Recently I interviewed Dr. Amie Hornaman, as we chatted about thyroid blood chemistry, and below is the written transcript. If you would prefer to watch the interview you can access it by Clicking Here [1]:
Dr. Eric:
With me, I have a very special guest, Dr. Amie Hornaman, who is host of her own podcast The Thyroid Fixer. How are you doing, Amie?
Dr. Amie Hornaman:
I’m great, Eric. Thank you so much for having me on.
Dr. Eric:
Wonderful. Let’s dive into Dr. Amie’s bio here. She again is known as The Thyroid Fixer. She is a woman on a mission to optimize thyroid patients around the world and give them their lives back using her proprietary transformational program, the Fix Method. She is also the founder of the Institute for Thyroid and Hormone Optimization. After her own experience of unsufferable symptoms, misdiagnoses, and improper treatment, Dr. Amie set out to help others who she knew were going through the same set of frustrations and who were on the same medical rollercoaster. With a focus on optimizing thyroid and hormone function, and thus optimizing her patients, Dr. Amie looks at you as a unique individual, not just a lab value. She examines all factors that tie into thyroid dysfunction and thyroid symptoms and fixes you to get your life back, which I assume is why you’re called the Thyroid Fixer.
Dr. Amie:
And that’s the goal.
Dr. Eric:
Why don’t you start off by giving a little bit of your back story? How you started fixing other people’s thyroid glands. Obviously, you do more than just the thyroid. But let’s talk a little bit about your backstory.
Dr. Amie:
So many of us in this health space, it’s that pain to purpose story. It’s going through something ourselves that brings us into helping others. If we rewind to 20-something years ago, I was actually competing in figure competitions, which is like body building, but more softer, more feminine. You still have to get on stage in a bikini. I was doing fitness modeling, too. Listen, I do not come from a family of skinny minis. My family has obesity and Type 2 diabetes in it. I always would have to diet down and really work at it. I knew what to do. I knew how my body would respond. I had done it many times before.
I was getting ready for a show. The diet is chicken, broccoli, asparagus, fish. You’re going to the gym twice a day. This one particular show, I started gaining weight instead of losing weight. I mean 20+ pounds. I stopped weighing myself after I hit 20 pounds because I didn’t want to see the scale go up anymore. I was not myself. I was depressed, fatigued. My hair started falling out. I went from doctor to doctor saying, “Listen, I know my body. I know something’s off. Please do something and tell me what is going on.” They were all saying, “You’re ‘normal.’ You’re fine. Just eat less and exercise more.” Are you kidding me? There is no possible way to actually eat less or exercise more than I already am. They gave me the runaround. A lot of patients get the, “You’re just getting older. You have to live with it. Everything looks fine on your labs.” Back then, I didn’t know anything about labs. I didn’t know what they tested and didn’t test because I was just a patient, just like all of you, trying to figure out what the hell was going on with me.
Seventh doctor finally touches my throat and says, “Swallow.” She says, “You have a goiter. We’re going to ultrasound it. We’re going to run more tests, but you have Hashimoto’s.” I leave there and am like, “Yes! This is awesome! I have an answer and a pill. This will fix all my problems. I will lose weight and feel like myself again.” Five months later, nothing. No change whatsoever.
I always joke. I’m pretty sure, Eric, that we had Gateway computers back then, the big box ones. I went on there and found this thing called T3. I saw all this research that T3 works really well with T4. Of course, I was on Synthroid, like many people are stuck on in the beginning. I bring this information to my doctor and say, “Look at this. This T3 thing looks like it works really well with T4. How about we do that?” She goes, “I’m not going to do that.” I said, “I’m going to find somebody who will.”
I finally went into the functional, integrative medicine space. I kept hearing this guy’s name. When you hear it three times, it’s the universe telling you something. I go to this guy who changes my life. He is now my mentor. He got me on the path that literally gave me my life back: doing the right tests, doing the right treatments, supplements, nutrition, medication, the whole deal. That is when my career changed because I thought, “You know, if I went through that frustration,” I mean, I was crying in my car after the sixth doctor told me I was normal. I just wanted an answer. This is unacceptable. I needed to get out there and help other people who were going through these frustrations that I went through because I am just one little person in Erie, PA. There are plenty of other people out there suffering.
That’s why I’m here. I went to functional medicine training. Got my master’s and my doctorate. Now I am in this space helping others.
Dr. Eric:
Wonderful. Thank you for sharing that. In the bio I gave, one thing I mentioned is that you do more than just look at the labs. You want to treat the whole person. But we are going to focus on thyroid blood chemistry because we do look at labs. Same thing here on my side. I think labs are important; it’s just not the only thing. Unfortunately, medical doctors only look at labs; they may look at more than just TSH sometimes, but a lot of them just look at TSH and just give medication for Hashimoto’s, thyroid hormone replacement. For hyperthyroidism or Graves’, they will give antithyroid medication unless they resort to ablation or thyroid surgery. As far as thyroid labs, what do you do? TSH would be one. Discuss some of the labs.
Dr. Amie:
The must-dos. The must-haves with thyroid labs. If you don’t have these, we really can’t tell what’s going on. You start with the TSH. If you’re lucky, you will get a free T4. We might see those, but quite honestly, that doesn’t give me the whole picture whatsoever. We absolutely need a free T3 because T3 is the active thyroid hormone. I’m sure you talk a lot about that here. We want a free T3 level. We want the reverse T3 level, which is the antithyroid hormone. Of course, we want the TPO and TGA antibodies because I want to know if you have Hashimoto’s, even if you have your thyroid taken out. I have many patients who go, “I don’t have a thyroid anymore.” I go, “I know. I’m still going to check your antibodies because your antibodies can still be present even after thyroid removal or ablation.” Those are all of the thyroid labs that I like.
Of course, like you said, I look at the symptoms. I always say “both and.” Yes, we have to do the thyroid, but we also have to look at your hormones, insulin, nutrients, and all those other factors that come together so beautifully to help your thyroid medication work better, or if you still have it, your thyroid work better. We have to pair all of that up with your symptoms into one big, beautiful picture.
Dr. Eric:
That’s what I do, too. I definitely recommend a full thyroid panel. I will say reverse T3, and we can talk more about it, I don’t do it anymore on my Graves’ patients. With hyperthyroidism/Graves’, and most of my patient base has hyperthyroidism, because of the hyperthyroidism, pretty much everybody has an elevated reverse T3. It’s different in the hypothyroid world. We could talk about that. Pretty much I would say just about everyone who is hyper has that elevated reverse T3. When you correct the hyperthyroidism, often that will resolve.
Talking about TSH, thyroid stimulating hormone, can you explain why you don’t want to rely on TSH alone?
Dr. Amie:
I see so many patients in the hypo space, or they have gone through hyperthyroidism or Graves’, and they either had treatment with medication or removal or radioactive iodine. Now we are replacing with thyroid hormone replacement if they had removal or ablation. If we rely on the TSH, the TSH can basically lie. If we are replacing with medication, that is going to go down. Especially if we are replacing with medication that contains T3, because if you had your thyroid removed, guess what? We still have to replace with T4 and T3. If we are replacing with medication that contains T3, that is naturally going to go down. I have also seen it go down below a 1 with T4-only medication, which is more rare, but it does happen.
Then you are in a situation where you go to your conventional doc. That TSH is .5, .01, let’s say. Your doctor freaks out and thinks you’re hyper. Meanwhile, you’re like, “No, doc, I was hyper last year. Remember, we treated me. Now I’m gaining weight, and my hair is falling out, and I’m tired. I’m sure as hell not hyper.” If you rely on that TSH alone, that person will look hyper and not be. You have to look at the actual thyroid hormones since TSH is a pituitary hormone, not a thyroid hormone. You can’t rely on TSH alone to get the full picture of what is actually going on in a person’s body.
Dr. Eric:
Agreed. Thank you for explaining. That’s what I was looking for. The pituitary hormone, I knew you would get to that. Perfect explanation.
I mentioned that in hyperthyroid patients, I typically don’t test for reverse T3 anymore. Why do you recommend reverse T3 in your hypothyroid patients, which I do, too? I do see some patients with hypothyroidism and Hashimoto’s.
Dr. Amie:
If reverse T3 is high, let’s say we are using thyroid hormone replacement, NTD or T4/T3 combinations—because if they have had their thyroid removed or ablated, or if they have Hashimoto’s, so it’s slowly being destroyed and we are catching them in the later stages, we use that medication—that T4 can convert to reverse T3. If a person is on too much T4 medication, maybe not enough T3, or the other factors that cause reverse to go up like inflammation, high insulin, estrogen dominance, low iron status, anemia, or if you don’t have enough iodine, zinc, or magnesium, all of that can push up reverse T3. Reverse T3 is basically a survival mechanism of your body. But if that’s high, and you’re walking around trying to live life and do a job and raise a family and run a business, you will be in survival mode all the time. It might just mean that we need to adjust your medication or look deeper at what is causing that reverse T3 to be elevated and fix that so that your body is not walking around in a protective survival mode all the time.
When you’re in the ICU or ER, the reverse T3 can be high. If you’re a Graves’ patient, you’re in this autoimmune flare where your reverse T3 is going to go high because it’s saying, “Listen, we don’t need any more thyroid hormone. Stop, there’s too much anyway.” That makes sense. If you’re hypo or on the other side of Graves’, where you have already had the surgery or the RAI, then we don’t want you walking around in survival state anymore. Now we are replacing that thyroid hormone. We want that to work and your body to make you feel good. We no longer want you in that high reverse T3 state. You don’t need to be in survival mode anymore.
Dr. Eric:
Makes sense. Thank you for that explanation. Let’s talk a bit about optimal ranges. We both agree that we don’t want to rely on the lab ranges, which again, most medical doctors do. They will just test the TSH and maybe the free T4. But even if they look at free T3, they will usually say everything is okay if it’s not red flagged by the lab. Can you talk a little bit about lab ranges versus optimal ranges?
Dr. Amie:
This is a big thing for everybody. I heard Mark Hyman once describe that standard lab value ranges are like the side of a barn. If you stand 50 yards back, and I give you a ball and you throw it at the barn, you will hit the side of the barn. But if I put a target on the barn, it will be tougher to get in that target. That target is the functional optimal range. That is where we know as functional practitioners that you will feel better as a person. Your life will be much better if you are optimal.
Let’s take free T3. Free T3 is 2.4. The cut-off for the lab value range is 2.3. She didn’t get flagged. She didn’t get that L; it’s not red. If you don’t get the L or the H next to your lab value, your doctor is probably not paying attention to it and what it means. To me, as a thyroid practitioner, I am going, “This is bad. This is low. We want you at 3.5 or above.” For any listeners who might be out of the country, we want it in the upper quadrant of the range. Now, that being said, some people even do better when that free T3 is above range because most labs will cut it off at 4 or 4.5. Some people do really well at a 6. Some people do really well at a 10. That doesn’t mean they’re hyper because you have to look at the whole picture and how they feel and what we’re actually doing with them medication-wise. You cannot go by that standard lab value range, or you could be left feeling like garbage. You have to go by the optimal ranges. Then take it one step further and find your optimal.
Dr. Eric:
To clarify, for those with hyperthyroidism, you are talking probably more with hypothyroidism, if they are taking thyroid hormone replacement, you are not as concerned if they are hyper. But if someone with hyperthyroidism has a free T3 of 10, chances are their free T4 is elevated, too. Then of course we want to look at the whole picture. If TSH is depressed, and free T3/free T4 are elevated, and the person is hyper, that is a completely different story.
But you’re giving a situation where someone with Hashimoto’s might be on thyroid hormone replacement. I agree, some labs actually go as low as 2.0. Some might have a free T3 of 2.1. Most medical doctors, unless the TSH is elevated because the free T4 and free T3 are low enough to bring that TSH out of range, then they will pay attention to that TSH. If free T4 is .7 and free T3 is 2.1 and TSH is 4.2, which is within most lab ranges, they will usually ignore it. Maybe if the person presents with some symptoms, possibly. Thanks for that explanation as well.
Dr. Amie:
If I could expand a little bit, going off what you said, you really have to look at the whole picture. I’m sure you get this question a lot, too. People will go, “Dr. Eric, what should my free T3 level be?” 3.5 or above is the optimal range for me, but it’s the whole picture. Just like you said, if you’re walking around with a 3.5 or 5, and then your free T4 is a 7, and your TSH is .001, now you’re in a hyper state. You have to look at the whole picture and then ask the person those four important words that we normally don’t hear in conventional medicine, “How do you feel?” I know we are talking about optimal ranges, but it’s not just about one individual lab value. I get that question all the time: Where should my free T3 be? I can give you a general answer, but it’s about looking at how everything is working together.
Dr. Eric:
Getting back to the example of someone with Hashimoto’s, if they are on thyroid hormone replacement, and it’s a little bit on the higher side, but they are feeling great and everything else looks good, then you might be happy. On the other hand, if it’s on the higher side and they’re feeling hyper and not feeling good and experiencing hyper symptoms, then it might be a good idea to adjust the thyroid hormone.
You said you don’t take desiccated? You take actual T3, correct?
Dr. Amie:
Yes, I am a T3-only patient.
Dr. Eric:
You’re only T3?
Dr. Amie:
Ok.
Dr. Eric:
Many medical doctors only give T4. Here is a question. Going off track, if someone needs T3, but their doctor just refuses, I assume you would just say probably go to another doctor, maybe see a functional medicine practitioner. If they do test for free T4 and it looks good, but free T3 is a little bit low, you would say maybe see someone else?
Dr. Amie:
Yeah. You start with testing. My rule of thumb is if you ask your doctor for a full thyroid panel with all the tests that you and I just went over, and they say no, it’s time to get a new doc. That’s the first test. That’s a test for your doctor. If your doctor won’t test you as apatient to get that full picture, and you’re going in and saying, “Here’s my symptoms,” and they won’t even listen to you and see what’s on paper right in front of them and have answers to why you’re feeling the way you’re feeling, time to move on.
Part B is let’s say you do have a low free T3. You do the same thing that I did. “Hey, I was listening to this chick, and she is a thyroid expert. She said this thing about T3 being awesome. I’m on T4 only. Look, my free T3 is only a 2.1. By the way, I’m gaining weight, my hair is falling out, and I’mreally tired.” If your doctor says no, it is time to move on.
That being said, I do have patients who want to go the natural route. That’s fine. If you’re taking T4 and it’s not converting properly, and your T3 is low and your reverse T3 are high, we can do all of the other things to help that conversion happen. If you want to stay on your medication or you really are stuck- I have patients in Australia, the UK, and Canada where I can’t prescribe for them. We have to do it the natural route. We have to push that conversion of T4 to T3 and take out all the blocks that are impairing that conversion from happening. It can be done naturally. If you’re here in the States and you’re on the struggle bus, it’s definitely time to get a new doc.
Go the functional route. Yeah, you gotta pay out of pocket. Chances are insurance isn’t going to cover it. But guess what? You’re going to get more than five minutes with a functional doctor because that’s all you get with insurance at your current doctor at your PCP or endocrinologist. That’s absolutely what I would say.
Dr. Eric:
Let’s talk about thyroid antibodies. You mentioned for Hashimoto’s, there are thyroid peroxidase antibodies, anti-thyroglobulin antibodies. For Graves’, there is thyroid stimulating immunoglobulins, which is a type of TSH receptor antibody. How important are antibodies to you to look at initially and to keep track of? A lot of patients, I don’t want to say obsess over antibodies. Graves’ and Hashimoto’s are immune conditions. I like to look at antibodies, too, but I want to get your opinion when it comes to thyroid antibodies.
Dr. Amie:
We have to test for them because I want to know whether you have an autoimmune condition or not. I want to know whether you have Hashimoto’s or not or Graves’ or not. We have to test initially. We also want that baseline, where you are starting. Here’s the thing. Many times, doctors won’t test, so I will see patients after they have been through 10 years of testing or even 10 years of thyroid treatment, but they never had their antibodies tested. Or they had them tested once. The testing part is important, just to know whether or not there is an autoimmune condition present. With hypothyroidism, 90% of it is Hashimoto’s. It might not get flagged right away. Oftentimes, we see antibodies come up as a false negative. We want to test multiple times to check that.
We want to see if you’re doing big jumps. I don’t care about little jumps. You’re right. Patients will get kind of a little bit obsessed with antibodies. I will get messages like, “Oh my gosh, my antibodies went up by 50.” So? Maybe you were stressed out, or you got glutened at a restaurant. I don’t care about those little changes. If your antibodies go from 100 to 3,800, we need to pause and take alook at that. That’s why I like testing but not obsessing. It’s just knowledge. It’s just ongoing biofeedback for me and the patient. We don’t hang our hat on the antibodies.
It comes back to, “How do you feel?” those four words. If a patient is feeling great, obviously we want to get your antibodies to 0. But if you are feeling amazing, and you’re losing weight and are living life and have energy and your hair is growing, I don’t care if your antibodies are 100 or 200. We are going to keep working at it, but I’m not going to obsess over that number because I want you feeling good. Does that make sense? It was a long answer to a short question, but that ties all those pieces together.
Dr. Eric:
Yeah, it makes sense. It beats the opposite where if someone’s antibodies are looking great, and they are still feeling lousy, there could be other imbalances as well. It definitely makes sense.
When it comes to retesting, I have a couple of questions. One question is how frequently do you retest a thyroid panel? A second question that ties into it is do you test the antibodies every single time you recommend a thyroid panel?
Dr. Amie:
First question is how often. I get asked this a lot by my patients. General rule of thumb if we are doing an overhaul on their medication. Depending on how much we changed, in that beginning stage, we will retest in 4-6 weeks just to see what’s going on. Then after that, and after we get them more optimized, we can space it out. But I always tell them if you feel wonky, if anything is going awry, then we retest sooner. That three-month or four-month or six-month marketer of when we are going to retest you is not set in stone. If you are gaining weight or feeling crappy again, sometimes a patient will say, “I feel like I did before I started medication. What’s going on?” especially with that whole NP recall. I was getting messages left and right, being like, “Why do I feel like garbage? Why do I feel like I did before I started meds? Why do I feel hypo again?” It was the medication. We need to test again obviously. We need to test now. Something is going on in your body. We just retest sooner.
Antibodies, I space them out. Maybe every third test, we take a peek at them. Again, will we put them in a full panel if someone is feeling badly? Yes. If someone reaches out and is like, “What is happening?” then yeah, we test everything.
Dr. Eric:
I take a similar approach. I can’t say I recommend testing antibodies every single time.
Dr. Amie:
No.
Dr. Eric:
Endocrinologists differ. If they do test antibodies, it will just be the very first time, and that’s it. They will never test for them again. I do have some patients who are still working with an endocrinologist. Not that I’m complaining, but some test the antibodies every single time. It really varies. If they are getting testing through me, if they really want to test antibodies every single time, I won’t argue. But typically, it will be like every other time.
With hyperthyroidism, it might be a little bit different. Initially like you said, you might want to test more frequently. But with hyperthyroidism, you definitely want to keep an eye on them. if they are on antithyroid medication, there are other tests we will want to look at like liver enzymes, making sure the white blood cell count isn’t depressed.
Speaking of that, let’s talk about other tests that you do. As far as blood tests, I assume you do the basics like CBCs with differentials, comprehensive metabolic panels. Do you want to talk about that as well?
Dr. Amie:
Definitely. A long list. CBC with diff, CMP, obviously. I love looking at hemoglobin A1C and insulin because most thyroid patients, whether hyper or hypo, will have insulin resistance. Since the thyroid gland is the master, it will start throwing off your other hormones. We want to look at all the hormones. Insulin is a hormone; we want to look at that. We can’t hang our hat on glucose because glucose can lie. So we want to test A1C and insulin.
I like looking at a C-reactive protein for inflammation. Full hormone panel. Ladies, you have more than estrogen. You need a full hormone panel. That includes progesterone, free and total testosterone because testosterone is very important for my ladies. It is often overlooked by conventional medicine as being important. There is an optimal range for that, too, for you to feel good. Then we look at pregnenolone, DHEA. If we can get a four-point salivary cortisol panel to look at adrenals, I like to do that. Obviously all the nutrients: selenium, magnesium, iodine, Vitamin D. Vitamin D is a hormone. We look at that, too because that can get thrown off with hypo. I am probably missing some in there, but those are the ones that come immediately to mind. We will run an Epstein-Barr virus panel, Lyme Disease, tick-borne illness, all those things that could drive up reverse T3 and be co-infection.
Dr. Eric:
As far as Lyme, you will run a Lyme panel on everybody?
Dr. Amie:
No, I don’t. It depends on the symptoms. It’s obvious what’s going on with some people. It’s right here in black and white. As we get a little bit deeper, I had one patient that has long-haulers from C. I won’t say it out loud. She has long-haulers. As we look, what’s driving this? Epstein-Barr, less than 90% of us have that, too. Is it active or in its dormant stage? Is there a Lyme component, too, that is making her feel incredibly fatigued, or is it just her thyroid, or is it just the long-haulers? We want to rule that out when someone has that crushing fatigue.
If you look at their thyroid panel, and everything looks fine, or at least we have you optimized here, what else is going on that you’re so tired? Your Vitamin D is good. Zinc is good. You’re checking all those boxes. Then you think you better run Lyme and tick-borne here because there might be something a little bit deeper. So I don’t automatically run that. If I am working with a patient that is working with their own practitioner, good luck getting the full Lyme panel. It will just be the one marker. We have to do it on the side because this isn’t going to give us the information that we need.
Dr. Eric:
Yeah, I specifically asked you that question because I was diagnosed with chronic Lyme three years ago. I can’t say I run a Lyme panel on everybody. I do more frequently test Epstein-Barr in a lot of my patients. Also, with Lyme, the regular labs, Lab Corp, Quest Diagnostics, I don’t find reliable. You might get lucky, but usually if I’m testing, I’m using a specialty lab to look more at Lyme and co-infections.
I agree with the adrenal saliva testing. I’ve been doing that for years. I don’t know if you do DUTCH testing on patients. The last few years, I started doing dried urine testing on some patients. It depends. When you test for hormones, do you mainly do it through the blood? Or are you familiar with DUTCH?
Dr. Amie:
I’m familiar with DUTCH. I’m still on the fence with that, too. I’ll do it in patients I’ll feel like we need to compare both serum and urine and see the metabolites that we find in the DUTCH test. But I am all about saving patients money, too. If we can get the answers with a blood test that is by your insurance or you can get on the cheap from Ulta Labs, let’s go that route. That test is expensive. If we don’t need it, we’re not going to implement it and make you spend more money out of pocket. We can get a lot from blood. It is so split in our little world here of functional medicine, like the iodine controversy, the DUTCH hormone controversy. Dried urine is the best because we get the metabolites. No, that’s after the urine has already processed it; we have to use blood. You’re hearing both sides, and you know you need to land somewhere here. I go back and forth, too. Like you, I will use the DUTCH if it’s absolutely necessary to get a bigger picture.
Dr. Eric:
Saliva testing, you do use with most patients to look at adrenals?
Dr. Amie:
Yeah, that’s the gold standard. That’s the one where I will say, “We need to use something other than blood.” The four-point salivary cortisol panel, it gives us that look of what your cortisol is doing throughout the day. You can’t just go by blood and have one morning marker. It will give us some feedback, but I like to see what that cortisol half curve is doing. Is it actually in the right curve? Is it flatlined high? Is it flatlined low? That really requires saliva to get an accurate measure.
Dr. Eric:
Same here. I use more saliva testing than a DUTCH test. If I do recommend that, I add adrenals onto that. When I dealt with Graves’, I used the saliva test, and I have been using that for a long time. You definitely want to look at the circadian rhythm of cortisol and not just that single sample, which could again be influenced by like if someone is nervous going to a lab and they get that blood test, the withdrawal itself can cause the cortisol to spike up.
One other question that comes to mind for testing is thyroid ultrasounds. This obviously is straying from the blood or saliva tests. It’s different, but it does relate to thyroid. Do you recommend thyroid ultrasounds to your patients?
Dr. Amie:
I do recommend it. It’s that individual thing. Sometimes we can go off the blood, and we know what’s going on. There’s no palpable goiters, nodules. No one is having trouble swallowing. We don’t have those symptoms. On a case-by-case basis, if someone is having trouble swallowing, if they have a visual or palpable nodule, then we want to get an ultrasound. If they are in the latter stages of Hashimoto’s where that thyroid gland is being destroyed, we want to get an ultrasound.
I’m not sure where you use it with hyperthyroidism. But in those cases, yes. I have a patient right now who just got an ultrasound because she could actually feel that something has grown. Sure enough, one of her nodules has grown in size, so they are going to biopsy it. Okay, ultrasound. Good. In that case, really helpful. But not everyone needs one. I recommend it as a baseline if you can get it, if your insurance covers it. Coming back to the saving money part, if it’s black and white in front of me with the labs, and I know what’s going on, and I know what we’re going to treat and how we’re going to treatit, I won’t always say, “You must get an ultrasound” because they might end up with a $300 bill for that.
Dr. Eric:
I agree. I don’t think everybody needs it. When I was diagnosed with Graves’, I saw an endocrinologist at the time. She actually did not want to do an ultrasound, but I talked her into doing one. I was willing to pay out of pocket; I didn’t have insurance at the time. I wanted to know. I can’t say it’s necessary in every single person with hyperthyroidism or hypothyroidism.
This was a great discussion. I appreciate you sharing this information with my listeners. Any last words when it comes to any type of testing?
Dr. Amie:
The main thing is to get the full picture all at once, I know you probably see this in your patients, too, but I see conventional medicine do this willy nilly thing. We’ll test TSH first. If that’s bad, then we’ll do more testing, free T3 and free T4. If that’s a problem, then we’ll come over here and test your hormones. Why not do everything at once? Why not have everything right in front of you so you can look at it like a puzzle, and you’re putting the pieces of the puzzle together?
If I gave you a puzzle and said, “Hey Eric, do this puzzle, but I’m only going to give you a quarter of it,” you wouldn’t know if this was a corner or a middle piece. You have no idea. You don’t even know what the picture is. We need the whole thing. We need all the information at once.
You have to be your own patient advocate sometimes. Sometimes you have to order your own testing to get the full picture if there are pieces missing in your puzzle. Demand it. Testing gives us answers. We can compare that testing up with how you feel. Things can change. That is where the magic happens. Unless we have everything in front of us, how do we know? We don’t want to throw darts. We don’t want to say, “Maybe you have low testosterone. Maybe you’re estrogen dominant.” Then we start treating that, and it’s wrong. No, let’s get some numbers, some answers.
Dr. Eric:
I agree. When I recommend testing to my patients, I do take into consideration not everybody can afford everything. I will give options, too. Ultimately, it’s up to the patient. Even if I think something is not optional, it really is optional because they might- If we need to further prioritize, of course we will do so. We want to get answers. We don’t want to just rely on basic blood tests. Same thing with adrenals. I like to do saliva testing there. I think we’re on the same page with that.
Again, thank you so much for getting together. You shared some wonderful information. Where can people learn more about you? I know your podcast is one place.
Dr. Amie:
Yep, The Thyroid Fixer podcast on all podcast platforms. They can also find me by going to my website, DrAmieHornaman.com [2]. If they are interested in booking a call, they can book a free discovery call. You can talk to a member of your team about how we can work together if you are in that hypo state. I know a lot of your patients do swing from hyper to hypo, from Graves’ to Hashi. Do you see that a lot?
Dr. Eric:
Over time. People do it quickly because they are on the antithyroid medication. A lot of people with Graves’ also have the thyroid peroxidase antibodies. A lot of them also have anti-thyroglobulin antibodies. Over time, some people do become hypo. That’s also why we want to try to address that immune system component to prevent them from getting to that state.
The Thyroid Fixer is the podcast on all platforms. The website is DrAmieHornaman.com [2]. Thanks again. Appreciate your time, Dr. Amie. We’ll have to have a part two in the future.
Dr. Amie:
Definitely. Thank you, Dr. Eric for having me on.
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Dr. Eric:
Thanks again for listening. One thing I wanted to mention is that my optimal reference ranges differ slightly from Dr. Amie’s. Part of this is probably because I work more with people who have hyperthyroidism. For the free T4, I like to see the levels between 1 and 1.5. For the free T3 levels, I like to see them between 3 and 3.5. As for the TSH, I like to see it between 1 and 2. 1 and 1.5 would be even better. As Dr. Amie mentioned, everyone is different. If your numbers are slightly higher or lower, and if you’re feeling great, and everything else is looking good, you shouldn’t get too caught up with the numbers.