161. McCall McPherson: Why Your Thyroid Is Being Undertested And Undertreated

Fatigue, brain fog, weight gain, hair loss, low libido, high cholesterol, and a doctor who keeps telling you your labs look normal. For the millions of people walking around with an undetected or poorly managed thyroid condition, this is not just a frustrating experience but a dangerous one. Because what their doctor never told them is that the most important thyroid marker, the one that actually powers every cell in the body, is only being checked 4% of the time, which means the test they are relying on to rule out a thyroid problem is missing it almost every single time. In this episode of Extend, I sat down with McCall McPherson for a conversation that is going to completely change the way you think about your thyroid, your labs, and why the treatment that 89% of thyroid patients are on may be the very reason they are still suffering. If you have ever been dismissed by your doctor despite feeling terrible, this episode is going to give you the language, the labs, and the clarity to finally get the answers you deserve. McCall McPherson is a licensed Physician Associate, founder of Modern Thyroid Clinic, a practice with over 15,000 patients and hundreds of thousands of data points behind its approach, a TEDx speaker, and a 2024 Inc. 5000 honoree. She became one of the most sought after thyroid specialists in the country not just because of her clinical expertise but because she spent years as a thyroid patient herself, spending 16 hours a day in bed at 27 while being told her labs looked completely fine. There is nobody more qualified and nobody more personally invested in getting this right than she is. WHAT'S DISCUSSED: (2:12) The symptoms that signal a thyroid problem and why doctors keep dismissing them. (4:38) Why every person with low testosterone needs to get their thyroid checked immediately. (5:14) The three windows in a woman's life when thyroid disease risk spikes dramatically. (6:12) What Hashimoto's actually is and why medicine is treating it completely backwards. (11:46) Why TSH alone is missing the problem 96% of the time and what to ask for instead. (16:38) What reverse T3 is and why elevated levels are silently blocking your thyroid hormone. (35:15) Why subclinical hypothyroidism carries a 68% increased risk of heart attack and why medicine still is not treating it. (38:53) McCall's personal story of spending 16 hours a day in bed at 27 while being told her labs looked completely normal. Listen to this episode of Extend and finally understand why your labs have been coming back normal while your body has been telling you something is very wrong, what to ask your doctor to test, and what it actually takes to get your thyroid, your energy, and your life back. Thank You to Our Sponsors: Timeline: Timeline powered by Mitopure just dropped the price. Check it out at timeline.com/drshah http://timeline.com/drshah and get an additional 20% off your first month with code DRSHAH. IM8: Try IM8 today with a 30-day money back guarantee. You can get 10% off your first order with code DRSHAH at im8health.com/discount/DRSHAH https://im8health.com/discount/DRSHAH. Learn more about Dr. Shah: Website: drshah.com https://www.drshah.com/ Clinic: next-health.com https://www.next-health.com/ Instagram: darshanshahmd https://www.instagram.com/darshanshahmd Learn more about McCall McPherson: Instagram: @mccallmcphersonpa https://www.instagram.com/mccallmcphersonpa Modern Thyroid Clinic: www.modernthyroidclinic.com/ https://www.modernthyroidclinic.com/ Modern Weight Loss: www.modernweightloss.com/ https://www.modernweightloss.com/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:50Dr. Darshan Shah?

  You've been tracking your macros, you've dialed in your sleep, you've optimized every supplement in your stack, but you're still feeling exhausted, you're still gaining weight, you're still getting brain fog by 2:00 PM. And every time you bring it up to your doctor, they just run a little lab test protocol, and they tell you that you're fine. But here's what they're not telling you. Normal isn't the same as optimal. And for millions of people, the majority of them women, undetected or undertreated thyroid dysfunction is the silent reason every other protocol stops working. In this episode, I'm going to dive deep into this topic with McCall McPherson. She's the founder of Modern Thyroid Clinic, Modern Weight Loss, and Thyroid Nation. McCall came to this work the hard way,

• 1:33Dr. Darshan Shah?

  as a thyroid patient who spent years being told her labs were fine while she could barely get off the couch. She trained under a functional medicine practitioner who changed everything for her. And she's spent the years since then building one of the fastest-growing thyroid practices in the country. Because the need is that prevalent and urgent. We're going to break down the full thyroid panel that actually tells you what's going on, what optimal lab ranges look like versus the two-wide ranges most doctors use, and why your TSH alone is nearly useless if you're on thyroid medication. We're also going to talk about the free T3 number. This is a biomarker that most doctors are not checking, but it reveals more than any other thyroid test. So if you've ever suspected something was off,

• 2:16Dr. Darshan Shah?

  but you couldn't get answers, this episode might be for you. Here's McCall McPherson.

• 2:27Dr. Darshan Shah?

  Hi, McCall. It's so great for you to join me on Extend today. Thanks for doing this. All the way from Austin.

• 2:32Speaker 01

  Hey, thanks for having me. I know. I'm excited to be here. Thanks for having me.

• 2:36Dr. Darshan Shah?

  Yeah, this is fantastic. So, you know, we've only done a couple of episodes on the thyroid. So I'm really excited about this because, man, it's such an underappreciated hormonal, like a big topic around hormones that we never really talk about enough. I mean, I think estrogen and testosterone get 99% of the attention, but the testosterone pathway is definitely, you know, something that's been covered for a long time. But the thyroid pathway, we rarely ever talk about. So why is that?

• 3:07Speaker 01

  I feel like it's the orphan child and it impacts so much about testosterone production, hormone production. Like, we talk about the next level up, but we so often neglect the foundational piece. I think medicine in general hasn't really been invested in the evolution of thyroid in a bit. You know, we haven't really updated our recommendations and protocols and algorithms. So I'm hopeful that that's going to happen soon, maybe, you know, in part by a lot of conversations like these.

• 3:37Dr. Darshan Shah?

  Yeah. Yeah. And so, you know, when I was a surgeon, I remember we used to do a lot of surgeries for thyroids. A lot of goiters would be removed, lots of thyroid tumors. And it was almost like people had thyroid disease for decades and didn't even know it. And then when it became a huge surgical problem is when people finally started paying attention. So, you know, I think about the symptoms of thyroid disease and people get really confused about, I mean, like I look at these medical histories and the doctors are looking for everything else except for looking at their thyroid. And so, you know,

• 4:13Speaker 01

  Thank you for that.

• 4:15Dr. Darshan Shah?

  And then by the time they figure out it's a thyroid, there's like a huge problem that needs surgical intervention sometimes. And so, you know, for the people listening to this podcast, McCall, how would you tell them it's time to pay attention to your thyroid? What should they be looking at?

• 4:29Speaker 01

  Yeah. So, you know, you're looking for a constellation of symptoms, not one in isolation, but fatigue, brain fog, weight gain, hair loss, nails breaking, hair breaking, dry skin, low libido, cold intolerance. Maybe you go to your doctor or your clinician and they say, oh, your blood sugar is increasing, your cholesterol is increasing, right? You can't lose weight with effort. And, you know, medicine views symptoms of hypothyroidism as kind of nonspecific. They're like, look, it could be anything. Just because you have them doesn't mean it's, it's a thyroid issue. And I kind of disagree. Look, like maybe one, two, three of those things, but when you start to get five, six plus of those

• 5:14Speaker 01

  symptoms, I always say, look, if it walks like a duck, it quacks like a duck, it's probably a duck. So it usually ends up being a thyroid issue if you look for it in the correct, progressive, deeper ways, and you don't just simply rely on a TSH.

• 5:28Dr. Darshan Shah?

  Yeah, I think that's so true. And, you know, I, do you have like on your website, like a thyroid questionnaire or something that people could actually get some of those symptoms and like maybe check them off and understand, like, should they be asking their doctor about thyroid?

• 5:42Speaker 01

  I'm going to write that down as soon as we get off of this, and I'm going to add it to my website by the end of the week. I do have like a thyroid lab guide to tell them how to interpret their labs and what labs they need, but I need a thyroid questionnaire. Thanks.

• 5:53Dr. Darshan Shah?

  Yeah, you really need that because I think that people have these symptoms and go to their doctor. And like you said, they're poo-pooed. And there's no, there's no way for them to really like tell the doctor, like, look, like I got nine out of the 10 symptoms here. Like, you really need to look at this. I think that would be really helpful. And so you mentioned a lot of them there. Do men and women have similar symptoms?

• 6:15Speaker 01

  You know, I feel like they do, but men, do you tell me if I'm right? Men do not pay attention to how they feel. You know what I mean? So they will go, go, go until their wives drag them into the doctor, basically. And so it presents differently. It takes a lot for them to go to see a clinician.

• 6:36Dr. Darshan Shah?

  Yeah, and there's some overlap too between the symptoms of low testosterone and thyroid as well. And so I feel like there's a lot of confusion there. And obviously, men love going down the testosterone road because of all the other side benefits of having more testosterone.

• 6:53Speaker 01

  For sure, but you know, where there's smoke, there's fire. If you have low T, you should probably get your thyroid checked too, because hypothyroidism. Like with my women, we have 15,000 plus patients. I would venture to say 90% plus of them also have low testosterone. So the two go hand in hand so much of the time. It's one of the first hormones that I see drop. It's actually the first hormone that I see drop. So I feel like every man that has low T should check their thyroid and same for women.

• 7:20Dr. Darshan Shah?

  Okay, that's really good advice. So is there like an age-related decline in thyroid hormone like there is with estrogen and testosterone as well?

• 7:29Speaker 01

  Good question. So there are a few times in women's lives where we tend to have more thyroid problems. Number one is puberty. Think about hormone changes. Our hormones and our thyroid are so integrated. Postpartum, so pregnancy, postpartum. Postpartum is the most common time to get Hashimoto's, the autoimmune aspect of hypothyroidism. And it can even be transient. So you might have antibodies for a little while, not even know it, but be left with permanent hypothyroidism. And lastly, it's menopause. Like, women postmenopausally have a huge bump in incidence of Hashimoto's and hypothyroidism. Estrogen, I mean, you know this, but it's almost like an antioxidant. It protects us from inflammation, from autoimmune disease.

• 8:13Speaker 01

  So as that declines, our risk increases. So always, certainly, women should be paying attention during those times and in between as well. Because this is a pervasive, pervasive issue.

• 8:24Dr. Darshan Shah?

  That makes, that makes a lot of sense, actually. The estrogen is actually protecting your thyroid gland by modulating the immune system. When you don't have enough estrogen or zero estrogen, that's a prime time for Hashimoto's to develop.

• 8:37Speaker 01

  Totally.

• 8:37Dr. Darshan Shah?

  Yeah, and Hashimoto's, for the listeners, that's basically an autoimmune. Attack on your thyroid gland. Can you give us a little bit more color on like, what is Hashimoto's and why does it develop?

• 8:49Speaker 01

  Yeah, so you know, I'll give you kind of both standard of care, which is a little different than my perspective, but I think medicine is headed this way. Autoimmune diseases are when your body becomes confused and it thinks a part of your body is a foreign invader. So it goes to attack it. And with Hashimoto's specifically, that attack is mounted on your thyroid gland, your thyroid gland that secretes hormones that are so important for almost, you know, every aspect of our physiology. And as that attack happens, it sort of erodes away our hormonal secreting tissue in our thyroid gland. And it leaves us with scarring inflammatory tissue that just doesn't secrete hormones efficiently.

• 9:30Speaker 01

  And that's what causes, in, you know, 89 ish percent of cases, hypothyroidism, as far as research goes. You know, autoimmunity can be caused by a lot of different things, but it can also be influenced. Medicine just sort of looks at it and is like, it's the reverse lottery. There's nothing you can do about it. Good luck. We, we don't even ever need to look at your antibodies, the things we measure to diagnose you with Hashimoto's and see how bad it is. We just simply need to treat your hypothyroidism, right? With lebothyroxine, with thyroid medications, but truly you can influence Hashimoto's. You can reduce those antibodies by working on things like inflammation. If

• 10:11Speaker 01

  we know women are at risk because estrogen, the anti-inflammatory hormone reduces, then we know that Hashimoto's is influenced by inflammation. So lifestyle, cleaning up your diet, monitoring your stress, some targeted supplementation with nutrients like selenium have been shown to reduce Hashimoto's antibodies. And fun fact, I used to have severe Hashi. My antibodies used to be over 600. I had a massive goiter. And I've been in remission for my Hashimoto's for over 12 years. I don't have a goiter anymore. That's not always possible for everyone, but in some people that can actually reduce. So it is possible. And, and what that reduction in antibodies does, again, you measure them with your, your blood.

• 10:54Speaker 01

  Regular old labs, it can preserve more of your thyroid. If your antibodies were off the charts in 2000 and now they're 20, well, you're going to lose less of your thyroid gland as quickly. And two, you know, if you have one autoimmune disease, you're at an increased risk of developing another of over 30%. So the lower we get those antibodies, we can almost use it as a risk reduction for other additional autoimmune diseases. So, you know, it's worthwhile to find ways to influence that. It can be incredibly powerful.

• 11:29Dr. Darshan Shah?

  Oh, man, Nicole, that's such like an incredible example of how we need to rethink medicine completely. Because you're right, when people get Hashimoto's, like, okay, well, here's some thyroid medication to take because your thyroid's not working great. But all you're doing is you're just treating the end result of the disease and you're not even looking at the disease itself, which is an autoimmune condition that is due to just an overactivation of your immune system and inflammation in general. So instead of just giving someone thyroid and letting the Hashimoto's keep progressing and eating up their thyroid and just making the whole thing worse and covering it up with a thyroid disease. Instead, sure, maybe you need some thyroid hormone at this moment in time, but let's look at reversing the Hashimoto's. What can we do around nutritional supplementation,

• 12:14Dr. Darshan Shah?

  reducing inflammation, changing your lifestyle? So your Hashimoto's goes away. Like you said, there's a 30% crossover with other autoimmune diseases. So as you're reducing your inflammation and Hashimoto's, you're reducing some of these other diseases that might pop up that are autoimmune in nature and maybe diseases that inflammation can also lead to, like cardiovascular disease and even Alzheimer's in the future. So it's so important to look at why you have the problem in the first place and work on that simultaneously, right? And if everything in medicine was done that way, we'd be a much healthier society.

• 12:50Speaker 01

  We'd be in a very different situation. I think sometimes people forget, I think they're realizing now that medicine is meant to fix problems. It is not meant to our medical system. It is not meant to promote health, vitality. Those are two very different things. So we're trying to bridge that gap, you and I, and so many other clinicians too, which I hopefully will change that trajectory.

• 13:11Dr. Darshan Shah?

  Yeah, I fully, fully agree with you.

• 13:16Dr. Darshan Shah?

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• 13:58Dr. Darshan Shah?

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• 14:21Dr. Darshan Shah?

  Okay, so now let's dive in. You have a guide to looking at your thyroid labs. And this is, I'm a big believer in being the CEO of your own health because you and I both know when you go to the doctor's office, no matter what doctor or practitioner it might be, they're overstressed, they're overworked, there's minimal time to check lots of blood work. There's not a lot of time to really even dive deep into it. And so a lot of times, you know, if you even complain about your thyroid, you get one marker, the TSH, and that's it, right? And that's, that's what's typically done. And even up to today, that's what's typically done. So tell us why you think differently.

• 14:57Speaker 01

  Yeah, so you know, TSH is used as a screening tool. It's used to take the place of

• 15:06Speaker 01

  Actual thyroid hormones when we look at numbers. So T- thyroid stimulating hormone stimulates our thyroid. It's a hormone from our brain and it's telling our thyroid to work harder. If we don't have enough thyroid hormones, meaning it would be increased your TSH. Or to work less hard if you have plenty of thyroid hormones and that would be a lower TSH. Okay, so medicine still is built on the assumption that TSH accurately reflects output hormones. So it reflects your hormones that your thyroid is secreting, your free T4. Which is like an inactive hormone, think about it like crude oil. We don't really put crude oil in our car to make it run, but we need it to make gasoline, right? And then that crude oil largely just is supposed to convert to gasoline or free T3.

• 15:51Speaker 01

  What we do need to put in our car to make it run. And the problem is that research shows there's a disconnect between TSH. And output hormones about thirty five percent of the time. I see that happen all day, every day. So I think research is grossly underestimating the percentage, the rate of that disconnection. And TSH is actually not reflecting your output hormones. And there's an easy solution to this. We can actually just check our thyroid output hormones, just like we check our TSH. It's a blood test, it's cheap, but it is covered by insurance. I run a hundred percent of our patients at modern thyroid clinics, blood labs through their insurance. So I always check TSH, free T4, free T3 and reverse T3.

• 16:34Speaker 01

  As well as Hashimoto's antibodies, TPO and thyroglobulin. The other thing that I do want to highlight is TSH is also used to determine if someone needs more or less medication. And pretty much everyone, eighty nine to ninety one percent of people are on the same type of medication. All based on levothyroxine, all based on crude oil hormone. Okay, so again, crude oil doesn't help us at all. We've got to convert it to gasoline. A lot of people are walking around in the world not able to ever convert their crude oil medication to the gasoline to help them feel better, to improve their metabolism, their energy, their cognition. So in that case, what happens is they're taking a bunch of crude oil in the form of

• 17:18Speaker 01

  a pill and it's stockpiling in their garage, let's say. That stockpiled amount of crude oil absolutely powerfully sends a message back to your TS, to your brain and says, lower this person's TSH. And what's really crazy that people aren't realizing yet is the worse you are at using that medication, that crude oil, the better your TSH is going to look to a regular clinician who's only checking that, even if they're checking TSH and T4, your crude oil hormone. So that is automatically manipulated. And the moment someone is on a T4-based medication, levodaroxine, synthroid, unithroid, tiracent,

• 17:58Speaker 01

  all of those, their TSH becomes virtually unreliable to dictate what their hormones are doing and how their body is using that medication. So we really need to update that a little bit. We need to change it and evolve it.

• 18:11Dr. Darshan Shah?

  And that's such an important tidbit, especially for clinicians, but even patients that are listening. The TSH is the signal from your brain that tells your thyroid, I need to make more crude oil, which you refer to as like T4, right? However, when you have a lot of T4, then your brain gets this negative inhibitory pathway to make less TSH. And so everything looks hunky dory. But the reality is if you're not making the crude oil into the gasoline, everything looks hunky dory on your labs, but it's not doing anything. And in fact, it could be making the problem worse, is what you're saying.

• 18:46Speaker 01

  Absolutely. And research shows that your gasoline hormone, your free T3, in America is only checked less than 4% of the time.

• 18:54Dr. Darshan Shah?

  Yeah.

• 18:55Speaker 01

  So we're missing that 96% of the time. And people are walking around suffering, being told, no, your thyroid labs look normal. This isn't a thyroid problem. Your medicine's fine. We don't need to adjust it. Or hey, you don't have a thyroid issue at all, when 96% of the time, we're not checking the most valuable piece of information to effectively really understand what's happening.

• 19:18Dr. Darshan Shah?

  Got it. So free T3 is the hormone that we really need to be looking at to see whether or not we have enough of the actual gasoline that we need to power all the processes that thyroid hormone powers in our body.

• 19:32Speaker 01

  Correct. Not total T3, free T3.

• 19:36Dr. Darshan Shah?

  Right, exactly. What is reverse T3?

• 19:40Speaker 01

  Yeah, good question. So I want you to think about your T3, your gasoline hormone, like your hand, and reverse T3 is like your other hand. It's a very similar shape, but it's a mirror image of one another. And what that allows reverse T3 to do is bind and land in the same landing spot as free T3. But it doesn't activate that landing spot. So think about it like T3 will bind, it will activate your energy, your mood, your libido, your metabolism. Well, instead of free T3 binding, reverse T3 can bind in that same spot and just sit there. And it keeps free T3 from being able to activate that receptor, okay?

• 20:21Speaker 01

  The tricky part about reverse T3 is, is the source of it is T4. It's your crude oil hormone. So it's another layer of complexity, especially for people walking around on a high dose of levothyroxine, synthroid, unithroid, t-ricin. Why? Because we're giving them a whole bunch of T4. If they can't convert it, they have a crude oil, a garage full of crude oil, right? That reservoir serves to source elevations in reverse T3. So again, if no one is checking your reverse T3, and your T3 looks pretty good, but your reverse T3 is elevated, it's 25, 29, even 20, it's blocking a lot of your gasoline hormone from absorbing.

• 21:06Speaker 01

  And so you might feel, gosh, my numbers look good, but I feel so tired and I just can't make it through the day. All the while you have elevations in reverse T3, which again, can be checked by any regular old lab.

• 21:18Dr. Darshan Shah?

  Got it. So that so that another using your gasoline analogy, it's like putting a

• 21:25Speaker 01

  Water.

• 21:26Dr. Darshan Shah?

  Yeah, putting water in your tank is not allowing the real gasoline to come into your tank. There's water in your tank and that's still a big problem, obviously. So I love this analogy. Let's see how long I can stick with it on this call.

• 21:37Speaker 01

  I know. How did I end up with automotive analogies? You know, I don't even know. It's not not good.

• 21:43Dr. Darshan Shah?

  I love it. Okay, so where does T4, your crude oil, get converted to T3 in your body? And when it gets converted to T3, is T3 the first molecule and then it converts to free T3? Or is there another step in the pathway, I guess I'm asking you?

• 22:01Speaker 01

  Yeah, you know, it will convert in in various parts. A large portion will convert in our liver. It will circulate through other areas as well. But one of the first places people go if someone has poor conversion is they start to work on liver function. And obviously, this is sort of a chicken and egg scenario. Because if you have mild hypothyroidism, you have liver issues. And if you have liver issues, you have thyroid issues. And that that conversion that we're talking about from T4 to T3 takes a lot of things to happen. It takes a lot of your body, one, having enough micronutrients, not being really stressed,

• 22:45Speaker 01

  sleeping enough, pregnancy can interrupt it, inflammation can interrupt it. So I want you to think about it as our body doesn't activate those hormones on purpose. So it will sequester that T4, not turn it into T3, or dump it to reverse T3, so that we lay down, we rest, we recover. Okay? So think about the the situations where your body would want you to do that. It is when you're sick. It is when you're pregnant. It is when you're inflamed. It is when you're calorically restricted over exercising. So Sadly, that's kind of also standard American lifestyle, right? We kind of live in a world of stress and inflammation and micronutrient depletion.

• 23:26Speaker 01

  And so our body holds on to that T4, doesn't activate it. And that's why, you know, in turn, a lot of people are walking around persistently symptomatic despite being on thyroid nuts.

• 23:39Dr. Darshan Shah?

  Yeah, yeah. So you know, since reverse, I'm sorry, since free T3 is the critical hormone here, why isn't that the only thing we're measuring? Why does it start off just measuring T? You get a thyroid panel of someone, they give you a TSH. Sometimes you get a T4 and a T3 total. Why don't, why doesn't everyone just look at what's the free T3?

• 23:59Speaker 01

  I mean, I'd like your opinion on this, but I mean, as far as my training goes, I was not trained in the value of free T3 at all. Our clinical director of Modern Thyroid Clinic, who's a board certified endocrinologist, echoes the same. You know, it's literally TSH. If you want to check an additional number, you can check, you know, free T4. And then when people get more information than that, sadly, I think it's, you know, patients requesting a full thyroid panel and there's a pre-filled box that you can check as a clinician to check a full thyroid panel that isn't really actually a valuable thyroid panel. And so again, it's, it's not being checked 96% of the time.

• 24:39Dr. Darshan Shah?

  Yeah. And I think, I think my opinion on it is that, you know, obviously it's a little bit complicated. You do, you do a tremendously good job of breaking it down for us on this podcast. But I think even most clinicians, they don't have the time and they don't have the attention span because they're seeing, you know, 50 patients a day to look at any more than just one number. And then if that number is normal and the symptoms are maybe not as severe, or you have like a guy that's not really complaining, it just stops there, right? And so the way I look at TSH is it's. A marker that changes after the disease has been there for a long time. Right. And so it's, it's kind of like now we have to finally start doing something when it starts to change.

• 25:22Dr. Darshan Shah?

  And I think a lot of labs are like that in modern medicine, you know? We check the hemoglobin A1C and we don't even do anything about it until it's over 5.7 when you're prediabetic. Why don't we check fasting insulin level, right? It's the same thing. It's that's the first thing that's going to change. That's the most important thing that changes. But it's just not part of the standard blood work at a standard office. And so I think it's the same kind of, um, same kind of problem that we have in medicine. And so you probably do what I do, which is every thyroid panel has a TSH and a free T3 and a reverse T3 and a total T4. And so that way we can get a, a full indication of what's going on in that entire pathway.

• 26:02Dr. Darshan Shah?

  Cause if you can see the pathway in front of you and you have all the numbers, you can, you can have a much better clinical gestalt about what's actually happening and why the person is having symptoms.

• 26:12Speaker 01

  Yeah. I mean, without it, I describe it as throwing dartboards at a dartboard, blindfolded, hoping to hit a bullseye. Like it's just, it's not going to happen.

• 26:21Dr. Darshan Shah?

  Yeah. And also it's like throwing like a, uh, like a giant, like hitting the dartboard with a shotgun. When you give someone this pyroxine, right? Like you're just covering up the problem. You're never figuring out where the problem actually is. And so, um, yeah, it can be, it can become a big problem. So, um, okay. So there's different medications too, like you've talked about some of them, the one that are normally prescribed, right? And then there's also other forms of thyroid medication out there. Can you give us like a primer on thyroid medications?

• 26:51Speaker 01

  Absolutely. So obviously the vast majority of people, like 89 to 91% of people, as I mentioned, are on a T4 based medication alone. So Synthroid, Levithroxyne, Unithroid, Tercet, all the meds we talked about, crude oil. Okay. Think crude oil, not gasoline. In medicine, I'm trained, the clinicians that work at Modern Thyroid Clinic are trained and our board certified endocrinologist is trained to only use this class of medication. Okay, that other forms of thyroid medication that contain T3 or gasoline hormone are dangerous. Right. The research says something very, very different than that when you actually dig into it. But so we're not trained how to use them. We're trained simply to not use them and to

• 27:34Speaker 01

  be afraid of them. But the other class of medications that is life changing, exceedingly safe in my clinical practice, but also backed up in research are meds that contain T3 and there's two different classes of them. One is called natural desiccated thyroid. These are meds like Armour, renthyroid, NP thyroid. They come from pig thyroid gland and they're actually about 70 to 80% T4 crude oil and 25 to 30% active thyroid hormone or T3 gasoline. Right. So that's one. The other form is pure T3. So just like we have pure T4, the alternative or the complementing medications to that are pure T3. Those are drugs like cytemel and

• 28:18Speaker 01

  lyothyronine. And each one of these are used kind of in different cases. There isn't really a one size fits all approach. Like, for example, people who are on a lot of levothyroxine or synthroid, if they're, if they have low T3, the easiest thing to do is simply tack on some cytemel or lyothyronine as opposed to changing their entire medicine over to a natural desiccated thyroid like renthyroid or armour. So everything is, is unique and should be designed for the specific patient, but that's a little nuance for the meds.

• 28:49Dr. Darshan Shah?

  Got it. And the natural, natural or desiccated thyroid hormone, is that kind of where you start now with your patients? Or are you still, you know, trying to, how do you, how do you in your practice start someone that's having thyroid issues?

• 29:02Speaker 01

  Yeah. So modern thyroid clinic is kind of like the last ditch resort place, to be honest. Like, people don't come to see us until they've exhausted every other option. So most of them come to us on some form of medication, the vast majority of the time. It is a T4-based medication, like Synthroid Levothyroxine. And because of that, our goal is always, what is the fastest way we can get this person to their highest form of health? And what can we do to make sure they never get worse before they get better? And the solution for that, most always, is adding T3 to a Levothyroxine-based medication. If someone comes to us on no meds, then we have a lot of options, right?

• 29:46Speaker 01

  And we're starting kind of from ground zero. I love natural desiccated thyroid medications. You know, medicine teaches us that they're unstable, they're unsafe. They're actually very safe and incredibly stable if they're used in the hands of someone that knows how to effectively use them. We can predict within point two variables on labs where someone labs, where their labs will land the next time we see them using desiccated thyroid. So we know it's stable. We can tell early on if there's an issue with medication. So we're open to everything and really it is like the thing that thyroid people need is not a one-size-fits-all approach. Like, they need a unique plan and protocol that accounts for each of their variables

• 30:30Speaker 01

  in their biochemistry. And so that's kind of what we do.

• 30:32Dr. Darshan Shah?

  I love that. That's great advice, even for the practitioners that listen to this podcast to really consider. And then when you have people on treatment, what are the levels that you're kind of aiming for? Is it symptom relief? Is it blood test levels? How do you kind of like dial in their treatment?

• 30:49Speaker 01

  Good question. So always, we want symptomatic relief. We want people to hit the highest level of vitality they possibly can. So that's foundational for us. But what we've done as far as labs go is for the last 10 years, we, you know, started with functional medicine ranges where we trim a little off the top, a little off the bottom of each lab range. So we start more narrow. But based on our own data points, at this point, hundreds of thousands of pieces of data. Maybe even we've hit a million at this point. Every 12 to 18 months for the last 10 years, I've narrowed those margins down based on where people feel good, where they have symptoms, where they don't have symptoms anymore and where they have persistent thyroid symptoms.

• 31:32Speaker 01

  So we've narrowed them down so many times that we're left with these incredibly tight optimal ranges. And we find if we get people into them, they actually do get their lives back. They feel better. That's part of our thyroid lab guide. It's on like gift dot modern thyroid clinic dot com. I'll totally give, share it with you to put in your show notes.

• 31:51Dr. Darshan Shah?

  Yes.

• 31:52Speaker 01

  But, and I freely share our ranges so that people can understand where they should be to feel good and thrive.

• 31:59Dr. Darshan Shah?

  That's incredible work that you're doing. That's, that's awesome. And I definitely want to look at that and look, see, make sure my own personal thoughts around the ranges are kind of in line with what you've discovered after hundreds of thousands of data points. Um, how long can someone expect to start feeling better once they get on appropriate treatment?

• 32:16Speaker 01

  So most people feel a difference in days. Like by the time the first treatment cycle, from the time we first change their medications till we see them back, there is sort of a sequence of symptoms that improves before others. Like brain fog is usually completely gone. Energy has increased, but it's not where it will be in the long run. Part of the goal, you know this with thyroid is we want to make an impact and make people feel better. We also want to be very sure we don't over-medicate them. So we can't just put them on a bunch of thyroid medications right out of the gate. We have to kind of incrementally do it. But once you are on medications that fuel your body in the way that you need to be fueled, people start to feel better days, weeks, usually.

• 32:55Dr. Darshan Shah?

  Great. And are most people on thyroid medication for the rest of their lives, forever? Have you seen some people actually reverse their need for thyroid medication?

• 33:04Speaker 01

  Good question. So 89 to 90% of people with, with hypothyroidism had Hashimoto's. So again, their body destroyed part of their thyroid gland. It eroded that away.

• 33:16Dr. Darshan Shah?

  Did you see 80 to 90% of people have Hashimoto's that have hypothyroidism? Wow, I didn't realize the number was that, that big. So, so most Hashimoto's, if not almost all, uh, sorry, most.

• 33:28Dr. Darshan Shah?

  Hypothyroidism, if not almost all, is due to autoimmune Hashimoto's.

• 33:34Speaker 01

  That's what research says. I think that that number is less. I really do believe that it's not eighty-nine to ninety percent, but that's what the data says. So we'll go with that. And a huge percentage in our practice is as well. Our data is a little skewed because our people are motivated to get better, so they improve lifestyle long before they come to see us. So our data might not align with with the scientific literature. But yeah, most people have Hashimoto's and that's why they have hypothyroidism. So they've inherently lost thyroid tissue that functions. And because of that, they are not going to regrow that tissue if they perfect their lifestyle. So I give a couple analogies. You know, one is me. I've been in remission for twelve years. I absolutely would not be a functioning member of society

• 34:19Speaker 01

  or a member of my home if I didn't have thyroid medication. But you know, it's like if you cut off your pinky, but you have a perfect lifestyle. Hey, you're probably not going to get an infection. You're probably going to heal better, have less of a scar, but you're not going to regrow that pinky. And that's what I want people to know about thyroid too. But I am a little suspicious that potentially with stem cells, it might be possible pairing stem cells with hyperbaric. I'd be curious. We are starting a study in the second quarter of this year, fingers crossed, with Stem Regen, who I'm sure you're familiar with. They make a product that elicits our own natural production of stem cells.

• 34:59Speaker 01

  And we're actually going to measure people post thyroidectomy to see if they can regrow tissue at six and twelve months, maybe even up to eighteen months.

• 35:07Dr. Darshan Shah?

  Incredible. I can't wait for that study. Yeah, I agree with you. I think that, you know, there is a lot of potential around stem cell therapy just in general, but it's not quite there yet. And so to have resources like Stem Regen where you're pushing your natural production of stem cells and tie it with, you know, minimally invasive technology like hyperbaric oxygen could be a game changer for people. So that's exciting. We'll have to have you back on the podcast to talk about that research once it's done.

• 35:33Speaker 01

  I love it. Yeah, let's do it.

• 35:39Dr. Darshan Shah?

  Hi, Dr. Shaw here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30-year-old people with cells that look like they're pushing retirement. And I've also seen 60-year-olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells, you see, are like phones, and they have limited cellphone battery. Poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with IM-8. IM-8 powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92-ingredient formula designed specifically for cellular health and longevity.

• 36:24Dr. Darshan Shah?

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• 37:06Dr. Darshan Shah?

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• 37:31Dr. Darshan Shah?

  Can I ask you a little bit about, you know, hype? We talked a lot about hypothyroidism and the causes. And I just want to make sure we have a complete picture. If someone is hypothyroid, obviously, we want to check auto antibodies against the thyroid gland, right? But say those come back normal, what else should we be checking? How, what are some of the other causes of hypothyroidism?

• 37:54Speaker 01

  Yeah. So I, what I see in my practice is in the same manner that we lose hormone production and the same manner that our entire physiology slowly decreases as we age, I see that parallel with thyroid function. And so truly, truly, what I think is unaccounted for in research that I see far more frequently in my practice than is acknowledged in the literature, is a slow breakdown of thyroid function over time. And for that reason, between Hashimoto's, between the risks of menopausal, you know, incidence of Hashi and hypothyroidism, as well as slow breakdown due to aging, in my opinion, it's almost not a matter of if, but when, women will end up with a thyroid

• 38:39Speaker 01

  problem. So in my opinion, that is an even bigger cause than we recognize.

• 38:45Dr. Darshan Shah?

  Yeah, yeah, I agree. I think the age-related decline of thyroid function is something that's ignored. And, you know, like a lot of times, people will be subclinically hypothyroid, meaning that they're, they're not typical diagnostic criteria for hypothyroidism, but they still feel terrible and their anti-thyroid antibodies come back normal, meaning they don't have Hashimoto's, and then they're just left to their own devices. It's like, we don't know what to do. But the reality is, is that there is an age-related decline. And if people aren't feeling good, we should still do something about it. And I would love for you to talk about like this whole concept of subclinical hypothyroidism.

• 39:25Speaker 01

  Yeah. So subclinical hypothyroidism is defined by an elevated TSH, so an increased TSH, your thyroid's getting stimulated more, with a normal T4 or crude oil hormone. Okay? And what medicine has been doing I mean, since 2004, but a lot since 2018, 2019, and continues to do, is trying to further and further stratify patients to make them ineligible for treatment. Meaning they're trying to separate us into these little groups and say, well, this group doesn't need medication. This group doesn't need medication. And one of, in my opinion, the biggest flaws in medicine of my generation, especially for thyroid, is in 2018, a study came out that really changed the trajectory of thyroid care that looked at subclinical hypothyroidism.

• 40:10Speaker 01

  And it said, all right, until people's TSH is over 10, they don't feel any better. It doesn't change anything when we treat them with levothyroxine. So we need to not treat them. Okay? And that really has cascaded into a lot more studies with the assumption that that study is valid. And the problem with that study is inherent that they assumed levothyroxine worked. So the whole premise is, well, we're giving people this medication that works, and it's not really changing anything until they're so severely sick. So let's just not treat them. When in fact, what we should have considered is, wait, maybe the mainstay of treatment,

• 40:51Speaker 01

  maybe the medication that 89% of people are on by itself isn't working and we should reevaluate our treatment protocols. Right? That's not what happened. So we've accepted subclinical hypothyroidism. People should not be treated. And in fact, in my opinion, it is a huge root cause of the chronic disease burden in our country. If you have subclinical hypothyroidism, you are at a 68% increased risk of a heart attack. You are at 37% increased risk for cardiovascular death, 36% for a fatty liver, and 1.8 times more at risk for dementia,

• 41:32Speaker 01

  and three times higher than risk for dementia than youth thyroid patients. So to me, that doesn't sound very subclinical.

• 41:41Speaker 01

  That sounds a lot like overt hypothyroidism that we should probably be treating.

• 41:47Dr. Darshan Shah?

  Yes. Oh, my gosh. Oh, I'm so glad you gave us some of that data because it just really alerts us to the importance of treating the thyroid gland. I mean, that's so that's a massive risk reduction in treating subclinical hypothyroidism.

• 42:02Speaker 01

  Yeah. And, you know, even when we look at data comparing T4 to T3, we're taught in medicine that T3 promotes heart attack, stroke, when in fact, higher normal levels of T3 reduce all-cause mortality, heart attack, stroke, unemployment, early retirement, and higher levels of T3 predict socioeconomic status. And inversely, higher levels of T4 increase cardiovascular risk, heart attack, stroke, all of the things I just mentioned, which is the opposite of what you and I were taught in medicine. I'm certain of it.

• 42:33Dr. Darshan Shah?

  Yeah, absolutely the opposite. So it's such, it's so good to know this. You know, I'm curious about you and your passion around thyroid hormones. And it sounds like you have your own personal kind of struggle with this in the past. Can you, can you tell the audience a little bit about your struggles? And did you, were you already a practitioner when you had this thyroid issue? Or was it the opposite?

• 42:54Speaker 01

  No, I was already a practitioner. I was already a PA practicing medicine. I was already years into my thyroid journey. I was 27 on Synthroid and was spending 16 hours a day in bed. I'm not exaggerating. Like every moment I wasn't at work, I was in bed trying to like recover enough from the day, rest enough for the next day. Weekends were entirely spent in bed as well. Of course, I went to my doctor and was like, hey, having all these symptoms of hypothyroidism, please help me. I think my medication needs to be adjusted. Was told, you're fine. It's not your medicine. Your TSH looks good. In fact, let's reduce your medication. And by the way, I'm going to put you on Lipitor because your cholesterol is elevated

• 43:33Speaker 01

  from my low T3. Eventually, I found my way into the hands of a physician that specialized in complex thyroid issues. Progressively, completely got my life back and Obviously became a passion of mine and from that, Modern Thyroid Clinic was born. I'm so grateful it was because now we get to change tens of thousands of people's lives directly and I think millions of people's lives just by educating and empowering them.

• 43:57Dr. Darshan Shah?

  What is Modern Thyroid Clinic? Is it a location? Is it telemedicine? Can you tell us a little bit more about it?

• 44:03Speaker 01

  Yeah, so we started as a brick and mortar practice in Austin, Texas, just regular old, regular old medical practice. And in about 2022, our waitlist got to almost 9,000 people. They were flying in from all over the country, all over the world. And so at that point, we made a change and we started pursuing telemedicine. And now it's taken a long time, a lot of work, a lot of money, a lot of infrastructure. But we are in 48 states now. We'll be in 51 later this year. And our goal is that every person in our country has access to true, good thyroid care that allows them to get their lives back and truly thrive.

• 44:41Dr. Darshan Shah?

  Well, that's fantastic. Such a needed service. And so I'm sure a lot of people out there have primary care doctors that are trying to treat their thyroid. They're still struggling with like high cholesterol, hair loss, weight gain, all the symptoms that should be better once you have the right thyroid medication. And I just think that, you know, having an additional level of evaluation and a practitioner like you to talk to through your now telemedicine clinic could be a game changer for people out there listening and still struggling. So thank you for providing that service.

• 45:14Speaker 01

  Thank you. Thanks for having me today. Thank you for your work. I'm such a big fan. I've had you on my podcast recently too. And yeah.

• 45:22Dr. Darshan Shah?

  Yeah, this is, this is great. I mean, I think this is all so needed. And could you give us the URL for that guide again and tell us how other people can hear more from you?

• 45:32Speaker 01

  For sure. So you can go to gift.modernthyroidclinic.com. You can find more about our practice at modernthyroidclinic.com. And I'm always on social, on TikTok at McCall McPherson, on Instagram at McCall McPherson PA. And I have my own podcast, Modern Thyroid and Wellness, where Dr. Shaw was a guest probably a month or two ago. So you can find our conversation from him there as well.

• 45:55Dr. Darshan Shah?

  Yeah, this was really awesome and I really thank you so much for being on the podcast and spreading such incredible information. And can't wait to have you on again. I'm sure there's a lot more to talk about.

• 46:06Speaker 01

  Thanks for having me.

• 46:08Dr. Darshan Shah?

  You're welcome.

• 46:11Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.