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Conversation with Mary Shomon, Patient Advocate

Mary Shomon shares about her thyroid journey, how to challenge the status quo to support your health, and misconceptions held among thyroid patients.

Intro: [00:00:00] Welcome to My Happy Thyroid, your source for all things thyroid health and wellness. My Happy Thyroid is presented by Paloma Health, the first online medical practice focused on living well with hypothyroidism.

Marina Tarasova: Welcome. Super excited to have you here, Mary. How are you?

Mary Shomon: [00:00:29] Great Marina. Thank you. It's exciting to be here.

Marina Tarasova: [00:00:32] It's a great day. Welcome everyone to the My Happy Thyroid podcast, where we talk about all things that are thyroid and hormone related. We're brought to you by Paloma Health, the first online medical practice that's focused on improving thyroid health for the millions of women and men who suffer from thyroid conditions. And today I'm so thrilled to have Mary Shomon, I'm with us to have a conversation. So welcome, Mary.

I just want to tell folks a little bit about your background first, before we dig in and because it's such an honor, really to have you here.You've dedicated your career for over 20 years to being a patient advocate. You're also a New York Times bestselling author, a communications consultant, you're a mother, and you've transformed your own thyroid disease struggle into an advocacy campaign on behalf of patients. And you help countless of patients navigate their condition and feel better over time.

Now I know you have your own story with thyroid conditions. I want to hear about that, so we'll talk about that in a little bit. I just want to share that you really cut through the jargon, out there, the medical jargon and some of the confusion around thyroid health.out there and make things really digestible for the folks that you help. And you've written a number of bestselling books. You've written Living Well With Hypothyroidism: what your doctor doesn't tell you that you need to know. That was your first book.

Mary Shomon: [00:01:54] That was the first thyroid book, yes.

Marina Tarasova: [00:01:57] And you've written other books before that—that's awesome. That was in 2000 by Harper Collins. And that's gone on to do more than 20 printings. I think it's translated in every language and, and all that. And then you also wrote a best-selling book  called The Thyroid Diet: manage your metabolism for lasting weight loss, in 2004, which is so important.

So maybe we can chat a little bit about how that came about, and I think some of your latest work is Hair Loss: Master Plan, which is—I can't tell you how many times I hear patients complain about that and how there's such, so very little out there to help, so that is super interesting.

We can dive in on that a little bit too. And you also, very importantly, wrote a book about healthy pregnancy with thyroid disease with Hypothyroid Mom, Dana. And you guys both have a lot of great insight there. That book, I know, changed and helped so many people's lives, to conceive and create families, which is so wonderful.

You've written a number of other books, and we can go on and on. So those are awesome. And I know you've been featured on like hundreds of television shows and newspaper radio articles, and, are really quoted in the media frequently as a thyroid and hormone health expert. So yeah, we're just so lucky to have you. And we've done a little bit of work together. We look forward to doing so much more over time.

So I want to start like way before all of this great thyroid work that you've been doing and just get a sense for, like, where did you grow up? Did you grow up in the DC area where you are now?

Mary Shomon: [00:03:28] No. I actually grew up in Westchester County, right outside of New York city. On the east coast and a small, small neighborhood, right in the heart of Westchester and  went to grammar school and high school there. And, then I ended up coming down to the DC area to go to college at Georgetown U niversity. So I went to the school of foreign service there—thought I was going to become a foreign service officer at the time. And then, after I finished at Georgetown, I did a sort of shift in direction and ended up moving more into communications and outreach. And ended up working in advertising, marketing, public relations, communications for international types of programs and then government agencies. And, all of this was going on up until the point when my thyroid went haywire. And then I had a big shift in my career path.

Marina Tarasova: [00:04:29] Okay. So we're going to hear about that. So you mean you didn't graduate college and think you were going to become a thyroid health advocate?

Mary Shomon: [00:04:34] No, I did not sit around when I was a little kid saying when I grow up, I want to be a thyroid health advocate and I didn't have a thyroid problem as a child or teenager, or even as a young adult.It wasn't on my radar at all. Health issues were really not much on my radar, except for the normal childhood experiences and the things that you go through as a kid, illnesses and things like that. But I didn't have any chronic diseases. So it was new to me when that showed up.

Marina Tarasova: [00:05:02] Was any of your family in medicine or healthcare growing up?

Mary Shomon: [00:05:06] Not really. I had a grandmother who was a nurse, but she wasn't around very much when I was little because she left us far too soon. So really it was not a family of healthcare workers or healthcare focus for the most part. My dad worked for American Airlines, as a director of purchasing. And my mom was, she was actually a hospital administrator, but she was the HR director. So it wasn't really the healthcare business. It was more the, the HR business.

Marina Tarasova: [00:05:36] Yeah,how interesting. And so you went on to do advertising and worked in all these different industries and then you started noticing some things. Tell us more about what happened then?

Mary Shomon: [00:05:47] It was an interesting time because I had just gotten engaged to be married and I was just around 30 years old and I was going to get my dress fittings and I had picked out a dress and, I was feeling tired and draggy, but I thought, okay, I'm planning a wedding, busy working, I got lots of things to do, social life, all this kind of thing. I'm running and going non-stop. I had never had a weight problem in my life. I was like a size six, size eight my whole life without ever thinking about it. And all of a sudden I'm going in—every time I go to get a dress fitting, the dress needs to be let out.

Wait a minute. Something's not right here. And  I went for three fittings and it got let out three sizes, which is horrifying as a bride —that's the last thing in the world that you want. And I was also depressed and tired and draggy. And I thought something's not right.

So I went to the doctor maybe two times over the course of about a five month period. And the first time she said, Oh, probably just stress and sleep some more and here take some vitamins and things. She was a good holistic doctor. And then the second time I went in, maybe about a month later, she said I'm going to check your thyroid.

Something sounds off. So she ran a complete thyroid panel, which was good because in those days, even today, you're not likely to get a complete panel. You might just get a TSH. She did a full panel.  But as was typical, and as still as typical, I got a phone call from the doctor's office that said, oh, Dr. Kate found your thyroid's a little bit low, we've called in a prescription for you. Go pick it up. And that was all I knew. And this is before the earliest days of the internet. So it's about 1994, where everybody has their giant AOL disks to dial up and it takes half an hour to get online and things.

So there wasn't the ready-made, panoply of information available for us to get at our fingertips. So I've got a thyroid problem. I don't know really what it is. And I'm taking some medication and I'm not feeling better. I'm not losing weight. I'm not feeling more energetic. Nothing seems to be helping.

Marina Tarasova: [00:07:59] So is it like just Synthroid?

Mary Shomon: [00:08:00] It was, yeah. I think it was just a Levoxyl or not even Synthroid. I think it was Levoxyl or even a generic levothyroxine, but I know it was synthetic T4. And I was just mystified. So I started to try to do some research and went to the library. I found one book about thyroid disease and it was—I always call it "your thyroid, the most boring gland in your body by middle-aged man, MD" because it was downplaying how not important it really was. It was just like, this is just a breeze. I went and looked at articles. There wasn't much of anything in magazines  So I ventured on to the internet—the Wild West in those days—and got on to the databases for the national library of medicine and started doing some reading.

Yeah. And I found in those days we had those use net alt net. The use net groups, which were the earliest kinds of forums for people to connect and talk to each other. So there was an alt support fibroid Usenet group. Wow. I got onto this group and I found out that there were a lot of other people that were in the same situation as me.

And we were like, wait a minute, what's going on here? We're taking these meds. It's not working. Something's not right. And then there were old timers. People that had been diagnosed in the fifties and sixties saying, I'm still taking natural thyroid or I'm taking Thyrolar and I'm taking this or that.

And we're hearing about other meds that we've never heard about. And it's all new information to most of us. So I'm the kind of person that I like to understand everything. So I started gathering. Everything I could find. And I saw as new people got on, they got their AOL disc and got, and found their way to us.

We were having a constant influx of new thyroid patients. And so I put together an FAQ for the newbies. That was just, if you have this issue, if you have this question, et cetera, frequently asked questions and I would share it and send it out. And then people said, you should make, put it on a webpage.

Instead of reposting it constantly. So I was like, okay, how do you do that? So stayed up one night, like 24 hours straight, on the computer, like a crazy person and learned how to code, I  learned HTML and put together a webpage.

Marina Tarasova: [00:10:17] Amazing.

Mary Shomon: [00:10:17] And that was like in 1995.

Marina Tarasova: [00:10:20] So this is after you've been married?

Mary Shomon: [00:10:22] Yes, I was just at the beginning of my marriage. Yeah. I think I had just been married. I'd been on thyroid medicine for maybe a year. And, so I get on, I create this webpage and I start sharing the webpage. And fairly soon after that, then there were sites that started to develop and there was a little website that said we're recruiting people for health-related pages.

We'll pay your internet bill  if you put together some information. So I said, I'm doing it already, I might as well. So I signed up with this company called The Mining Company. And very soon after that, The Mining Company changed its name to About.com and they were then acquired by the New York Times.

And, we went public, we went live. And, the next thing I knew, my website was getting, a million hits a month. Insane. It was crazy. And it was funny because back in those days, all the editors at About.com were all like very young 20-somethings, living in Brooklyn, New York hipsters, they were  hopped up on Red Bull and playing foosball all day in their offices.

And they were like, yeah, nobody's going to care about that. Thryoid—like, no, who cares about it? And I said, I bet you people are going to care. And because they were young, they were healthy. No idea. And the next thing I knew, it was one of their top rated health sites and actually then became one of the top rated health sites on the internet. And, for quite a long time was the top rated.

Marina Tarasova: [00:11:55] I completely understand how it works,  how it could be such an important site. I just continue to be— it's mind boggling how the thyroid is still portrayed as this boring, unimporant thing when really, so many people care about, it's got such a bad rep.

Mary Shomon: [00:12:11] People just assume it's  middle-aged women who are overweight and want to lose weight and so it's just whiny, overweight women looking for an excuse for why they're fat and it's so much more than that. And that so underplays the reality of what it really is for people.

And, I was talking to women from 16 years old to 85. So it was not just my demographic, which at that time was women in their thirties. It was women trying to get pregnant in their twenties. It was women in their forties going through the early stages of perimenopause. It was women who were pregnant and struggling women within fertility, and senior citizens.

I said, wait a minute, I'm 75 and I'm sharp as a tack, but I feel like I'm a hundred what's going on with this. It was just, it was a really interesting time in the world for thyroid because I had a lot of pushback from the endocrinologists and they were not happy because they were very comfortable with patients that didn't ask questions and do research and just accepted what they said as the gospel truth and went on their way. So it was here, you have a thyroid problem, take your thyroid medicine and come back in a year for another test.

Marina Tarasova: [00:13:29] Now how did you hear from these endocrinologists? How did they get in touch with you?

Mary Shomon: [00:13:34] Oh my gosh, there were a couple that were just absolutely out of their minds. There was one that used to post on the alt support thyroid and call me all sorts of names that I can't even use in polite public. He was terrified of thyroid patients taking control of their own care. I was stalked for seven years by another endocrinologist who created a fake Twitter account and said I was a drug addict and that I was a drug pusher. I mean said all kinds of crazy stuff until Twitter finally shut them down.

I've been sued by chiropractors who said that they had solutions to cure thyroid issues and I've been sued by them. Their suits were all thrown out of court cause they had absolutely no merit. I have had endocrinologists say all sorts of crazy things about me.

I think one of my favorite stories is there was a meeting of the American Association of Clinical Endocrinologists and they were starting out the meeting. Everybody was there and the guy that was opening up the meeting, a prominent MD endocrinologist. It was the time when the David Letterman top 10 lists were quite popular and he started out the session and he said, okay, we're going to get started everybody.

And to kick it off, I'm going to do my David Letterman, top 10 signs that you have a crazy thyroid patient walking into your office. And his number two. I can't remember what the number one, top 10 sign was, but his number two top 10 sign was, she walks in carrying a copy of Mary Shomon's book.

That's when I knew I had made it because they if endocrinologists are opening up their meeting, talking about my book, I'm having an impact because that means that patients are walking in with copies of my book and saying, why didn't you tell me this? Why aren't you helping me feel well, why aren't you doing what I need to help me get well?

And so that was really actually very affirming. I've had an uneasy relationship with the endocrinology world for decades now, but that's okay by me. Because any time you are trying— as we see in the world today—anytime you challenge the establishment or you challenge the status quo, there's people that are going to come out fighting to try to keep things the way they are.

The endocrinology world is no different. They do the same thing and they are notoriously slow to change and adapt to new information. And, so you know, the fact that patients now we're getting information, knowing their options, asking for different choices, being empowered was a threat and it's changing.

Marina Tarasova: [00:16:18] It's changing  for sure. Certainly, we work with endocrinologists. We think not all endocrinologists have changed, but many have, and I think some of it's a testament to the work that you've helped catalyze and the availability of other information that's right available in many locations. And that patients really did, I think, start to take care in many aspects into their own hands and it has forced the system, if you will, or many physicians, to start to react to it rather than have to not do that.

Mary Shomon: [00:16:52] And I think it's been it's been fantastic but, you know, the idea of the empowered and knowledgeable patient is it's not a unique to endocrinology either. We're seeing it across the board, across medicine, and it's also a function of HMO's and health insurance and the seven minute doctor visit and people being shuttled in and out very quickly. We don't have time with our doctors.

I sometimes will say you have to be the CEO of your own health. Because nobody else is going to worry about your health the way you do. The days of the family doctor, the Marcus Welby, who worries about you from cradle to grave is gone and that's one of the things I think is like the most unfortunate around of the current healthcare system.

Marina Tarasova: [00:17:36] There's so much innovation, there's so many breakthroughs and technology and research but we forget sometimes that an important part of medicine is really the connection to the human being and the doctor knowing you from your background and your family and talking to you about all the things that are in your life, not just the medicine you're taking, and your blood work, but like, how are you sleeping? How are you eating? What are you eating? Who is living in your house with you and how's your relationship with them?

Mary Shomon: [00:18:05] Yeah. I agree a hundred percent. And when it comes to something like thyroid, where the emotional symptoms, the mental health related symptoms, the cognitive symptoms, these are all things that are very difficult to measure, it's not going to come back on a blood test, a chart with a flag that says high, low, normal. It requires some nuance. It requires some subtlety. It requires the art of medicine, not the science of medicine. And through no fault of their own, there simply isn't enough time for many doctors to practice that kind of art.

They just don't have enough time, which is why, I'm always advocating for people to find and work with doctors, at least for their thyroid care, that know what they're doing, that are already up to speed and doctors who are not going to rush through a five minute visit where they're on the phone and texting and talking at you from the door of the office, which is how a lot of people's doctor visits go.

Marina Tarasova: [00:19:06] Definitely. Now at this point, you've probably interviewed hundreds of patients, doctors, the various practitioners, you do your own one-on-one coaching with patients to help them out. What do you think are some themes or maybe like common misconceptions that, you feel are out there? From a patient perspective that are myths if you will, around thyroid care and third world that like have crystallized to you as like maybe top two or three things that you want to share now.

Mary Shomon: [00:19:37] Honestly, I think one of the biggest myths is that everybody who's hypothyroid needs an endocrinologist. You really need someone who specializes in managing thyroid symptoms and managing thyroid care. So you need a doctor who knows better how to optimize your hypothyroidism treatment. And that may be the endocrinologist. There are some that are very tuned in, but it may not be an endocrinologist. It may be a nurse practitioner. It may be an osteopathic physician or a holistic MD. Sometimes it's the physician assistant at your doctor's office.

Marina Tarasova: [00:20:17] And there's different modalities that I think can meet different patients' needs. I think some endocrinologists, they're definitely the experts, like you said, in the thyroid and the endocrine system so we, at least with Paloma, we definitely handpick the experts that we work with. I think one of the things that you've like hit on is that all these practitioners have to be tuned in. They have, it's not just about  in a rote way, giving the same dose to everybody, given their numbers, really listening, and uncovering and really hearing what's going on. And there's some small change can make a really big difference because the thyroid is so sensitive and it's also, the whole system interplays with  itself, with each other, is something that requires someone that's really gonna take their time and be tuned in.

Mary Shomon: [00:21:08] Exactly. And, people want thyroid to be cookie cutter. They want it to be so easy. If you have a prop, here, take this, do that , three point plan, all solved. And that's the thing. It's not that easy. The standard guidelines that a lot of doctors are forced to follow. Whether it's the medical society or their health insurance, or an HMO are very limited.

It's like we're giving you 20 problems and we're only giving you two tools to fix them. Whereas when you're dealing with somebody who's actually tuned in and understands what they're doing, they realize they have many different medications. At their disposal, different brands, different dosages, different combinations, as well as supplements and dietary changes.

And other issues that come into play and it is a trial and error process. Doctors are not always going to get it out of the gate. Even the best, most tuned in smartest doctors are not going to be able to talk to you and say, Aha, this is a breeze. You need to take this medicine at this dose and take this supplement and everything's going to be fine in four weeks.

It's not like that, but a lot of doctors either they don't have the knowledge or they don't have the time to do that tweaking, that back and forth, that hey, we need to look at your T3 levels and see, are you getting enough t3? Are you converting? Are you, optimal? Is this causing you hypo or hyper symptoms? How can we support you with diet or nutritional changes? Is your lifestyle not supporting good symptoms and things?

One of the most common, whenever I do, thyroid workshops and teach thyroid works up shops, I'll say to people, okay, everybody raise your hand if you're tired. And then I say, all right, everybody who is sleeping at least seven hours a night, bring your hands down. And everybody keeps their hands up because nobody's sleeping seven or eight or more hours a night. And I said, all right, every one of you tired and complaining, number one, I want you to start aiming towards at least seven hours a night, because anything less than that is short sleeping and you're shortchanging your hormonal system.

You're shortchanging your thyroid and you're not getting enough sleep. So all the thyroid medicine in the world isn't going to solve your problem. If you're not getting the basic sleep you need. So people need to understand that it's a multidisciplinary process. Thyroid medicine—and for some people, yes, if they're borderline, mild hypo thyroid, they got a few symptoms, they're a little out of sorts, they get on a thyroid medicine a couple of weeks later, they say, I feel back to normal, more power to them. I'm so happy for them, but that's not the standard experience of a lot of thyroid patients. We need time. We need some trial and error and we need that support and relationship with a good practitioner who's going to work with us, hand in hand so that we can find the thing, the medication that safely works best for us to relieve symptoms and get us feeling and living well.  

Marina Tarasova: [00:24:17] Yeah. Totally. Any otherbig myths out there that you want to help?

Mary Shomon: [00:24:21] I guess another big myth is just one that you'll see promulgated by everybody from the endocrinology societies to some of the very, radical patient sites, which is that there is one medication or one brand of medication that is better for everyone.

Every one of us is unique. And so people often say to me, what's the best thyroid medicine? And I say the best thyroid medicine is the one that safely works best for you. And that may be a generic, it may be a brand name. It may be levothyroxine. It may be a synthetic T3 or Cytomel or generic. It may be natural thyroid and any one of the brands, Nature Thyroid, WP, Armour, et cetera.

But the reality is you're going to have to find the one that works best for you. There's excipients, fillers, dyes, different ingredients, different formats. In levothyroxine, we have liquid gel caps, tablets, there's all different modalities and finding the one that's going to work for you best for you is a trial and error process.

And I have talked with people who are on every possible combination. You can imagine. That found that was their sweet spot, their perfect solution. Yeah.

Marina Tarasova: [00:25:36] No, I couldn't agree more. Everyone is so unique—your thyroid is super sensitive. Your body is super sensitive. There have been like amazing things that, in our practice we've seen someone who's just has a slight sensitivity to an excipient and you switch it out beautifully.

And that's such a small tweak and easy, but you do have to be on both sides. The provider has to be willing to go through and do that detective work, and the patient has to work and do the changing and, going on to the next thing. There a process to it too. And unfortunately we don't have the science yet to know, like, for you, Mary, it's going to be this one that's going to be personalized...

Mary Shomon: [00:26:15] And you hit on a point. I think that's really relevant for people to keep in mind, too, that I think is important for thyroid patients to remember is that this process does require a certain degree of patience.

And, we have to be patient patients, so to speak, because it does take time. Even if you were lucky enough to, right out of the gate, get on the right thyroid medicine at the right dose. It still could be four weeks to three months before you really start to feel the full results of it in your body and in your symptoms.

And if you are doing some trial and error, you have to give it time to see, okay, is this working okay? Then I got to get rechecked and see what my blood levels are. And then we're going to tweak the dose or add something or change something. And then we've got to see how I'm doing on that and then get rechecked again.

It can take some time  so people need to keep in mind that. It's not like taking an aspirin for a headache. You're not going to say, oh, I took my thyroid medicine today and now everything's going to be back to normal. It takes time to become hyperthyroid. It takes time to become back into balance again.

Marina Tarasova: [00:27:28] Yup. And conversely, like, if you forget your thyroid hormone, it doesn't mean you're going to be like feeling hypothyroid right after, so yes. It's a longer term process and education  that I think m any people  listening to you will appreciate learning. Other than perhaps being stalked in your career, what are some of the other, like most challenging things that you've had to fight for in terms of advocating for patients and getting the education out there around it?

Mary Shomon: [00:27:55] I think one of the biggest issues was in the late 2000s, around 2008, 2009, when, we faced a major unavailability of some natural desiccated thyroid. And there were some threats at that time that the FDA was going to either pull natural thyroid off the market or, and, or require it to go through the formal drug application process because, people don't always understand, but natural desiccated, thyroid drugs are FDA regulated, but they are not FDA approved. They were on the market before the FDA even came on the scene. So these drugs were essential. You couldn't pull them off the market and have them go through years of testing,  and they had been in used safely for years.

So the FDA said, all right, we're grandfathering them in and letting people continue to use them. And, so behind the scenes, there was a lot of discussion and the FDA was ready to start putting it on the list and basically saying, look, you can take levothyroxine and you're not going to die so we can pull these drugs off and require them to go through review. And patients that were on natural thyroid were furious and terrified. And so we mounted a major advocacy and communications effort. People were calling and writing the FDA. We were promoting information and people's knowledge and, they didn't want to deal with the hassle.

So they put it on the back burner. And it's still, there's always still a possibility that it's going to come to the top because they're working their way through all these grandfathered drugs that were in existence in the  early part of the. 20th century and eventually they may require most of them to go through a formal drug application process.

But for now their natural thyroid seems to be safe. And, it hasn't been a particular interest, although I always worry with drugs like that, as it gets more of a market share, cause it's coming back up again. Now people are starting to use more natural thyroid. You worry then that the FDA will get on the radar again. But, that was a serious issue because I was taking natural thyroid and I didn't want it pulled off the market. And I certainly knew that a lot of my fellow patients didn't want that either. So that was another big challenge that I think we've had.

And then, for me on an individual level, the challenge, I think for me is also is in talking with people who don't have health insurance. They're afraid because they know they have a thyroid problem. Some of them have lost their jobs or lost insurance. And this is going on long before the pandemic, but it's obviously even more of a crisis right now with the pandemic, but we have so many people that don't have insurance or have very, their insurance is very limited.

And so they can't really afford to go to a doctor who do they even go to get properly diagnosed? And then, they'll say, look, I was on Armour forever, but my doctor retired and then I lost my job. And where do I go to get, to get natural thyroid anymore?  I can't walk into a doc in the box, or a minute clinic or something—they're not going to help me. So people are really confused about what to do. And they're also frustrated about the costs of medications because you go to a pharmacy. And you could pay that $5, $20, $50 for the same medication, with or without insurance and co-pay cards and everything has a lot of confusion for people and they need to know where they can go to get the right kinds of doctors without trial and error with 20 different doctors. And they need to know how to get information about how to get their prescriptions filled safely with the medication that works best for them and to be able to afford it. And so it's not breaking the bank, especially when things are tough economically.

Marina Tarasova: [00:31:49] Yeah. We always try to help when we can but it's one of those things that in a healthcare system shouldn't be a problem, but it is.

Mary Shomon: [00:31:57] And that's why I'm excited about  services like Paloma, where we have an opportunity for people in those areas where first of all, you can get testing at a very inexpensive cost. You're not going to pay ridiculously high markups that some doctors are charging or you're not going to pay— even insurance copay sometimes for thyroid blood testing is absolutely insane. If you're in states that are served for telemed [with Paloma Health], you can actually get with a doctor right away who's smart and knows what you're not going to have to educate them.

They're going to be educating you. And, we've got information and that's one of my missions is to help people understand where can you get your thyroid meds for the least amount without sacrificing quality of what you need and the meds you need. And so that's why I'm really excited about  the kinds of things that  Paloma is doing to help make testing and treatment available and affordable, and why I'm out also out there, working on trying to educate people about their options and how to afford their medication, under the current systems that we have.

Marina Tarasova: [00:33:04] Yeah. thank you for that.  I think you've clearly done a fantastic job. You've made it to the front lines of the doctor's meetings, you've been stalked— all signs of that you've clearly had an impact. You obviously, of course, having impacted so many patient's lives, you've shared in the past that you get baby photos of people who you've been able to help conceive. What better?

Mary Shomon: [00:33:29] Those are my favorites—those babies.

Marina Tarasova: [00:33:31] So what's next? What do you see as next on the horizon for the improvement—as I think you've brought the folks that you're able to impact up to speed on the options. Definitely crack the sort of veneer of what the medical community hasn't shared necessarily .

Mary Shomon: [00:33:48] I have a couple of things that I think are important to me. Number one is I do really want people to begin to understand and see the importance of a multi-disciplinary approach to their thyroid. Again, for a small percentage of people, taking the pill is all they have to do. They're not going to think about it much more than that, but for those of us with a thyroid as a real true chronic health condition that we are living with and trying to manage and suffering from in some cases, I want people to begin to look beyond just that bottle of medication and look at their, what they eat, how they manage their stress, their movement, their sleep, their hydration, their supplementation, the toxins in their environment, all of the different things that have an impact on thyroid health.

But also frankly, we're now understanding they have an impact on all our health issues across the board. So that's one thing that I think is going to be important. The other thing I really want to see people do is to recognize and get beyond the frustration with their insurance and their doctors and their plans and things that sometimes you have to jump out of what you're in order to get what you need, because people say, my health insurance is supposed to pay for this. So darn it. That's what I'm going to do , and they'll take an inferior treatment or an inferior doctor when for just a few pennies more, or maybe not even, they might even save money.

They can go out outside their insurance or their HMR, whatever, and get what they need that will work for them more quickly. But people are they just, they have these boxes around it and they just don't think they don't realize they can go outside the box to do things. And so I want people to understand that, these are tools, they are not restrictions for us.

So that's another thing. I'm also very excited because I know that some of the drug companies are researching some new thing, new forms of thyroid medication. I know there's, T4, T3 combinations and time releasing, which I think is going to be a big, game changer for a lot of patients. There's also  we were talking about the endocrinologists coming along and starting to get with the program—and I was so encouraged to see that, the endocrine society and the thyroid association and stuff did a survey not too long ago. And they found that the vast majority of their patients on levothyroxine and weren't happy.

They were like, wait a minute. We were expecting that these patients were going to tell us how, happy and fabulous everything was, and all of a sudden, they're like, wait a minute. It's  not working for us. And so I'm so excited to see that they are actually starting to acknowledge we have to do better for these patients. They're not happy on the standard, cookie cutter, same old treatment approach that we're giving people and that's going to force them to think outside the box as well. So I'm really pleased to see them starting to assess those because honestly, 20 years ago, the idea of assessing thyroid patients as to whether they were happy with their treatment, it was like, they were like, who cares?

Take your thyroid and go away and leave us alone. And now they're saying wait a minute, these patients aren't feeling well and they're not losing weight and their cholesterol is high and they're on antidepressants and cholesterol meds and something is missing and at something we've been yelling for 20 some years, better, late than never.

I'm glad to see them coming into an era where they're starting to recognize that the patient voice is important. We're always hearing about evidence-based medicine. And I years ago, I said, what about patient-based medicine? What about patient evidence? I've talked with thousands of patients. I know certain things. They may not be in the New England Journal of Medicine. But I know it as much as a fact, as if it's published in a major medical journal, because I've heard from thousands of people that anecdotal information, it may not be in a science journal, but it's just as valid. And so to listen to patients and to start taking patient voices into account is a tremendous positive movement in my mind.

Marina Tarasova: [00:38:19] Totally. Totally. And I think so many, the work that you've done has helped move so many practitioners forward in that sense. And I think we're seeing a lot more focus on the patient, focus on what the patient's saying, and evidence-based medicine is important, but it's not more important, or differently important, than hearing from the patient from patient-based medicine.

I love that. And I think we'll start seeing a lot more innovation in the thyroid space, which I'm encouraged about as well. So that's awesome. I look forward to that and I think maybe we'll have another podcast. Some, sometime, hopefully in the not too near future to talk about those thing .  So thank you so much, Mary. What a pleasure to chat today.

Mary Shomon: [00:39:02] Oh, it's been great Marina. Thank you.

Marina Tarasova: [00:39:04] And where can people find you if they have questions or they want to read more about what you're doing?

Mary Shomon: [00:39:08] They can find me on my website at mary-shomon.com. And I'm also on Facebook at Thyroid Support. And, my funny name on Twitter, which is Thyroid Mary.

Marina Tarasova: [00:39:24] Thank you so much, Mary. It's such a pleasure and we will talk soon. Have a great day. Stay safe, please.

Mary Shomon: Thanks, Marina.

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