Is Your Thyroid the Missing Piece? Dr. Amie Hornaman on Energy, Metabolism & Real Answers

Transcript

Welcome back to the podcast. Today’s episode is a powerful one, especially if you’ve ever struggled with low energy,
brain fog, stubborn weight gain, or just the feeling that something in your body is off, but you’re not getting real
answers. I’m joined by somebody known around the world as the thyroid fixer doctor Amy Horniman. Doctor Amy is
the CEO and founder of the Advanced Thyroid and Hormone Clinic, an international telehealth practice serving
patients around the US and Canada. She’s also the host of the top rated podcast The Thyroid Fixer, where she’s on a
mission to empower people with the truth about thyroid health, hormones and functional medicine, especially when
conventional medicine leaves them sick, dismissed, or still feeling unwell. Doctor Amy is also a sought after speaker
and the author of The Thyroid Fix the No Nonsense Guide to Fix Fatigue, Fogginess and Fat That Won’t Budge. Her
experience has been featured in documentaries like Sealed on Amazon Prime, Ageless and Hormones, health and
Harmony, and she’s become a trusted voice for outlets like Forbes Health, CBS news, Fox News and Posh. And this
conversation we dive into why thyroid hormone is so critical for metabolism, energy, and overall health, and why so
many people can have thyroid dysfunction without fully realizing it. We talk about the common signs that may point
to a thyroid issue, what to look for, and why it’s important to look beyond surface level symptoms and labs.
We also get into Doctor Amy’s new book, and what makes it different from most thyroid books out there. Instead of
giving a one size fits all approach, her work explores the different treatment options for hypothyroidism, including a
focus on T3 treatment while emphasizing the importance of a balanced, individualized treatment approach. This is a
nuanced, practical, and empowering discussion for anyone who wants to better understand their thyroid and
advocate for their health. So whether you’ve been diagnosed with hypothyroidism, suspect something may be off, or
simply want to better understand how your thyroid affects your body, this episode is packed with insights you do not
want to miss. Let’s get into it. So thank you so much for coming on the podcast and talking to my listeners about your
new book that’s coming out in general. We’re going to be talking about thyroid today, which is super important. I
have a lot of people who struggle with thyroid issues. So I want to start, Amy, like, tell everyone what you do, how
you got into this thyroid space, and then we’ll kind of go from there.

Oh yeah. Absolutely. Well, thank you Doctor Kassi for having me on. You know, my journey is no different from many
of the listeners. It’s a pain to purpose story. It’s six misdiagnoses. So way back way back in my 20s, I was a
competitor. I competed in fitness and figure competitions. I did some fitness modeling, so I knew how to get my body
into shape. It was a really strict diet, really strict exercise regimen, super disciplined. So I had done it plenty of times.
I knew how my body was supposed to respond. This one show I was getting ready for, and I’m working with a coach
and I’m sending him my my scale weight every single week and my I progress pictures? Well, my progress pictures
kept getting bigger and the scale kept going up. So here’s my coach thinking I’m binging on donuts and ice cream.
And that wasn’t the case. I was doing more. I was restricting more. I was hitting the gym three times a day. You
know, I started blaming myself. I’m like, why? Why is this happening? It doesn’t make sense. Why is my body literally
rebelling against me and doing the opposite of what it should do? So what’s the next logical step? I went to my doctor
and I go to my doctor. Doctor number one does some testing. We know it was probably TSH, maybe free T4. That was
it says your thyroid’s fine. Everything’s fine. Your labs are fine. You’re normal. Everything. Nothing to see here. So I
leave, and I continue to pursue this because, you know, second opinions are real.
So are third, fourth, fifth and sixth opinions. So I kept going and literally six, six doctors in a major medical system.
We’re talking UPMC Pittsburgh. It’s equivalent to the Mayo Clinic, Cleveland Clinic, the best of the best medical
systems out there, right where you think you’re going to get the best of the best care. Six doctors all misdiagnosed
me. One of them actually told me to eat less and exercise more, which was such a joke because I had brought him in
my diet. He saw I was eating chicken, broccoli, and asparagus every single day. So finally, the seventh doc touches
my throat. You’ll appreciate this from an endocrinology practice, right? First doctor to touch my throat and says,
swallow. And she goes, oh yeah, I’m feeling some nodules on your thyroid. And based on your labs, it looks like you
have hypothyroidism. So there it was. There was the diagnosis. I was like, yes, there’s an answer. There’s a name.
This is awesome. And then she gave me a pill. So of course I left her office with my Synthroid in hand and I was so
happy. I’m like, this is going to be the miracle pill. Finally going to lose this weight and I’m going to feel better. And I
gave it about five months. And of course, as you know, as you’ve already talked about, as your listeners know, T4
only just doesn’t work. And it didn’t work for me either. And I didn’t lose any of the weight.
I didn’t feel any better. So I do some doctor googling. We didn’t have chat GPT back then. We just had like, it was like
the the start of Facebook. So we didn’t have the Facebook groups to go in and complain in. So I started doctor
googling and I see this T3 thyroid hormone. I’m like, oh, that’s active. Wait, what? She gave me this T4, it’s the
inactive thyroid hormone. And now there’s this active thyroid hormone. And it turns out you can put them both
together and it really works well. So I go back to her and I say, hey, can we add this in? It makes sense. She goes, no,
that’s not standard of care. I don’t do that. And I said, thank you so much. You’re fired. I’m going to find somebody
who does. And that’s what led me into functional medicine. So my functional medicine practitioner mentor literally
sat down with me. I always joke, I say for 83 more minutes than any other doctor did. He spent time. He spent time
with me. He went through my labs. He did all the right testing and explained to me what my body was doing and
explained to me how my elevator reverse T3 was, why that T4 only didn’t work, and how we needed to bring in some
T3 medication as well. And he walked this journey with me to the point where I changed careers and he became my
mentor. And I went into functional medicine specializing in thyroid and hormones because I was dismissed that many
times.

So seven times, it actually took eight times to get to the right provider.
Right. Exactly, exactly. And we’re still seeing that today. It hasn’t changed in the past 30 years. I mean, you and I
both still get patients that have been to eight, ten, 15 doctors. It’s ridiculous.
Yeah. And it’s really sad that it’s not getting better, even with, you know, more providers knowing about this and
functional medicine becoming more known in T3. But I actually saw a lady yesterday who we were talking and I
looked at in her labs and of course, she’s on this big dose of Synthroid and her T4 is like 1.5 and her TSH was like
three and her T3 is two. And I’m like, we need to change her thyroid medicine. And she started crying actually, and
she said, I’m just so scared to have you change my medicine because I’ve had eight doctors change my medicine and
I never feel better. And I usually feel worse. And at least now I know the bad that I feel. And so I’m scared to feel bad
in a different way. And I was like, well, but nobody’s ever given you T3. And she’s like, well, that’s true. And I’m like,
so we gotta try something else, right? And it’s just I feel for her because, yeah, she went through the same thing for
ten years and, you know, levothyroxine and then, oh, Synthroid is better. And then, oh, well, let’s try Tirosint. And for
ten years she’s had a T3 of two and nobody’s put it together for her, you know. And, and so I remember, you know,
thinking like, wow, I remember what that was like too. But she literally cried. She said, I’m just scared because at
least I know how bad I feel right now. And when somebody messes with my thyroid medicine, the bad changes and
it’s usually worse, but it’s never good, right? And so I think that’s the frustrating thing for people is like, why does it
take eight doctors? Why does it take ten years to fix this?

Yeah, exactly. And to your point, people experiencing a new norm of bad, it’s almost like we’re seeing these women
medically gaslight themselves. Like, well, this is as good as it’s going to get. And I don’t want to do any more changes
because I don’t want to get worse. I’m okay dealing with this level of bad. I don’t want to deal with that level of bad.
They don’t even realize how good they can feel. They can’t even see the potential of how their lives can improve.
Yeah.
So when you were on your journey, what were like the top three symptoms you had that you just couldn’t get rid of?
And then when you started the T3, how long did it take for those symptoms to change? And like, what did you notice?
Yeah. So the big one was weight gain. So the scale actually went up about 25 pounds to where I stopped getting on
the scale. If I think back and if I look back at pictures, I see about a 3,540 pound weight gain on me and there was
nothing I could do. I was doing all the things. I was doing all the things, and nothing was taking it off. So that was
really number one. The fatigue was there, but it was almost shadowed by all of the fat burners that I was taking. The
stimulants, you know, the Hydroxycut at the time, the damn near killed me because I was trying to get the weight off.
So the fatigue was there, but I masked it with with caffeine and stimulants. And then there was the hair loss. And
those really are the classic top three symptoms that I see from our patient population. I mean, sure, there’s the brain
fog and the, and the, the anxiety, the depression, the constipation. But those top three, the hair loss, when you start
being scared to wash your hair, because then you get clumps and you put them in a little baggie and you take them
to your doctor to prove like, look, doc, this is how much hair I’m losing every day. If this continues, I approximate that
I’m going to be bald in the next two months, right? And that really is.
Those are the top three when I started. So I transitioned from T4 only to armor thyroid. And just like so many people
out there, when they make that first transition and we bring in that first dose of T3, even though it’s only in like 20%
because armor and NTT is like 8020. When we brought that in, I was like, whew. Yeah, my cells lit up, my body was
happy. It was getting some T3. So really, those first six months were fantastic because my body adjusted, the weight
came off, you know, the hair stopped falling out, my energy came back. But then we were seeing something in my
labs where the reverse started kind of shifting and climbing, and some of the symptoms started coming back. So as
we kind of moved along, we started experimenting. I transitioned from that to T4 and T3 separated out. So then I had
the Liothyronine as T3 and I had Synthroid. We stuck with the brand for T4, but we kept reducing the dose of the T4
where the T3 would dominate the ratio. So it would be more like an 80% T3, 20% T4 split. And then my practitioner,
because he really knew his stuff, taught me everything I know.
He’s like, we’re gonna pull out this T4, because I have a feeling you might be converting all of your T4 to reverse T3.
You know, you might have a genetic snip. We couldn’t test genetics at the time. No one had DIO1 and DIO2 genetic
testing. So he’s like, I just had this gut feeling. Let’s try it. So we pull out the T4 and I would get better. And then he’d
be like, all right, now we’re gonna put it back in just a try, like 12.5 micrograms. That’s it. And as soon as we put back
in the T4, I would gain 10 pounds, become clinically depressed. I’m like, okay, this isn’t working. And that’s actually
what we do with patients now is sometimes we’re doing this trial and error because there’s a certain subset of the
population that is T3 only. I’m one of them. Not everybody is, but I’m one of them. And we had to kind of go through
that experimentation process to determine what was going to be best for me. So all in all, I would say to answer your
question, the changes started happening relatively quickly, as in like 3 to 6 months. But then the, the major changes
where I really moved into that optimized state didn’t occur until I was ultimately on T3 only.
Yeah. And I think that’s really important for people to hear. I mean, everyone is different to your point. Some people
get put on, you know, Synthroid levothyroxine. They’ve been so hypothyroid for so long, they feel great and maybe
they feel great on that forever. My theory is most people that are on T4 only medications just don’t know what great
feels like. But that’s just I think that most people do need some T3 because unless you just have a very solid gut. And
metabolically, you are in phenomenal shape and that T4 can be converted to T3 in your gut and you don’t have any,
you know, deiodinase inactivity or, you know, anything shunting that conversion, then most people are going to need
some T3 because we’re so chronically overstimulated. Our diets are poor. We have, you know, our light circadian
rhythm is not right. And so we’re not going to convert T4 to T3 like we’re supposed to in our gut. And so most people
do need a little bit of T3, but they don’t know because they’ve never had it right. And traditional medicine doesn’t
teach us to use it. And you know, what’s really frustrating to me is people have never had it. Or doctors will scare
them into saying, oh, well, if you take T3, you’re going to get an arrhythmia or you’re going to, you know, somebody’s
going to kill you or whatever. Like none of that is factual. There’s actually studies that show higher T3 levels help
your heart. They don’t hurt it. You’re less likely to get arrhythmias, right? You’re less likely to get dementia, all sorts
of things. But and to your point, your weight is much better as well.

And so unfortunately, there are a lot of people who, like you said, they’ve had these doctors who have played games
with, with their depression and their weight and just their symptoms for a lot of years. And the patient is the one that
suffers, unfortunately. And everyone is different. Everyone’s sensitivity is different. There are some people who, you
know, and we’ll talk about this in your book who need different treatments, but it’s just frustrating because to your
point, also, a lot of people get gaslit medically gaslit either from their providers or I think it starts with providers. And
then patients start to gaslight themselves because they’re like, oh, I saw providers. And you know, I saw two
endocrinologists and they told me you’re fine. And so I was like, okay, well, maybe I am fine. But I think that it’s really
important that people listen to themselves and, and know that, hey, if I don’t feel really well, I need to keep looking.
So I want to transition. You said a couple of things about reverse T3 and free T3, and I know in your book that’s
coming out soon, You talk a lot about the way it’s a little different, you feel like, than other thyroid books as you talk
about the treatment of thyroid disease, and you talk a lot about T3. So tell people, I guess, you know, tell people
about the book, tell people what you think is different in the book. Let’s talk about some of the things that you think
is different as far as the treatment.

Absolutely. So, you know, as a thyroid patient, of course, I own every thyroid book that there possibly is, as most
thyroid patients do, right? We gather this information and we really want to learn about our own condition. So that’s
fantastic. But when I’m looking at the books that are out or that have been put out and some by our friends, I mean
they’re fantastic books, but I found that there’s this missing component. It’s almost like people might be a little bit
scared to talk about in this health world. And that’s the medication piece. Now I frame thyroid medication as thyroid
hormone replacement. We are replacing hormones that your body is no longer properly making in the correct
amount, very similar to progesterone, estrogen, testosterone. We can now replace those hormones as a woman goes,
or a man goes into mid-life and they start to lose their hormone function. We bring them back in and we bring them
back in, and they look identical to what your body makes. So same thing with thyroid hormone. And whenever I’m
asked, okay, what’s your favorite thyroid hormone replacement? I go, the one that works for you in the combination
that works for you and in the dose that works for you, there’s no one size fits all when it comes to thyroid
optimization. So what I really wanted to do in this book is treat it like the patient that’s coming into our practice and
with full realization that not everyone can work with us. Not everyone can afford functional medicine. Some people
need to have this educated, collaborative partnership with their insurance based Provider because that’s what’s
available to them. So I really wanted to take the reader by the hand and through this entire process, so that I could
empower that reader to truly know what their labs mean.
And I have taught thousands of women how to read their own labs, how to interpret it, even from a standpoint of, oh,
I’m on 100 micrograms of Synthroid and my reverse T3. Yes, it is a 20. So therefore I have to move over to this
column per Doctor Amy’s book, and then I need a reduction in my T4, and I need the addition of T3. And I have a
couple different options here that I can have a discussion with with my doctor. So I wanted to actually teach people.
Yes. Even the medication piece, that thyroid hormone replacement piece teach you what you need, what you need to
change, what you need to add in, what needs to shift in your thyroid hormone replacement, just like the patient that
you shared about like, she was so scared to make this change. But I explained the why. So let’s just say this woman
has been bounced around. Okay, we’re going to change from Synthroid to Tirosint. We’re going to increase it. We’re
going to go from 50 to 70 5 to 1 25 to 150. She’s not feeling any better. So therefore we need to look at what
probably no other doctor has looked at with her. And I know you looked at it. We need to look at the reverse T3 and
the free T3. And then we see, okay, Susie, here’s what we need to do. We need to bring that T4. We’re going to bring
that on down to 50 micrograms because your reverse is falling between, let’s say, a 16 and a 20, right? So if you’re in
that column of the reverse T3 and your free T3 is in that lower quadrant of the range 22.3, then what we’re going to
do is we’re going to lower that Synthroid, and we’re going to bring in T3 five micrograms twice a day.
And I’m going to teach you how to pay attention to your body. So where you can climb that T3. Now obviously you
can’t do this alone. So that brings into that next part of. How do you even find a doctor? What to ask for? Now, this is
even in the insurance based system, or this is before you hand over thousands of dollars to a functional practitioner
who I joke, you know, I mean, we see so many of them. Doctor Cassie Jacks of all trades, master of none. It’s that
typical functional practitioner that does they do gut and adrenals and autoimmune and thyroid and hormones in your
brain and your big toe and your your hair loss. And they do everything. But what do they do good. What do they
really know? What do they really focus on? And that’s one of the things that people really have to look for before they
jump into functional medicine as well, because we also can’t think, okay, I’m going to learn this, learn this, learn this,
and go to the functional doc down the street and talk to him or her about my thyroid. If they’re not a thyroid expert,
that’s not really going to work. So I also teach people of what to look for when they’re choosing a doctor or a
collaborating practitioner to work with them.
Yeah, I think that’s really powerful.

It’s true. Like, there are some lots of people out there you can work with, right? And I think unless you have a lot of
extensive training, it’s hard to put all those pieces together. And so the fact that you kind of took this book and you
said, hey, if you have thyroid issues, these are the labs you want. And then guiding people through the treatment, I
think is, is really important for the listeners that are listening. Most people know that free T3 is the active thyroid

hormone, right? And so a lot of people are taking T4 or our body makes T4. And then there’s something called de-
iodinase enzymes that help convert T4 into T3. Or there are some that convert T4 into reverse T3, which is what

we’re talking about. The free T3 is the important hormone, the active one, and the reverse T3 is the inactive one. So
can you tell listeners, what are some of the reasons that your body would be making reverse T3? You mentioned
taking levothyroxine or taking a lot of T4, but besides a genetic mutation, are there other things that are causing
their reverse T3 to be higher. There are things that we talk about in the book that can help them lower that. And
what is reverse T3? Like, why do we even have it?
Yeah, well, let’s start there. So reverse T3 is beautifully made in our bodies, thank God, because if we’re ever in a
traumatic place, we’re in a car accident. We’re fighting for our life. We’re in the ICU, we’re in the E.R., we want
reverse T3 to go up. Our bodies are so smart. Our bodies know that when you’re in that trauma space, that we need
to shuttle energy in different ways. At that point in time, you don’t need to burn fat. You don’t need to think. You
don’t need to grow your hair. You don’t even need to poop every day. You just need to lie there and survive. So we
want all the body’s energy to go toward healing and survival. The problem is, is if reverse T3 is elevated, but you’re
not lying in the ICU or the E.R. fighting for your life. You’re trying to live life day to day. And what that basically does
is it puts our body into that same survival mode where you’re not burning fat, you’re not growing your hair, your
brain’s not lit up. You’re not pooping every day. You’re constipated. That’s not good. So we want reverse T3 there. We
just don’t want it there when we don’t need it. So we know that T4 is the only hormone that can convert and become
reverse T3. And it’s like T4 sits at this intersection of two paths, and it can choose to become free T3, which is
amazing. That’s what we want. Or it can kind of go down this other path and become reverse T3. Now sometimes this
can be your own thyroid hormone production. It could be you’re not on thyroid medication at all, but you have this
elevated reverse T3, meaning your body is taking the T4 that your thyroid gland is making and it’s pushing it down
this pathway.
So we want to look at different factors that are interfering. Now, these factors are the same factors that we look at
even if you’re taking T4 only. But one of the changes that we can make if you’re taking thyroid medication is we can
lower that T4. So whether it’s Levo, Synthroid, NTT, we can just back that dose down a little bit. And that’s going to
pull back on the amount of T4 that’s being pushed down that reverse T3 pathway. While we are looking at and
checking off all the boxes as to why. So, okay, here’s the why. Why does reverse T3 go up when we’re not fighting for
our life? Insulin resistance, estrogen dominance. Nutrient deficiencies like low iodine, low magnesium, low zinc, low B
vitamins, A dysregulated immune system. Maybe your vitamin D is low as well. Selenium is a big factor. Elevated
cortisol, high cortisol or low cortisol, just really dysfunctioning adrenals, gut dysbiosis, any issue in the gut. We know
that the majority of diet enzymes are made in the gut and the liver. Liver issues. Nonalcoholic fatty liver disease, just
a heavily burdened liver, overt toxification. I mean, we’re living in basically a toxic soup environment at this point.
Unless you’re living in a bubble in the rainforest, you’re exposed to toxins, and then there are genetic snips. So we
can actually test. Now we can test that DIO1DIO2, snip and see if there’s a propensity in your genetics for you to not
convert. So you can see, I mean, there’s a lot of different factors that play into reverse T3 and that conversion of T4
to T3.
Yeah, I love that. The other thing is, like you said, micronutrients. So ferritin is really important for your thyroid also,
you know, keep in mind stress when you’re stressed, it brings your cortisol up and then medications. So this is what
kills me. Levothyroxine actually increases reverse T3, metformin, statins, birth control. I mean these are medications
that millions of people take. And so, you know, that’s the other conversation I have with patients when they come
into our practice is like sometimes the medications that we’re taking are actually pushing our body to metabolize our
hormones in ways that maybe we wouldn’t want them to metabolize.
Oh, yeah. Yeah. I mean, birth control, you said it now, I was on birth control for more than ten years. So when I say
this, I’m not judging or throwing shade here. But the reality is, is that if you are on birth control for more than ten
years, one study showed that you have a 283% increased risk of developing hypothyroidism. So that really shows you
that those synthetic hormones really start to mess with our overall hormonal balance.

Yeah. And I love that you brought up dysbiosis. You know, that’s part of the reason I wrote my entire book. There’s
chapters in there about just how dysbiosis affects not only your thyroid hormone, but your insulin, your cortisol, and
to your point, how your insulin, cortisol are all very tightly regulated with thyroid hormone production. So I think that
it is important for people to understand that. And I know you brought up the genetic snips that people can do. And
you know, what I tell patients is we can do that. But you can also just check labs like, I mean, if you’re team three, if
your free T3 is low and your reverse T3 is really high with a higher, a normal free T4, you’re shutting all that to
reverse T3. Now, if if there is a reason, right? You know, we know, hey, your adrenals are shot your insulin. But if you
have everything pretty well, you know, in line, you’re doing what you’re supposed to be doing. Your gut is balanced
and your T3 levels are where they’re supposed to be. Your T4 is not too high. You’re not on a medication that should
be shunting everything, and you still have a really high reverse T3.
Then we probably have a genetic issue. And so I do think all these things are really important. And it’s good that you
have this in your book. People can kind of walk through, and I’m curious to know in the book, like, what do you tell
people if somebody goes to their primary care doctor and they can’t afford to see you or I, and they’re in traditional
health care. Do you just recommend they walk in and say, hey, I want you to check my reverse T3 and my free T3.
And if the doctor says no, go to somebody else. Because to be honest, even as an endocrinologist, I was never taught
about reverse T3, right? Even in fellowship I wasn’t taught. So what are patients supposed to do if they go to their
provider and say, hey, I think I have this issue where I’m making a bunch of reverse T3, I want to get off this T4 and
go on to T3 because most doctors are going to look at them like they’ve lost their mind.
Yeah, I mean, listen, it is going to be a challenge, right? Because exactly what you said, the training just isn’t even
there. So it’s not that these docs don’t want to help you. They do. I mean, you right out of school, you wanted to get
out there and start helping people. It’s not your fault that they didn’t go into in depth what reverse T3 means and the
use of T3 and all that good stuff. You had to learn that after the fact. So I would say, number one, we do have the
ability these days to really affordably order our own labs. So really, it can even start with you just looking inside of
yourself and you knowing your own numbers. Now, the reason why I say if a doctor says no to testing is time to get a
new doctor. It’s because if you have to order the labs, then you actually have to interpret them for your doc. Now that
can work. It can still work if you have that open minded practitioner and they’re out there, they’re unicorns, man, but
they’re out there and, and you can have that educated conversation where you come in as that patient advocate, as
that educated patient, and you have a real down to earth, scientifically based conversation with your doctor where
you’re bullet pointing your symptoms.
First of all, you don’t write a book. Nobody wants to hear your life story since 1985 and how it all started, you know,
with inflammation and whatever, right? Bullet point your symptoms and then, you know, you could start off by trying
to bullet point the labs that you want to be tested with, like a little blurb next to him reverse T3. I want to check how
well I’m converting this Synthroid that you have me on to the active thyroid hormone that might actually spur a
conversation right there where the doctor goes. Oh, okay. Well, can you tell me more about this? Why would you
want to? Why would you want to look at this? And believe me, I have had audience members, Facebook group
members come to me and say, just because of that information that I’ve given, because I’ve given this out outside of
the book as well, that that really helped with their conversation with their doctor. And their doctor now wants to learn
more, and they’re actually buying a copy of the book and handing it to their doctor because, you know, they, they do
exist because at the bottom, at the end of the day, every single doctor practitioner specialist wants to help people.
They got into the practice of medicine because they have this deep desire to help.
They don’t want to harm. They’re not out to gaslight you. That’s not why they got their degree and went to four years
of school and and accumulated hundreds of thousands of dollars in debt. They really do want to help you. So if you
have that educated conversation, and if you go through the book and you literally learn what your body needs to
where you can sit there and say, here’s what I’m thinking, doc. I’m thinking because I have this elevated reverse T3
and you can see my active thyroid hormone free T3, it’s a little bit low. And I know you say, okay, that can move
around and, and jump around, but you know, it’s consistently low for the last three times that we tested it. So I really,
truly believe that adding in a little bit of T3 will absolutely help. I mean, that’s why that medication was made, right?
Or adding in some nrti let’s throw in some red thyroid. It’s amazing. Very low in little to no fillers. Let’s throw that in.
Let’s throw in some nrti and let’s see how my body does. And I’ll monitor and I’ll communicate with you. And we will
be a team in this. And maybe I get better and you learn something that you can help your other patients. Why not?

I mean, that sounds amazing. Amen. Hopefully people are willing to listen. And I tell people this too, like, I don’t think
doctors mean to be like gaslighting or, you know, it’s just that they don’t have the tools in their tool belt to help you
because they went to traditional medicine, just like I went to a fellowship about thyroid, right? I did two extra years
where I just learned about thyroid and hormones and metabolism. And they don’t teach you one thing about free T3.
They don’t teach you about reverse T3. They don’t teach you about your gut. And I have the highest training you can
get in the United States as a medical doctor in thyroid and metabolism. And there was zero conversation about any of
that. And I just recertified my boards and there are zero questions about that. And so it’s frustrating, but, you know,
it’s just the doctors don’t have the tools in their tool belt to help you. I tell people, it’s kind of like, you know,
sometimes when you have a specific thyroid issue and you go to your primary care doctor, it’s like calling an
electrician and asking an electrician to come to your house and fix your plumbing issue, right? They are like, okay,
I’m an electrician.
I have a general rule of, but I don’t know how to unclog your toilet. I don’t, you know, and it’s just that they don’t
have the tools in their tool belt to do that. And so then sometimes you do have to find somebody else or you have to
teach them, like you said, you have to get them a copy of your book. And so I think that it is really important for
people to understand. I don’t think it’s, you know, negligence that’s on purpose. It’s just people don’t get it. And you
have to be your own best advocate. And when you have symptoms, you have to just, you know, took you eight
doctors. It took me three, almost four doctors like you just have to keep trying and keep being persistent. And so I
think that that is really important. There’s another thing that you said to me that I want you to tell the listeners, Amy,
we were talking before about how you feel like T four. I said, do you think T4 is important? And you said, well, I think
it’s sort of like your savings account. What does that mean?
So I use that analogy a lot where T4 is like your savings account because it is the inactive thyroid hormone. But we
can tap it when we need it and turn it into T3 if your body has the capacity to do so. So we want to think of T3 as our
checking. It acts really quickly in the body. So we know that T3 is kind of it comes in, it does its job. And then it’s
basically kind of trickling out. Whereas T4 is slow you know it just hangs out. It’s there. It’s ready to be converted into
T3. So if we have a person in a perfect world, we would have someone be able to have some T4, and that might be
20%, that might be 50%, that might be 80% T4 that they can keep in storage because their body does a pretty good
job. We’ve checked all the boxes. We looked at the reverse T3, it’s below a 12. All is well here and we’re still giving
them some T3. On the other side, we’re still giving them some of that active thyroid hormone, but they have some in
reserve that they can pull from into checking and then spend it. I myself have already said I’m T3 only. That means I
have to live off my checking account. Like that’s not an ideal world. We want to have some in savings, but I can’t.
I have to continuously live off my checking, meaning I have to have a continual flow of T3 coming in. You give me T4,
I’m done. I’m going hypo. It’s not good. So it really is that analogy of, you know, when because I’m sure you get it too.
We’ll always get the patient that goes, well, what’s the point of even having T4? Why do I even need it? Why even put
it in? It’s like, well, because it is giving you some storage. It’s giving you some thyroid hormone storage that we can
pull from on a rainy day. I also find, and I don’t know if you see this too, but occasionally you’ll have like the super
sensitive people, the ones that like you give them five micrograms of T3 and they feel anxious and they’re crawling
out of their skin. So yeah, you’re checking ferret and you’re checking cortisol. You’re like, what the heck? You just
give them a little bit of T4 and it’s almost like it balances. It’s like it come in, it comes in and it starts to, to even them
out. I don’t know why. It just does. So whenever we can combine it, we do. But that being said, if you are truly T3
only, then your T3 only and we just deal with it.
Yeah, I agree with that. I think everyone’s different. Sometimes I find myself starting people on low doses of T3 and
titrating up. Sometimes I do desiccated. I’m a huge fan of Ren Thyroid. But you said two things. One of them was, you
know, starting people on that lower dose of T3. Because I agree, some people, when you put them on T3, you can
just hammer them with T3 and they’re like, yes, yeah. Some people, you give them a little bit and they feel like
they’re dying, right? They’re just like they’re having palpitations. I think it’s because some people are really sensitive
just because their T3 has been so low for so long. And then you give them all this D3, their body doesn’t know what
to do. I also think it has a huge impact based on their gut. So like if you have good gut microbiome and you can, you
know, regulate these hormones, you can metabolize them, it has a lot to do with your estrogen. So everyone is very
different. And I feel like in people who you do give T3 to, and they can’t tolerate it in very large amounts. You
definitely want to look at, yes, their insulin, you want to look at their cortisol. You want to look at their gut because
we need to figure out why can’t they tolerate this hormone. But I do think I like your analogy of a savings account
and a checking account.

I do want to say I have some people who comment on this. Sometimes we’re talking about people in general. If you
are pregnant, it is different. So when you are pregnant, T4 is very important not for you but for your baby, because
babies can’t make thyroid hormone until they’re 18 weeks. And so when you’re pregnant, T4 is very important. But
also T3 is important for the mom. So we could talk about that for an hour. But other than that, I agree. Like some
people, I mean, they don’t need any T4. They’re making a little bit of T4. If you’ve been if you surgically have had
your thyroid removed and you have no thyroid hormone, no thyroid hormone being made, then you’re going to need
some T4 as well for that savings account. But I think it’s important for everyone to realize we’re talking in general.
That’s why you made a book with flow sheets, but everyone is an N of one. That’s why it’s important to work with a
provider who understands hormone physiology and understands your symptoms, and knows how to put all that
together because your symptoms will help guide, you know, labs are helpful, but symptoms are helpful too, and you
have to have the symptoms and the lab in order to guide the correct treatment.
Well, and it’s a beautifully nuanced art form, which is why, you know, the one thing I would say to people, it’s one
thing to try to have a stay in the insurance based network and have those conversations with your doctor. And, you
know, I wish you luck. You have a chance. It’s a small one, but you got a fighting chance. And then you have people
like us that we really individualize and personalize treatment because it is a beautifully nuanced art. Where I would
tell people to beware and avoid are all of these pop up hormone clinics where it’s like you get a box of hormone
shipped to your door. You’re nothing but an algorithm. No one is sitting back and looking at your gut and your
adrenals and your insulin and your nutrients. They might test your thyroid, and then everybody’s going to get the
same treatment. And that’s really what drives me crazy. I mean, this whole conversation has really shined a spotlight
on how nuanced it is to truly get your thyroid optimized. There is no one size fits all.
I could not agree more. So tell everyone about your book. Tell everyone where they can get it. And do we miss
anything? Do we miss anything? That’s like you have to tell everyone about the book. I know you know. It obviously
talks about your thyroid, and you do a lot with helping people figure out how to treat their thyroid, which I think is
wonderful. But did we miss anything we want to talk about that’s in the book. And then where can everyone find the
book?

Oh, no. You did a great job of covering things. I mean, yes, I have chapters on Glp’s how they have come in in a
microdose form and help the thyroid. We don’t want to. I mean, it’s a double edged sword. You don’t want to go too
deep, too heavy on the glp’s because it can be detrimental. Used correctly, it can be a huge help for your thyroid. I
go into biohacking. I of course go into the nutrients, the different diets that go hand in hand with, you know, ways of
eating with thyroid conditions. So really, we touch on all of that in the book. The biggest thing is just get the book
because that’s the way you’re going to get all this information. So you can go to thyroid book.com. That’s where
you’re going to get the bonuses. So of course you can go to Amazon, Barnes and Noble target. But when you go to
thyroid book.com, that’s where you are going to get in on all of the bonuses that we have available until May 16th.
On May 16th. Also, if you buy the book now, you get a VIP ticket to our all day live launch event, and by being a VIP,
you’re going to get direct access to me.
So you’re going to have a chance to ask me live questions where we’re literally going to be on live chatting through
your thyroid and hormone issues, you’re going to have a chance to do a live lab read with me where we pull your labs
up on the screen. We go through it all together. So you’re going to know exactly what your labs mean and the
interpretation of them. We have over ten thousands of dollars of prizes that we’re giving out on that day. So go to
thyroid.com to grab your book. So you get in on all of the bonuses. And then of course, you can go to doctor
amy.com, DRAMIE. And from there you can book a call, connect with me on Instagram, join the public Facebook
group, which is a great place to jump in and get love support answers on your labs as well. So know we covered it all.
Thank you doctor Cassie I appreciate it.
I love that. So May 16th you said is the big day alive?
Yeah. Yep.
I’ll have to pop on and listen to some of the good questions. So I have, and we’ll make sure that all the listeners have
a link and get all the information about the book. So make sure you go buy it before May 16th. So you get all the
good freebies because that’s the best part. I have three questions that I ask everyone at the end of every podcast, I
want you to say the first thing that comes to your brain, don’t overthink it. This is okay, so what is one food that’s
most beneficial and why?

A steak, a ribeye, uh, that’s the first thing that came to my mind. Protein, protein, protein. Women are so deficient in
protein. Just eat the damn ribeye. It’s so good for you.
Yes. Okay. Rib eye. I’m from Oklahoma, so we love our steak. What is one thing that anyone listening to this podcast
right now can do that’s 100% free, that would benefit their health.
Get more sleep. Turn off your damn phone. Like at eight, not ten, not 11. Just turn off at eight. Throw on some blue
light blocking glasses if you want to dive into Netflix, but get better quality sleep. I was at a conference once. I know
this is a longer answer than what you want. I was at a conference once and a woman said this. I think it was Doctor
Stephanie Estima. She goes, if people would just literally get 8 to 9 hours of sleep, that would solve so many issues.
We could get rid of these supplements. We could get rid of this protocol. I’m like, ooh, that’s good. That’s. And it’s
right to it’s true.
And a lot of people say sleep. So get more sleep, people. It’s so true. And what is one thing you wish you would have
known about your health 40 years ago, 30 years ago that you would have done differently?
Mhm. That’s a good one. I would have not taken birth control for that long. Now, here’s the thing with birth control.
And I say in the book too, I get it. If you’re, you know, a teenager and you’re on birth control, you’re going to college,
you got your whole life in front of you. You don’t want to get pregnant and have a baby and derail your life. I get it, I
get it, but what really peeves me off are these 40 year old women that are taking birth control because it’s
inconvenient to bleed every month? No no no no no. Ladies, you are damaging your body. It’s time to be an adult.
You know, use some other form of birth control and get off the damn synthetic hormones.
Completely agree. And if you don’t want to bleed every month because it’s painful, the reason it’s painful is because
you have a dysregulated gut and dysregulated hormones. So I agree, like birth control is so bad. I was on it too in my
20s. Biggest medical mistake of my life besides being on levothyroxine for so long.
Oh, there you go. And that’s it, right?
Yeah, I could not agree more. Well, thank you so much for coming on and explaining all these wonderful things about
the thyroid to our listeners. And we’ll have to have you back sometime.
Love it, love it. Love hanging out with you. Thanks, doctor. Cassie.
What a great conversation with Doctor Amy Horniman. I hope this episode gave you a better understanding of just
how important thyroid hormone is for metabolism, energy, and overall health. And it helped you recognize some of
the signs that thyroid issues may be affecting your own life. I also hope you enjoyed hearing about Doctor Amy’s new
book, The Thyroid Fixer, and how her approach stands apart by walking through the different treatment options for
hypothyroidism, including a focus on T3 treatment with an emphasis on balance and individualized care. If you liked
this episode, please share it with a friend. Follow the podcast and leave a review on your favorite podcast platform.
This really helps us reach more people and keep bringing you conversations like this one. And if you want to go
deeper in your own health journey, be sure to check out my new book on Amazon. Fix your gut, fix Your Hormones. If
you’re looking for personalized care, also consider becoming a patient of modern endocrine. We’re licensed in 46
states, and we provide in-person care in Oklahoma City as well as telehealth across all 46 states we’re licensed in.
Thank you so much for listening, and I’ll see you in the next episode.