[Angela Foster] (0:00 - 0:06)
Why are so many women over 40 walking around with an undiagnosed thyroid condition?

[Dr. Amie Hornaman] (0:06 - 0:46)
Oh, that is like the question of the year. And it really comes down to these poor women not being tested properly, and then they're not being treated properly. Here's the probably one of the most important markers that you can get.

You want to know what your reverse T3 number is. Reverse T3 is actually a hormone that's built into us for times of distress, injury, illness, sickness. I think too often women are sold a gut healing protocol as the be all end all.

All you need to do is heal your gut and your thyroid will be fine. All you need to do is heal your gut and your hormones will balance out. All you need to do is heal your gut and your adrenals will be fine.

Gut is important, but healing the gut without treating the low thyroid function and the low hormones, probably not going to do anything.

[Angela Foster] (0:46 - 0:54)
If we take a woman perimenopause, and she's now also thinking about hormone replacement therapy, how will this affect things with her thyroid?

[Dr. Amie Hornaman] (0:54 - 1:10)
It will actually help support the thyroid. Get your hormones optimised and especially testosterone because it is that armour. It's our shield against autoimmunity.

Thyroid is treatable. Perimenopause, hormones, all of it is able to be addressed and you are able to get your life back.

[Angela Foster] (1:11 - 1:14)
Dr. Amy Horniman, it is so good to have you back.

[Dr. Amie Hornaman] (1:15 - 1:19)
It's good to be back. You know, I love chatting with you and I love your audience. So this will be fun today.

[Angela Foster] (1:20 - 1:29)
It's going to be a lot of fun. Let's kick off with why are so many women over 40 walking around with an undiagnosed thyroid condition?

[Dr. Amie Hornaman] (1:30 - 2:20)
That is like the question of the year. And it really comes down to these poor women not being tested properly, looked at through a functional medicine lens like you and I do, and then they're not being treated properly. So it really, it obviously starts with the diagnosis.

It starts with when the woman walks into her doctor's office and just says, hey, doc, I'm gaining weight. I'm losing my hair. I'm so tired.

I have brain fog. And then they do a thyroid test. I'm using air quotes there for the listeners.

And they tell that woman, oh, you know what? It's not a problem with your thyroid. You're normal.

You're fine. Everything's good. And then she just leaves thinking, oh, well, okay, maybe it's my fault.

Maybe I need to eat less and exercise more. Maybe I need to take more supplements. When really the doctor just didn't test thoroughly enough to really see what was going on with her.

[Angela Foster] (2:20 - 2:49)
Which so many women have this problem, right? And a lot of women as well have noticed they think it's perimenopause, right? They're not even looking at the thyroid in the first place quite often because the assumption is, oh, I've hit 40.

It must be perimenopause. It's not my thyroid. And don't even consider ruling it out.

How would a woman listening to this know if she's getting weight gain, her energy's dropping, she's experiencing brain fog, how can she know what to start testing? Or do you just advise let's test across the board to try and get to what the problem is?

[Dr. Amie Hornaman] (2:50 - 4:32)
Well, the thyroid testing is really simple. So it's not crazy extensive. It's not expensive.

It's not something that you have to go to a functional practitioner to obtain. It is very common testing in the conventional medicine system. It's just getting that doctor to do all the right things.

So I talk about this in the book, and I have the full list of labs that you need to get as well as their optimal ranges. But let's just kind of throw them out right here for the listeners. So there's TSH, which your doctor is going to test anyways.

That's standard of care. That's actually a brain hormone. It's not a thyroid hormone.

So that's why we can't rely on just testing TSH to tell you whether you're normal or optimal or you have a thyroid problem, don't have a thyroid problem. We need to go further. So we need to test free T4, free T3, reverse T3, and then the TPO and TGA antibodies.

So there's only a few more tests that we have to add on to really get that full view, that full picture of what's going on with the thyroid. And these tests are very easy to order, very easy to order. But you have to ask for them.

And then my rule of thumb becomes, if your doctor says no to testing, then it's time to get a new doctor. Because whoever you're working with, doctor, MD, PA, NT, functional practitioner, naturopathic doctor, whoever, they should always want all of the data. They should want to know everything that's going on with you to best help you.

Because if we don't have the data, we don't have all the information. So how can we possibly help someone if we don't have that information? So it really starts with thorough testing.

[Angela Foster] (4:33 - 4:56)
Making sure you're getting all the panels, as you say. And then there's the point, right, that these ranges get kind of recategorised according to what has become common in the population, as opposed to what's optimal. So we can confuse optimal with normal.

How can people get the right information, Amy, so that they know that they're looking at being within the right part of that range? Because I think that's where women get dismissed often as well.

[Dr. Amie Hornaman] (4:57 - 9:46)
And yes, and this is where you literally take your power back. When you know where you need to fall in that range, where the optimal range is, that's really where you can stand your ground and stand up for yourself to get proper care. So, oh, the optimal ranges.

Again, I'll go over them here. I have them in the book. I post them everywhere, like my Facebook group, on my website, everywhere.

Because I want the optimal range in the hands of as many women as possible, because exactly what I just said, it gives you the power. It gives you the power to be a patient advocate for yourself. So when we're looking at the thyroid panel, I'll just rattle these off.

People can rewind, listen to this a couple of times and write them down. TSH, we want below a two. And that's pretty universal.

Doesn't matter what country you're in. We want that under a two. Yes, the range will go up to a 4.4, 4.5, sometimes a five or a six. We want it under a two. Now remember, TSH is a brain hormone. So we certainly don't stop there.

Even if you are under two, if you're a one, if you're a 0.5, I don't care. You don't stop. You keep going.

You keep looking. So next up, what I mentioned was free T4. This is the inactive thyroid hormone.

Don't want it too high. I want it between like a 0.8 and a 1.2. So depending on, again, what country you're in, you might have to look at that lab value range, the standard lab value range that's next to your result. Look at that range.

And then what I want you to do is I want you to cut it into four quadrants. Cut it in the fourth. And with the free T4, I actually want you in kind of that lower quadrant.

We don't chase T4 to be high, and we can talk about that. I want you in the lower quadrant of that range. So in the United States, it'd be, for LabCorp, it'd be right around like a 0.8 to a 1.2. Then we move down to free T3. Now this is your active thyroid hormone. This is what's giving you a metabolism and lighting up your brain and giving you energy and letting you poop every day, which is a huge bonus because we want to poop every day. So with free T3, we want that in the upper quadrant of the range.

Again, it doesn't matter what country you're in. Take that standard lab value range. Cut it into four.

We want you in the upper quadrant. Free T4 is the lower quadrant. Free T3 is the upper quadrant or even a little bit over.

That's fine as well. Then with reverse T3, here's probably one of the most important markers that you can get. And another rule of thumb that I have that everyone can live by is if you are working with someone who claims to know what they're doing with the thyroid, but they don't test reverse T3 every single time you get labs, then that's their way of telling you that they don't actually know what they're doing with the thyroid.

It is one of the most vital markers that you can get on your labs, whether you're on thyroid medication, not on thyroid medication, diagnosed, not diagnosed. You want to know what your reverse T3 number is because reverse T3 is actually a hormone that's built into us for times of distress, injury, illness, sickness. When you're lying in a hospital bed, fighting for your life because of some kind of trauma, injury, maybe you were in a car accident, reverse T3 will climb because our bodies know at that point of time, you don't have to burn fat or make major decisions or balance your checkbook or have sex.

You need to lie there and survive. However, if reverse T3 is elevated when we're walking around trying to live life, that means that your body thinks that you're dying and that's not really a great place to live our best life. If our bodies are shutting us down and basically putting us into a hospital situation when we're not in the hospital, we're walking around trying to do things.

Reverse T3, I want that under a 12. Now people in different countries, what I often see is you just have to move a decimal point. So the range here goes from a nine to a 25 and we want you under a 12.

And I don't care even if it's below a nine, if it's flagged low, that's fine. So in other countries, usually it'll be like a 0.9 to a 0.25 or a 0.29. Just have a swing that decimal point over and then we want you less than 12. Or you can even cut the reverse T3 range in half and we can say, I want you under halfway.

If it's above a 12, if it's in that upper half of the range, that tells me that you are not converting your inactive thyroid hormone to the active thyroid hormone and your poor body thinks that you're in hibernation mode. Then with the TPO and TGA antibodies, that allows us to test for Hashimoto's, the autoimmune form of hypothyroidism. And really simple, we want those at zero.

So unless you fall into that optimal range, your doctor can tell you all day long, you're normal, you're fine, your labs are fine, your thyroid is fine and you will not feel fine. You will have all the symptoms and you will feel like total garbage.

[Angela Foster] (9:46 - 10:31)
So that's super helpful, the way you've broken that down. And I think for people who just listened to that or watched it, go back and rewind and go through it again, because I just think that makes it so, so simple. When you look at reverse T3 then, you were saying, if it's high, your body basically thinks you're dying.

So at this point, your body is conserving energy, right? So you may see weight gain, sluggishness, fatigue, you want to go back to bed, you don't really want to go exercise, record a podcast, whatever it is. So in that situation, if reverse T3 is going up, sometimes doctors not test it because then they're like, well, we would see it on free T3, that would be coming down.

Is that the idea behind not testing it? But are you saying then that they don't necessarily follow that mirrored pattern?

[Dr. Amie Hornaman] (10:32 - 12:46)
They really don't. They really don't. And they're incorrect in thinking that we don't have to test it and that we only look at the T3.

Now free T3 is vitally important as well. If we don't have free T3 and reverse T3, we don't have a full picture. However, we also don't have a full picture without the reverse T3.

Because here's something interesting that can happen in certain subsets of people. I've been doing this so long that I just see these patterns, I know them, I can spot them in a second when I look at someone's labs. If the reverse T3 is elevated and it's not being tested, oftentimes what can happen is we'll look at the free T3 and it will actually be in that optimal range that I just gave you, in that upper quadrant of the range you're over.

So a doctor will look at that who's testing free T3, maybe even your functional or naturopathic doctor will look and go, oh, your thyroid's perfect. Look, your free T3 is in the optimal range. They're not wrong, it actually is.

However, if we look at the reverse T3 and it's high, what's actually happening is a phenomenon called pooling. So I love to use analogies so people can imagine it in their minds. Reverse T3 comes in and it blocks the receptor site on the cell.

So we have 40 trillion cells in our body. Every single cell has a receptor site on it for thyroid hormone, specifically T3. If reverse T3 is elevated, I always use the analogy of a bouncer at the club.

It's like it's blocking that receptor site on the cell and not allowing T3 to get into the club, to get into the cell to do its job. It just kind of hangs out there as like this Franken hormone that our body doesn't even recognise. So if too much reverse T3 is blocking the cell, but T3 is being produced by the thyroid or maybe someone is taking T3 in the form of thyroid hormone replacement, that T3 can almost get backed up like a dam, like a dam and then the water is behind it.

So we'll see the T3 in the bloodstream. We'll pick it up on the labs. It can look perfect on the labs, optimal on the labs, but it's not getting to the cell and you don't have that information unless you test the reverse T3.

[Angela Foster] (12:47 - 13:03)
And what would be driving that? Why would reverse T3 be going up? Is this somebody who is, you were talking about their body basically thinks they're dying.

Is this the classic kind of burnout? I've just been pushing my body too hard for too long and now it's kind of overreacting or when does this happen?

[Dr. Amie Hornaman] (13:03 - 16:20)
So it happens in a few different situations. That's absolutely one of them. Pushing the body too hard, elevated stress.

I mean, all the things that you talk about on this show come into play here and will drive up reverse T3 if people are not properly sleeping, eating, taking care of themselves, lowering their stress, managing it. That will drive up reverse T3. Insulin resistance, nutrient deficiencies will drive up reverse T3.

But the other factor can be that that person, maybe they are diagnosed with hypothyroidism or Hashimoto's and they're put on a T4 only medication or they're put on too much natural desiccated thyroid. So what do I mean by that? The T4 medications are levothyroxine, lavoxil, synthroid, tyrosine, unithroid.

Those are just T4, meaning you're only taking the inactive thyroid hormone. And like we already said, the body needs to take that inactive thyroid hormone, pull off an iodine atom from it and convert it to T3. Now that sounds simple, but it's actually very, very hard for the body to do.

So if we're giving someone T4, T4, T4, and we're just crossing our fingers that their body does a good job at converting it, that's a huge problem. And that's where I see elevator reverse T3 often because the stat, and this stat was given at A4M years ago, and I love it. I've held onto it ever since.

Only 2%, 2% of the population with hypothyroidism will do well on, and that's the actual terminology that they use. So I'll come back to that in a second. Do well on T4 only.

98% of us need T4 and T3. Some of us need T3 only. And some of us need a higher ratio of T3 to T4.

So what does that tell us? If you're on T4 only, you're probably not going to feel your best. Honestly, I think 2% is high.

What I see in my clinic, I don't see anyone doing well on, or thriving, or optimised, or living their best life on T4 only. And we see the same issue in the functional and integrative space with NDT. And I talk about this so often because I really want to educate people.

Going to a functional practitioner who doesn't know the nuances of thyroid, what they'll do is they'll put you on natural desiccated thyroid, NDT. That's ARMR, NP thyroid, WP. It could be a compounded T4 and T3.

The problem with that is that the ratio is stuck at 80% T4 and 20% T3. So again, if we're pumping all of this T4 into someone's body who doesn't properly convert, which, I mean, if you're a woman over the age of 40, newsflash, you're not going to convert well. Your reverse T3 is going to be high from a variety of other factors as well, such as hormonal decline and progesterone loss.

So when we pump in all this NDT, NDT, NDT at 80% T4, that also drives up reverse T3. So there's a couple of different reasons why reverse T3 will climb. Sometimes it's in the lifestyle department.

Sometimes it's in the treatment department of how that woman is being improperly treated at the time and then not testing her reverse T3.

[Angela Foster] (16:20 - 16:55)
If you're getting value from this show, the single best thing you can do to help us keep bringing you the highest calibre guests is to subscribe or follow wherever you listen or watch. It takes 10 seconds, but it genuinely makes a difference to the quality of the guests we bring you week after week. Super helpful.

And in this situation, how is she feeling at this point? Is this the woman who looks in the mirror and goes, I don't look like me anymore. I don't feel like anymore.

I'm bloated, I'm puffy. My energy's gone. Is that how she's going to be feeling or what would her symptoms be in this situation?

[Dr. Amie Hornaman] (16:56 - 17:28)
Yes, all of those, all of those. And just like you said earlier, what she's probably going to do is go, yeah, I'm just getting older. It must be perimenopause or menopause.

And that's simply just not, it's not as simple as that. And also it's all treatable. I mean, yes, there can be overlap with thyroid dysfunction and perimenopause or menopause at the same time, but all of that is treatable.

Thyroid is treatable. Perimenopause, hormones, all of it is able to be addressed and you are able to get your life back.

[Angela Foster] (17:29 - 17:55)
That's so reassuring. Before we dive into the treatment and also the nutrient insufficiencies and things, if we take a woman in this situation, she knows she's in perimenopause and she's now also thinking about hormone therapy, hormone replacement therapy or menopause hormone therapy. And so she's now going to have an oestrogen patch, some oral progesterone, possibly some testosterone.

How will this affect things with her thyroid, if at all?

[Dr. Amie Hornaman] (17:56 - 20:46)
It will actually help support the thyroid because thyroid and hormones play in the same sandbox. However, thyroid has like dictatorship over hormones. So the thyroid's at the top and it is the master gland.

So if the thyroid is low and slow, not functioning properly, we can see hormonal imbalance at any age. It doesn't have to be just midlife with perimenopause. We can see a woman in her 20s have progesterone levels of that of a woman in her 80s.

So the thyroid runs the show and dictates the hormones, but they all play together. Meaning, let's say someone is oestrogen dominant because she's losing progesterone. This is the classic 30, 40-year-old loss of progesterone, heavy cycles, PMS, PMDD, insomnia, anxiety.

That's what we'll start to see go. And that is the first hormone to go. So then as progesterone declines, she's getting all of those symptoms, but it's also affecting her thyroid hormone conversion of T4 to T3.

Then testosterone starts to decline, which we know that can happen 30s, 40s, 50s. Testosterone provides a beautiful layer of protection against inflammation. And it also provides a beautiful layer of protection against autoimmunity.

So oftentimes during perimenopause with that progesterone and testosterone drop, that's where we see the Hashimoto's switch, that autoimmune switch, go from the off position to the on position. And that's where I talk about thyropause, where your thyroid gland cramps a bit after the age of 40 due to those fluctuating hormones. So then let's go back to the progesterone being low.

What does that set us up for? Well, oestrogen then is higher and it's almost like an oestrogen dominant state. And this isn't the case where we want to lower the woman's oestrogen.

What we wanna do is bring up the progesterone, but that oestrogen dominant state where oestrogen is higher and progesterone is non-existent as the first hormone to go, increases something called thyroid binding globulin or TVG. And what that does is exactly what it sounds like. It's a hormone that binds to thyroid hormone.

So it's going to bind your T4 and your T3 and it's gonna kind of carry it around on a train. So sometimes when we're talking about hormones, we talk about sex hormone binding globulin, where our little sex hormones jump on a train and they get delivered to their sites around the body. Same thing with thyroid binding globulin, the thyroid hormone jump on a train to be delivered to the different sites around the body.

Although if TVG is high, then it becomes this really sticky train that the hormones are stuck to, but then they can't get off at their stop. They can't get off and actually do the work at the cell level. So this is where hormones and thyroid absolutely play in the same sandbox.

[Angela Foster] (20:46 - 21:15)
Very interesting. So this can happen in the early stages of perimenopause when her progesterone is dropping. So now she is oestrogen dominant, not because as you say, we need to do anything about her oestrogen levels necessarily.

It's because we actually wanna keep healthy oestrogen levels, but her progesterone has dropped. So she's now oestrogen dominant by default. And this is causing those increases.

And now that's gonna affect her metabolism, right? And she goes back to feeling puffy, bloated, weight gain, visceral fat, presumably as well.

[Dr. Amie Hornaman] (21:16 - 21:25)
So you get this overlay of the low thyroid symptoms along with the perimenopause symptoms. And it's just like a double whammy. I mean, she's getting hit from all sides.

[Angela Foster] (21:25 - 21:44)
From all sides and commonly as well, right? The other thing that we see, I think that goes into the mix here is if her progesterone is dropping. And so now she's got some heavy bleeding because she's not thinning out that lining.

She starts to drop her ferritin levels, which now compounds the energy. What happens in this case?

[Dr. Amie Hornaman] (21:45 - 22:05)
Yes, yes, amen. Yeah, that's exactly what happens. And then the low ferritin affects thyroid.

With hypothyroidism or Hashimoto's, we like ferritin levels in the States to be right around 80 to 100, even over 100. When that ferritin is low, it compounds the hypothyroid symptoms. So the fatigue, the weight gain, the hair loss, absolutely.

[Angela Foster] (22:06 - 22:14)
So many things going on. Let's talk about then, we've touched on iron. Let's talk about nutrient sufficiencies.

How can we best support our thyroid?

[Dr. Amie Hornaman] (22:15 - 23:45)
So there are core nutrients that the thyroid gland absolutely needs, requires. And I actually lumped them. In the book, I put them under the list of no duh supplements.

It's totally dating me. It's ageing me, I know. I grew up in the 80s with the Valley Girls where we go, duh, of course, you're gonna take these every day.

So that's why I call them the no duh supplements. So these are magnesium, selenium, vitamin D, vitamin B, zinc vital for the thyroid as is iodine. And I know that's a hugely controversial topic in our world, but I am a firm believer in the importance of iodine.

I go right for the science on that because it does support thyroid hormone production, as well as that T4 to T3 conversion. And it protects our cells against those toxic halides like fluoride, chlorine, and bromide or bromine. It protects our cells against those because we're exposed to those toxic halides every single day.

If we don't have enough iodine coming in, those toxic halides will attach to the receptor site on the cell meant for iodine. But if there's not iodine, then guess what? Those guys win.

The toxins win and you lose because you don't have enough iodine in your system. L-tyrosine is another vital. It is the amino acid.

So essentially, what is T3? It's L-tyrosine with three iodine atoms attached to it. That's what it is.

So that just tells you the importance of L-tyrosine and iodine in the production of thyroid hormone.

[Angela Foster] (23:46 - 23:47)
And where can you get iodine?

[Dr. Amie Hornaman] (23:48 - 24:19)
Here in the States, it's over the counter. So I actually have iodine fixer as part of my line. I studied iodine for literally three years before I brought it into my supplement line.

I knew about the importance, but there's a lot of research out there on the different types of iodine. So we have the OG Lugol's formula, which is potassium iodide and iodine. And then we have a form called monatomic nascent iodine.

And I looked and I studied and I read and I talked to experts.

[Angela Foster] (24:19 - 24:36)
Super helpful. And in this situation, how is she feeling at this point? Is this the woman who looks in the mirror and goes, I don't look like me anymore.

I don't feel like anymore. I'm bloated. I'm puffy.

My energy's gone. Is that how she's going to be feeling or what would her symptoms be in this situation?

[Dr. Amie Hornaman] (24:37 - 25:09)
Yes, all of those, all of those. And just like you said earlier, what she's probably going to do is go, yeah, I'm just getting older. It must be perimenopause or menopause.

And that's simply just not, it's not as simple as that. And also it's all treatable. I mean, yes, there can be overlap with thyroid dysfunction and perimenopause or menopause at the same time.

But all of that is treatable. Thyroid is treatable. Perimenopause, hormones, all of it is able to be addressed and you are able to get your life back.

[Angela Foster] (25:09 - 25:36)
That's so reassuring. Before we dive into the treatment and also the nutrient insufficiencies and things, if we take a woman in this situation, she knows she's in perimenopause and she's now also thinking about hormone therapy, hormone replacement therapy or menopause hormone therapy. And so she's now going to have an oestrogen patch, some oral progesterone, possibly some testosterone.

How will this affect things with her thyroid, if at all?

[Dr. Amie Hornaman] (25:36 - 28:26)
It will actually help support the thyroid because thyroid and hormones play in the same sandbox. However, thyroid has like dictatorship over a hormone. So the thyroid's at the top and it is the master gland.

So the thyroid is low and slow, not functioning properly. We can see hormonal imbalance at any age. It doesn't have to be just midlife with perimenopause.

We can see a woman in her 20s have progesterone levels of that of a woman in her 80s. So the thyroid runs the show and dictates the hormones, but they all play together. Meaning, let's say someone is oestrogen dominant because she's losing progesterone.

This is the classic 30, 40-year-old loss of progesterone, heavy cycles, PMS, PMDD, insomnia, anxiety. That's what we'll start to see go. And that is the first hormone to go.

So then as progesterone declines, she's getting all of those symptoms, but it's also affecting her thyroid hormone conversion of T4 to T3. Then testosterone starts to decline, which we know that can happen 30s, 40s, 50s. Testosterone provides a beautiful layer of protection against inflammation.

And it also provides a beautiful layer of protection against autoimmunity. So oftentimes during perimenopause with that progesterone testosterone drop, that's where we see the Hashimoto's switch, that autoimmune switch go from the off position to the on position. And that's where I talk about thyropause, where your thyroid gland cramps the bed after the age of 40 due to those fluctuating hormones.

So then let's go back to the progesterone being low. What does that set us up for? Well, oestrogen then is higher and it's almost like an oestrogen dominant state.

And this isn't the case where we want to lower the woman's oestrogen. What we wanna do is bring up the progesterone, but that oestrogen dominant state where oestrogen is higher and progesterone is non-existent as the first hormone to go, increases something called thyroid binding globulin or TBG. And what that does is exactly what it sounds like.

It's a hormone that binds to thyroid hormone. So it's going to bind your T4 and your T3. And it's gonna kind of carry it around on a train.

So sometimes when we're talking about hormones, we talk about sex hormone binding globulin, where our little sex hormones jump on a train and they get delivered to their sites around the body. Same thing with thyroid binding globulin, the thyroid hormone jump on a train to be delivered to the different sites around the body. Although if TBG is high, then it becomes this really sticky train that the hormones are stuck to, but then they can't get off at their stop.

They can't get off and actually do the work at the cell level. So this is where hormones and thyroid absolutely play in the same sandbox.

[Angela Foster] (28:27 - 28:56)
Very interesting. So this can happen in the early stages of perimenopause when her progesterone is dropping. So now she is oestrogen dominant, not because as you say, we need to do anything about her oestrogen levels necessarily.

It's because we actually wanna keep healthy oestrogen levels, but her progesterone has dropped. So she's now oestrogen dominant by default. And this is causing those increases.

And now that's gonna affect her metabolism, right? And she goes back to feeling puffy, bloated, weight gain, visceral fat, presumably as well.

[Dr. Amie Hornaman] (28:57 - 29:05)
So you get this overlay of the low thyroid symptoms along with the perimenopause symptoms. And it's just like a double whammy. I mean, she's getting hit from all sides.

[Angela Foster] (29:06 - 29:25)
From all sides and commonly as well, right? The other thing that we see, I think that goes into the mix here is if her progesterone is dropping. And so now she's got some heavy bleeding because she's not thinning out that lining.

She starts to drop her ferritin levels, which now compounds the energy. What happens in this case?

[Dr. Amie Hornaman] (29:25 - 29:46)
Yes, yes, amen. Yeah, that's exactly what happens. And then the low ferritin affects thyroid.

With hypothyroidism or Hashimoto's, we like ferritin levels in the States to be right around 80 to 100, even over 100. When that ferritin is low, it compounds the hypothyroid symptoms. So the fatigue, the weight gain, the hair loss, absolutely.

[Angela Foster] (29:46 - 29:55)
So many things going on. Let's talk about then, we've touched on iron. Let's talk about nutrient sufficiencies.

How can we best support our thyroid?

[Dr. Amie Hornaman] (29:55 - 31:25)
So there are core nutrients that the thyroid gland absolutely needs, requires. And I actually lumped them in the book. I put them under the list of no-duh supplements.

It's totally dating me. It's ageing me, I know. I grew up in the eighties with the Valley Girls where we go, duh, of course, you're gonna take these every day.

So that's why I call them the no-duh supplements. So these are magnesium, selenium, vitamin D, vitamin B, zinc vital for the thyroid as is iodine. And I know that's a hugely controversial topic in our world, but I am a firm believer in the importance of iodine.

I go right for the science on that because it does support thyroid hormone production, as well as that T4 to T3 conversion. And it protects our cells against those toxic halides like fluoride, chlorine, and bromide or bromine. It protects our cells against those because we're exposed to those toxic halides every single day.

If we don't have enough iodine coming in, those toxic halides will attach to the receptor site on the cell meant for iodine. But if there's not iodine, then guess what? Those guys win.

The toxins win and you lose because you don't have enough iodine in your system. L-tyrosine is another vital. It is the amino acid.

So essentially, what is T3? It's L-tyrosine with three iodine atoms attached to it. That's what it is.

So that just tells you the importance of L-tyrosine and iodine in the production of thyroid hormone.

[Angela Foster] (31:27 - 31:28)
And where can you get iodine?

[Dr. Amie Hornaman] (31:28 - 32:50)
Here in the States, it's over the counter. So I actually have iodine fixer as part of my line. I studied iodine for literally three years before I brought it into my supplement line.

I knew about the importance, but there's a lot of research out there on the different types of iodine. So we have the OG Lugol's formula, which is potassium iodide and iodine. And then we have a form called monatomic nascent iodine.

And I looked and I studied and I read and I talked to experts. Three years I did this before I decided. And what I landed on was the nascent iodine because it is more bioavailable.

It is better for thyroid patients overall. It doesn't pack a wallop. It doesn't pack a punch.

What I mean by that is when you start taking iodine, number one, you can get a detox reaction because if you're toxic and that iodine's coming in and it's pushing off toxins off your cells, yep, you can get a little bit of a detox, meaning a headache, little rashiness on your body, anything that you can associate with a detox reaction you can get from taking iodine. It's temporary. It'll go away, but hey, you need it because you got to get the stuff out of you.

And then it does not contain heavy metals. There are some sources that have tested Lugol's solution and found that there's traces of heavy metals in it, which of course is not good for any of us, especially thyroid patients. So that's why I went with the nascent iodine.

[Angela Foster] (32:51 - 34:25)
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Can they get iodine in their diet?

[Dr. Amie Hornaman] (34:25 - 35:11)
Not anymore. You know, it's the whole, it's just the depletion. I mean, sure, there's iodine in, seaweed if you're eating sushi and all of that, but again, if you're relying on food, we also don't know the contamination.

So we don't know the sources, right? We know that our oceans are polluted. We know that some fish source, your radioactive plants actually contain radioactive material and heavy metals.

So it's all, getting enough from food can be a little bit tricky because then you're putting other things in your body that aren't really required. And the dose that we see the most effective, especially in thyroid patients, is anywhere between six and 25 milligrammes, not microgrammes. Really, really hard to get that with food.

[Angela Foster] (35:12 - 35:15)
How would someone know that they needed iodine?

[Dr. Amie Hornaman] (35:15 - 36:35)
I interviewed this gentleman years ago and I'll never forget this interview. He was an expert in hair tissue mineral analysis. And I remember I asked him, I said, do you have iodine on here?

And his answer blew me away and I've stuck with it ever since. He goes, no, every cell in the body needs iodine. So why test for it?

Why not just take it? I was like, that's brilliant. I love that answer.

It's so simple, right? We don't have to test, test, test, test, test for it. And really, when you look at iodine testing, it's so all over the place in accuracy.

I mean, some people are telling people to put iodine on their arm and see how quickly it absorbs into their skin. That's not accurate at all. Then some people will do a provocation test where you take 50 milligrammes of iodine.

You collect your urine for 24 hours. We see how much you're peeing out. And that tells us if you're having enough.

Just take it. You know, I mean, I just take it every single day. I feel great.

You know, go by how you feel. Iodine can be a little bit stimulating. So if you feel like, hey, did I just drink like three Red Bulls today?

Back off your dose. Just drop your dose down for the next time. That would be quite a good feeling.

Hey, well, yeah, yeah, there you go. Some people like that. Some hypothyroid patients with no energy, they like that, yeah.

[Angela Foster] (36:36 - 36:38)
Is there a danger to taking too much iodine?

[Dr. Amie Hornaman] (36:38 - 37:27)
There is, yes. So if you take too much, number one, you're going to feel it. You're going to feel jacked up and amped up.

It can also in certain people, especially, and this really comes back to where iodine got a bad reputation in the first place. There were practitioners that were high dosing it right off the bat. And these patients would go into a thyroid storm, meaning their thyroid gland would dump a bunch of thyroid hormone and they would feel hyper because they were hyper.

They went into a hyper thyroid mode, which is exactly as it sounds. You feel amped up, jittery, insomnia, sweaty. It can start affecting your eyesight.

If you ignore it and continue with that dose, yes, absolutely, that can become a problem. But it's all in the dosing. It's like that whole saying of the cure versus the poison is in the dose.

[Angela Foster] (37:27 - 37:32)
So for people who've had Graves disease, should they avoid taking iodine?

[Dr. Amie Hornaman] (37:32 - 37:43)
That's the only case I say avoid it. If you have active Graves, now, if you've already had your thyroid removed or ablated, then you're basically in a hypothyroid state now. And yes, you can take it.

[Angela Foster] (37:45 - 37:58)
And the other nutrients you mentioned, selenium, vitamin D, magnesium, are these staples that you would like people to just take every day? Can they get it from food like selenium, Brazil nuts, things like that? What do you advise there?

[Dr. Amie Hornaman] (37:59 - 39:11)
Selenium, you can get from Brazil nuts. Yep, absolutely. Magnesium, we know we are so deficient, so deficient in magnesium and in the soil and soil depletion.

That's one that you just, I really do recommend taking a good magnesium supplement, especially for my perimenopause menopause ladies. Magnesium depletes during times of stress. We already have problems sleeping in perimenopause.

So magnesium helps calm the brain and relax the muscles. I recommend taking supplemental mag. Vitamin D, it's really hard to get proper conversion from the sun in certain people.

I actually have a genetic sniff that does not allow me to take sunshine and produce vitamin D in my body. I have to take it exogenously as a supplement. What else do we say?

B vitamins, that's again, really, really hard to get in food. A nice B complex just makes it so easy. And then zinc, again, I mean, I just prefer taking a zinc supplement rather than trying to look for food, like does this food contain zinc?

But selenium and Brazil nuts, that is the one that, you know, you can eat a couple of Brazil nuts every day and pretty much get your recommended daily allowance per functional medicine, not for the government, the RDA for functional medicine of selenium.

[Angela Foster] (39:12 - 39:36)
Yeah, but the others, as you say, are harder. I mean, iron is also very difficult, right? For many, many women and taking an iron supplement.

You know, when I was looking at the research now around hepcidin rising, and actually it seems like there's some research that you're better off taking iron on alternate days in order for it to absorb better than taking it every day. You shouldn't take it close to a workout. I mean, so many people, so many women struggle with iron.

What are your tips there, Amy?

[Dr. Amie Hornaman] (39:36 - 40:12)
Exactly what you just said. You know, you take it every other day. We have to take iron four hours away from our thyroid medication.

So I usually advise women to take it at dinner. If they can take something like a ferrous bisglycinate, that's the most gentle on the stomach. So we try, especially with our ladies that are really low in ferritin, we try to get them to take the ferrous bisglycinate on an empty stomach if they can.

If they get stomach upset, obviously they have to take it with food. And then we just have to watch and wait. You know, some individuals will actually need an iron infusion because their body just doesn't respond to the supplementation properly.

[Angela Foster] (40:13 - 40:23)
Yeah, I've had to have that. It's a tricky one, isn't it? What about antibodies?

Can you have high antibodies and still be healthy if your thyroid markers are in range?

[Dr. Amie Hornaman] (40:24 - 42:29)
Oh, girl, I love this question because this is a big one. So yes, yes, you can. I always say don't hang your hat on your antibodies.

So the antibodies we want to test, we want to know your number. Ultimately, we want the antibodies at zero. So if there's any number present on the TPO and TGA markers, we know that you have Hashimoto's.

Okay, that's knowledge. Now, some people can have very, very high antibodies and sometimes in the high 600, 700, 800, 1,000, more than that. So for those people, we'll say, okay, here's the deal.

We know that your thyroid is under attack. We're going to do everything that we can to lower those antibodies while at the same time addressing your low thyroid hormone, your low free T3, your elevated reverse T3, whatever it is we need to do over here. So over on the antibody side, we're going to go gluten-free.

We're going to control for stress. We're going to add in black cumin seed oil because that really helps to push antibodies down. We might add in low-dose naltrexone, which is a prescription, which also gives another layer of pushing those antibodies down and putting it into remission.

However, yes, I can show you someone with 1,000 antibodies whose thyroid lab values and their thyroid hormone replacement is perfecto. Like they are optimal. It is amazing.

They're feeling their best. They're not gaining weight, looking sideways at a brownie. They have full brain function again.

They're pooping every day. Oh, but they have 1,000 antibodies. Well, we're going to keep working on the antibodies, but they're living their best life over here.

Then I can show you somebody with zero antibodies, low T3, elevated reverse T3, on T4 only or on NDT only, and it's too much for them. They feel like garbage. They have all the symptoms, but they have zero antibodies.

Who's in a better situation here? So I would rather have the antibodies and just keep chipping away and working at that, but feel amazing and be optimised rather than, oh, I have no antibodies. But again, I feel like absolute garbage and I have every symptom.

[Angela Foster] (42:30 - 42:45)
Yeah, I agree. And so for somebody who doesn't have, they've got very, very low antibodies, but they're getting all these thyroid issues. What's the typical driver of that in your experience?

Is it nutrients? Is it stress? Like what's driving it?

[Dr. Amie Hornaman] (42:46 - 43:55)
Well, there's a couple of different things we have to cover first, though. The fact that 95% of all hypothyroidism actually is Hashimoto's and antibodies can come back as a false negative. So that's why we want to test it all the time to really, really, really make sure.

So just because you get a zero on one test, test it again, test it again, because it's very, very rare that we see a primary hypothyroidism. So to answer your question, what is another driver if it's not autoimmune? Chemotherapy, radiation, excessive dieting, eating disorders, excessive restriction over exercising, under eating, we can see that.

Certain medications like beta blockers, immunosuppressants, they can have an impact. Birth control, definitely birth control taken for more than 10 years can trigger hypothyroidism. But again, that's usually Hashimoto's because of a woman taking a synthetic progestin for so long, it starts affecting the thyroid and it will turn on that Hashimoto's switch.

But in some instances, we can see a primary hypothyroidism from years and years of birth control and synthetic hormone use as well.

[Angela Foster] (43:55 - 44:04)
Are there a list of things that you would have people do to try to maintain really good immune health, avoid autoimmunity and protect their thyroid?

[Dr. Amie Hornaman] (44:04 - 45:48)
Well, first and foremost, like we talked about earlier, testosterone. You really wanna get your hormones optimised and especially testosterone because it is that armour. It's our shield against autoimmunity and this is why men get hit so much less with all autoimmune conditions and especially Hashimoto's.

I mean, we just don't see that many cases in men. Men, we love you guys. I feel for you because when you have Hashimoto's, your testosterone is always low, but even at a low T for a man, let's say a man, I actually just got an email today from a patient who her husband got tested and his testosterone is at 300.

I'm like, girl, we gotta get him on some testosterone here. So even if a man has a low T of 300, that's still more testosterone than a woman will have even taking TRT. So unless she's really jacking herself over the high dose, properly taking TRT, she's not gonna hit 300.

So men just have that extra layer of protection. So we want to address hormone function first and foremost. We want to control for stress.

We wanna lower your insulin. Being insulin resistant makes the body inflamed. I mean, it's like you're walking around in a state of inflammation and here in the States, the estimate is 93% of Americans have some form of metabolic dysfunction or insulin resistance.

So that is going to just wallop the thyroid. Toxin exposure, lowering your toxin bucket, that is going to help. Just how we eat, the processed foods or choosing organic over non-organic, eating real whole foods.

I mean, all of that tremendously helps support the thyroid.

[Angela Foster] (45:48 - 46:55)
All of those things are important. Where do you come out? I think that one of the most like interesting discussions, let's put it that way on social media at the moment, is around belly fat for women or even just a protruded belly.

And there are so many, I don't wanna get political here, but there's so many different views on this, right? Some is you shouldn't have to put up with that. Of course, it's affecting your confidence.

Let's help you get sorted and going through many of the things that we've just been speaking about. Another narrative is, and that would include thyroid health. Another narrative is actually women are built that way.

You often have this. This is part of the female physique. We shouldn't be worrying about it.

Another narrative is, actually sometimes it's to do with your pelvis adjustment in very lean women in particular, right? Maybe it's just protruding or they haven't done enough stomach turning, but it doesn't really matter in a way. There are so many women that are upset by it.

And certainly it's a symptom that they didn't experience in their 20s or their early 30s. And it comes on in their late 30s and 40s and it troubles them. What have you found helps with this?

[Dr. Amie Hornaman] (46:56 - 48:02)
Well, we wanna get to the root cause first. Like what is driving it, right? Just like you said, is it a muscle issue where you don't have strong enough abs?

Is it a cortisol issue? We know that high cortisol will create this belly fat bloat in the midsection. Low thyroid function will slow down gut motility.

So food gets backed up and we get more gassy, we get more bloated, we get that constipated bloat look. Low oestrogen will start expanding our waistlines and create bloating. Low progesterone will create bloating.

So we wanna really look at, or is it just a gut issue? You know, is this something that we need to do a GI map and test your microbiome and see what's going on there? But what we know for sure is that when a woman goes through perimenopause and especially in menopause, there is a direct effect on the microbiome of the gut or gut microbiome literally changes as our hormones are declining.

And that change in our microbiome environment can absolutely produce more bloating and distension.

[Angela Foster] (48:03 - 48:04)
And is there a way around that?

[Dr. Amie Hornaman] (48:05 - 48:36)
In your experience? Hormones. I mean, addressing what you see.

So addressing the low hormones, addressing the low thyroid, addressing the insulin resistance, addressing the high cortisol, or addressing what we see on your GI map. Because it's all about, I always say like peeling an onion. You know, we wanna peel that onion and get down to the core and find out what is actually going on.

So obviously we're gonna start with our hormones, test this, test that, do an elimination diet, test your gut until we can find like what is that core source of your bloating.

[Angela Foster] (48:37 - 48:53)
So for you, when a patient comes to see you, you will look at their full thyroid, their hormones, so do a full workup on their blood work, right? Do you then also test for things like cortisol, oestrogen pathways within the body, gut health? Do you do the full spectrum of functional medicine labs?

[Dr. Amie Hornaman] (48:53 - 50:32)
So yes, but... So I'll explain. Yes, we do all of those functional labs, but this has been my philosophy from day one.

I do not believe in someone coming into our clinic and right off the bat, we're like, well, girlfriend, you need like $2,000 and functional tests. It's like, I don't even know you yet. I don't know what's going on with you yet.

I'm not gonna have you come in and drop a couple grand on functional tests when let's start with the basics. Let's start with the blood and look there first and see what we see. Then as we start addressing what's in black and white and covered by insurance, then we can move on to, okay, we're addressing what we see here, not quite getting the results that we want.

Now, maybe we bring in a functional test based on us establishing that relationship and working together for a while. Well, now we know you better. So now we can say like, well, Jane, you can tell us about all this stress you've been under for the last year.

You're taking care of your parents. Your kids just went off to school. You're like, let's test your cortisol because that could be playing a huge role.

And that's a really nice, affordable test. And then maybe if that doesn't show us anything, then we'll go, okay, Jane, let's keep digging then. Let's just do, let's do the GI map test.

Let's check your gut. Let's see what's going on there. Women who have been on hormones with us for like six months to a year, we do always recommend the Dutch test.

However, again, that's an out-of-pocket expense for them. So if they absolutely can't afford that, don't want to do it, you know, we'll talk to them about the pros and cons and the information that it gives us. But I never force functional testing on someone, especially right off the bat.

[Angela Foster] (50:32 - 50:53)
Yeah, I like that approach. I think it's much more accessible for people. With the gut health we mentioned there, it kind of seems like it's further along the line.

Have you found that for a lot of people when they get their thyroid functioning well and they're on hormones and they're supporting those systems, that actually their gut comes back into balance without you necessarily having to do too much work on it of itself?

[Dr. Amie Hornaman] (50:53 - 50:56)
Oftentimes. Oftentimes, yes. Yes.

[Angela Foster] (50:56 - 50:57)
Interesting.

[Dr. Amie Hornaman] (50:57 - 52:30)
And that's why I speak up a lot. I get a little bit controversial online sometimes about like, and listen, before I say this, I know how important the gut is. I am not dismissing whatsoever the importance of the gut and the gut immune connection and the gut brain connection and leaky gut and all of it.

But I think too often women are sold a gut healing protocol as the be-all end-all. All you need to do is heal your gut and your thyroid will be fine. All you need to do is heal your gut and your hormones will balance out.

All you need to do is heal your gut and your adrenals will be fine. It's like, okay, the gut is important, but healing the gut without treating the low thyroid function and the low hormones, probably not going to do anything. I've never known someone to heal their gut and bring their T3 from a 2.4 to a 4. It really just doesn't happen. So yes, I do often see things balance out. In fact, what I also notice is that when we get their thyroid hormones truly optimised and really make their body resilient, and of course, doing all of the lifestyle things, the diet, the exercise, the sleep, all of it, even mould and Lyme.

I mean, people who have been exposed to mould or have Lyme disease, which I'm pretty sure is all of us at this point, they don't react like they once did or like the subset of people do whose thyroid isn't optimised, who are not treating their hormones. I just see this more resilient body able to take on these onslaughts of our world in a much better fashion and not be sidelined by it when our thyroid hormones are optimised.

[Angela Foster] (52:31 - 53:09)
Isn't that interesting? Because I think the other thing as well, when you start going mining effectively in the gut, it's such a new area in terms of it being in its infancy compared to the rest of medicine as a whole and what we do know and that we can do things about with certainty that, yeah, it feels, I think, overwhelming for many patients as that being a place to start and often highly, highly restrictive in nature that they feel they can't stick to as well because you're almost excluding everything and then trying to slowly bring things back in. And it's just its own project when by the sounds of it from the things that you're doing, Amy, and the things that I see, we can actually get people feeling better quite a bit quicker.

[Dr. Amie Hornaman] (53:09 - 53:11)
Yes, yeah, I agree.

[Angela Foster] (53:12 - 53:24)
Before you go, you mentioned something that I think would be remiss for me not to circle back on, which is thyroid pause. Does this mean that everyone can expect to have some form of thyroid symptoms or not?

[Dr. Amie Hornaman] (53:24 - 55:17)
So my estimate, and I mean, this is really based on 25, 30 years of doing this and working with women. My estimate is about 80 to 90% of women over the age of 40, definitely over the age of 50, will get hit with thyroid pause. And again, why is that number so high and our data so low?

Again, it goes back to what we talked about in the very beginning, it's the misdiagnoses. It's the not being tested properly, not being addressed properly, not being listened to in the conventional medicine system. But when we look at, if I took 10,000 women and got their thyroid panel done from let's say age 40 to 55, we are going to see a progressive decline in thyroid function through the years if she doesn't stop and treat it.

And that's just reality. I mean, we're not gonna get away from our hormones declining. If you live long enough, not even Brian Johnson has figured out how to reverse ageing, right?

We know how to slow it down. We do not know how to reverse it and bring back the hormones that we had in our 20s and 30s. So our hormones are going to decline.

It would be remiss of us to say, oh, but our thyroid will be fine. What? You mean the master controller of our endocrine system is just gonna be fine when everything else is breaking down and slowing down?

How is that even possible? It doesn't even make sense. Of course, the thyroid and the hormones play in the same sandbox.

So as those hormones decline, they're gonna pull the thyroid down with it. And a couple of women will skirt this. Genetically, I mean, of course, we talk about this, you talk about it too.

Genetics can absolutely separate the women in their perimenopause-menopause state where some will get hit hard and some won't. Some will have menopause symptoms and some won't. But the same thing with thyroid.

Some women will skirt it and not get hit by it. Many of them won't.

[Angela Foster] (55:17 - 55:33)
Is there a body fat percentage where the thyroid starts to take a hit when you're looking at it? So I know like under eating, for example, in women can affect thyroid health. What about women who are very, very active, train a lot and they're pretty, you know, very lean?

Will that be affecting their thyroid?

[Dr. Amie Hornaman] (55:34 - 56:05)
Not necessarily, because we can see hypothyroidism occur in the lean, in the fit individual where there's no weight gain associated with it. Although that's rare because weight gain is a huge symptom of hypothyroidism, but we can see it. Now, what I will say is that woman that you just described has a much better fighting chance because she is taking care of herself on all fronts.

She has a much better chance at eluding hypothyroidism as she transitions.

[Angela Foster] (56:06 - 56:50)
Quite often, right? And those women actually there, their sex hormone levels tend to be a little bit lower, right? Quite often with things like oestrogen, because they have less body fat.

And then maybe that then eventually circles back around to the thyroid, right? But as you say, she's probably better protected from a metabolic health perspective. I feel like we've only scratched the surface, but thankfully we have your book, which is very, very exciting.

It's kind of like, I think a handbook that everyone should have, because this is a complex area that you have really, really managed to simplify and just make it so accessible, just in the way you've described it here with the different boxes and tiers and things. It's been amazing, Amy. Where can people connect with you, find out more about your work, your book, amazing book, The Thyroid Fix?

Please share.

[Dr. Amie Hornaman] (56:51 - 58:44)
Oh, thank you so much. So anyone can connect with me on draimy.com. That's where you can book a call if you're interested in working with us.

We prescribe to all 50 states. Our jam is thyroid and hormones. That's what we do.

It's all telehealth. You don't have to go anywhere. So we got you covered there if you want proper treatment.

And then the book can be found anywhere books are sold. You can go to Amazon, type in The Thyroid Fix. You can get it in hardcover, Kindle, or the audible version.

In the audible version, I actually added on bonus chapters at the end of every chapter. So you get me kind of riffing like I do on here at the end of each chapter and where I really expand it. But I wrote this book exactly as you said, Angela, as a handbook.

I call it The Thyroid Bible. So, I mean, I've been a thyroid patient now for 25, 30 years. I've read every thyroid book under the sun.

And I know what's missing for the woman out there. I know what she needs. And what was missing is going deeper and talking about those things that no other author has talked about so far in the thyroid space, including medication and dosing.

Because I am a firm believer that you have the intelligence and the power to know exactly what your labs mean and exactly what's going on in your body and exactly what you need to do to fix it. You don't have to rely on a doctor or a white coat to tell you what you need. And I think that's been the fear of many authors of the past in the thyroid world is like, oh, we don't wanna talk about medication because that's kind of a dicey subject.

And then people will be like, oh, I'm medicating myself. No, I trust that you guys are intelligent enough to read the book and not go rogue with getting medication off the black market. This is meant to be a discussion with your practitioner, which I also give guidance in the book on that as well.

So it really is the thyroid Bible.

[Angela Foster] (58:44 - 59:12)
Yeah, I love it. And just so empowering because as you say, you're licenced in 50 states across America, but people globally have this problem. And if they can take this and give this book to their doctor, let them see it, let them see the evidence and say, look, I'm not making this up.

It's not in my head. This is how I feel. And this is the root out of it.

This is how I can help. You can help me to feel better. It's just gonna help so many people.

So thank you. Thank you for the amazing, amazing contribution that you're putting out into the world. And thank you for coming back on my show.

[Dr. Amie Hornaman] (59:12 - 59:13)
Well, thank you for having me. It was a pleasure.

Labs read "normal" but you're gaining midsection weight, foggy and running at 70%? Your thyroid - not just perimenopause - may be the missing variable. Dr. Amie Hornaman explains why TSH alone misses the picture, how elevated reverse T3 "pools" and blocks T3 at the cell even when free T3 looks optimal, and why roughly 98% of women don't thrive on T4-only. She links falling progesterone, rising thyroid-binding globulin, low ferritin and the "thyropause" hitting 80-90% of women over 40.

WHAT YOU'LL LEARN

Why a "normal" TSH can completely miss a thyroid problem - and the five markers that actually reveal what's happening

What reverse T3 "pooling" is, and how it blocks active thyroid hormone at the cell even when your free T3 looks optimal

Why roughly 98% of women stop thriving on T4-only medication once they're past 40

How falling progesterone drives estrogen dominance, raises thyroid binding globulin, and quietly strands thyroid hormone before it reaches the cell

What "thyropause" is, why it hits 80-90% of women over 40, and how it overlaps with the perimenopause symptoms you're blaming instead

Why testosterone acts as armor against autoimmunity - and what its decline switches on

How low ferritin, insulin resistance and cortisol compound thyroid-driven fatigue and stubborn belly fat