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Fertility and Hypothyroidism

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Hear from Dr. Afrouz Demeri, Zermina Akbary, and Madeline Given about how to improve fertility while managing a thyroid condition.

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Katie: [00:00:00] Hi everyone. Welcome.  My name is Katie. I'm part of the team at Paloma Health. And I am your co-host today, along with Mary Shomon, who I will introduce in just a second. For those of you who are new here, maybe you heard about the event from one of our speakers, Paloma Health is the first online medical practice focused exclusively on hypothyroidism.

We offer at-home test kits, consultations with thyroid doctors and nutritionists, prescription management, and we recently came out with a vitamin supplement, a daily thyroid care vitamin supplement. So that's a bit about who we are. And you're joining us today for our monthly speaker series.

Each month we have a 60 to 75 minute event, doing a dive on a specific topic related to hypothyroidism, and we feature, two or three experts in the women's health field. And then we include time at the end for live question and answer. So we'll have time for that today. You'll see, at the bottom of your screen a chat feature. Start thinking now, and as stuff comes up, as our speakers are talking, feel free to drop your questions in there and we will get to as many as possible at the end.

And we'll make sure that you know where to find the speakers so if you have more questions afterwards, you're able to access them on their websites via email, via social. So without further ado, let me introduce Mary Shomon. Mary is a patient advocate and a best-selling author. She's written, I think, 15 books.

And she really is an expert in the world of thyroid and diabetes. And we're really lucky to have her here with us to help moderate the Q and A and co-host this event. Mary, I will let you take it from here. You can tell us a little bit more about who you are, and then Mary will introduce our speakers.

Mary: [00:01:51] Thank you, Katie. As Katie said, I'm Mary Shomon and I am first and foremost, a patient advocate. That really is my mission. And I consider it my mission to help people fast forward up the learning curve, through all of the growing pains of dealing with their health condition and get to the good part feeling well, living well and having a healthy, fantastic life.

And that's why I'm really excited tonight that we are focusing in on issues around fertility, because when you are trying to have a baby, the good part is the best of all. It's having that baby and adding to your family with such a precious, welcome new edition. So I am so thrilled. We have three absolute powerhouse, superbly bright and empowering experts to share their wisdom with you. And every one of them has walked in the trenches of this issue, that intersection of hypothyroidism and fertility. And so they're going to be bringing you expertise from a variety of integrative holistic and whole person perspective.

So I wanted to start out by introducing our first expert. Dr. Afrouz Demeri is a board certified naturopath and she is really specializing in treating and working with and empowering women who have hormonal imbalances, including thyroid issues, women that struggle with fatigue, with weight issues and with other common, but often overlooked and dismissed issues.

So she is really putting her laser-focus on these kinds of issues that are plaguing women of all ages. And in particular, the issues surrounding fertility, healthy conception and healthy pregnancy and a healthy postpartum period. Dr. Demeri is also Director of Functional Medicine at UC Irvine. And she is also seeing patients at the Susan Samuel Integrative Health Institute and in her private practice.

So Dr. Demeri is going to be talking to us today about the causes and treatments of infertility while managing hypothyroidism. And then we will have our two other amazing experts following up, as part of tonight's presentation. And please keep your questions coming because we're going to be keeping track of them and coming back around to them as we go through tonight's presentation.

So I'm going to turn it over to and thank Dr. Demeri for joining us. And, take it away.

Dr. Afrouz Demeri: [00:04:40] Thank you everyone. So I'm happy to be here. I like to start off my talks with giving you the end goal right away in case I lose some of you till the end. I'm going to tell you what's really important. Or fertility is to make sure your thyroid is optimal before you become pregnant, not once you are pregnant.

And what that means is please get a complete panel. Now I love Paloma because it is so cost-effective, it's so easy. I use it all the time with my patients, but before you guys were around, make sure you check at least your TSH and you want that number to be less than two. And we say two, but for some people that's still not optimal.

You want to make sure you don't have Hashimoto's. If you have Hashimoto's and you have time, please deal with it before you become pregnant. And this is a huge passion of mine because my mother had Hashimoto's and she didn't know. I had Hashimoto's and I had a miscarriage. Thyroid runs in my entire family.

We have everything from graves, to thyroid cancer to nodules to Hashimoto's to hypothyroidism without Hashi. So I had to become an expert in this field, not because I wanted to, but because I realized every single woman I saw had some sort of hormonal endocrine issue. So with that said, please,

if there's anything you learn from today is go get your thyroid checked. TSH, T3, T4, which Zermina is going to talk about and make sure your numbers are optimal. They're not just within the normal range because for fertility, we don't want normal, we want optimal. The most important thing I want you to know is I always say there's two things that your body needs.

Every single cell of your body uses. And that's vitamin D and T3, what is T3? We're going to talk about that, but just remember that your thyroid hormone is used by every single cell of your body. So whether you have fatigue, you have hair loss, you have issues losing weight, you feel cold in general, you're that person that's always like having their sweater on or your husband's like hot at night, and once the AC is on and you're freezing to death, Or you go to the doctor and they take your temperature and it's sub optimal. Now that is huge because that is your thermostat. Your thyroid is your thermostat. And the other thing is, have you been stressed for a long time, chronic stress and remember stress doesn't have to be something mental, emotional.

We're going to talk about viruses and things that you might be doing. Your toothpaste might be a stressor to your body, which then stresses out your thyroid. Feeling sluggish, feeling like your brain just doesn't work like it used to, you're not as smart as you were. I remember I was a math genius and in school and math was like my thing.

And then slowly as my thyroid started becoming dysfunctional, I remember just feeling, oh my God, I don't remember things very well. So it affects the brain and affects your mood and affects your joy and how happy you are, and also how smart and how good you are at recalling things. So just a reminder for those of you that are new with us, the thyroid dictator, or the boss at your work is in the brain and that's called TSH, thyroid stimulating hormone.

That's like your employee, right? That's the guy that tells the workers what to do. Then your workers are your thyroid gland. What does it make? What do they do? They make something called T4. That means four iodine molecules. So remember thyroid is made up of iodine. We'll get to that in a second, but guess what?

These workers imagine they're going to turn on their computer and work. But the computer is off. The computer does not work. They cannot work. What am I trying to say is what your thyroid makes is inactive. The cells cannot use it. They have to have very good functioning liver. Your liver has to function well for that t4 to convert to something else called T3.

Now I hope you're asking why is this so complicated? Why can't we just make that thyroid hormone and have it active and just get it used up. There's a reason. There's a reason why we have a boss and a director and a manager and work. So if your employer is like work guys, work thyroid, we need thyroid hormone.

Then we're going to go to the workers, say like, how are you guys doing? Are you guys actually, okay, are you making enough T4? And then we're going to see, are you making enough T3? And that's what's important. That's what the cells needs. But it gets even more complicated. Let's say I'm going to write that email, but then something happens and it breaks down in that traveling and it actually doesn't make it to me.

There's something else that can happen called reverse T3. That T3 can go into the cell, but then it gets blocked and actually is inactive again. So as you can see, this is pretty complicated. It's not very straightforward, but unfortunately the way medicine has been practiced today, the way primary care physicians, even including myself, were trained in school was just to check TSH and then we give the little tick of you're good. Everything's fine. Because the range for TSH as Zermina will go through is pretty large. So for fertility, remember, we want the brain to tell her thyroid to make around two or less than number the value to be two.

Now, if the guy is screaming to your thyroid, make more, the TSH will be higher in value, right? If it's saying, please don't make more. There's probably a reason. So that's what I want. Most of us advocates for our patients, we're asking these why questions. We're knowing, why is it high? Why is it low?

Why is your reverse T3 high? Why is your body saying slow down? So there's a reason why these workers--imagine you're overworked, you're going to stop working. You're not going to produce as much quality work and that's what the body does. The thyroid does this for a reason. It's not out to get you. What we want to look at is the whole picture.

So here's a really good graph that shows T4 converts to T3, but it can also convert to reverse T3. And you can read all the factors here, but I'm going to go through this more in detail in a second. And then it goes into the cell. It's very complicated. It's not as easy as it seems. So that's why you really want to find a doctor who like myself likes Zermina, like Madeline, who are, this is this is all we do.

We know this inside out. And we still don't know enough. Recently, two years ago, I found out that the reverse T3 is actually made inside the cell. There's a reason why it goes up. We don't want to just crank up T3. If it's low, we want to ask why is the body making more reverse T3? It's like your car.

You're trying to go fast on the highway. And you're just putting the gas pedal on and it's brake is on. There's a reason why the break is on, right? The break is reverse T3. So hopefully you're trying to understand your values and asking your doctor. Why is my T4 low? Why is it high? Why is T3 low when T4 is high. I'm making enough, but how come it's not converting?

So a lot of people have in my practice, what I see as a T4 to T3 conversion issue or T4 is going into reverse T3, and you can see things that can promote that as stress trauma, fasting, not eating enough. That is a stressor: famine. Fight, flight, or famine is fasting. So fasting, I know is very trendy, intermittent fasting for women, but I always say you have to do it at the right time of the month and you also have to be very careful depending on your adrenal function and how well you regulate blood sugar before you start stressing your body out.

Toxins, fluoride. I talked about toothpaste. Mercury was one of my bigger, I had eight fillings in my tooth before I had my daughter and I had no idea that mercury was an issue. I loved my sushi and sashimi and tuna spicy tuna rolls. And just thought I was healthy because I was more of a pescatarian. Little did I know how much mercury passes on to your first born?

And we see this in their meconium. So I'm a huge proponent of detoxifying the body--the female AND males before they conceive. And this really helps the thyroid out. The thyroid is so sensitive. It's right under the skin here, you spray cologne, you spray perfume. You put lotion on your neck.

It goes straight into the thyroid. Please keep this away from any endocrine disruptors. Obviously we don't want to going into the skin, but keep it away from here. But the other big one is auto-immune disease. Whether you have celiac, whether you have even gluten sensitivity and not true celiac, but obviously the biggest one that we all know about, which is 90% of the females I see as Hashimoto's thyroiditis or auto-immune attack on your own thyroid. Hashimoto's is not a thyroid issue. You have to ask yourself if your body, your doctor, why would my immune system overreact and go into this mode of attack when we are pregnant? What happens is that kind of fixes itself, right? Because now we have a foreign person inside us. So our immune system is so intelligent.

It says I can't go into attack mode. I have to defend this baby. So everything fixes itself. And when do we typically see thyroid and Hashimoto's come on? Typically after that first birth or the second birth, when there's a huge hormonal shift. We see a lot of women having issues with losing fat body fat.

So I always say you want to fix your thyroid, but you also want to be at your optimal fat percentage before you can save. There's tons of research, even on sperm, health, and men and obesity, and what happens to the offspring later on in life, in their sixties. So this is not just for females. This is also important for men.

And sperm quality, air quality, leptin sensitivity, thyroid resistance, all these words, I'm going to throw out you. Basically, we got to become friends with stress. Stress is not bad. It's what you think about what's happening that is good or bad. And so for you might be stressed and not knowing. So sometimes I will measure and say, wow, your cortisol is through the roof.

Like you're waking up, like there's a lion in front of you. And the person will be like, That makes so much sense or they might not be in tune and tell me I don't feel stressed. So then we have to investigate and figure out what's happening. What are some stressors for that person? The other huge one, as I said, fasting. I mentioned that is blood sugar dysregulation is a huge stressor on a body and that can throw off the thyroid.

So it's very important that your sugar. I'm not saying diabetes, I'm saying blood sugar regulation, which means no, yo-yoing, no going up and down and up and down. That's the issue. Most diabetics don't just have too much sugar. They actually start off by having bouts of low sugar. Then they, the brain's like I need glucose.

So then they crave sugar and they eat. So it's actually low sugar and these dips of hypoglycemia, that is the root often of the issue. So you want to figure out why is that happening? Why am I eating? And then two hours later, I need to eat again and I'm hungry and I'm moody and I'm shaky and I'm busy.

So my analogy for the thyroid, when patients come to me and they're right away, given thyroid meds is the thyroid is in the middle of your sandwich. If you eat bread and sandwiches and you're not paleo, there's always something above it. And there's always something below it. Your thyroid never decides all of a sudden that it's going to go off.

There's a brain above it that dictates to it, what to do. And there are adrenals and sex hormones right below it, your ovaries that are right under it. So whenever I'm trying to fix and understand someone's thyroid issue, I'm looking up here. And literally sometimes we have to do MRI. We have to actually look at the brain and see is there actually an avid Noma, but I'm always assessing the sex hormones, insulin and cortisol, which is below the thyroid.

You want to look at the whole cascade and go, who's talking to the thyroid. The thyroid is I have a light bulb here. It's just the thing that turns things on and off. But you got to look at the light bulb, you got to figure out why is my body slowing itself down? Or why is it speeding it up?

So there's a communicator from a peer and below. So just remember that if you're only looking at your thyroid values again, very important to do that. But if there's something off, please test everything else in the, in this sandwich model. We want to look at the whole sandwich. My understanding, and this is what I've come up with now, and maybe I'm missing something, but after 14 years of doing this to me, there's always, this is how I assess my thyroid patients.

Is there a command issue? I said, who's talking to the thyroid. Is the adrenals telling the thyroid slow down or are, is the brain telling it to, is there a production issue now? We're going local. Is something attacking the thyroid? Is there a virus like Epstein-Barr virus or other viruses or other issues that the body almost goes into self-sacrifice, right?

Or like gluten. It looks a lot like the thyroid gland, And it has to sacrifice itself and kill itself in a way to get rid of the thing that can be detrimental. And that can trigger the autoimmune aspects. Or is there been so much radiation? Let's say your you've got your.

Teeth fixed a lot and lots of x-rays and they never covered your thyroid, but actual damage is done to the thyroid. So is there a production issue from damage or inflammation from Hashimoto's or viral or endocrine disruptors, mercury, fluoride, whatever. Or is there a signaling issue? Is the communication, like I said, when you're sending that email.

Is the email going through is the T4 getting converted to T3? And is it getting inside the cell and then is it getting into the nucleus that we can't measure yet? But there's a whole cascade just cause you have enough T3 also doesn't mean everything's going to work well, which is why I listened to my patients.

Your numbers are 50% of your case. If you have amazing numbers. Which there may no, we'll go through what's optimal, but you tell me I'm cold. I'm losing hair. I can't lose weight. I'm constipated. I have dry skin and you might not have all of those, but at least if you're cold or you have any of these issues and you're tired.

Then I'm going to go. It might not be working in there. There's something else going on. So that's important. The signaling could be off. And then, like I said, the receiver is the cell receptor open. Are you going in? Is the T3 actually going in and are the receptors working? So the root cause of most firearm issues as I'm sure you've you could figure it out by now from everything I've said is.

Nutrient deficiency, stomach acid being below. Most of my patients, we don't have enough stomach acid anymore. I don't know if it was 20 years ago, when I was in school, we used to measure stomach acid. We used to make people actually swallow a pill and see how high the acid would be and pull out this string.

And it was a horrific test. So I don't do that anymore, but most of us are so stressed when there's go sympathetic mode that we don't have stomach acid when we're digesting our food. And our nutrients, our soil is so depleted. We're not getting magnesium. We're not getting a lot of these nutrients.

And if we do eat the most amazing meal, we're not even absorbing everything. So nutrients are huge. Inflammation from Hashimoto's inflammation, from the diet inflammation, from stress. This is what can make the cell say, I don't want, I don't want T3 when you're inflamed. So you can measure this from CRP or ESR, but sometimes those will come back normal, but the body's still inflamed.

The thyroid slows down when there's inflammation, the thyroid goes, I don't want to burn right now. I gotta hold onto this fat, just in case something goes wrong. Remember caveman times, we couldn't be like super thin and skinny because we had to have reserves in case something happens. So when your body is inflamed and it's stress, it will hold onto things  just so it has enough reserve for later. So you want to fix the inflammation and not just crank up the thyroid and crank it up and crank it up. I see a stressor, our cortisol goes up. Chronic I see all the time. Flat-line cortisol. No cortisol all day. Person is burnt out. Addicted to coffee, loves their sweets or salty food.

Easily gets up and gets a little dizzy and fainted or has low blood pressure. So I'm for sure many of you fall into this category. Heavy metals mold is huge. I'm a huge proponent of checking mold issues and women's specially since they are more prone to genetically having mold issues before pregnancy. Lyme disease, environmental toxins, pesticide.

So please be eating like you're pregnant already. Don't wait until you're pregnant, eat like a queen. Organic, just really self care. Imagine what you would feed your baby. And you want to start doing that now, whatever you wouldn't put on your baby's face, don't rub it on yours, whatever you wouldn't do to that child don't do it to yours.

So I always say, do you really need coffee? Is it. Okay. Is it going to make you have a miscarriage? No. But would you give your baby a coffee is a necessary? Is it giving you nutrients? Is alcohol giving you something that's good for you? So all of these things, if you have thyroid issues, you want to fix these things and say, what is my motivation for having these things in my life to begin with?

So in medicine, we are trained to look at disease and say, this is going to cause disease. That's not what naturopathic and functional medicine is about. I don't care if you can have one cup or two cups. You don't need it. It doesn't help you. You are missing out on having a different beverage that actually gives you nutrients and helps your thyroid viruses.

The biggest one I see that affects thyroid is Epstein-Barr virus. And I will do a PCR and actually look at the viral load and the body. And I have seen clinically many patients that whether I put them on low dose naltrexone, or I have them on monolaurin. Lysine transfer factor. All of these herbs, cat's claw, and I help reduce the Epstein-Barr viral road.

I have seen their TPO values will come down. Okay. And then lastly, I want to talk about this, the cell danger response that I said, this is huge. This is so big for thyroid as one of the root causes. It's the thyroid itself saying, please? I'm in danger. Let's slow things down. So let's respect the thyroid.

Let's respect the intelligence that the body has when it's trying to communicate with us. Something is off. But I will say when my patient says, I want to get pregnant now, or I am pregnant now, or I wanted to get pregnant yesterday. I sometimes don't have time to do this. Okay. So as much as I love this.

I'm going to be realistic and say, you know what? Your TSH is five or 10 or four or 3.5. I'm putting you thyroid because I want to make sure if you are pregnant right now, that's okay. Everything, that's the DNA and everything that's replicating that you don't miscarry and that your baby grows. And that you're well.

So as much as I'm very holistic. We're also going to be safe and we're not going to wait and wait and figure out the root cause when you want to get pregnant right now. So with fertility, it's a little different than if you were 56 seeing me, right? If you're 56, I'm going to take some time to do some testing.

Look at your guts. Look at your secretory iGA, do a stool test. Look at your immune function. If you have Hashimoto's. But again, if you are in having fertility issues, I will probably prescribe a natural desiccated thyroid like nature throid, WP thyroid, all of the nice cleaner ones. If you are sensitive to those and they don't work out, I prefer Tyrosint.

And levothyronine and T4 and T3, that's more clean. I'm not a big fan of Synthroid. And the more, some of these drugs, just, they cause sensitivity. People know right away, they go on it. They don't feel good, but again, if you are wanting to get pregnant, make sure your T3 is in the optimal top third.

Your TPO is in remission and it's totally doable. I will stop there. Cause I know we're out of time. I just want to show you quick graph. This is your cortisol curve. I love looking at your cortisol to tell how your thyroid is doing so you see here where it says metabolized cortisol is very high.

Metabolized cortisol is very low. What is your metabolism? We all blame when we are gaining weight and countless weight, why don't we all blame it on our poor thyroid? So your metabolism or anything that metabolizes in the body is the thyroid and the liver. So if someone has an adrenal function like this and they're metabolized, cortisol is super low, I automatically start thinking we need a comprehensive thyroid panel and I will do the Paloma Health  test to make sure the thyroid's working well.

Mary: [00:26:55] That was D . Afrouz Demeri, and she has given us so much food for thought and so much information. And I think you're beginning to understand, because I know we have viewers that are already know you have a thyroid condition and are trying to conceive and looking at being as healthy as possible for conception.

I know we have some folks that have had a miscarriage, or have experienced some infertility and are looking to make sure that the thyroid and the immune system is not getting in the way of conceiving going forward. So we have people coming from a variety of different perspectives, but as you can see, the advice that we're getting from our experts today is really focusing in, on all of the factors related to the thyroid and the related hormones and supporting the nutrition.

To keep this all in balance to allow us to have a healthy pregnancy maintain that healthy pregnancy. And of course have that healthy baby. So we're going to move on now to Zermina Akbary and Zermina is a registered nurse and she's a certified holistic health counselor. And, as with all of us here today, she's really come to this world because of her own challenges to her own challenges with infertility and with thyroid disease led her to become a functional fertility nurse consultant.

Wow. I wish that I had one of those a few years back when I was, looking to, to have my children, She's also an independent consultant and in practice, really, and again, like all of the women here to help women balance their hormones heal and optimize their chances for conception.

And in particular, Zermina is using functional medicine and integrative nutrition approaches that she is bringing to her practice working with women. And she's going to talk to us today more about the issue of testing. So if you are new to the thyroid issue, you're going to learn about some of these tests.

If you are already a thyroid patient, but you are looking to optimize for fertility or to resolve some infertility challenges, Zermina's going to give us some advice on testing and the micronutrition. So I want to welcome Zermina Akbary. Thank you so much for joining us today.

Zermina Akbary: [00:29:27] Great. Thank you everyone. Thank you, Katie and Mary, for inviting me to talk about one of my favorite glands. I'm so honored to be speaking alongside Dr. Demeri and Madeline on this topic because it is a very common topic. And then we see that the statistics are not, unfortunately  getting better. A as you mentioned,  my name is Zermina.

I work with patients who are struggling with thyroid disorders, having infertility struggles, imbalanced hormones, and balanced adrenal glands. Many of my patients have a really hard time getting a full panel from their traditional doctor. So I love using Paloma for my patients because it's easy to collect the samples.

And so cost-effective like Dr. Demeri mentioned. So one of the things that I do with my patients is I do fertility awareness method charting. And so I look at their charts and as Dr. Demeri mentioned, our thyroid is like our thermostats. And we often see that when I am having them check their core body temperature on a day to day basis, I can now see their core body temperature.

And oftentimes doctors will just check TSH and say, oh, it's within range. It's above two, but under 4.5, everything looks normal. Let's you know, you don't have to go into reverse T3, or T4. And so when I request this, then they come back to me and saying, I don't have optimal levels of free T3 or free T4.

And in some cases they get a new diagnosis of Hashimoto's because that hasn't been checked, their TPO antibodies haven't been checked. So I'll be going over a testing and micronutrients that are needed for thyroid function. So we'll start with testing. Why is it important to test for thyroid hormones when you are trying to conceive?

Clicker is going a little bit too fast on me. All right. So we know as Dr. Demeri went over very well, thyroid stimulates the growth of tissues and controls your metabolic rate and key production. A fetus depends on the mother's thyroid hormone for the first 24 weeks. A little over half of the pregnancy term, as we know, and the fetal brain develops rapidly between 12 and 22 weeks of gestation, which means that optimal thyroid hormone from the mother is essential for fetal brain development.

I love the example that Dr. Demeri gave was you look at Japanese children. They're so incredibly smart because a lot of the mothers don't have any hypothyroid issues may have very optimal third function. So you want to go ahead and have your thyroid properly be assessed. And so your thyroid was probably assessed by checking only a TSH as the single lab screen, as is the case for the majority of patients seen in traditional medicine.

I know because I used to be trapped in this one concern. I struggled with infertility challenges for about three and a half years. Hashimoto's hypothyroidism, as well as thyroid cancer, being the cause. And my doctors only just went ahead and checked TSH. And there are several problems with using only a TSH to assess third function.

TSH actually comes from the pituitary gland to stimulate production of more thyroid hormone by the thyroid gland. If there isn't enough thyroid hormone circulating, so a high TSH can mean a low thyroid hormone. The first problem with. just testing TSH is only that it's just one player in a multitude of hormone that makeups thyroid function.

The next problem is that their range for normal TSH is quite wide. So usually it's about 0.5 to 4.5, depending on what lab you go to. In functional medicine, we look at optimal ranges over normal ranges, and we look at personalized levels. Dr. Demeri touched upon, you're not just treating the number.

You're also treating the patient and you're looking at their symptoms. Do their symptoms line up with the number that we are getting through labs? So the optimal range for TSH is typically between 1.0 to 2.5 for women preparing for conception at TSH under two is ideal. We also want to check free T3 and free T4.

Your most abundant thyroid hormone is T4. That means about 95 to 97% of your thyroid makes T4. But this is inactive. This T4 has to be converted into T3, which is the power force. The queen of all thyroid hormone, and we want the conversion of T4 to T3, to be assessed. And we want that T3 to get into the cell where it's used to drive metabolism.

Using this functional medicine perspective helps us to find more third problems and find them sometimes earlier, giving us a chance at more effective reversal of that or disease process. We can also, we also now are finding that most thyroid diseases is auto-immune, which we can also screen by looking for TPO and TG antibodies.

And oftentimes the thyroid will actually start to go off and that Hashimoto's is a immune problem and not necessarily a thyroid problem, but over time it turns into a thyroid problem. And so if you test this early on, you can actually go ahead and reverse this or put a stop to attacking the thyroid.

So it's very important to make sure that this is checked. Generally we like to say annually, as I do screen patients, I do request and I'll send them the Paloma kit and have them go ahead and test them. Sometimes it's their first time getting this tested and they find out they have Hashimoto's and what's really sad is that patients will come to me with miscarriages and this biomarker was never tested.

And they also have trouble conceiving and this was never tested. And we finally went ahead and tested this, got them, the proper treatments worked on their micronutrients, tested those. And then we were able to help to bring those antibodies down.

So that was your full thyroid panel. And then there are also additional nutrient lab testing, which Dr. Demeri brushed upon, that I recommend all thyroid patients to go over with their doctor. First is iron and ferritin. Ferritin is an important protein because it stores iron. If you're deficient in it, then you probably have symptoms like hair loss, fatigue, poor thyroid function. The optimal ferritin level for thyroid function is above 70. This one really gets me because the range is so wide. It's anywhere between 15 to 200, 150, depending on what lab you go to and patients will present with a lot of these symptoms. If you're having a level of 20, you're going to have one of the late markers is having the third of your eyebrows.

You're losing hair in that area. So a lot of patients will say, my ferritin was normal, it was checked. But again, we're talking about optimal ranges and you want that to be above 70. Selenium and vitamin D. This is a major two players in the immune system balance. So Hashimoto patients often have very low vitamin D ranges.

And most of my clients who have gotten into remission have optimal levels now, of this nutrient. And then the vitamin D levels should also be between a 60 to 80. So we're also talking about optimal ranges for vitamin D as well. You don't want to be in the twenties or thirties. You need to have optimal vitamin D levels to have optimal thyroid receptor and immune system function.

Iodine has got to be my most favorites. And this is so interesting that I'm on this panel with Dr. Demeri. When I was going through my struggles with my fertility challenges and Hashimoto's, I was so torn with all of the research. In fact, I went for personal enrichment to really get trained in thyroid health and I was so torn because I would visit so many providers that would have different view on iodine supplementation for Hashimoto's. I've came across many of them where they're like, it's absolutely so harmful for you. And I met Dr. Demeri at a summit. Then once I found that I finally got pregnant, I was actually moving back to Orange County and I reached out to her and I was like, Dr. Demeri, you speak very highly of iodine. I know that you love this mineral. I've used it. It's actually helped to bring my TPO antibodies down. Are you familiar with the work of Dr. David Brownstein and when she responded yes, I was like, I'm going to go to her because I know that I don't have to be aggressive with testing.

I know that I'm going to be in really good hands. And for me, I felt like that's really what my body needed. And I also have a history of, and I still have PCLs. So that was a huge struggle for me as well. And I knew that iodine was not just an important mineral for thyroid, but also breast health and ovarian health as well.

So we do know how important that is. And we know that T4 has four iodine molecules, iodine isn't just needed for thyroid function. Like I mentioned, many organs in your body needs to have iodine. And then I also recommend to have your minerals, selenium, iron, zinc, and B12.  Selenium and zinc should be done by RBC Cantonal, to also look at optimal thyroid function.

That's one important reason to ensure that you're taking a multivitamin or prenatal supplement that has enough of these minerals to support your natural third hormone production. like Dr. Demeri was saying, some people may have a gallbladder that's not functioning well. And or low stomach acid. We need to optimize that first.

And sometimes food may not just be enough. You can be so deficient that you may need to supplement. So really important that you're working with the health care practitioner that is looking at these biomarkers. And then it's also very important to test for cortisol. Dr. Demeri  mentioned and said that the thyroid never just decides to give out.

It's always the adrenal glands. And so I always test for cortisol for my clients. You can either do saliva or urine. My favorite is urine. And so it's important to test this marker because treating hypothyroidism without treating the adrenals is one of the biggest reasons why people continue to feel exhausted despite receiving treatment with thyroid hormones.

The best way to test for this as either by a four points of library, urine tests, urine cortisol will only give us one marker. And it's not the best way to test for this.

So just a quick, thyroid physiology. We need to look at how the body even produces TSH and your respective thyroid hormones. The very first thing is that this TSH doesn't just magically appear in order to properly make TSH, you have to maintain adequate protein in your diet. Magnesium, B12 and zinc are also required to make this particular hormone.

So these three micronutrients, magnesium, B12, and zinc, and then the major macronutrient protein are all responsible for helping us to properly produce TSH. So if you're on a vegan, vegetarian diet, this is going to be very challenging for you. Then there are also certain nutrients required to make T4.

One of them is iodine. As we talked about that foreign T4 refers to the four molecules of iodine. Some to make T4, you have to have four molecules of iodine. If you ever see iodized salt in the United States is iodized as a result of a widespread goiter epidemic. And goiter is when your third is enlarged.

And because of this, they found out that there was an iodine deficiency, and this is why table salt is iodized. However, it's not my most favorite form of getting iodine because by the time it's actually been exposed to air, it's been very oxidized and it's been depleted of all its other important minerals. So I don't recommend trying to get your iodine from that particular source because there are negative consequences to over-consumption of standard table salt.

You can get your iodine from eating fresh vegetables. Seafood is my favorite. Kelp and seaweed. So I had done this not only in the nutrient required to make T4. There's also mechanism inside your thyroid gland that helps to draw iodine into the thyroid gland. That mechanism is a little kind of Door called a symporter.

And it requires B2 and vitamin BC, sorry, vitamin C. And that vitamin C, we know that's something that our body doesn't make. So we need to be getting that from antioxidant, fruits, and vegetables. That' symporter won't work to bring iodine into the thyroid gland, unless you have these two nutrients in place to run that symporter pump.

Then there's also an enzyme that converts T4 into T3. And that enzyme is driven by selenium and sync. And a lot of Hashimoto patients have this problem where they're not converting that T4 into T3. So it's really important to make sure that your selenium and zinc are at optimal levels. So it doesn't just stop there.

And that T3 has to activate the nuclear receptor of the cell. And that requires vitamin D and vitamin A. So vitamin A and D deficient can also stop T3 from activating yourself to increase your metabolic rate and increase your energy. So I do often see that a lot of patients will be put on Synthroid or levothyroxine.

They start them off usually around 25 micrograms. Let's see how you do when they never addressed these micronutrients. And what happens? I feel tired. I feel exhausted. So three months later, I go back. My doctor says your medication must not be working. Let's go ahead and increase their dosage. And over time, they just feel worse and they may have not necessarily needed that medication to begin with.

If all of this was addressed, as Dr. Demeri said, there is definitely a time and place for medication. And that's why proper testing is so incredibly important here.

Dr. Demeri touched upon, food. So I'm going to go over some food sources where you can get a lot of these micronutrients. We're going to focus on iodine. You can get that from seaweed, eggs, saltwater, cold fish. And making sure that it's wild caught. So it doesn't have the high mercury levels, especially for fertility. Selenium in Brazil nuts, about one to three a day. Shrimp, halibut, sardines, grass fed beef and salmon.

Vitamin D: salmon, sardines, mackerel, mushrooms, and of course, staying out in sunlight. Magnesium: many of us are very deficient in this and the soil is very depleted. So you can get a lot of this from pumpkin seeds, almonds, spinach, quinoa, dark chocolate, and avocados. And vitamin a: my favorite fertility food is grass fed liver.

It has so many important nutrients and it can actually help with your iron and ferritin levels as well as also your vitamin A levels. So my big advice here is for fertility, make sure you are eating nutrient dense, whole foods. Eat minimally processed food that look as much like their plant or animal origin as possible.

I know that there is a lot of talk around goitrogenic foods like kale, cauliflower, Brussels sprouts, cabbage, broccoli. And with hypothyroid is you tend to be more on the colder side. So I always say, as long as you are cooking those vegetables down, it's okay. You have to be having like five bags of broccoli for it's actually affect you.

You don't want to be having them raw, especially for fertility purposes. You really want to have more warming foods. So it's really important to make sure you have those cooked down and just think of that baby wanting to be snuggled up in a very warm environment and not a cold environment. My second favorite is homemade broth.

It's highly nutritious and healing to the gut. Gut imbalances are usually a common trigger for thyroid disease. Seaweed is another favorite one because it's high in iodine and essential nutrient for thyroid hormone production and then gut health. Dr. Demeri did a great job on going over this, but fermented foods are so important for gut health.

Your gut health is where most of the T4 to T3 conversion actually happens. If you don't have a healthy gut, you're most likely to have challenges, making proper amounts of thyroid hormone. I will now have Madeline takeover so that she can go more into nutrition and supplementation. Thank you everyone.

Mary: [00:47:03] Thank you so much. That was Zermina Akbary, a registered nurse and expert on a lot of aspects of thyroid and fertility and the nutritional component and the testing. Thank you so much. For going through all of that really valuable information. And I'm hoping that everyone is beginning to get the message that we're hearing from all of our experts, that it's not enough to fall into just the normal range or the reference range.

We really need our optimal numbers. So even if it's a little intimidating, cause I know we're throwing around a lot of terms today, a lot of different tests, it's going to be really important for you, if you want to master this topic, to start to really know the names of the tests. And the numbers and your test results, because it's not enough for your doctor or the nurses office or somebody to call and say, oh, your tests were normal.

You want to know what was my result? What was my number? And where does that fall on the reference range? And then you're going to come back and watch the replay of tonight's wonderful speaker series so that you can understand what all of those different numbers mean. So we're going to go on to Madeline Given.

And Madeline, thank you so much for joining us. Madeline is a holistic nutritionist, a mom, a cookbook author. She really loves to empower women and help them take control of their health and their fertility. She has an active consulting practice. She is working with her clients on meal planning, non-toxic living, which is a big issue these days, because, as Dr. Demeri  was talking about, we want to avoid all of these toxins and they're in our beauty products, in our foods, in our environment.

So healthy non-toxic living is an important preconception step and she is going to be talking with us a little bit more about the diet and supplement issues for thyroid health during preconception. And while we are hearing this third of our three presentations, I also invite you to continue to keep sending in your questions because when Madeline is finished, we're going to shift into Q and A mode, and we're going to be able to get answers to the questions from all three of our amazing experts.

Madeline Given: [00:49:33] Thank you so much. I just have to share, as I'm listening to these amazing women, I'm crossing off on my notes, okay, so glad we covered that, glad they heard that, but it's funny to go towards the end. Such a fantastic, full, rich presentation. So I feel like the words were all ready taken out of my mouth.

So thank you so much for sharing that. I have reworked a little bit of what I wanted to say based on just the incredible amount of knowledge that was already shared. So I thought I would just briefly share a little bit of my own journey. I don't have a huge thyroid story, but I did do a lot of testing with Paloma.

I have two children. I have a three and a half year old and then I have a two months old. So I'm technically on maternity leave right now. So if I seem a little scattered,  there's not a lot of sleep going on over here. But I'm happy to be here. And I think what Paloma is doing is fantastic.

I predominantly work with women who are pregnant. And then the rest of my clientele is kind of split between postpartum and preconception, and so much in terms of diet and supplementation. It's very similar, in terms of my preconception and prenatal patients, because you really need to prep this so far in advance, which has been stressed already by both of the previous speakers, that there really is no time like the present to start prepping for pregnancy and making and for setting yourself up to have a really successful and healthy postpartum, which is something that I did very differently this time around when I had my second.

I did not take care of my self in terms of preparing for postpartum. So if I could even get you to think, as your fertility, that this is setting you up for success and not just for a successful pregnancy, but also for the next ten years down the road, because, I actually tended to find postpartum as really anytime after you have a child.

So it's not just those first few months. It's not just that first year. I always say the phrase like postpartum is forever. It all is so intertwined. So we did a couple of tests before pregnant the second time. I really didn't ever have known issues with my thyroid throughout my earlier life.

And so I never actually had that tested because as the, previous speakers have explained, you often have to really push for these kinds of things. So if you don't have outright issues or symptoms or things, in my point in that direction, very blatantly, and you're probably not going to get them shoved in that direction by a typical conventional doctor.

And so I did two different tests through Paloma within the year before. The second time I was doing it out of curiosity. I'd had a lot of, fatigue, but of course I was a new mom and that feels very common. So I often see a lot of clients who chock up, what ends up being hypothyroid symptoms to being a mom or being a working, stressed out adult. And I think it's really powerful when professionals and doctors like Dr. Demeri actually go out of their way to listen to those, even if your labs are a little off. I think my first lab was for 4.5 TSH, which was really surprising because I just assumed, I'm a nutritionist, I eat well, I have a good lifestyle. It should all be wrapped up with a nice bow for me. And then realized, oh, do I want to work? Do I want to be getting pregnant right now? Is this going to be a problem for me in terms of, continuing to, carry on with good thyroid health because babies really do suck the life out of you, literally.

You really want to set yourself up ahead of time to be like they said previously, not just at okay levels or within range, but optimal. I love that word optimal. I use it all the time, like as optimal as it can possibly be. So I did a lot of work just through diet and I ended up meeting with a lot of clients who are possibly more in the gray area than who  maybe not seeing a doctor yet, they're not visiting a naturopath, they have some symptoms. They're not sure what's going on. So I do think there's some things that you can be doing that I call them more in a gray area where maybe your lab's a little off, you just want to optimize, you don't have explicit t hyroid disease that you know of.

But it's still a lot of things you can do if you know that maybe you're allowed to they're a little wonky or if you're feeling some symptoms. And so I w just did a couple of really basic things about with my, clients who be going in that direction thyroid wise, and was able to get it down to 3.4 within that year and then, conceived and had a healthy pregnancy. So I love that they're talking about the number two, because I also agree, and I was also a little freaked that it still wasn't below two. But I guess I share that just so you know that numbers, again, aren't everything.

I haven't retested since giving birth and I'm excited to do that. I'll probably do that usually around four months postpartum. But I remember being worried about my numbers and thinking, oh my goodness, if I get pregnant right now, it's all gonna go poorly because I was so invested in the numbers.

And  I think you should be invested in the numbers to some degree but just to give people some comfort or some hope that there are there other things or other factors that are all at play here. And so the really basic things, like I said, so much of this has already been shared.

But I did just want to like quickly point out. I had a really basic supplement protocol as so many supplements, micronutrients, in some of my favorite foods, but so much of that has been shared. But one of the really basic things that I did that is, I think really just attainable because I think listening to all of this might feel a little overwhelming.

If you're in a place of, where do I start? How do I work through this? If I want to start taking the more natural approach before necessarily going on thyroxine or some type of medicine, then, what can I do? And so one of the really basic things that I started doing, and then actually I, continued into pregnancy with this protocol because it was a safer pregnancy protocol. Just to sign up pretty much any preconception or fertility program that I will place someone on, is almost always going to be something that's acceptable in pregnancy, just for the simple fact that the whole goal is that you're trying to get pregnant. So if you get pregnant in the middle of all of this, you want to be able to continue to support your thyroid doing the same thing you're doing when you get pregnant.

So again, these are really basic things. So much has been shared, but one of the things I did was I made sure to really increase my vitamin D3. Again, this is obviously very safe in both pregnancy and breastfeeding, preconception, all of it,  upwards of 2,000 to 4,000 IUs a day. And they, I think, a lot of that was already stressed before, but some of the more, maybe less known micronutrients that I focused on was I actually, I didn't take straight iodine, but I was taking selenium and inositol, which is something that I don't think was mentioned.

I did a combination of these two, which are both safe in pregnancy. Selenium is really critical for conversion of T4 to T3. Like I said, I'm really focused on the rest of life as well.

So it's been shown to decrease the risk of developing postpartum thyroiditis, which like a whole other chapter, the postpartum thyroid chapter in women who are positive for TPO antibodies before or during pregnancy. So this can all be started, like I said before pregnancy, during pregnancy and then continued.

So I took about 200 micrograms of selenium a day. And I'm sharing numbers, although I would stress that you don't just run out and, take these amounts. This is something that you would want to work with a professional through. But this is the same values that , in general, will work with clients.

And again, this is what I did for myself. So I upped my vitamin D. I did about 200 micrograms of selenium, which again, is safe during pregnancy if you do  conceive. A and then there's some  research that's shown that when you combine selenium with inositol that it can be really powerful at reducing like anti thyroid auto antibody.

And that can also help to really improve TSH levels. And that was really my main goal was to get that down. So I added that onto my selenium protocol. And from what I have researched, around 600 milligrams a day, combined with that selenium is also safe as you go into pregnancy as well.

So I saw a lot of success with just to those three things. And I was, considering do I want to just take a little hint of some more prescription medicine. I was working with a couple of other, naturopaths on that, and ended up getting pregnant and everything panned out really well.

So I'm really thankful for that. But I also just want to stress quickly, that to really pay attention to your symptoms. I can share a quick story about a postpartum client . I think as women, we're not always taught to believe in ourselves and listen to our all intuition and we have such powerful perception and self perception and intuition.

And I see that a lot when clients have finally come to me after, and I'm not a doctor, but will come to me after seeing multiple specialists and doctors who are not really listening to them. And because I've either been there or I'm just really believe in the power of a woman's intuition,  listen to what they're going through and what they're actually feeling as opposed to just a lab.

And that is to realize that there really is a problem. And I had a client who was at one year out post partum, absolutely exhausted. TSH numbers ended up being like off the charts high, but she didn't know that because no one bothered to send her that direction because they just assumed, you must be tired because you have a one-year-old.

And she had no reason to think differently. She was immediately put on a protocol and her life was literally changed by that. And I've seen that happen a lot. Even in preconception. Maybe you don't have a child yet, but there are a lot of other stressors in life. And I think those things can often get blamed on when really what's going on is within your body.

And there's a lot that you can do to see comfort and to seek healing. So that's just a little quick kind of laying out what that could look like. If you are in that gray area where you haven't been diagnosed with something but you really want to work towards thyroid health. You want to make sure that you're not in that kind of, area, but really get optimal.

So those are the different things that I did. The other women shared a lot about foods and whatnot. I think somebody shared this little piece of info, but, it's so important to be optimal before you conceive. The whole point of this topic is fertility and preconception, but, the whole point of conduction and fertility is obviously to have a beautiful baby. And pregnancy can be a real pain, or it can be a real, dreamy time. I think some of that is genetic and some of that has to do with other environmental factors, but a lot of it can really be whether or not you can set yourself up for success during this pre-conception time.

So if you have like an itching to get pregnant tomorrow, I would say, take three months, six months, to really focus on your nutrition. Someone mentioned that your baby does use your own thyroid hormones until you're in your second trimester. And so you're getting that sucked out of you as well.

So if you're already low or high or you're off balance in some way, once you do conceive, if that happens, like it's not going to get better unless you're really working aggressively to keep that healthy and keep those numbers healthy and to keep everything balanced out.

Once you hit your second trimester, ideally your baby has their own thyroid hormones that are being created within them and not just sucking from the moms. And then just knowing that, in terms of iodine, which has been talked about excessively, because it is the number one. It is so important and it's the main nutrient being discussed in this chat. But yeah, the requirements for women, they almost double when you do become pregnant?

So just to imagine if you're not setting yourself up for some kind of optimization beforehand, it's going to be a real big stretch to get that amount . Pretty much every pre prenatal has a very bare minimum, like just enough to stay by.

And that's, if you are already fully loaded with that nutrient, meaning that you're already not, seeing decreases in your own system. So if you're already low, that is not going to cut it. So there's that where there's a very low amount of prenatals on the market today that actually you're seeing really high optimal amounts.

There are some. I love that there are more companies focusing on that. It's something to be aware of. I think a lot of people end up taking a prenatal. A lot of women are requested to take a prenatal in their preconception phase of life. And that's something that I definitely recommend, but know that's usually, unfortunately not enough, even if it's this, bonafide prenatal.

They don't always have your best interest in mind. And dietary sources really can be the best sometimes. Veggies, seaweed, a lot of dairy, and then eggs as well. So  if you are not an animal eater. If you are a vegetarian, if you're not consuming dairy eggs or fish down, that is going to be another big red flag for you to be aware of that.

And that's something I often see is women thinking, well I'm eating a really healthy diet and vegetarian, and yes, you can eat a healthy diet when you are vegetarian, but it takes a lot of work, especially when you are in the conception phase of life. If you're in a childbearing phase, I think it is really difficult and most prenatal experts will agree with me.

I think that it can be done, but it's something that has to be done really carefully in terms of, the nutrients that you're getting. because this is a very different time than just you living your single life on your own. Like you are trying to create a new life from scratch.

If there are not a lot of animal products or fish products in your diet, then that's the thing to really know and be aware of that. You're not probably getting a ton of dietary iodine anyway, and it's crucial for all of that thyroid hormone production.

I'm jumping all over the map here and I know that we're already way past time. So if someone wants to get into Q and A.

Mary: [01:03:16] Yeah,  I think we're going to go ahead and move on to questions. Thank you so much, Madeline. I get the feeling like that all of our experts tonight, we could have done probably a full day seminar with all of this incredible in-depth information. And, I hear you have some amazing recipes, I'm still thinking, oh, I wish I could get some recipes. I'm going to start with a question for you and then I'm gonna bring up a different question, but this is one that I've seen come up several times during tonight's presentation for everyone.

As we were talking about foods, we've talked about the good things for the thyroid, the things to eat to help put good things back into our thyroid. What should we be avoiding specifically? Are there things that we need to stay away from? To, ensure a healthy preconception period, a healthy prenatal period, a healthy pregnancy.

And during that postpartum period, are there some things that we need to watch out for as far as what we're eating or supplements we're taking?

Madeline Given: [01:04:22] Yeah. So much of it is really general and there's not necessarily like one specific ingredient, food out there that's going to really make or break it. Obviously there's food groups and different things you don't want to binge on. So I think that's usually what I work on with clients is it's not overdo certain things as opposed to completely cutting things out of. There are obviously certain things that you would be absolutely fine cutting out, such as trans fats and processed sugar, soda. You don't need caffeine or alcohol, which is what I think someone else mentioned earlier. These things are not going to necessarily make or break your health and the health of your future child. But again, my question that I often ask people is how is this going to nourish your body and how is this going to nourish your child?

And if the answer is well, it's not, then you might as well just drop it in such a special and unique time as this childbearing time. That's a short time. And it really is. It's like a blanket in the span of your whole life. If you can give up some of those creature comforts, that can be really helpful.

And I usually focus on what you're adding in because it feels a lot less negative. And then if you're really able to fit in all the good stuff you actually end up finding, you don't have a lot of time or a lot of room on your plates for the bad stuff.

Mary: [01:05:30] A question that has come up a couple of times, Zermina, if you can unmute, I'm gonna throw this question to you.

We've had a few people that have said, what about smoothies? Because, they have started that, they think I'm going to do the healthy thing for myself and they start having the kale and spinach smoothies. And they're going to absolutely, hog-wild on this amazingly healthy smoothies and their TSH is going up.

And they're wondering if this is not a good idea when they're planning for pregnancy to start indulging in lots and lots of green smoothies, or is there a way to do it, right?

Zermina Akbary: [01:06:15] Yeah. So that's a very good question. And I see this with a lot of my clients who come in and say, I'm having salads and I'm having smoothies all the time.

That's healthy, but it's not necessarily good for preconception and thyroid health. And I always say for preconception, you really want to be having warming foods and it could be really hard on your thyroid to go ahead and take in that raw food, the raw vegetables. So I always say, cook down your vegetables and then make it into a puree.

And in a soup you really want to focus on having more warming foods. I always say, if you need to have your smoothie, then add a little bit of tumeric or ginger, add some type of heat to that so that it doesn't creates so much dampness. You don't want to have a damp uterus. In traditional Chinese medicine, we really want to have more warming foods. And so my response to that is just be sure that you're adding in some type of spice, ginger, tumeric. That's going to go ahead and create a little bit more heat to balance that out. And if you can, your kale, your spinach, just try to cook that down before you consume it raw.

Mary: [01:07:26] Great. Now I want to go back to Dr. Demeri, because we've had a couple of questions that are focusing on how do we know from a number standpoint, whether we are in an optimal place from the auto-immune standpoint? We've talked about our optimal numbers for TSH is less than two. And obviously we want to see T4 and T3 numbers that are robust and strong and capable of supporting a healthy pregnancy.

But when we're talking about auto-immunity and the ability to get rid of those antibodies completely may not be in place. So where are we in remission or where are we in a healthier place? For preconception and for healthy pregnancy, when it comes to those thyroid antibodies,

Dr. Afrouz Demeri: [01:08:17] First of all, it depends on the lab. So I know I saw some people are in Europe. Whether you're in the US, Australia, different labs have different ranges. So be careful what you're looking at. Mine is the less, the better. Ideally we want less than one, but that's not always the case. So you want to look at the trend over the years.

It's not, if it's the first time you've ever checked and it's at 600. There it's active. But typically if it's less than 300, I'm not as worried. However, for miscarriage prevention, I still put my patients on thyroid medication if they are actively trying, just to be sure. Okay. And then as soon as they become pregnant, I saw lots of questions on how often I test, I will test sometimes every week or two at the beginning to make sure that it is still in that range.

I stopped testing after two or three readings are consistent. And, I'm good. I know that it's. It's staying that way because your thyroid, as Madeline said, those double in production, however, that's what we've seen in research. That's not clinically what happens always. So again, you want to look at what the research showed on those 388 people they tested, but you might not be that 388 person.

So I have tons of patients where we're expecting it to double and it doesn't. And so I am increasing their thyroid meds fairly quickly if they have Hashimoto's. If they don't have Hashimoto's, I tend to be less stressed and I can sleep at night, but if someone has Hashis, I will put them on thyroid. If they're anywhere over 300.

Mary: [01:09:55] That's, that's great information. And I'm gonna come back to you with one more question here, which is related to timing because we all know that it's very important. If you're testing hormones, the estrogen, progesterone. If we're testing pregnancy, we have to wait a certain amount of time after conception. We want to test certain times in our menstrual cycle for estrogen, progesterone, et cetera.

But we've had a few people that have said, is there a particular time, in the hormonal cycle, when we're going to get better information or more accurate thyroid testing. And it's a valid question. And I think maybe you can handle that for us.

Dr. Afrouz Demeri: [01:10:36] Such a great question. And just so everyone knows every, if there were 10 endocrinologists here, 10 naturopathic doctors like myself who are fellowship trained in endocrinology, you will probably get different answers from everyone. So I want you to understand what's going on and figure this out for yourself. It's not rocket science. A thyroid insulin, highest in the morning, which is why I'm not a huge fan of skipping breakfast for my females.

If you want to lose weight, skip dinner, don't skip breakfast. Dinner turns into fat. It's all goes in your belly, right? We were not supposed to have a heavy meal at night. So morning is when we want to check your thyroid. We're supposed to wake up with their highest cortisol energy, right? You're not supposed to have a lot of energy at night, so you never want to test the thyroid at night or in the evening.

The other thing is some people are on hormone meds. Now, some of the thyroid medications you'll see patients taking it at night. I will prescribe it at nighttime before bed. We always want empty stomach. Sometimes I have patients take it in the morning. So then testing is very important because you are trying to ask yourself, when does T4 and T3 peak with this medication that I'm on?

Let's say you're on Armour or Nature-Throid or WP thyroid, there's T4 and T3. T3 peaks around four to five hours after you've taken it, that's supposed to be its highest. So if you tend to, and most endocrinologists tell you to go fasting, don't take your thyroid meds and you have gone 24 hours without anything in your system.

So just know that if you're not, then your numbers come back on the top third high, then you're probably over-medicated. If you're like really low with it and ask yourself, but I'm going to take my thyroid med right now anyways. So it's never going to stay this low. So my preference is to see what you're doing with your medication.

So I will either test before fasting. And four or five hours after you've taken it. So if you take your med at 6:00 AM, I will have you go at 10:00 AM. Once you've taken your medication and add should be at its highest. That should be at its peak. Sometimes T3 actually won't be higher right at the cutoff at 4.5, 4.6.

And those are my patients that usually give me the best gifts for Christmas because they are thriving. They are happy because they are at their peak.

Mary: [01:13:05] Thank you so much. I feel like we could go for another hour with questions, but I think we're going to need to wrap things up. And, I know that we will have a replay of tonight's presentation available that will go out via with email link.

Am I right Katie? Within the next day or two. And will that have contact information for all of our amazing, experts on tonight's panel for people who might be interested in connecting with them or doing some consulting with them?

Katie: [01:13:39] Yeah, that's perfect. We will send out a replay email tomorrow that will include links to all of our speakers, websites, and social accounts.

So that if you have other questions, they might be able to answer them there. I know you weren't able to get to all of the questions, but a lot of information was shared. And so hopefully, people found this valuable. I want to say a big thank you to you, Mary, for co-hosting this with us and to all of our speakers for giving us their time and knowledge and expertise and a big thank you to all of you who joined us that attended and spent time on your Monday night to learn about this.

I think if we've learned anything it's that you need to work with a trustworthy doctor who takes a comprehensive approach and find what works for you. There's so many variables in diet and micronutrients and your thyroid and all of that. And so obviously there's some valuable resources here a nd Paloma has some excellent doctors who are all really carefully vetted to take a comprehensive approach to thyroid health, as well.

So again, keep your eye on your email. We will send out a replay and information about all the speakers and thank you so much to everyone who's joined us.

Mary: [01:14:48] Thank you.

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