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Thyroid Myth Busting (Part 2): What Actually Helps and What Doesn't · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to Clearly Hormonal, the podcast where we stop googling our symptoms at midnight and actually start understanding what's going on in our bodies.
• 0:09
  Dr. Komal Patil-Sisodia: I'm Dr.
• 0:10
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, an endocrinologist, internist, obesity medicine specialist, and a Menopause Society Certified Practitioner, which is really just a whole lot of words to say hormones are kind of my jam.
• 0:21
  Dr. Komal Patil-Sisodia: I've spent 17 years watching women try to navigate their hormonal health without ever having been taught the language for what's happening in their own bodies, and then meeting clinicians who want nothing more than to help them figure it out, but are up against 10-minute appointments and a system that just wasn't built for it.
• 0:37
  Dr. Komal Patil-Sisodia: This podcast is my answer to that gap.
• 0:40
  Dr. Komal Patil-Sisodia: We'll cover menopause, metabolism, hormones, and everything in between with real evidence, not trends, and without the overwhelm.
• 0:48
  Dr. Komal Patil-Sisodia: A quick disclaimer.
• 0:49
  Dr. Komal Patil-Sisodia: I'm a physician, but this is education, not personalized medical advice.
• 0:53
  Dr. Komal Patil-Sisodia: Take what resonates and discuss it with your own healthcare team.
• 0:56
  Dr. Komal Patil-Sisodia: Now, let's get into it and talk about what's clearly hormonal and what's not.
• 1:03
  Dr. Komal Patil-Sisodia: Somewhere out there tonight, there is a woman who just got a diagnosis of Hashimoto's thyroiditis, and she is doing what all resourceful women do, which is going online and trying to find information about ways that she can improve her health.
• 1:19
  Dr. Komal Patil-Sisodia: And within 48 hours of joining an online support group, she's been told to eliminate gluten, cruciferous vegetables, soy, and dairy, start iodine drops, take ashwagandha for her adrenals, and demand desiccated thyroid from her endocrinologist.
• 1:35
  Dr. Komal Patil-Sisodia: And her grocery cart now looks like a different person's.
• 1:38
  Dr. Komal Patil-Sisodia: Her anxiety is through the roof, and she still feels terrible.
• 1:43
  Dr. Komal Patil-Sisodia: Today, I want to be your fact checker because the thyroid wellness space is huge, and it is largely unregulated, and most of what it's selling is not just unhelpful, some of it can be actively harmful.
• 1:56
  Dr. Komal Patil-Sisodia: So on today's episode, which is the second part of the Thyroid Myth Busting series, we're going to go through all of that.
• 2:04
  Dr. Komal Patil-Sisodia: The first myth that I want to bust is around cruciferous vegetables and soy consumption.
• 2:10
  Dr. Komal Patil-Sisodia: Cruciferous vegetables are things like broccoli, kale, arugula, which is my favorite, cauliflower, Brussels sprouts, collard greens.
• 2:20
  Dr. Komal Patil-Sisodia: Cruciferous vegetables contain glucosinolates, which are substances that can potentially interfere with iodine uptake in your thyroid gland.
• 2:29
  Dr. Komal Patil-Sisodia: And like we talked about in the last episode, iodine is necessary to make thyroid hormone.
• 2:35
  Dr. Komal Patil-Sisodia: But the important thing to note is that anti-thyroid effects, meaning how they interfere with that iodine uptake in our thyroid gland, are only clinically relevant when you are consuming huge amounts...
• 2:51
  Dr. Komal Patil-Sisodia: When you are consuming extremely large amounts of these cruciferous vegetables, like say you're juicing a 10-pound bag of kale or something like that.
• 3:01
  Dr. Komal Patil-Sisodia: I don't juice, so maybe that's unreasonable.
• 3:03
  Dr. Komal Patil-Sisodia: But you're juicing large amounts of cruciferous vegetables, and then you also have iodine deficiency.
• 3:09
  Dr. Komal Patil-Sisodia: Those two things together will mess up how your thyroid gland takes up iodine and can impair thyroid hormone production, meaning it can prevent how efficiently you make thyroid hormone in your body.
• 3:22
  Dr. Komal Patil-Sisodia: Broccoli, kale, Brussels sprouts, they all contain minimal levels of this at normal dietary amounts, and there is nearly a zero clinical risk in people who have enough iodine in their diet.
• 3:38
  Dr. Komal Patil-Sisodia: The United States started iodizing their salt in 1924.
• 3:41
  Dr. Komal Patil-Sisodia: So that actually helped with iodine deficiency.
• 3:44
  Dr. Komal Patil-Sisodia: But interestingly, iodine deficiency is re-reemerging in the United States, and the highest risk populations are pregnant and lactating women because pregnancy will increase iodine needs by roughly 50%, and up to 46% of women don't actually get the right amount of iodine.
• 4:02
  Dr. Komal Patil-Sisodia: The interesting thing is that iodine deficiency is reemerging in the United States, and a lot of that comes down to the fact that people are starting to avoid iodized salt.
• 4:13
  Dr. Komal Patil-Sisodia: And if you eat out or you eat any packaged foods, you're probably getting some iodized salt.
• 4:19
  Dr. Komal Patil-Sisodia: But for people who are swapping out the Morton's iodized salt that we all grew up with the little girl holding the umbrella on the container.
• 4:28
  Dr. Komal Patil-Sisodia: A lot of people have stopped using that and they're swapping it out for specialty salts like sea salt or Himalayan pink salt or kosher salt, which generally are not iodized.
• 4:37
  Dr. Komal Patil-Sisodia: But the overwhelming majority of people, if they are eating out of their house, are getting enough iodine in their diet.
• 4:45
  Dr. Komal Patil-Sisodia: Additionally, people who are vegan and vegetarian are at higher risk, as are women who are pregnant and lactating.
• 4:53
  Dr. Komal Patil-Sisodia: And then racial and ethnic minorities like Black women or Hispanic women will be at higher risk for iodine deficiency compared to the general population Next on the list is soy.
• 5:05
  Dr. Komal Patil-Sisodia: Here's the evidence around why soy is still pretty safe for people to eat.
• 5:11
  Dr. Komal Patil-Sisodia: There have been several studies, a systematic review, and a meta-analysis of 18 randomized control trials that found that soy supplementation had no significant effect on free T4 or free T3.
• 5:24
  Dr. Komal Patil-Sisodia: The TSH only showed a modest increase, but there was no clear clinical significance around why that happened.
• 5:31
  Dr. Komal Patil-Sisodia: And when we look at the long-term study, avoiding soy hasn't really shown any benefit in thyroid patients.
• 5:38
  Dr. Komal Patil-Sisodia: So here's one practical note, though, where soy can impact.
• 5:42
  Dr. Komal Patil-Sisodia: If you have hypothyroidism and you're on levothyroxine, soy can impair how your body absorbs the levothyroxine.
• 5:50
  Dr. Komal Patil-Sisodia: So if you're eating soy within three to four hours of taking your thyroid medication, it may not get absorbed properly.
• 5:57
  Dr. Komal Patil-Sisodia: So timing matters, but you don't have to eliminate soy altogether from your diet.
• 6:01
  Dr. Komal Patil-Sisodia: So the important takeaway I want you to have is that you don't have to be afraid of these vegetables.
• 6:07
  Dr. Komal Patil-Sisodia: You don't need to be afraid of your salads.
• 6:09
  Dr. Komal Patil-Sisodia: You do need to possibly fear your supplement aisle and what they might be selling you, but we'll get to that a little bit later.
• 6:16
  Dr. Komal Patil-Sisodia: The next myth that I want to bust is that everybody who has Hashimoto's should go gluten-free, and this one is complicated.
• 6:24
  Dr. Komal Patil-Sisodia: And again, it really matters what clinical situation you find yourself in.
• 6:30
  Dr. Komal Patil-Sisodia: So here's what the evidence shows for the general population who has Hashimoto's thyroiditis.
• 6:36
  Dr. Komal Patil-Sisodia: There is not enough evidence right now to routinely recommend going gluten-free for all patients with Hashimoto's who do not have celiac disease.
• 6:45
  Dr. Komal Patil-Sisodia: And now you might think,"What is celiac disease?" Celiac disease is an autoimmune disorder that happens when you eat gluten, and that's a protein that's found in things like wheat, barley, and rye, and that causes the immune system to attack and damage the small intestine.
• 7:00
  Dr. Komal Patil-Sisodia: That can lead to abdominal pain, bloating, malabsorption of nutrients.
• 7:05
  Dr. Komal Patil-Sisodia: It can cause quite a bit of damage internally, and it can be associated with other autoimmune illnesses.
• 7:12
  Dr. Komal Patil-Sisodia: So in people who have Hashimoto's thyroiditis, but they don't have celiac disease, the studies do not show a huge improvement in thyroid outcomes.
• 7:22
  Dr. Komal Patil-Sisodia: And usually, when we're looking at Hashimoto's, I think a lot of these studies have looked at whether the antibodies or the inflammatory markers for the Hashimoto's are going to improve by going gluten-free.
• 7:32
  Dr. Komal Patil-Sisodia: So there was a meta-analysis of four studies that total contained about eighty-seven patients, and that showed borderline non-significant reductions in thyroid antibodies on a gluten-free diet.
• 7:44
  Dr. Komal Patil-Sisodia: So only eighty-seven patients.
• 7:46
  Dr. Komal Patil-Sisodia: Then there was a twelve-month randomized control trial that was done that showed no significant differences in the anti-TPO, or thyroid peroxidase antibodies, or the anti-TG antibodies, which are the anti-thyroglobulin antibodies when they looked at people who were put on a gluten-free diet versus people who were allowed to eat anything.
• 8:08
  Dr. Komal Patil-Sisodia: But here's what I think is really important.
• 8:11
  Dr. Komal Patil-Sisodia: In people who have Hashimoto's thyroiditis and celiac disease, this is a well-documented association.
• 8:18
  Dr. Komal Patil-Sisodia: So if you have Hashimoto's and you're having GI symptoms like abdominal discomfort and bloating and diarrhea and malabsorption, it's really reasonable to test for celiac disease.
• 8:30
  Dr. Komal Patil-Sisodia: The gold standard will always be an upper endoscopy with a small intestine biopsy to prove it on biopsy.
• 8:37
  Dr. Komal Patil-Sisodia: But there are blood panels that you can do if somebody is eating wheat and they don't necessarily want to go through the endoscopy.
• 8:46
  Dr. Komal Patil-Sisodia: Sometimes these panels can show positive antibodies that we see in celiac disease, and you can make a diagnosis that way based on symptoms and the lab test.
• 8:55
  Dr. Komal Patil-Sisodia: But truly, the gold standard is the endoscopy with the biopsy And in patients who have confirmed celiac disease or confirmed gluten sensitivity, a gluten-free diet can improve levothyroxine absorption and reduce the high levels of thyroid antibodies.
• 9:13
  Dr. Komal Patil-Sisodia: And the benefit in that population is very real.
• 9:16
  Dr. Komal Patil-Sisodia: But recommending it to everybody with Hashimoto's, even if they don't have celiac disease, that doesn't really make sense.
• 9:24
  Dr. Komal Patil-Sisodia: So a gluten-free diet isn't harmful, but it's also not a thyroid treatment unless you have celiac disease, and you should definitely talk to your doctor about getting tested for that.
• 9:35
  Dr. Komal Patil-Sisodia: Now, the next myth I want to talk about is iodine supplements.
• 9:40
  Dr. Komal Patil-Sisodia: Everywhere I look online, and maybe this is just my feed because I'm an endocrinologist and all endocrine things happen to pop up on my feed, whether they're good or not, is that iodine supplements boost thyroid function, and that is not the case.
• 9:55
  Dr. Komal Patil-Sisodia: Taking too much iodine can actually be incredibly harmful.
• 9:58
  Dr. Komal Patil-Sisodia: And the reason that people will take it is because iodine is needed for thyroid hormone synthesis.
• 10:03
  Dr. Komal Patil-Sisodia: We just talked about what happens to people who are iodine deficient.
• 10:06
  Dr. Komal Patil-Sisodia: If you don't have enough iodine, which is a building block for thyroid hormone, you won't make enough thyroid hormone.
• 10:12
  Dr. Komal Patil-Sisodia: Some people think,"Okay, well, that just must be a very easy conclusion to draw." The logic is the more iodine, the more thyroid hormone, and that's not always what happens.
• 10:22
  Dr. Komal Patil-Sisodia: It can backfire pretty significantly in people who have enough iodine in their diet, which is really most of the people in the United States with access to iodized salt and a variable diet.
• 10:35
  Dr. Komal Patil-Sisodia: Supplementation does not improve thyroid function in people with normal thyroid glands.
• 10:40
  Dr. Komal Patil-Sisodia: And here's where it gets interesting.
• 10:42
  Dr. Komal Patil-Sisodia: Taking too much iodine can cause either hypothyroidism, hyperthyroidism, or inflammation of the thyroid, especially in people who have underlying Hashimoto's or thyroid nodules.
• 10:57
  Dr. Komal Patil-Sisodia: And things like kelp supplements are a big risk because they have a lot of iodine.
• 11:02
  Dr. Komal Patil-Sisodia: It's not really regulated how much iodine is actually in that supplement, and I've seen multiple patients who have had thyroid dysfunction triggered from that.
• 11:11
  Dr. Komal Patil-Sisodia: Too much iodine confuses your thyroid, it will either look at all that iodine and get analysis paralysis and then shut down and be like,"I don't even want to make the thyroid hormone because there's too much, and I'm too overwhelmed, and I don't want to do it." Or it can go the flip side, and you can have an eager little thyroid gland that sees all this iodine around and goes,"Ooh, let me make more thyroid hormone." And in that case, people become hyperthyroid.
• 11:35
  Dr. Komal Patil-Sisodia: So in the analysis paralysis situation, there's no thyroid hormone production or decreased thyroid hormone production because the thyroid gland is overwhelmed, and then you get hypothyroidism.
• 11:46
  Dr. Komal Patil-Sisodia: Or in the overeager thyroid gland, and it's just sucking up all the iodine, you can become hyperthyroid.
• 11:52
  Dr. Komal Patil-Sisodia: And it's not predictable which way it will go.
• 11:55
  Dr. Komal Patil-Sisodia: In fact, I had a patient, gosh, I want to say this was a few years ago, who was eating those seaweed snacks from Costco and was eating, like, six or seven of them a day and came into my office hyperthyroid on the labs.
• 12:10
  Dr. Komal Patil-Sisodia: We couldn't find any antibodies for Hashimoto's or Graves' disease.
• 12:16
  Dr. Komal Patil-Sisodia: There were no thyroid nodules, and we were just trying to figure out where it came from because usually there's a pretty clear cause for why people become hyperthyroid.
• 12:25
  Dr. Komal Patil-Sisodia: And so finally I started asking about diet and iodine consumption and what they were eating, and it did not even register to this person that these seaweed snacks have a lot of iodine.
• 12:36
  Dr. Komal Patil-Sisodia: But seaweed is basically kelp, which, you know, if we shouldn't take kelp supplements, we really shouldn't be eating a ton of seaweed snacks from Costco.
• 12:44
  Dr. Komal Patil-Sisodia: I had this person stop for a period of a few months, and we checked the thyroid function test after stopping eating the seaweed snacks, and everything went back to normal.
• 12:54
  Dr. Komal Patil-Sisodia: So this can happen very commonly.
• 12:57
  Dr. Komal Patil-Sisodia: You have to be really careful about what you are eating, and I would say stay away from high amounts of iodine, especially iodine supplements, because it's really unpredictable about which way it's going to go.
• 13:08
  Dr. Komal Patil-Sisodia: Now, the next myth I want to talk about are all the supplements that are out there that are showing up on your TikTok feed or your Instagram feed about treating your thyroid disease or curing your thyroid.
• 13:19
  Dr. Komal Patil-Sisodia: And I want to explain whether there is any evidence behind each of these.
• 13:24
  Dr. Komal Patil-Sisodia: First on the list is ashwagandha.
• 13:27
  Dr. Komal Patil-Sisodia: I have seen this everywhere for adrenal support, for improving mood and depression and calming people down, and there are also some claims out there saying that it might help improve the TSH in what we call subclinical hypothyroidism.
• 13:43
  Dr. Komal Patil-Sisodia: So that's where the TSH is elevated and the T4 and T3 are normal.
• 13:49
  Dr. Komal Patil-Sisodia: But this evidence is very preliminary.
• 13:51
  Dr. Komal Patil-Sisodia: They have done studies in very small numbers of people, not enough for us to look at the statistics and draw a conclusion that it can be helpful.
• 14:00
  Dr. Komal Patil-Sisodia: And the other thing with ashwagandha is it actually contains active compounds that will interact with thyroid medications and potentially other medications.
• 14:07
  Dr. Komal Patil-Sisodia: So you want to be really careful about that, and if you are going to take it, I don't think thyroid should be the reason why.
• 14:13
  Dr. Komal Patil-Sisodia: And if you are on thyroid medication, talk to your doctor.
• 14:17
  Dr. Komal Patil-Sisodia: I usually tell people any supplements need to be four hours apart from thyroid hormone so that there's not any interference.
• 14:25
  Dr. Komal Patil-Sisodia: Next on the list is vitamin B12.
• 14:28
  Dr. Komal Patil-Sisodia: B12 deficiency is pretty common in hypothyroid patients, and you do need to correct it.
• 14:33
  Dr. Komal Patil-Sisodia: But the B12 supplementation doesn't actually treat thyroid disease.
• 14:37
  Dr. Komal Patil-Sisodia: So you will feel better, and you might feel more energy if you treat the B12 deficiency because that can impact your energy level, but it's not actually doing anything for your thyroid.
• 14:49
  Dr. Komal Patil-Sisodia: And a side note that I think is really important, for people who are vegetarian or vegan, you will tend to be more B12 deficient compared to the rest of the population Because B12 is largely found in animal byproducts like milk or meat or, eggs, things like that.
• 15:06
  Dr. Komal Patil-Sisodia: So if you're not eating any of those things or you're a strict vegan, you might be B12 deficient.
• 15:12
  Dr. Komal Patil-Sisodia: And taking that is important for your health, but not going to fix your thyroid.
• 15:16
  Dr. Komal Patil-Sisodia: Next on the list is low-dose naltrexone.
• 15:18
  Dr. Komal Patil-Sisodia: Now, this is one that I hear quite a bit, and it seems to be gaining a lot of traction in autoimmune circles.
• 15:25
  Dr. Komal Patil-Sisodia: And when you look at the mechanism of action of how it can potentially reduce autoimmunity and reduce inflammation, it's possible that it could help with reducing the antibodies in Hashimoto's, but there's still not enough data for that.
• 15:42
  Dr. Komal Patil-Sisodia: There's been a few case series, a few one-off stories about it, but there's no randomized control trials looking at this.
• 15:49
  Dr. Komal Patil-Sisodia: So I think, under guidance of your provider who's prescribing these to you, it would be reasonable to try.
• 15:56
  Dr. Komal Patil-Sisodia: But if you're not seeing an improvement in your symptoms or the levels, continuing it doesn't really make sense.
• 16:03
  Dr. Komal Patil-Sisodia: So again, proceed with caution.
• 16:05
  Dr. Komal Patil-Sisodia: Definitely talk to your healthcare team about whether that's right for you.
• 16:09
  Dr. Komal Patil-Sisodia: Now, the one supplement that actually does have the most data is selenium.
• 16:13
  Dr. Komal Patil-Sisodia: Selenium supplementation has shown some small but real reductions in the TPO antibodies in Hashimoto's patients in a lot of randomized control trials.
• 16:23
  Dr. Komal Patil-Sisodia: But it's not really ready for universal recommendation because I don't think we have quite enough data yet, but it is the most evidence-supported supplement that we have.
• 16:32
  Dr. Komal Patil-Sisodia: And when patients ask me about it, I always give them a trial of it.
• 16:36
  Dr. Komal Patil-Sisodia: We'll check TPO antibodies before and after, after they've been taking the supplement for a few months, and if it's not really making a huge difference, I'll tell them, can continue it if you want, but I don't know that it's going to help your antibodies." So again, making sure we're looking at what is actually happening to these levels and then adjusting things I think is reasonable.
• 16:56
  Dr. Komal Patil-Sisodia: And again, for any supplement, you want it spaced out four hours from when you take your thyroid medication because you don't want to interfere with the absorption.
• 17:06
  Dr. Komal Patil-Sisodia: Now, the last myth on my list for this episode is that desiccated thyroid is superior to levothyroxine, and desiccated thyroid is the preparation that is made from a pig or a porcine thyroid gland that is dried up and then encapsulated, and it contains both T4 and T3.
• 17:26
  Dr. Komal Patil-Sisodia: Some people claim that it's more effective than, quote,"synthetic levothyroxine," which is T4 only.
• 17:32
  Dr. Komal Patil-Sisodia: Here's the funny thing.
• 17:33
  Dr. Komal Patil-Sisodia: Synthetic levothyroxine is technically bioidentical, it's just made in a lab, so hence it got the name synthetic.
• 17:41
  Dr. Komal Patil-Sisodia: But that levothyroxine is-- people glom onto that word synthetic or thinking that it's not natural from the body.
• 17:49
  Dr. Komal Patil-Sisodia: But here's the deal.
• 17:51
  Dr. Komal Patil-Sisodia: What's natural for pigs is not necessarily natural for humans.
• 17:54
  Dr. Komal Patil-Sisodia: The T4 and T3 ratios in humans versus pigs are very different.
• 17:59
  Dr. Komal Patil-Sisodia: In humans, the T4 to T3 ratio is about ten to fourteen micrograms of T4 per one microgram of T3.
• 18:08
  Dr. Komal Patil-Sisodia: In pigs, it's about four micrograms of T4 to one microgram of T3.
• 18:13
  Dr. Komal Patil-Sisodia: So in pig thyroid glands, there is a lot more T3 compared to what we make in our own glands.
• 18:22
  Dr. Komal Patil-Sisodia: And here's what the evidence shows.
• 18:24
  Dr. Komal Patil-Sisodia: There was a three-arm double-blinded crossover randomized controlled trial of 75 patients who compared levothyroxine, levothyroxine plus liothyronine, and desiccated thyroid extract, and there was no overall difference in quality of life, cognition, or mood.
• 18:43
  Dr. Komal Patil-Sisodia: And neither the European Thyroid Association nor the American Thyroid Association actually endorses desiccated thyroid as a first-line treatment.
• 18:52
  Dr. Komal Patil-Sisodia: But here is where I think it's important to listen to people.
• 18:57
  Dr. Komal Patil-Sisodia: In the same trial, there were a few scenarios that I think deserve some attention.
• 19:03
  Dr. Komal Patil-Sisodia: About one-third of the people who were the most symptomatic, about one-third of the people who were treated with levothyroxine who had the most symptoms actually preferred and showed subjective improvement on a combination therapy, so a combination of T4 and T3.
• 19:23
  Dr. Komal Patil-Sisodia: And the meta-analysis confirmed that patients overall preferred the T4/T3 combination, which is really important patient-reported data, even if the objective measures of looking at the TSH and free T4 and free T3 numbers weren't significantly different.
• 19:39
  Dr. Komal Patil-Sisodia: If they felt subjectively better and there was no harm done, I don't see any problem with giving people a combination of T4 and T3.
• 19:46
  Dr. Komal Patil-Sisodia: When I say combination of T4 and T3, I'm talking about levothyroxine plus liothyronine, which are two separate pills.
• 19:53
  Dr. Komal Patil-Sisodia: The desiccated thyroid extract, which is coming from the pig thyroid glands, one of the biggest issues that I have with it is there is a lot of dose variability, just even in one batch of pills.
• 20:04
  Dr. Komal Patil-Sisodia: There was a study done probably over a decade ago now that looked at all of the different desiccated thyroid hormone preparations that were out there, and they found that there could be a huge amount of variability just in one batch of pills alone so you could be getting a whole lot of nothing or a whole lot of something.
• 20:23
  Dr. Komal Patil-Sisodia: And there's a few clinical situations that I don't want people's thyroid levels to be going up, down, right, and left, and those are pregnancy or if somebody has thyroid cancer.
• 20:32
  Dr. Komal Patil-Sisodia: So desiccated thyroid is not on my list for patients who are pregnant or who have thyroid cancer because you actually need stability of those thyroid hormones, number one, in pregnancy for good neurodevelopment of the baby and then in thyroid cancer to help with TSH suppression and prevent thyroid cancer from recurring.
• 20:56
  Dr. Komal Patil-Sisodia: I want to tell you a funny story about when I first started practice.
• 20:59
  Dr. Komal Patil-Sisodia: So we would have reps come by for different medications so that they could leave samples.
• 21:04
  Dr. Komal Patil-Sisodia: Somebody came in to talk about the desiccated thyroid preparations.
• 21:08
  Dr. Komal Patil-Sisodia: At that point, there were like three or four different companies who were making them.
• 21:11
  Dr. Komal Patil-Sisodia: And they asked if I had any questions about the medication.
• 21:14
  Dr. Komal Patil-Sisodia: So I asked,"Do you test the pig's thyroid gland before you harvest the thyroid gland and then dry it out and encapsulate it?" And they just kind of looked at me like I had five heads.
• 21:24
  Dr. Komal Patil-Sisodia: And I said,"No, no, no, I'm asking this question seriously because if the pig is hypothyroid or the pig is hyperthyroid, and you don't know that before you extract their thyroid gland, and you're going to assume that all pig thyroid glands are created equal, you can't actually say that people are getting the same amount of medication in each pill." No company that made those hormone preparations were able to answer that question for me.
• 21:49
  Dr. Komal Patil-Sisodia: So that's another reason I don't trust it.
• 21:51
  Dr. Komal Patil-Sisodia: I don't know that the testing is robust.
• 21:53
  Dr. Komal Patil-Sisodia: And if you look at all of the data, it was actually grandfathered in by the FDA because the treatment is so old, going back so many years, that they didn't actually have to do all the studies that the makers of, the brand levothyroxine or liothyronine preparations had to do.
• 22:09
  Dr. Komal Patil-Sisodia: What I always tell my patients is,"If you're not feeling great on levothyroxine alone, let's try the branded preparations.
• 22:15
  Dr. Komal Patil-Sisodia: Let's try adding liothyronine if you're still not getting there." And then as a last resort, I will try desiccated thyroid hormone.
• 22:24
  Dr. Komal Patil-Sisodia: The majority of people actually feel better on either levothyroxine in a brand formulation or a combination of levothyroxine and liothyronine.
• 22:33
  Dr. Komal Patil-Sisodia: So your preference for how you feel on the medications really does matter.
• 22:37
  Dr. Komal Patil-Sisodia: And the important thing to know is the evidence does not prove in any which way that desiccated thyroid hormone is better.
• 22:44
  Dr. Komal Patil-Sisodia: If anything, I have a harder time adjusting the doses and the levels for some of my patients because the absorption is so up and down, and I don't know what's actually going into these pills.
• 22:55
  Dr. Komal Patil-Sisodia: So it's really important for you to talk through each of these different scenarios with your doctor so that it makes sense to you and you're picking the best treatment.
• 23:05
  Dr. Komal Patil-Sisodia: This wraps up our second episode on thyroid myth-busting.
• 23:09
  Dr. Komal Patil-Sisodia: If you missed part one, go back.
• 23:10
  Dr. Komal Patil-Sisodia: It's just the episode before this one, and it covers testing myths, TSH, subclinical hypothyroidism, and what a normal thyroid result actually means.
• 23:20
  Dr. Komal Patil-Sisodia: If anything you heard on this episode resonates, and if you know somebody who was recently diagnosed with Hashimoto's and is really struggling about what to do next, and is very overwhelmed by all of the information online, forward them this episode.
• 23:33
  Dr. Komal Patil-Sisodia: I really think it can help dispel some of the myths that they might see out there, and may save them from buying some supplements that they don't actually need Thank you all for being here today, and I will see you on the next episode.
• 23:47
  Dr. Komal Patil-Sisodia: That's it for today, but the conversation doesn't have to stop here.
• 23:50
  Dr. Komal Patil-Sisodia: Come find me on Instagram or TikTok at drpatilsisodia.
• 23:54
  Dr. Komal Patil-Sisodia: And if something from today's episode resonated, I'd genuinely love to hear about it.
• 23:59
  Dr. Komal Patil-Sisodia: Leave a review, which makes the podcast searchable, share the episode, or just send me a message.
• 24:04
  Dr. Komal Patil-Sisodia: The more women who have access to this information, the better.
• 24:07
  Dr. Komal Patil-Sisodia: I'll see you next week on the next episode