Episode 58: Thyroid Health with Dr. Mark Holthouse, MD

Podcast Drop Date: 5/15/2025

In this episode of the Functional Medicine Foundations podcast, we are providing a special replay of a previous provider event with Dr. Mark Holthouse, MD. Dr. Holthouse shares the impact of thyroid dysfunction on various aspects of health, including weight gain, brain fog, energy levels, gut issues, insulin resistance, and hormone imbalances. He discusses the importance of a comprehensive lab workup beyond TSH, bioidentical hormone therapy, and the role of micronutrients in supporting thyroid health. Listen for expert insights and actionable tips to support your thyroid health!

Transcript:

Amber Warren, PA-C: Welcome to the Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper. Today's episode features a very exciting conversation that was originally presented at a provider event here at our Center for Optimal Health. If you're tuning in for the first time to hear this episode, or if you've already heard it and you're just revisiting it. But today's episode features a lot of really good tidbits on thyroid health by Dr. Mark Holthouse.

Amber Warren, PA-C: Dr. Holthouse is the Chief Medical Officer for the FMI Center for Optimal Health and Functional Medicine of Idaho. He graduated from Loma Linda School, Loma Linda University School of Medicine, and went on to obtain his family practice training at UC Davis Medical Center. While in the Air Force Scholarship Program at David Grant Medical Center, Travis AFB, Dr. H has over 32 years of family practice experience and brings years of practice in the areas of functional and integrative medicine as part of the Institute for Functional Medicine teaching faculty. He has educated thousands of practitioners in hormonal health across the nation over the past ten years. As an assistant professor of medicine on the teaching faculty at Loma Linda University School of Medicine. He is an expert on cardiometabolic diseases, disease prevention, reversing type two diabetes, heart disease, high cholesterol, obesity, and metabolic syndrome. In addition to his clinical and teaching experience, he has 30 years of owning his own private practice as acting Medical Director, implementing strategic models in clinical practice and the business of functional medicine. Doctor Holthouse and his wife, Tammy, enjoy photography, snowshoeing, skiing, sailing, sailing, hiking, kayaking, and good food. Of course.

Amber Warren, PA-C: Here's a special replay of Thyroid Health with Dr. Mark Holthouse, brought to you by Functional Medicine Foundations.

Dr. Mark Holthouse, MD: Thank you all for showing up. Um, thyroid is a kind of the forgotten hormone when it comes to talking about estrogen, testosterone, progesterone. People kind of tend to forget that thyroid thing. That's a hormone too. And it's a there's bioidentical thyroid hormones just like there are bioidentical sex steroid hormones. And last month we talked a lot about estrogen. Talked a lot about progesterone and testosterone primarily in women but a little bit with the guys. Yeah, there was a lot of questions on testosterone. So I said I'm going to be back mid-March. Let's do one on T on the other T. It's a very polarizing topic, just like estrogen, especially in postmenopausal, premenopausal, perimenopausal women. You'll get a lot of fire around this topic because there's widely divergent views. There's doctors like, uh, David Brownstein have written books on this on how to actually assess thyroid correctly. He happens to be somebody that I believe a lot of what he says, not everything, but a lot. Your everyday endocrinologist here in the Treasure Valley and across this country really has a very different view on how to treat, manage, assess thyroid than, than I do. So if you've got thyroid issues, whether it be graves, Hashimoto's, autoimmune thyroid conditions, a history of thyroid cancer, or you've just got low thyroid that's being managed by endocrinology, you may hear some things that kind of raise your eyebrow tonight.

Dr. Mark Holthouse, MD: And that's really hopefully what I'm going to be doing is dispelling some of those practice myths that I was trained and thought was the way you did it. So there's there's a lot of ways to think about this, but probably the most important thing to begin a talk on thyroid with is how do you recognize you got to maybe have a thyroid imbalance. There are the classic symptoms, right? Of my hair, I'm losing my hair. I've got constipation. I've got low energy. I have issues with dry skin. A lot of people don't know that high LDL cholesterol is a symptom of low thyroid. So when you have a problem with your doctor saying you need to start a statin, which I'm not statin averse, they're appropriate in certain cases, which is another whole talk. You also want to make sure that the thyroid is optimized, because a lot of people will actually improve their LDL. And that's something that is sustained as long as you keep that thyroid kind of dialed in. So it's that it can be problems with fertility. It can be problems with testosterone. One of the most common things I'll see with guys who have low thyroid is suboptimal testosterone levels. It's one of the causes of secondary low T, testosterone, is having a problem with suboptimal thyroid, and either too much or too little can be problematic when it comes to fertility for women. So we have a lot of changes in females, premenopausal when they're pregnant with thyroid.

Dr. Mark Holthouse, MD: In fact, they become essentially hypothyroid 100% of the time, which, if you've had trouble with infertility, can be a problem because it can be part of the reason you're having recurrent miscarriages. So it's intimately involved with female fertility as well as testosterone production. So pretty much the whole spectrum. Other things, cognition is a problem with suboptimal thyroid. A lot of people feel like their name recall, their processor speed, their executive function, their ability to multitask is impaired. They don't have hair loss, constipation, weakness, fatigue, muscle problems. But they've got cognitive brain fog. They feel like somebody there's just this fog and their attention and their ability to learn new information has been hit. Um, what makes this even more complex is that a lot of times around the period of the menopause in women, the thyroid decides to do some funky things to. I think part of the reason that thyroid draws so much emotion is because a lot of folks get it in their minds that, well, this is what I have. I have this list of symptoms. So therefore everything I'm experiencing is due to a thyroid problem. And there's some, you know, validity to that. But it's not operating in a vacuum. There's adrenaline, cortisol and other things that are impacting thyroid. And so what's problematic, especially around age 50 and most women, is that at the same time estrogen is going away.

Dr. Mark Holthouse, MD: Progesterone is going away. Testosterone might be going away. Thyroid can give you some grief too. And they have overlapping symptoms. So it can be really inconvenient. The body doesn't read the textbooks. And so we have to use a very individualized approach just like we do with sex steroids. This topic is as much or more. I spent a lot of my time helping clients unlearn bad information that they've received about thyroid. I spend a lot of time helping people. What's the right way to say this? Trust what I'm about to present and give me a moment to, or give me a chance to kind of try some new things, as opposed to just throwing on more T3, more of the high octane fuel, if you will. And we're going to talk a little bit about the differences of T4 and T3 in a minute. Um, as the only source to the problem. There's people that I have in here that have been seen by other providers that are on 2-400mg of Armour® thyroid or levothyroxine or something like that, and they still feel like crap. They're still fatigued, they still feel tired, but wired at night. They still have brain fog. And it's as if somebody just heard their list of symptoms and they were tunnel vision and didn't think of any other opportunities where, hey, there might be something else going on, so let's just throw more thyroid on because they felt really good when I did that the first time it went away.

Dr. Mark Holthouse, MD: Maybe if I just keep doing this. And what will happen sometimes is you rev the engine metabolically with T3 so hard that you literally drive the adrenal gland into adrenal dysfunction. We used to call it adrenal fatigue. Uh, that's kind of an inaccurate term to those of us that look at the science. So we now just call it adrenal hypo or low function. So looking at adrenal cortisol, DHEA two hormones made by the adrenal looking at estrogen, testosterone, insulin, glucagon things like leptin in the context of vitamin D which is a hormone is important when you're assessing thyroid. So there's these atypical presentations that you want to identify. So high LDL is one or low LDL is one that you'll hear a lot of cognitive. That's another one that you'll sometimes run into. So a little bit about what systems are affected. The thyroid is incredibly important with cognition and, and and your ability to think and process and remember. It's incredibly important for things like hormone production. It's obviously very important for metabolism and weight and, uh, staying in a, in a, uh, body composition. That's ideal. Um, it's equally important for gut health. Uh, people that have low thyroid have constipation for a reason. It really just stops peristalsis, that involuntary movement of the gut from here to the other end that we just swallow and we don't think about it till later.

Dr. Mark Holthouse, MD: It all does its thing automatically. A lot of that's driven by thyroid. So there are a lot of folks that have Sibo, small intestinal bacterial overgrowth, because they've got a sluggish gut because they've got hypothyroid. Um, so intestinal tract problems, bloating, maldigestion, small intestinal bacterial overgrowth, Sibo. Think thyroid, think sluggish thyroid. Problems certainly with the skin, dry skin, uh, changes in the nails, changes in hair, coarseness, edema, swelling, non-pitting swelling. So it's not going to be that type of lower leg swelling, at the end of the day where you go, you pull up your pant leg and you see where your your sock is made a ring, a dent. It's not pitting like that. It's, it's a non-pitting swelling. It's like I just feel like I'm bloated everywhere. I just feel like I'm retaining water everywhere. My rings are harder to get off. So you'll often hear complaints about bloating from water retention. So it's not just about too much estrogen or too much testosterone. Inappropriately dosing those, you can get it with problems with inadequate thyroid. A word, we talk a lot about hypo, low thyroid. Hashimoto's being the number one cause of hypo, low thyroid in this country because it's so much more prevalent. I'll pay a little bit of homage tonight because it's really another topic to hyper thyroid. You can have hyper or overactive thyroid production. It's usually something called graves disease, which is an autoimmune disease, as well as Hashimoto's. Hashimoto's being the low eventually thyroid. That's the outcome. Graves is where it's just too much stimulation. And you have antibodies, basically, that are stimulating the heck out of your thyroid gland. And if you don't treat it, you get kind of that little goldfish eye thing happening. And that can be permanent. That's a cosmetic side effect. You can have racing heart, you can have palpitations, insomnia. You can actually have fatigue with too much thyroid too, when it's just revved all the time. Your body's just dragging. Give me a break, white flag. This thing has just always, always on. Um, but that's not near as common. There's goiters, multinodular goiters, and hyperactive goiters that can secrete too much thyroid. What we're really focusing on tonight is more on the hypothyroid side of things. Thyroid cancer is kind of its own discussion as well. What's interesting about Hashimoto's, it's named after a Japanese surgeon in the 19th century. Autoimmune Thyroiditis. It's basically a condition where the body's immune system has gone after your own thyroid, the actual gland, and you've got antibodies that are made against components enzymes, thyroid peroxidase and thyroglobulin, which is part of the thyroid storage of T4 tissue. And you can measure these in the blood. And what's interesting about this, it is the most common cause of low thyroid in this country. 20, 30 years ago, I'd see a new case of this maybe every six months. Now I'm surprised when I don't see a new case every day.

Dr. Mark Holthouse, MD: And our genetics haven't changed. So we're thinking what is going on? A lot of us feel that it's the chemicals we're living in. That's what's done this. The thyroid and integrative medicine and integrative endocrinology is thought of as the sentinel gland. It's out there on point to get sniped. It's the first autoimmune disease usually that shows up. And it's associated with things like type one diabetes in kids and in celiac. So whenever you see autoimmune thyroid you should always be getting checked for celiac. And if you're a young, younger person. Possibly even antibodies against your pancreas leading to type one diabetes. They're all related. So they're autoimmune. It's the most common cause of of killing the thyroid. What's interesting about it is that when it first starts the the autoimmunity, you can actually have a bump, a hypothyroid response as your gland gets injured and dumped, some of it stored thyroid. Thyroid is interesting. It's one of the only endocrine glands that stores its own hormones. In fact, it stores it in the form of T4, which is a prohormone that has to be converted to T3, which is the active version of thyroid. And it stores about 100 days worth of T4 thyroid in itself. So when you have something like trauma or goiter, a nodule, or an autoimmune insult attacking this storage vault, if you will. It can actually dump excess thyroid T4 into the bloodstream. So you can have this initial hyper looks like graves autoimmune thyroid condition.

Dr. Mark Holthouse, MD: And as it burns out it becomes normal and eventually becomes hypo thyroid. So depending on when you're checking the labs in the disease process, you can see elevated, normal or low. They all eventually burn out. Ultrasounds of thyroid are really telltale of what's going on, and they can see the blood vascularity the blood circulation in the thyroid gland. They can tell often if you've got hyper normal or hypothyroid, Hashimoto's can be highly, highly detected using ultrasound as a confirmatory image. The diagnosis is usually made by those antibodies that we get in a simple blood test, which really brings us to kind of some foundational stuff.

Dr. Mark Holthouse, MD: Let's talk a little bit about thyroid and then about the appropriate labs that we should all be kind of looking for. Whether you see us, whether you're seeing someone else, these are things you guys need to be empowered and understand and demand that they order. T3 is the active form of thyroid. Period. End of story. T4 pretty much exists to make T3. Your gland makes almost all of the thyroid that your thyroid gland is pumping out is T4. That pro hormone, you know, like 90 plus percent. A little tiny percentage of thyroid hormone made by the gland itself is actual T3. The majority of that T4 then has one of two pathways to go. It can go down the break reverse T3 or the accelerator active T3. There's a waypoint there, and there are three different enzymes deiodinase enzymes where they're pulling iodine molecules off to convert them to T4, or either active T3 or reverse T3.

Dr. Mark Holthouse, MD: So think of reverse T3 as the brake pedal. It's reversing your metabolism. It's slowing you down. Why would you ever want that in a system? Well, we have to have checks and balances. When you're in the hospital, God forbid, with a heart attack or sepsis or pneumonia, the last thing you want to be doing is having a fast metabolism. You want to be reining things in, healing, slowing it down, not burning a bunch of calories. So all that 100 days of stored T4, it's got to go somewhere. So it goes down the brake pedal route down reverse T3, reverse T3 goes up. We can measure it in the blood when your body is ill, or it feels like it needs to pull or rein back the metabolism. What happens is some people get stuck converting T4 over to reverse T3. When it's in those high mid 20 ranges, it's clearly not optimal. We like to see it in the teens on the blood test. We look at the ratio in blood tests of total T3, the active stuff, divided by reverse T3, and we get a ratio and we know what's considered optimal. We look at the ratio of free T3 to free T4 to get an idea of how much of this T4 that I started out with is going to active hormone. So these are some of the additional labs that you're going to want to look at when you're asking for someone to do what we call a complete thyroid evaluation.

Dr. Mark Holthouse, MD: So you've got reverse T3 the brake pedal. You've got active T3, the accelerator. You've got these enzymes that are directing the T4, which way to go based on a whole bunch of stuff, which we'll talk about in a minute. And you've got TSH and I've purposely mentioned that one last because it's the least important. Developed in the 1970s, this test was at best a weak diagnostic predictor of diagnosing hypothyroidism. It was never meant, created or intended to be used as something to monitor treatment. And yet, that's what every endocrinologist and pretty much every doctor that's not trained in integrative thyroid management relies on exclusively. And they have something called a third generation ultra sensitive TSH because that sounds really important and really good. And it's a really great assay. But the problem is it's measuring a product made by another gland, the pituitary. So it's used to diagnose hypothyroidism, but it's made by the pituitary. There's a whole lot of science in why TSH isn't probably the best way to monitor thyroid function. Suffice it to say, it's really only useful if you're in an insurance practice and you've got to diagnose hypothyroidism to get medications paid for. I look at TSH because I want to know where it is. Some people worry about giving too much T3, and we're going to talk about how to give thyroid correctly and what you should really be looking for as a result, if you give too much of that high octane active three as a prescription, you can actually suppress TSH too low.

Dr. Mark Holthouse, MD: And there's a whole bunch of folks that are concerned about that. Um, but TSH, it's really the only thing that most doctors are using. If you twist their arm, they might get you a free T4, but that's kind of pushing it. So those in individual labs are important. But their ratios looking at the total T3 to reverse T3, looking at the conversion rate of active T3 to free T4. That's where the magic happens. And we've got formulas that we use to get an estimate of how good somebody is at converting T4 to T3.

Dr. Mark Holthouse, MD: So what determines, other than being acutely ill, whether you're going to go to the accelerator versus the brake. Believe it or not, the very enzymes that are doing that are affected by things like calorie restriction, prolonged fasting can shut your thyroid down a little bit, slow your metabolism down a whole nother discussion. Toxins. And there's a whole bunch of them. Heavy metals. Medications. There's a whole list of them. Um. Chronic inflammation, chronic infection. High cortisol, stress can affect which way your prohormone goes. Break accelerated. So now we have to, this is really inconvenient part about functional medicine when you're looking at root-cause. Now guess what we have to do?

Dr. Mark Holthouse, MD: We have to ask all these crazy questions. How do you sleep? Do you eat organic? Do you heat things up in plastic in your microwave? Do you drink out of plastic water bottles? Are you, um, spraying roundup? You know, without any protection with the wind blowing in your face? Um, you know, you've got to ask all these things. Um, have you been in a career field where you've been exposed to heavy metal? You know, have you been handling a lot of lead based battery? Do you go to the firing range indoor and do a lot of indoor range rounds where you're getting a lot of lead dust? These are the folks that end up shutting down these enzymes and having thyroid dysregulation. The body has receptors for thyroid hormone all over the place. Probably second only to vitamin D receptors, which is really a hormone as well. Third place goes to testosterone, and estrogen is probably a distant fourth. But testosterone has got ubiquitous volume of receptors. You can tell in a human system how important a hormone is by how many receptors and which tissues have them. And like testosterone and estrogen and vitamin D, testosterone has receptors in nearly every tissue in the body. So it's pretty important stuff. Um, a little bit about medication. Let's talk. Let's talk first about nutrient assessment. So a lot of people say, doc, I really don't, you know, you're telling me I've got this kind of suboptimal thyroid function. What does that mean? My other doctor said it's in the normal range.

Dr. Mark Holthouse, MD: Well, when I look at that active free T3, there's a reference range of about 2.2 to 4.4, and most people when I check them are below three. And if you look at that reference range, you know that's below 50th percentile. And most of my college professors would not have passed me with a 50th percentile score. It's not a passing grade. Those reference ranges are coming from normal people. Okay. When I walk into Walmart and I look around, I don't need to say anymore. I'm thinking I don't want to be judged against that being normal, because the new normal isn't necessarily healthy guys, and we all kind of know it. But I don't want to be judged by that. And that's where these lab normal reference ranges are coming from. They're coming from populations of folks, and they're not all stellar, you know, eating wheat grass and gluten free avocado toast without, you know, they're not necessarily those folks. So our ranges are skewed from being optimal to something that's we call normal. So when I look at T3 and I have somebody coming in and saying, you know, my primary care said my TSH is fine, so not to worry about it, I'm going to just stay on this levothyroxine or synthroid. Um, and I look at their T3 and it's 2.2, 2.6, you know, 20, 30th percentile, lowest quartile you can find. And they're still constipated.

Dr. Mark Holthouse, MD: They're losing hair or they're cold intolerant. I'm cold all the time. I'm often going to ask them to consider adding some T3 to that T4. I like Armour and NP Thyroid and these glandular because they're more of a natural product. They're not synthetics and they don't have a bunch of binders and fillers in them. But we'll talk about the prescriptions that I use at the end. Um, these are the kinds of tweaks that often people come back and say, wow, I feel that extra 20% is back energy-wise. My constipation is gone, my dry skin is gone. And you know, I'm not wearing a parka in July anymore,driving my husband crazy over here in the corner because I'm always cold. If there aren't any symptoms of low thyroid and your T3 is 3.0, treat that person for goodness sakes, not the two dimensional piece of paper. You have to corroborate these labs with symptoms. Um, I see people that are coming in. I mentioned earlier on excessively high doses of thyroid, in particular T3, and it gets this initial bang, you know, and then they're just trying to recreate that forevermore. Often suppressing that pituitary control gland of the thyroid, the TSH, into oblivion. You know, it's normally 0.5 to 2.5 is the range of TSH we like to see. It's 0.00 something. A lot of cardiologists would call that malpractice and say that you're going to cause that person to get osteoporotic and atrial fibrillation. That's a whole discussion that I would love to entertain, it's a higher level discussion. Uh, to put it plainly. That ain't true. That's the science does not show that. Now, if I have a 65 year old female that has a lot of anxiety and has palpitations, am I going to rev their T3 engine and suppress that TSH? No, I have a license to defend. I'm not an idiot. I'm going to be careful. I'm going to be careful with those seniors. My seniors are more vulnerable just by the fact that they've got more birthdays for atrial fibrillation. But the cardiologist that reviews my case at the med board isn't going to take that into consideration when I'm doing things that they deem dangerous, optimizing T3. Because they weren't trained to think that way, nor was I.

Dr. Mark Holthouse, MD: So whatever we do with thyroid, we have to be responsible. We have to look at the age of the patient, their cardiac risk factors. Realize that if you overdrive thyroid in osteoporosis, in osteoporotic or osteopenic women that are postmenopausal, you could risk speeding up bone loss. And so we look at things like bone turnover markers. You can look at them in the urine and in the blood pre and post treatment to know if you're doing that. You can look at EKGs. You can talk about electrolytes and use things to mitigate risk with palpitations and arrhythmia. So arrhythmia is the biggest concern. And the biggest reason you will get pushback from any traditionally trained MD anywhere in this country because of the risk and fear of atrial fibrillation. Period. That's why they give you so much grief. So know that they're looking out for your best interest. But know that the data, the only study I'm aware of that showed that to be a problem is when you're using T4, levothyroxine. And that's another reason I don't use those products really, any more than I absolutely have to. Levothyroxine is a very, very popular thyroid prescription. It's probably one of the most popular that's out there. It's got a few problems other than its synthetic, uh, fillers and binders in it. One of them it shares with synthroid brand name has gluten in it. Interestingly enough, gluten is one of the things that we eliminate as soon as we find somebody who has autoimmune thyroiditis. I mentioned earlier the relationship between that autoimmune disease and celiac disease. You start to see patterns, right? Okay. This is what is fun about this type of medicine. So we look at levothyroxine as something that really was created to make the TSH look great. It doesn't really solve the problem in a large part of the population with optimizing T3. In fact, its net effect is to suppress the active T3. Many of the patients have great looking T4 because that's what levothyroxine is. There's no T3 in it. It's given under the assumption that it's going to be converted to T3, right? You put in T4, the body does the rest.

Dr. Mark Holthouse, MD: The problem is that the data doesn't show that in a large number of folks. Some people it's just fine and they do great their whole life on synthroid or levothyroxine. Levothyroxine, however, has the ability to up regulate the enzyme, the deiodinase type three D3 enzyme, which makes more brake pedal. So you're converting T4 to reverse T3 predominantly. It also tends to inhibit the conversion the deiodinase one and two enzymes of T4 to active T3. And there's some other problems that it does centrally in the pituitary all ending up with suppressing net active T3. So giving you a thyroid hormone can actually cause low active thyroid hormone. Crazy, right? So what do we do? We give something that we make as mammals Armours from pigs. And it's an 80/20 ratio of T4 to T3. It's fixed. It's a glandular. There's no binders, there's no fillers. It's got the whole rainbow of thyroid hormones. We haven't talked about T1 and T2, but there's T1, T2, T3, T4 and it's got all of those. So you're getting this complete glandular that's supplying all of these hormones there. No gluten in that one. No the pigs don't put gluten in there. Now if you're eating if you're eating pork that's not that's GMO that's been fed grain. It's it's full of glyphosate and roundup and things like that. Probably not so much gluten, but um, no, no gluten. Np thyroid is another brand that is a glandular that we like to use, um, as well.

Dr. Mark Holthouse, MD: There's other versions of T4 alone that are out there. Tirosint, which is a clean synthetic T4 alone that gets away from some of the binders and fillers. It's a little cleaner product, but it's still just T4. So we like to give what's called a bioidentical thyroid replacement. The way the body really wants it, which is a little bit of T4 and T3 together, more of it. The majority is T4, which is how our bodies do it now. What's interesting is that there are some people who don't do well in Armour. And why might that be? Well, Armour's from pigs. We're not pigs. It's pig identical, not human bioidentical. So for those people, we have to go to a compounder, and we make a custom blend of T4 and T3. One of the differences is that we can make it human bioidentical. 90/10 instead of 80/20. So 90% of the mix is T4, 10% being T3. That's what we have as humans. So that's human bioidentical as a ratio. So every once in a while I'll get somebody who just doesn't do well on NP Thyroid or one of these other glandular from animals and will compound a, um, a natural thyroid. Um, that's a little bit about the differences between synthetics and bioidentical glandular.

Dr. Mark Holthouse, MD: So what are some of the things that you can do to support your thyroid naturally, and what are some of the important labs that we want to look at besides just the thyroid labs we talked about? Well, some of the most important micronutrients to make T4, which ultimately is becoming T3. Everyone kind of knows about iodine, right? You guys, we don't have a lot of it around. It's been taken out of the salt. And we have to, have to, like, be intentional about getting it. You know, the Himalayan stuff doesn't have any in it. You know, the old Morton with the umbrella? Yeah, that's where it's at. Um, you can get it from dolce and nori and seaweed and sea vegetables, eating things like that. It's a great resource. Or you can take a supplement in a bottle. The main driver of creating T4 and ultimately ti4 getting converted is having enough iodine to do that. Iodine has a pump, a sodium iodide symporter pump that pumps iodine from our diet into the thyroid gland to make T4. If that thing is, um, it all impaired, we have a hard time making T4, and that's that's another discussion. But you'll see it on the labs. And that's one of the things you think about. Ooh, what's missing in this person's diet? Iodine is a biggie. Next, iron is huge. I like to have people with ferritin, which is the marker in the blood that we look at for iron storage at least 40. Now there's some issues with iron and heart disease and inflammation. And so we have to look at where your iron is in the context of inflammation oxidative stress.

Dr. Mark Holthouse, MD: But I like to see somewhere 40 or higher to keep a healthy thyroid. Some people will argue closer to 100 on ferritin to get ideal iron storage, but iron is intimately required as a substrate to make T4 along with iodine. Next is an amino acid called tyrosine. Tyrosine is one of those amino acids that has multiple important functions in the body. You know it's involved with dopamine and neurotransmitter transmitter production DL phenylalanine becomes tyrosine becomes dopamine and on and on adrenaline cortisol that's one of our, our neurologic systems, um, neurotransmitters that allows us to focus. Um, it also is extremely important though as a building block to make T4. So where does tyrosine, it's an amino acid. Where does that come from? Protein. What's the thing that's hardest for us in this room, including your guy standing here yakking at you to get? Protein! Oh my goodness. It's the only macro that we really don't store, you know. And so it's it's the one that's very, very difficult to get enough of, people that are at ideal body weight. I shoot for a gram per pound of body weight. So 150 pound person, that's got normal kidney function. I'm looking at, you know, 140 to 150 and and that's really hard to do with just food. And so we use a lot of amino acids supplementation. I take five of those things every morning minimum just to get even close. Not even where I want to be, but in the ballpark, in the same room for protein goal. So this is one of the most common reasons that we see problems with thyroid dysfunction. People aren't getting enough tyrosine. They're not getting enough l-tryptophan. They're not getting enough taurine, they're not getting enough of these, uh, really important amino acids. Um, the diets that are extreme, whether it's carnivore or vegan, are where you can really run into trouble with some of these things because of the, the breadth of components that are needed. Equally up there is your vitamin E, your B vitamins, vitamin D and vitamin A and C and zinc. Selenium is a biggie. Um, one of the things that's used to help um, in patients that have Hashimoto's is selenium around 200 micrograms a day, along with zinc, 15 to 30mg a day, along with vitamin A, around 10,000 international units per day. And again, this depends on if you're a woman trying to conceive and vitamin A, because you have to be cautious with that with birth defects. But vitamin A, selenium, iodine, iron, vitamin C, the B vitamins, vitamin D, um are all incredibly important. And then of course zinc is in there. Zinc is one of the things that, along with vitamin A, allows that active T3 to bind to the receptor in the nuclei of the cells and do all the action of thyroid. So if you don't have good zinc, if you don't have good vitamin A levels, your cells, you could have optimal levels of T3, or it's not binding to the receptor and doing what it's supposed to do.

Dr. Mark Holthouse, MD: So these micronutrients, minerals and amino acids are incredibly important at baseline. So when people ask me, you know, what's my favorite thyroid supplement? I tell them the foods that are high in those things, and it's getting adequate protein, it's getting adequate veggies, and it's making sure you're getting supplementation and things like vitamin D3, which everyone in Idaho is low in, pretty much without exception. It's true in California and Oregon to pretty much everywhere north of Atlanta, Georgia, Georgia, that latitude is deficient in vitamin D3. Um, so, uh, that's a little bit about some of the micronutrients, minerals, food groups to support a little bit about the different medications. Why the differences might be important. Um, a little bit about lab testing. Um, we talk about hormone optimization. We talk about metabolic weight loss. We talk about anti-aging medicine. We talk about thyroid optimization because they're all part of the same discussion. It's really artificial to kind of chop them up. Anti-aging medicine is really just doing your best to avoid the most common chronic diseases. Uh, Peter Attia calls them the Four horsemen, you know, dying of heart disease, stroke, cancers, dementia and type two diabetes. And if we address the Four Horsemen, we're addressing pretty much what takes most of us statistically out at the end of the game in this room. If you look at it and it's really all around the world.

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Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today. Specialties available at the FMI Center for Optimal Health and the highest Quality of supplements and more. Go to funmedfoundations.com.