, my community and for pelvic health. So it's a topic that I like to discuss a lot. And, and I like your people, I was like, yes, I know Amy Horniman. I say your name probably 15 times a week.
Dr. Amie Hornaman (41:53.236)
Thanks, Cam. I love you.
Kim Vopni (41:54.126)
Yeah, but I'm glad now that there's also this resource, because podcasts can sometimes be overwhelming. Is this going to be the one that I'm investing this time in? Is it going to be the one that answers all my questions? And when you have your book in front of you that's going to answer everything and they can come back to it, I just think that such an amazing resource and will really put a lot of power in people's hands to get some help. So thank you for writing this book.
Dr. Amie Hornaman (42:17.936)
goodness. Well, no, thank you for helping me get the message out because just what you said a little bit earlier, this was on my mind when I wrote it. Not everyone can afford functional medicine. The reality is conventional medicine is tough. I give you the tools. I give you the power to have a fighting chance. Like if you're ever going to have a chance at getting help in the insurance based system, this book will give you that fighting chance. But also, I also wanted to put the power.
into these women's hands that they can get better on their own without having to pay thousands of dollars in the functional system. Like you don't have to, and that's really why I wanted to write this book, because we have to help the masses. We just do.
Kim Vopni (42:59.779)
Yeah. I forgot two questions that I, I, if I may ask two more questions. you mentioned nodules. Does everybody who has hypothyroidism have nodules? Like can nodules, could somebody have hypothyroidism without nodules?
Dr. Amie Hornaman (43:04.223)
Yeah.
Dr. Amie Hornaman (43:16.48)
Yes, yes, you can have hypothyroidism without nodules. If you have a nodule on your thyroid, however, the thing that pisses me off in the conventional system is that doctors will be like, oh yeah, we'll just watch and wait and recheck in a while. What other body part or organ can you have a growth coming out of it that we just ignore it and just check it out another six months to a year? The thyroid is the only one that they're like, ah, don't even worry about it. It's like, why don't?
Kim Vopni (43:33.391)
Yep. And we'll wait for it.
Yep, yep.
Dr. Amie Hornaman (43:45.184)
If your gland is growing something out of it, like a nodule or a goiter, that means that gland isn't working really well. So we really should check that out.
Kim Vopni (43:49.422)
Yeah.
Kim Vopni (43:54.507)
Yeah, what caused those nodules? Why do they show up?
Dr. Amie Hornaman (43:57.104)
Usually low iodine, So thyroid dysfunction. So you can grow a nodule just if you're, you are hypothyroid. It can occur from the autoimmune attack. So when those, always picture those soldiers as like little Pac-Men and they start just chipping away your thyroid because literally when we look at it under an ultrasound, it looks really jagged and small. Like it's been like eaten away at the sides. So that can actually produce a nodule and then low iodine intake is another reason.
Kim Vopni (44:27.469)
Yeah, we didn't even get into that. know there's lots of debate on iodine with the thyroid. But my last question I wanted to ask was from a medication perspective, I myself have Hashimoto's, I have high reverse T3. I've tried all the things. I take LDN. We didn't talk about that. We should talk about that really maybe very quickly. But I've never been on thyroid medication because my TSH
is usually in, you know, just below two or around two. So when, at what point should somebody go on medication or should they always, if they have Hashimoto's?
Dr. Amie Hornaman (45:10.132)
So, okay, let's break it down. So with Hashimoto's, if we can catch it in the beginning stages where your symptoms are really not that bad, you know, this would be the woman that's like, well, you know, I'm a little tired, but not too bad. You know, maybe I've gained a couple pounds, but not too bad. And then we're seeing those antibodies there on the labs, on the TPO and TGA blood work. We'll start her on lacumen seed oil, low dose naltrexone.
have her go gluten free because there's autoimmunity present. And maybe just for, let's say, her weight loss, we'll start her on some T2. We'll add in some iodine for support. We'll make sure that she has all of the nutrients, like magnesium and selenium. And that's one that we will check again in six months. But I would tell her, listen, if you get any kind of symptoms, if that scale starts to go up, if you start to get fatigued, if you're losing your hair, if you're causing all the symptoms that we already talked about.
then check back sooner because we'll run another full thyroid panel and make sure that reverse T3, free T3 is all in check. As opposed to someone who, let's say we are checking, we see the antibodies and she's suffering, like she's all the things, she's put on 20 pounds, she can't lose, she's doing all the things. Then at that point in time, it's like this is about quality of life. And we need to get you back the quality of life that you deserve.
So yes, let's use thyroid hormone replacement. And you know, the other thing, know, we, I'm totally guilty of this as well. We focus so much on the aesthetics. We focus on the weight gain and the hair loss and you know, the dry skin and you can lose your outer corners of your eye. You can lose your eyebrows entirely. They thin out, it's horrible. But we forget about the longevity part. We forget about the fact that as women, the number one killer of women is heart disease. And,
your heart has T3 receptor sites. So what will we see if someone's thyroid isn't optimized? We'll see tachycardia, AFib, herp palpitations, we'll see elevated LDL, we'll see the cholesterol panel go all wacky, we'll see high insulin levels, so a greater propensity for type two diabetes. I mean we see plaque buildup because circulation is even low, our ability to clear plaque is down.
Dr. Amie Hornaman (47:35.614)
with that high insulin, that increases cholesterol as well. We see higher incidence of Alzheimer's dementia because of the receptor sites on the brain. So we're really forgetting about that longevity aspect when we're talking about the thyroid. And I'm totally guilty of not talking about that enough because if the aesthetic part doesn't get you, then think about long-term. Like, do you want to die of a major disease earlier?
Or do you want to live your best life and just maybe pass from old age in your sleep? Like, let's fix your thyroid. Yeah.
Kim Vopni (48:06.722)
Yeah, yeah, yeah. Okay, where can people first of all find the book and where can also if people want to learn more and potentially work with you, where can they find you?
Dr. Amie Hornaman (48:16.848)
Absolutely. So for the book, go to thyroidfixbook.com because on there, you're going to see all the bonuses that we have. If you're listening to this before May 16th, you want to go to thyroidfixbook.com and link there and buy it from there because you'll automatically get a VIP ticket to our all day live launch party on the 16th. And what that is going to involve is you're going to have a big Q and a session with me. We're going to be doing live lab reads.
We're going to be giving out over $10,000 in prizes, including a six month program with me. We're giving out our test plus consult bundles where you can test yourself at home, thyroid and hormones and have an interpretation. We're giving out a year supply of thyroid fixer. So tons of prizes. You want to definitely get that VIP ticket for the 16th. If you're listening to this after the 16th, then you can go to any major retailer.
Kim Vopni (49:01.752)
Wow.
Dr. Amie Hornaman (49:11.014)
Amazon Barnes & Noble Target and buy it there. And now to find me and to work with us at the advanced thyroid hormone clinic, you can go to drami.com, D-R-A-M-I-E.com and book a free call. No obligation, we're just going over, number one, we wanna make sure that we're all gonna jive and that you're a right fit for us and we're a right fit for you. Then we're gonna go over what if you tried, what are you on? Are you on T4 only? What's worked? What hasn't worked? How many doctors have you seen? And we're gonna go through your history.
so we can figure out exactly what program is gonna be right for you.
Kim Vopni (49:44.376)
Perfect. You're amazing. I love your brain. I love the knowledge that you share. Thank you again for writing the book and for joining us today.
Dr. Amie Hornaman (49:52.082)
Absolutely. Thanks so much for spreading the message.
