Transcription
You say that in fact the percentage of patients with severe hypothyroidism that need combination therapy is 95%. Talk to me.
The reason I say 95% of people with severe Hashimoto's or severe autoimmune thyroid disease is because we have an epidemic of obesity. And we have a lot of women with thyroid disorders that have a higher fat percentage than muscle percentage. And so if you don't have muscle tissue, which is where you get your Dionis 2, that's your biggest activating, you're not activating your medication. There are people out there who have been on the wrong thyroid medication for 50 years, five decades of being tired, gaining weight, losing hair, and being told that their levels are fine.
Dr. Brittney Henderson is a board-certified endocrinologist who trained at Duke and ran thyroid clinics at two major university programs before opening her own thyroid-only practice in Charleston because she got tired of watching patients spend decades on the wrong medication or no medication at all. She says that 95% of patients with severe hypothyroidism need combination therapy, not the single drug that almost every doctor in the country defaults to. And right now, the FDA is about to pull access to a treatment that 1.5 million Americans are currently relying on. In this episode, we're getting into what a real thyroid workup looks like, why the standard of care is leaving patients behind, and why being told your levels look normal might be the worst thing your doctor has ever said to you.
Welcome to the Medical Disruptor, a place where well-versed humans can ask the hard questions and get evidence-based answers you won't find anywhere else. Every guest on the show must be clinically trained MDs, NPs, DOS, PAs, and researchers who want more and expand beyond their conventional training to find deeper answers for complex health challenges. I'm Dr. E, the NP with a PhD, and I help smart, well-versed humans go from medically gaslit to medically empowered.
Dr. Britney Henderson, thank you so much for being on the medical disruptor.
Thank you so much for inviting me. I'm excited about the conversation today.
Oh, me too. So, okay, for everyone listening, you are fellowship trained at Duke. Hello, a big deal. You ran thyroid programs at two major academic centers cuz one wasn't enough. You're obviously not an overachiever. You opened your own clinical dedicated entirely to thyroid. And at some point in that trajectory, you started seeing patients whose labs kind of said they were fine, but whose lives said otherwise. Something shifted, right? Something shifted where you were like is the TSH and levothyroxine off which we're going to get into deeply but what is the thing that shifted for you how did that come about?
Yeah, I'm a board-certified you know conventionally trained MD you know run-of-the-mill uh TSH is the only thing we check we put everybody on levothyroxine and if they don't feel well it's all in their head and they need to go see another doctor.
Probably a psychiatrist.
Yes, always a psychiatrist. Everybody who doesn't feel well. It's obviously not the thyroid or anything we're doing wrong. It definitely has to be a different issue. So, that's where I came from. That's how I was trained. Um, you know, I did my fellowship at Duke. I ran the program for the thyroid um patients afterwards and and then at Wake Forest um in North Carolina as well. And it's really not hard to figure out pretty quickly that conventional medicine in the thyroid space has got it all wrong. And the reason I say that is because if you are a good physician or a good provider, you listen to your patients and you really
I know um you actually think maybe we don't know it all. Maybe, you know, there are some things we have yet to learn. And so, by doing so, I realized that, you know, okay, it wasn't just one or two people that still didn't feel good. It was like almost all of them, honestly. Um, especially if they were on T4 only therapy, if they had their thyroid removed, or if they had really bad Hashimoto's or autoimmune thyroid disease, those patients still did not feel good. And so, um, you know, being the good doctor that I am, you know, I thought, well, maybe there's something else that we're missing. We're just checking a TSH. Maybe there are other labs that we should be looking at. Maybe there are other forms of treatment that we should be looking at. And, you know, that was kind of looked down upon to even think.
Oh, please. So I just I'm going to interrupt you for a second like before we get to the colleagues thinking that you're crazy because I have no doubt that's why you're on the show called the medical disruptor. And that's why it's really important. I know my listeners are know this already but I just want to say that's why my guests are all conventionally trained first. So you're not listening to someone who just like did a weekend certification. It's like oh they got it all wrong. Like you're listening to someone who came in from the church and has to unlearn because I know myself on many topics the unlearning is is a big deal in the sacrifice of the colleagues but I want to take this step by step for a second and I want to talk about your colleagues in a minute step by step to make sure our listeners probably our listeners listening know already but let's just catch them up right our thyroid makes T4 and then a really oversimplified way our brain is kind of checking T4 levels and then when it's when it's low the TSH rises is super simplified. And so that is the entire range of what is thyroid treatment, right? In in commercial medicine, no one's going to check T4. That's crazy. So we've just decided that we only check the TSH. And then you said, "Huh, I keep doing what they told me. I keep checking that TSH." And what were you seeing in your patients that didn't add up?
They all had hypothyroid symptoms, which granted those symptoms can overlap with other things, depression, side effects from other medications, but they were classic hypothyroid symptoms, and they were symptoms that patients said, "Hey, I didn't have this prior to having my thyroid removed." You know, like there's a definitive thing that happened. I had my thyroid removed. Now I have all these symptoms. I'm not depressed. I'm depressed because I feel bad. You know?
T4, right? You giving me T4, my TSH is normal. On paper, I should be fine, right? Make sure we tie that up.
Why don't you feel good? And I mean, a scientific mind, you have a PhD. I was in the basic science lab. You know, I did thyroid specific research. I did clinical research. I can't just stop there. I can't just say, "Okay, well, TSH is good. Must be something else. I'm not going to look. Who cares?" I don't I didn't go into medicine for that. I went into medicine to actually help patients. I went into medicine to do no harm for real. And if I had recommended a thyroid surgery, they had it and they didn't feel better or I caused any issue with how they felt, then I was going to pursue how to make that better and how to do a better job as their doctor. And yes, I got a lot of side eyes from my peers. Um, you know, I was the person running the program at these two major centers.
Saying this thing TSH is not enough.
Right. And and I was ser to say, okay guys, like I think we need to use combination therapy, which means using T4 and T3, just like what the thyroid makes. You know, 80% of it is T4, 20% of it is T3. Maybe we should mimic the actual thyroid gland when we're trying. Why would you do that? You know, and I I want to surface like how important this what you're saying is not just the science, which we'll definitely spend more time on, but this idea that, you know, we come from rigorous backgrounds and rigorous backgrounds means studies and, you know, RCT trials and and volumes and volumes of of literature and research. And what made you change your mind was something that's the thing that we're taught not to pay attention to is anecdotal. You listen to the patients and one after the other after the other. And even if it was hundreds, it's still nothing compared to an RCT trial. It's not thousands. And so we have this this reflex when we come out of our the church of medicine to like, well, if it's there's no paper, you know, on this, if there's no research on it, then and you're just seeing it, then it's anecdotal and it's many people just whisked away, which is why patients are like, kind of gaslit like, yeah, no, it can't be. It must be you. What is it about you that made you pay attention to this very anecdotal non-researched evidence? Like what is it? Why were your colleagues, your colleagues are not evil people, they're lovely people. Why is it that they saw the same patients that you may not be able to handle this? It just came up to me, but like, why did they see the same patients and they're like, "Yeah, it's you." And for you, you're like, "It can't be you."
I think because I was in research, honestly. So.
Do you know what I mean, right? I mean, like you, if you're in research and you've ever written a paper or you've ever been in basic science and you've ever like done an original study and you've seen what goes on around you, you know that science is very flawed and if the guidelines are based on science which is like 20 to 30 years old at this point, then I don't believe it all and I will absolutely believe that we do not know everything and I think honestly that medicine and treatment should be very logical and it's not all, you know, in somebody's head. I would say, you know, as conventionally trained physicians, we're told that that happens a lot. That happens never. Like 99.9% of people that tell you that they don't feel good and that the this is their symptom are telling you the truth. Nobody wants to feel bad. They're telling you what the symptoms are. And that is actually what the symptoms are. And they can be fixed if you actually understand the underlying problem and you treat it. So I don't know why most clinicians don't like go one step further. But I will say the ones that I know that are that much against it are people that either were never in research or they just trust research blindly and don't question things. Um, or they don't listen to patients and they think that they know everybody and they have a god complex.
Yeah, that's true. That that is really true. Um, you you said so many things there. I think that a lot of clinicians are probably not doing uh are not seeing what you're seeing. First of all, let me say you said the sentence that happens never. Like I love that so much before I even get to because when my patients come in, this is why I chose to stay in primary care because someone has to be logical in primary care. Like we can't just keep all of us abandoning it but because it gets really hard to do some days.
Yeah. So I when they're like, "Well, maybe I'm just anxious." I'm like, "Okay, listen, sis. We're going to put anxiety, depression on the list, but it's going to be on the bottom of the list and we're going to it's our responsibility to rule every possibility. And then if we literally find nothing, then I'm willing to talk to you about this unless the patient comes in and says like this is what I'm here for. I'm here for meds." But like that has to be the bottom of your differential that it's in that person's head. They're anxious. So I'm so glad you said that. Then going back to your clinician and then I have a question for you is I think a lot of clinicians do this because unlike in research when you're just in med school, MP school, PA BA school, the idea of not listening to the protocol of digressing from the protocol is so dangerous. It's fraught with lawsuits. This is how the world ends. Um, right, fire and burn. So it's like if it's not in the guidelines, you just don't do it. Um, and I want to say that because I I don't think there's any doctor out there that's malicious. Well, maybe 5%. Let's just ignore them. But most people don't do all the school is being malicious.
But that natural curiosity that you have comes from being a researcher and I don't think most clinicians actually know the research. I think you're right about that.
Tell us like tell the listener a little bit about why TSH is not enough and what is this T4 T3 stuff you're talking about? Like give it to us in layman's terms.
Yeah, I mean, so okay, TSH, it's not a bad test. It's very helpful. It's not a thyroid hormone. It's actually a pituitary hormone. Um, and there is a lot of controversy around what is a normal TSH. That's because when they actually made the normal TSH reference range and they used the population to make that, about 15% of that population had underlying Hashimoto's or thyroid disease that was not diagnosed and they were included as normal patients. So, that really skewed the range. And if you look at your labs, you're going to see that the normal TSH range goes from about like 0.45 or 0.5 to about five, five and a half or so. And when they actually looked at that data later on and they excluded those patients that they knew had Hashimoto's antibodies, the reference range for a normal TSH, they made a lot smaller, 0.5 to two or 0.5 to 2.5. And that's what we use when we're trying to get a TSH optimally. The reason that it's still published the way it is where the reference range looks so wide is because that's the way that they were all FDA approved to be tests and that's, you know, what the studies were done at and that's just the way it is. So, it makes it confusing because if a physician sees that the TSH is in the reference range, but it's really three or four or five, it could absolutely not be correct. Um, it's a logarithmic value. So minor changes in T4 and T3 can make big changes in TSH. Um, and TSH can be affected by multiple things. It doesn't always correlate with T4 and T3. Sometimes it can be um artificially normal because of thyroid antibodies going on in the background. Sometimes it can be artificially low because of the same issue. Um, and with the aging pituitary, sometimes the pituitary is more sensitive to thyroid medication, especially after menopause, and TSH can be artificially lower than you would expect. Um, if you have things like a toxic adenoma, which is like a thyroid nodule that's overactive, you can't trust TSH in that situation because the thyroid nodule is in control, not the pituitary. So, there's many reasons why you can't trust just a TSH level.
Would you say if I could I like to come up with metaphors because you said a lot of great things and some of our listeners are going to eat that up but some of our listeners are like what did you just say? Um so would you say cuz as you're speaking it just occurred to me like if I'm looking at a gas tank there we know there's gas underground. Tell me I could be wrong. I just made this up. There's gas under the ground but what we're looking at is the numbers the digital numbers. The TSH is like the numbers. Assuming it's giving us information about what's in the ground, but it would be really cool if I really want to know how much like gas is either in a tank or in the ground for me to like be able to see in there, like what's actually there. Cuz the TSH is kind of like uh it's it's it's kind of sort of telling us a reflection of what we think your your T4 and T3 status is, but it's not really your T4 and T3 status, right?
PSH from which is a pituitary hormone. It can be very trustworthy and great information if you have a gas gauge that's working very well and you don't have any other issues. But many people have gas gauges that are influenced by other factors like antibodies, thyroid nodules, medications, you know, other things that can influence TSH. That's very common, very common. It is not like a one-off. So yes, if it's perfectly working in in order, it can be great. But many people don't have that um luxury. And so if you can actually count how much T4 and T3 is in the gas barrel, you know, then why would you not just do that instead of measure, you know, look at some random gauge?
I I recently had a patient in my office um who was a type of patient who's very easily dismissed because for a long time she was a drug user and so the system is not listening to anyone who was on drugs and then she had the strength to come off of drugs. She is 11 months sober at this point. I'm so proud of her. And of course again everything is going to be attributed well of course you don't feel better cuz you have this and and by the way this not just her I I wish it was just extreme case you could anyone who's heavy gets dismissed because heavy anyone who's stressed gets dismissive of stress or was menopause.
A lady today who is blind telling me this like how much prejudice.
Like it's because of blindness so it's like there's always a reason. I was just drawing this particular vision because she's classically someone who's you know, as I say it, I'm like all women are but nonetheless she she had more points against of not being believed. Anyway, she came to me and her, this is more to do with hypothyroid in general. Her TSH was 21. There's just no conversation that she was hypothyroid. Um, and so I'm looking at her med list and I and I'm like, "Wow, you're on Trazadone for our listeners. That's some really heavy-duty psych meds to put someone on." And I'm like, "Why Trazzadone? How long you been on it?" And she's like, "About 6 months." Anyway, short short story is she was diagnosed with depression around the same time that her thyroid was low. And I was like, "Hello. Hi. I'm not telling you to go off any medication, but I am telling you that we are going to spend a long time optimizing your thyroid and then we can reconsider if you ever need these heavy-duty guns." And so, we're quick to prescribe something as intense and serious as Trazzadone.
Yeah. But we're not giving T3 like make it make sense. I can't make this.
Well, and also like for listeners, you should ask for this whole panel. TSH, free T4, free T3, reverse T3 plus antibodies. But that's another story. But you know, at least those core four. And when patients ask their providers, their providers push back. No, no, no. You don't need that. It doesn't mean anything. It's a terrible test. You know, why are you wasting money? It's really bad. And that is because that's again because of ego, really, because physicians don't want to be told what to do. Physicians think that they know everything and they're I don't know how to fix that honestly.
They don't know how to read it.
No, they don't know how to read it either.
And they're not comfortable giving T43. I can't say I'm super comfortable DMT T3, but if I if I notice it, I will hand it over to someone who is like you don't, right?
Like fellow clinicians, you don't have to be comfortable managing everything. You just have to be comfortable finding it and then handing it over to someone who can. They're still going to come back to you for the other things. It's okay.
It it that part makes me mad because ordering simple labs and no like I order labs like cholesterol all the time. I I don't but I will send you to a cardiologist if you have like high cardiovascular risk factors and things. I'm not going to do that part.
No, you know, I really am glad you brought that up because that's the part of medical saying I don't think I've discussed here, right? Like we talk about that feeling and I'm not and not diagnosed and but this we empower them to ask this test. By the way, covered by insurance, not crazy, not genetic testing, super simple, not not expensive. Reverse T3 can be hit or miss as far as coverage, but but honestly, if your doctor has like um self-pay rates for that, it's like 30 bucks, so it's really not a big deal.
It's not It's not crazy. And and this what I don't know if you'll have the answer, but what should a patient do if her if her doctor says, "No, I'm not running it."
Okay, quick break. If this episode is hitting home, just ask yourself this. Are you gaslighting yourself without even realizing it? I made a free guide called Self Gaslighting Habits to Watch For. So, if you're constantly second-guessing yourself in the exam room, this is your starting point. Check out the link in the description. Now, let's get back to it.
I mean, typically I tell them to go seek another opinion or find another doctor, but like there are only so many doctors and there's not a lot of open-minded ones. Um, I mean nowadays you can go to, you know, any lab now or what are the online ones that like you can order your own kind of labs, which I I mean you definitely want to make sure you have somebody who can interpret them. But if you have somebody who can interpret them and all you need is a blood test done, I think that's definitely a reasonable option.
That's true. I think I think it's not unreasonable when you say that. Sometimes I I I I don't want to always say, "Well, find another provider." But I think there are certain areas where it's absolutely reasonable. First, if they're rude to you, find another provider. Um, but I tell my women who go to gynecologist all the time, and I'm like, "Did your gyn talk to you about HRT yet?" And she's like, "No." I'm like, "Oh, great. You need a new gyn. You just need a new one." Like, I think that's just appropriate. Like, maybe he was great birthing your babies. He's not great at postmenopausal. I think this would be a case like that, too. Like, refusing to run these labs on you. Yeah, I think you need a new primary. There are times where I think we need to say that and not for every little thing, but I think this one especially if you're if you're feeling great on your thyroid, God bless. Go do your thing. But if you're still still feel symptomatic in your heart of hearts, you're feeling like it's not it. You need to find your provider. It's okay. And by the way, like you don't have to leave that provider. They may be great at other things. You could have a team that you could have you can go to Dr. Henderson just for your thyroid and then go to your cardiologist for that stuff. Go to your primary for all the other things like you don't you don't have to leave. You know, it's a family medicine down the street that you really like that's great like it doesn't have to be either or caution you're not going to change the provider's mind so also don't fight with them.
So let's go on to treatment for a second. Uh anyone who's dealing with um Hashimoto's hypothyroid is likely on Synthroid or levothyroxine. Um again, if you're doing great, leave it alone. Like don't don't no need to to mess with things. It's just for those of you who are on the med like I but I still feel like I'm dragging or I can't lose weight or my hair is thinning, whatever. I'm freezing all the time. Um, you say that conventional wisdom, I'm going to take this from your guest form, says that 15 to 20% of hypothyroid patients need combination. So, the regular doc is saying 15 to 20% of hypothyroid patients need combo therapy. T4, T3. That's what combo therapy means. I'm sure you're going to explain that to us. But you're saying that's so incorrect that in fact the percentage of patients with severe hypothyroidism or complete thyroidectomies that need combination therapy is 95%. And for some less severe 50-75. Talk to me.
The reason I say 95% of people with severe Hashimoto's or severe autoimmune thyroid disease or with a thyroidectomy is because we have an epidemic in our country of obesity and we have a lot of women with thyroid disorders that have a higher fat percentage than muscle percentage. We have a lot ofia as patients enter into menopause and because a lot of these patients who have had thyroid surgeries or have Hashimoto's are female, um they basically don't have the muscle mass to take T4 only medication and muscle is the the part of the body that has diodnese 2. Diionic 2 is the activating form of and yeah of the enzyme and so if you don't have muscle tissue which is where you get your diionase 2, that's your biggest activating, you're not activating your medication.
So I didn't know those mass. So I'm sitting here going, okay, it happens to the body. So I guess some people on converters and you need certain supplements. I've heard that theory to help you convert more. Why do all these people not convert? And this was the missing piece for me that the chemical reaction that's needed to happen at you need to have muscle mass for that.
You need to have muscle mass.
And all people who are older do not have muscle mass. That's just a fact as you're referring to in sarcopenia. People who overweight or obesity do not have muscle mass.
Back in the do Synthroid only lots of people had muscle masses like we have a problem. This is crazy. So where is this conversion supposed to happen? It's like not happening. Now I understand the 95%. Now I want to talk to you. So okay, so we got T4, T3. Girl, I just got it for the first time. Why it's a big deal. So thank you for that. But then the other thing that you talk about is desiccated thyroid. Can you tell us what that means and why that's different from Synthroid?
Yeah. So basically desiccated thyroid extract is is basically powder that's um taken from a pig or a cow or another animal and it's thyroid tissue that is made into a powder that is then made into a tablet. Kind of sounds crazy, but it does give both T4 and T3 because within the thyroid 80% of it is T4 and 20% of it is T3. When you're getting it from like a porine or pig source, it might be a little bit more T3 compared to T4. And back 130 years ago when we were starting to treat hypothyroidism, DTE desiccated thyroid extract was standard of care. That's what we used. That's all. Then then um in the 1950s um they made T4 in the laboratory which laboratory great science awesome.
Crazy.
And it makes sense that okay, you know, people who are on this T4 T3 combination therapy and this is true for today's patients too. You need to be with somebody who knows how to dose this because you could get hurt if they don't know how to dose it and they're overdosing it or not dosing it correctly. It can cause funny heart rhythms. That can cause a lot of side effects, jitteriness, chest pain, anxiety. Like there's lots of things that can happen if it's not dosed right. And so they were seeing that patients were maybe getting some of those side effects when it wasn't dosed correctly. And they said, well, if we give the inactive form of thyroid hormone T4, nobody will have side effects. TSH will be normal and then they'll just convert it in the periphery and we'll be good. And that makes sense logically. The original studies actually only looked at TSH and whether or not it went back to normal. It never asked a single patient, "Do you feel better?" It never looked at peripheral conversion. So really, it was it was approved based on TSH normalization, not on actual improvement of hypothyroid symptoms.
Wow.
And and follow the money. You know, they gave a lot of medicine to the American Dietetic Association and other places that basically wrote the guidelines to say only use this. I think I think it's really important because a lot of uh primary care are not comfortable uh prescribing desiccated precisely for that reason you said because for those listening like oh I don't want I don't want chest pain. Of course no one wants you to have that but T3 is the active form and so you need very little of it compared 120 micrograms or 200 some of my patient are 220 micrograms of T3. It's it's you need a much lower. It's very active. And so if it's not managed correctly, it could send you over to feelings of hyperthyroid and all those. And so it has to be managed with someone. And so again, uh I myself I will refill if somebody's already on it. If you have someone that's managing, but it's not something I'm it's in my wheelhouse, but I'm certainly uh have good people I refer to to manage it. Um, so I I I just want everyone to know that your PCP might not be comfortable and that some they might say, "Oh, you don't need desiccated thyroid. That's just nonsense." It's not nonsense. It's just their comfort zone. It's not what they're taught in school.
So, you have patients who are in love with thyroxine for 50 years, diagnosed in their 20s, now they're in their 70s. What happens when you finally get their medication right?
This is a recurring thing. And this is why I love my job so much because I went into medicine to like fix it. I didn't go in to just be like, "Take, keep taking it. Here's your refill. Go get on an antidepressant." Like, I really wanted to fix things for patients. And this is such an easy fix. So we see patients, you know, they've been on T4 forever. They might even say, "I feel okay. Like, I feel fine." But I always tell them like, "Hey, you haven't had a thyroid since you were 20. Maybe you just don't have perspective as to how good you actually could feel. Maybe that's right, you know, and and 50 years of the wrong thyroid medicine basically contributes to the development of a lot of metabolic diseases. Obesity, you know, hyperlipidemia, thyroid hormones, one of the most important hormones in lipid metabolism, insulin resistance, you know, um just all of these cardiometabolic bad outcomes over 50 years of bad thyroid treatment that then need to be reversed on the back end. And now we have a lot of other tools that can help us do that. Um, but when we get these patients on the right treatment, you know, I've had 70, 80 year olds, lots of them come in and say, "I feel better than I have since I was 20 years old.
Love.
I have my life back. I can think again." Like, oh my gosh. And it is like night and day, like difference. And it's there's only one right way to do it. It's not rocket science. It's really not. And it's been so dismissed by the medical community and the scientific community. And when I was at my last institution and people were looking at me like, "What the heck are you doing? Why are you using T3?" I'm like, "Peace out. I'm going and I'm going to do thyroid the right way."
I love do it the right way cuz there's only one right way to do it. And if you can fix somebody and alter their life,
Amen.
for the good. That's why we went into this profession. It's hard. It's a hard profession. People are messy. It's It's hard.
It's a lot.
It's a lot. And if you can actually like take somebody's life and completely change it and then get their weight off and help their get off their lipid medicine and get their blood pressure under better control and take them off medicines. That is the goal of medicine. The goal of medicine is to fix things, not just manage chronic disease.
I say all the time, I I hope you never need me. That's exactly what I tell my patients all the time.
Yeah. I mean, yeah. And people don't seek medical care just to add another prescription. They seek medical care to fix the underlying problem.
Now, on the flip side, you've also taken patients off thyroid medication, some after they've been on it for 25 or 30 years. How is that possible?
Yeah, that's the that's the downside of T4T3 overzealousness. So, I will say there because endocrinologists primarily, which is I am one, um have gotten a really bad rap in this um arena and among thyroid patients. Many thyroid patients have abandoned endocrinologists as like not knowing what they're doing, which is true. And they go see, you know, other providers that may not have the education or the background on how to treat this, how to diagnose it, how to dose it. And so I do see about 10% maybe 15% of my patient population who were put on T3 or a T4T3 combination therapy or desiccated thyroid extract who never really actually needed it. And that can be people who've had an elevated TSH in the past. TSH can go high. It's not like, oh my god, your TSH is high. You need medicine immediately. There can be reasons that it goes high. It's a hormone, you know, and it can go high transiently. Um, and you know, if there's other things going on that's stopping T4 to T3 conversion, lots of things, iron deficiency, inflammation, you know, sickness, there's lots of things that can do that. If that basically is blocked for a time, patients and patients get blood work and that's seen by their other physician or other provider, they're automatically put on this medication. In my clinical practice, I do thyroid ultrasound. I love to see the thyroid. I love to figure out like what is the health of the thyroid. I can tell that in an ultrasound. I could see how much um the immune system has beat up the thyroid gland over the years. Some patients, and I love when this happens, they come in, we do an ultrasound, they've been on thyroid medicine for 20, 25 years, and their thyroid looks better than mine. Like, it looks amazing. And I'm like, okay, like, why were you put on this? Do you have your original labs? Like, let's go back 20 years. We've been in 20 years of medicine for no reason. And we come off. They actually feel better when the actual pituitary takes over direction of their indogen because it's way better for your body to do it than if artificial medicine and they're off medication with perfect numbers.
This is this is really interesting. This is one of those I love this so much because this is one of those moments where a patient can get gas lit or wrong information on both sides. So on the one hand we have it's a pendulum swinging. We have these endocrinologists, some of your colleagues who are not well-versed, who are not willing to go do T3. It's TSHT4 and that's all. And so a lot of people, like you said, have fled over to u other providers who are not endocrinologists, but also those who took a weekend course on this topic. This is this is I'm try this is what I'm all about trying to avoid. I'm trying to avoid I'm trying to only bring people who that like they live their life around this and um there is there is there is something I I'll come back to my pendulum in a second but there is something to kind of walking away from your profession that you spent almost 20 years honing not walking away but like saying I I there is something there's a huge gravitas that I think is really important that's why my guests are vetted this way but then we have this so we have this pendulum people who are using thyroid medication as a longevity play for people who don't necessarily need it. If you just you said it so like, "Oh, your TSH is a four. Everything else is fine, but it's like, oh, you can't walk around TSH of four." Like, on the one hand, we have people who are like, "Oh, well, it's only a four. I'm only looking at TSH." But you then you run to the functional medicine provider who's like, "Oh, I can't believe you weren't medicated at TSH of four." And also not looking at the rest of everything. And so then putting you on medication and now you feel like you've done something natural or holistic or a longevity play. And both extremes are not correct. I'm so glad you surfaced that.
As we're nearing towards the end of the podcast, I have some questions I ask all of uh my guests. First is a little bit of a push back and I know you've heard this from my colleagues and I know we've just discussed it a little bit but I got to put it in there. Right. So your colleagues would say you're prescribing T3 and desiccated thyroid without large-scale RCT evidence. Um and you know and the um American Thyroid Association does not recognize this and then you're telling patients they might not need lifelong medications and the guidelines don't support this. How do you answer your colleagues of these esteemed associations?
Well, first of all, I will say that patient or people that say that probably have never ordered a full thyroid panel or the difference between how a patient before on T4 only and a patient after on correct therapy feels and how everything else falls into line. So, they've never actually had the clinical experience. And I think, you know, they're standing behind randomized control trials and guidelines that were made by people who've never had the clinical experience that know how to do this. That's the disconnect, you know, like um academic medicine and people who make these guidelines, you know, they rely on these clinical trials that again I mentioned before, they're not done well. There are so many variables that the people designing the trials don't even consider. They don't know how to dose these medications. This is the problem and they don't they wouldn't ask somebody like me to comment on that. And here's a here's a thing. So, I did a clinical trial in my own clinic on um like liquid T4 products in in SIBO and small intestinal bacterial overgrowth and showing that it's better absorbed and things like that. And when I was designing the protocol cuz it was an investigator initiated one, I said, "Okay, I want the TSH between 0.5 and two." They're like, "No, no, no. The TSH should be 0.5 to five. That's what Okay. Then I want to check the T4 and the T3 and the No, no, no, no, no. We can't check T3 and reverse T3. That's not in the guidelines. You can't do that." So, even when you're trying to actually do a new clinical trial.
To show that this is not being metabolized right, they won't actually allow you to do that because they they know that journals won't accept it down the road because it's not in the guidelines. So you can't change the guidelines because you can't design a study that aren't in line with the guidelines. It's really messed up. It really like.
It's really messed up. So even when you have one willing, let's do this. You can't.
You can't.
That's insane. That's that's that's insane. So this is the medical disruptor question. I think we've answered it, but we got to ask anyway. What's one belief about thyroid disease that medicine does that we need to dismantle and what would you replace it with?
I think that medicine looks at thyroid disease as a one-size-fits-all approach. Everybody needs the same treatment and if the patient doesn't feel better on the treatment and the TSH is normal, then that's on the patient and that's another medical issue. It is not on the provider, the physician. I would say that's completely inaccurate and almost always it is the thyroid replacement medication that is the culprit and it is the provider that is the problem. Especially if that provider won't order the correct tests to look at how the body is metabolizing the medication. How can you fix something if you don't have the actual data and the information? And if you can't understand it and you don't know how to dose it and you don't know how to treat it, that's okay. Be honest with the patient. Say, "I don't know how to do this. Let me get you to somebody who does and maybe let me take some more courses and education on how to do this correctly so that I can help people in the future."
So, a conventional endocrinologist somehow stumbles and falls and listens to this episode. What's their very first push back? Well, free T3 levels, they vary throughout the day and and with dosing, how do you even trust what they're what they show?
I would say treat it like you would treat testosterone, right? So, you.
Oh, I'm leaving.
I'm leaving. You finish.
Treat it like you would treat testosterone. If you just gave yourself a shot, that's a peak. And if you are looking right before you give a shot, that's a nater. And midway point. So, you just figure out when did they last take their medicine? And then you think to yourself, okay, am I looking at a peak? Am I looking at a trough? Am I looking at a midway point? And that's how you interpret a free T3 that changes. That is, you know what? I'm like, now I'm angry because I'm so angry cuz testosterone changes throughout the day. We want when we're trying to do blood work, we say please don't come at the end of the day. It depends if you worked out also. It's pans eight and yet we are so comfortable just prescribing it once a week not even daily once a week and we never have that conversation. That's the push back that T3 changes throughout the day and therefore.
And that's why you that's why you can't trust it and that's why you can't.
But you could trust a random testosterone that's done on a Tuesday at 4:00 PM and base that on I'm done. I'm actually leaving right now. I'm so mad. I'm so mad. And it's not coincidental that most people who need testosterone are men and most of the people who need his T3 for women. It's not a coincidence.
Does not have time for this anger. Oh my god. The one thyroid test every doctor should be ordering, but almost none of them do.
Reverse T3.
Tell everyone where they could find you.
So, I'm physically located in Charleston, South Carolina. I have a brick-and-mortar practice here called the Charleston Thyroid Center. I have patients throughout the whole entire country that come um and um international as well. And then I'm licensed in nine different states. Um, so I see patients virtually through my telemedicine practice called My Thyroid Doctor. So I'm in Minnesota, Ohio, Arizona, Tennessee, Virginia, North Carolina, South Carolina, um Georgia, and Florida. All all nine of those.
Wow.
So if you live in a state that I'm licensed in, you can see us. Um, you can also read more about thyroid and Hashimoto's. I wrote a book about it. It's called What You Must Know About Hashimoto's Disease. It's on um Amazon. You can buy it there. And then you can also follow me on social media. I'm on Instagram. It's @myThyroidDoctor and it's spelled out. But I try to give some useful tips every week.
I love that. And if you're in New York and you end up seeing Dr. Henderson and you need someone to prescribe whatever she recommends, I'd be happy to do that for you.
I love that. Yeah, I love that.
Absolutely. Dr. Britney Henderson, thank you for being here.
Thanks so much for having me.
Of course. Well, that's another episode of the Medical Disruptor. And this is what disruption actually looks like. Not blaming clinicians, not dismissing patients, but exposing the limits of the system and refusing to stop the conversation there. This community exists because too many people were told they were fine when they weren't. Here, you're allowed to ask questions. You're allowed to challenge assumptions. And you don't have to choose between science and skepticism. If you want tools you can actually use, head to medicaldisruptor.com. You can search any topic and find the episode with information that you need. You'll also find the book, practical PDFs, and my newsletter where we break down what the system does well, where it fails, and how to navigate care without losing your mind. Until then, keep asking questions, keep asking for more, and keep disrupting.