How to Optimize Your Thyroid and Fuel Your Body’s Metabolism (Performance & Longevity Series)

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Transcript: How to Optimize Your Thyroid and Fuel Your Body’s Metabolism (Performance & Longevity Series)

Season 11, Episode 14  | September 11, 2025

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Welcome to Life Time Talks in our series on performance and longevity with MIORA. I’m Jamie Martin and I’m here today with Dr. Greg Pippert, who is the medical director of MIORA, to talk about optimizing your thyroid, which fuels your body’s metabolism.

The thyroid is a small gland that’s located in the front of your throat, but it controls big processes in the body, including how it turns food and oxygen into energy. An estimated one in seven people are affected by thyroid issues, though they may not be aware that their thyroid is behind whatever their symptoms might be.

So Greg and I are going to be talking about the role that thyroid plays in overall health, identifying common symptoms of the imbalance, and discussing key biomarkers that can tell the story of how the thyroid is functioning. Greg, thanks for coming back with me.

Thanks for having me.

All right, let’s jump right in. Let’s talk about the important role that the thyroid plays in overall health, and the processes that it’s responsible for in our bodies.

Well, you said it earlier. Metabolism. I mean, that’s what we mostly think about the thyroid for, is metabolism. So it converts food to energy. It affects how we burn calories. So when we think about high thyroid, low thyroid levels, we think about things like weight gain on the low end. We think about weight loss on the high end, not good weight loss.

We also think about its effect on cardiac health. I mean, basically there are thyroid hormone receptors on every cell in our body. So it’s not like we can target one organ or another. It affects everything.

But just to specifically to think about the cardiac system, so hypothyroidism, or low thyroid function, can contribute to things like increased risk of heart disease, congestive heart failure. But too much thyroid hormone, you’re driving the heart fast, arrhythmias, atrial fibrillation, tachycardia. So overstimulation.

Got it.

And we think about the skin, the hair. I mean, it functions in so many things. So hypothyroid, thinning hair, dry skin. So we need thyroid for those organs. So it really touches everything that we encounter in our life.

Right. So what are some of the — how can it contribute to thyroid imbalances, or what contributes to thyroid imbalances in the body?

So thyroid hormone, it’s a series of two hormones, which we’ll talk about I’m sure, but they’re operating in our body. And they have to operate in a way that is impacted by other things, so things that can impact how thyroid hormone works, or say, endocrine-disrupting chemicals.

So endocrine-disrupting chemicals are just what they sound like. They’re chemicals that disrupt our endocrine system and thyroid hormone. Well, the thyroid system is an endocrine gland, so. So we’re disrupting how those hormones work. So they may impact — we’re not going to make the thyroid hormone as well, or we’re not going to be able to respond to when we need more or don’t need more. So the signaling is off.

OK.

And those chemicals are things that we find in plastics, fragrances, residues in our food, pesticides, herbicides. So they’re everywhere, and they’re really impacting that. Now, what are the things that can impact thyroid function? Immune issues. So the thyroid gland seems to be a target of the immune system more frequently than a lot of other things. Hashimoto’s, one of the most common autoimmune issues.

Now, it’s really common in females. It’s about 10 times more common in females than it is in males. So it’s when the immune system maybe gets triggered by something. It might be an imbalance in the gut, a bacterial imbalance, or a food sensitivity. Your body starts to attack that. Or maybe a virus.

And then the immune system starts to look for other things that were a little bit like what it was just attacking, and then the thyroid gets in the crosshairs and now that just runs with it. And so now you’re going to start attacking thyroid function. Well, you’re going to degrade that function and you’re going to be able to make less and less thyroid hormone. So that’s another impact of thing that can impact thyroid hormone.

Stress, cortisol. A biggie. So we’re all stressed. Now, we need cortisol when we need it, but when we’re constantly running hot, that cortisol impacts how the hormone works.

So if you have a high cortisol level, the receptor and the thyroid hormone are not going to impact each other quite as effectively. So you can have an appropriate thyroid hormone level, but it won’t feel like it because it’s not working in the same way.

And stress also impacts how we message the thyroid the need for thyroid hormone. And you think about that and metabolism. So then when we’re stressed, what often happens? We can gain weight. So is it the cortisol? Is it the thyroid? Is it both? It could be a lot of things.

So that’s another thing that can impact it. And then just good general health. We need good nutrition. If we’re not getting the right micronutrients to support the thyroid hormone, we can’t make it. So thyroid hormone is — it’s made of a lot of different nutrients. If you don’t have the right building blocks, you can’t make the hormone.

So let’s talk about some of those nutrients, because there’s iodine, ferritin, selenium, chromium. Those are some of those kind of nutrients you’re talking about.

Yeah, so iodine and selenium are one of the things, or the two of the ones we think most frequently about the thyroid. That’s why we iodized salt, because we live in an area used to be called the goiter belt. We didn’t have enough iron in the soil. We don’t eat seafood. We don’t have sushi every night. So we aren’t getting enough iodine in. And so we put it in the salt and that takes care of it.

But we have to be careful with iodine because we can overdo. And there are people that will take a lot of iodine. And the problem is, if you overdo with iodine, you can either suppress thyroid function, so you’re trying to fix the problem, but you’re actually causing the problem to persist —

Yeah. So it’s a fine balance.

It is, or you can overstimulate the thyroid with iodine and create thyroid storm, or hypothyroidism, with too much iodine. Selenium, similar. Too much can create thyroid imbalance. But selenium in particular works the conversion of the T4, the main thyroid hormone, to the more active T3, which we’ll probably talk about later.

There’s iron, or ferritin. So iron is needed for the production of thyroid hormone, another micronutrient that we would need. So if we’re anemic, or if you’re a cycling female and you’re less and less and less iron and storage, it’s going to be harder to make the right thyroid hormone. Tyrosine, I think you mentioned. That’s the building block, the amino acid, that’s the building block of thyroid hormone. So if we’re not getting that in, we can’t build the hormone.

OK. Chromium —

Chromium.

—is another one.

Yeah, so chromium is involved in both thyroid production, but also good blood sugar stability. And when our blood sugars are off, we’re becoming more insulin resistant, sometimes the thyroid can become a little collateral damage, or the thyroid hormone can.

Yeah, again, nothing in isolation. Two other things that I want to make sure we address, overtraining when it comes to exercise, and then the second one is certain prescription drugs could be having an impact. So talk a little bit about those two.

So overtraining. More is always better, right?

No, we’re going to go backward from there.

Right, no. Overtraining is a stressor.

Yeah.

It’s that in a nutshell. So by pushing the body, pushing the body, pushing the body, the body is now having to deal with that stressor. What’s it going to do? It’s going to kick up more cortisol, adrenaline, norepinephrine, those stress hormones, which in turn circle back to what we were saying earlier, degrade the ability to make thyroid hormone, or the signaling may be off. So too much is not good. So it’s that Goldilocks thing, not too little, not too much just, right?

Yeah.

And medications. So there’s a couple of issues when we come to medications and thyroid hormones. So there are medications that directly impact the function of thyroid hormone, certain diuretics or water pills. Amiodarone, a cardiac medication, is a problem with thyroid hormone production.

Lithium, another medication. Anti-inflammatory steroids can affect that. And we think we go on prednisone for something it may impact your thyroid hormone. So those medications that we might take, we just have to take into consideration, is that impacting thyroid hormone?

Now, there’s also estrogen. So estrogen, when taken especially orally, which we don’t do in MIORA for reasons of, when we take estrogen, we increase clotting risk.

OK.

But estrogen when it goes up, increases, especially if it’s taken orally, increases something called thyroid-binding globulin. So protein. So it grabs on to the thyroid hormone and won’t let you use it. So you may have good thyroid hormone levels, but it doesn’t feel like it.

So we’ll see that happen in pregnancy. So when estrogen levels go very high, thyroid-binding globulin level goes high, and the TSH becomes a little harder to read because we’ll start to see that. So estrogen, in that way, affects it. But then also there’s the absorption of thyroid hormone when we’re actually taking thyroid hormone. So aluminum, calcium, magnesium, like things in antacids, if you take that in proximity to your oral thyroid medication, you’re not going to absorb it.

Interesting.

And so that’s what we say, take thyroid hormone in isolation, empty stomach, don’t eat or drink anything, other than say, water or black coffee, for 30 to 60 minutes on either side. Now, the cream in your coffee may have calcium, or your milk may have calcium, which then negates the absorption of the thyroid hormone.

So you need to be aware.

You have to.

Yeah.

So a hint we usually give people is, just put your thyroid hormone in your bathroom. When you first get up in the morning to go to the bathroom, take it and then do your stuff. By the time you get to the kitchen, you probably can start thinking about brewing your coffee and then later making breakfast.

Yeah. OK, so let’s talk about — we’ve talked about things that affect the thyroid, right? Let’s talk about those hormones that you mentioned. So I want to make sure we touch on the T3, T4, and then you said TSH as well. So let’s talk through those specifically.

So TSH is thyroid-stimulating hormone. That’s your pituitary gland registering how much thyroid hormone is in the bloodstream, and reacting accordingly. So if the pituitary gland doesn’t see enough thyroid hormone, it kicks out more TSH. Thyroid-stimulating hormone is trying to make your thyroid gland make more hormone. Yeah. So that’s a gauge. Think about it like your thermostat on the wall. You’re controlling your furnace.

So the main thyroid hormone we make is T4. The body will then, through gut interaction, which is why gut health is important in thyroid. Also, in the liver and the muscles, we will convert T4 to the more active T3. So a deficient T3 isn’t necessarily a thyroid issue but more of a conversion issue. Now, that’s where selenium comes into play, because selenium increases the conversion of T4 to T3, or supports that. T3 is the more active, the higher octane version of thyroid hormone. And those are both available in commercial medications, which I’m sure we’ll talk about later.

Yeah, we’ll get to that. So let’s talk about — we know that millions of people are suffering from thyroid issues. They may not know why or where their symptoms are stemming from. What are some of the symptoms that somebody might be feeling if they are having an off-balance thyroid?

Yeah, so think about metabolism, weight gain. But then we also think about energy because thyroid is involved in energy production. So the person who just says I am fatigued, I could get 8 or 9 hours of sleep. It’s good restful sleep. My FitBit tells me I slept wonderfully.

And they’re still tired. Yeah, OK.

Cold intolerance. People say, I am colder than anybody else in the room. Even in the summer, I’m cold. So that cold intolerance may be a symptom of suboptimal thyroid function. Fingernail issues, thin fingernails, ridged fingernails. Hair loss, dry skin, dry everything. Dry eyes be a symptom of low thyroid. Now, if we think about on the high end, so a hyperactive thyroid, hypothyroidism, that’s more revving things up. That’s anxiety, palpitations, heart skipping, heart rhythm disturbance, weight loss, insomnia
OK. There’s a lot. And so it’s like, how do you know where that’s coming from? Again, this is where I think some of the confusion can come. It’s like you don’t think necessarily about your thyroid right away because oh, I’m going to connect the weight gain to something else instead, or whatever.

In addition to those, then we think about gastrointestinal things. Low thyroid slows everything down. So constipation is a big symptom in hypothyroidism, and then we think about the effect on the brain. So we get foggy. We need thyroid hormone for brain function. So depression, foggy thinking. So those are a big, big player sometimes.

And then cardiac function. Like I said too much thyroid drives the heart too hard. But we need thyroid function, or thyroid hormone for the heart to function well. So we can get congestive heart failure with low thyroid hormone levels. We have increased cardiovascular risk with low thyroid hormone levels.

OK. Let’s stay on the path of low thyroid function. So we’re saying there’s been some correlation between low thyroid function and body composition, and other health issues.

So can you just explain what that looks like and why, or what that correlation is.

So since thyroid hormone is involved in our metabolism, if we’re slowing metabolism down, we’re not using those calories to burn. We’re going to store them. So if you’re still taking 1600 calories in, but now you’re only burning 1,000 because your metabolism has slowed, those extra 600 got to go somewhere. And so you’d be stored as body fat.

OK.

Plus, if you’re fatigued because you really don’t have any energy, you’re not going to exercise, that physical sluggishness, well, we’re not going to physically burn the calories.

We’re not going to exercise. We’re not going to be motivated to exercise. So it’s both in fatigue and how we process those calories.

Got it. OK, so what can we do to identify thyroid issues? I’ve got all of these symptoms happening. I’m not sure what the source is. How do you test for it, and what are some key biomarkers for thyroid issues?

Now, the classic biomarker is your TSH, or thyroid-stimulating hormone we were talking about earlier. Now, that’s a screen, is the way I look at it, because you’re looking at the brain’s perception of how much thyroid you have, but you’re not really looking at the thyroid hormone. So what you want to look at is the free T4 and the free T3. Those are the most usable levels of the hormone. Those are the thyroid hormones that are not bound to that thyroid binding globulin.

Yeah.

And looking at the ratio between T4 and T3. So you want to look at T4, T3, and the ratio.

Got it.

Now, something we didn’t touch on as much earlier is the autoimmune issues. And so what we really also want to look at is the thyroid peroxidase antibody and the thyroglobulin antibody. Now, these are antibodies that we produce against the thyroid gland or parts of the thyroid gland. And if we see those are elevated, we know your immune system is just chiseling away a little bit, little by little at thyroid function.

It’s kind of nagging at it there.

Yeah. So if we don’t try and work on that, we’ll continue to lose thyroid function. And plus, if we see somebody maybe with a questionable thyroid panel, but we know they have high antibody levels, we know they have a thyroid problem. It’s real. So we would probably treat them a little differently because we know where they’re going.

Right.

And then cortisol.

Always back to cortisol, man.

Coming back to that. So cortisol impacts how the hormone and receptor work. It impacts how we make thyroid hormone. So if you got somebody that has really high cortisol, or maybe a bad cortisol curve, we flatten the curve, their morning awakening response is not good, the thyroid hormone may not work as well, or we may not produce it as well. So it’s important to know where we are at stress wise.

Yeah.

So those would be the biomarkers that I would look at, thyroid function.

Great. So they’re identified. Now you’re starting to see this in the larger context, which we’re always talking about, right, of your overall health. You see this is the area you’re going to focus on. What are the options? Where does someone start if they’re like, OK, I know that this is my primary focus for the time being?

So if somebody’s got maybe a borderline level of thyroid, I’m not sure we really want to treat this, that doesn’t maybe meet that level, but you’ve got a lot of symptoms, and we’re pretty convinced they’re not coming from somewhere else, now, we still have addressed all the other lifestyle things, which we need to address, you may approach that from a nutrient-based approach. Looking at the iodine, the selenium, zinc.

And like I said earlier, those are things that we want to be careful with. So that’s best done under the guidance of a provider that can monitor your thyroid hormone levels and your TSH level to make sure we’re not taking it too far, and make sure we’re actually doing what we need to do.

Tyrosine, the building block. And there are different groups of supplements, things that are combined together. Maybe hit everything. So you can use a nutrient-based approach. And then if you see an autoimmune response, but maybe good thyroid function, you want to focus on the immune response.

And that’s gastrointestinal health. Often that stems from food intolerances, from gastrointestinal inflammation. So when we’re talking about gastrointestinal supplements, probiotics, fiber, all the things we can do to support the gut. And even something called magic hair, which may downregulate an overactive immune system. So that would be of a nutrient-based approach for the gut to support thyroid function.

But say maybe we really think, OK, you really need thyroid hormone. What are our options? So there’s levothyroxine which is T4. Now, it’s a bioidentical version of T4, which is the main thyroid hormone that we make. Now, that’s the most commonly used thyroid prescription, levothyroxine, or Synthroid is a brand name.

Then there’s T3, which is also available as a medication called liothyronine. And so oftentimes providers may start with T4, levothyroxine, and honestly, many of us convert T4 to T3 quite well. So we give T4, the body turns it into T3 and we are happy, and symptoms get better.

But some of us, because of stress primarily, that’s all, or maybe selenium deficiency, don’t convert T4 to T3 as well. So that’s where you can bring that T3 in. The person that needs that will tell you. They’ll say that made all the difference, because —

They’ll know.

Yeah, that’s the higher potency thyroid hormone. So you can bring that in. And so you use the two hormones, or two medications together. And the nice thing about having them separate is you can fine tune, up, down a little bit to fine tune the TSH versus your T4, T3 levels versus symptoms.

Got it.

And then there’s the natural desiccated thyroid hormone. So those are derived from pork thyroid. We’re very close to pigs by the way. So we can take their thyroid gland and it suffices for our replacement. Now, the plus is that contains T4, T3, and sub T3 to sub T2 as well, some other minor thyroid hormones. So the nice thing is it’s all in one.
OK.

A negative is that you can’t control the balance. And a pig’s ratio of T4 to T3 is really a little different than ours. So it’s a natural approach. It’s still a pharmaceutical, it is a drug, but some people perceive it as a more natural approach. Now, a little quirk to that, though, is individuals that have a Hashimoto’s, or have an autoimmune response to their thyroid gland, might not tolerate pork thyroid gland. It’s like taking something you’re already reacting to.

So when you say take the pork thyroid gland, I mean that’s still a medication?

It is a medication made into — they’re standardized, per tablet, how much T4 and T3. That was an old argument against desiccated thyroid, is pig A didn’t have the same thyroid hormone as pig B. They are standardized.

OK. Got it.

But they’re pork-based.

OK. Oh gosh, there’s a lot here. It really is independent, again, on your individual levels. Is there a way to test how somebody converts T4 to T3, is there a way to identify that, or is it really just talking with the patient and looking at that lab work?

It’s looking —

At the lab work

—the lab work and the lab. From a symptom standpoint, we really can’t tell, unless you add the T3 in and they say, oh, that was so much better.

Yeah. When somebody does start to feel better, what does that look like? What are some of the common things that you might hear from a patient like, oh, all of a sudden I’m feeling more energetic, or what does that —

Say, my energy’s back.

OK.

I’m actually getting to the end of my day and I still have a little something in the tank to do something either fun or something I need to do. They’ll say, you know that weight that was slowly creeping up and I really couldn’t fix it? Is now starting to recede. It may not be quick, but they’re feeling like they’re getting their body back.

Mental clarity. They’ll say, wow, I’m having thoughts again.

It’s not foggy and train of thought loss, yeah.

It’s, I can process things better. I’m clear. I feel better. And mood, mood can lift. Like we said, depression can be along with low thyroid. So they’ll say my mood is better. So it really is — when you think about the things that it can impact, our energy, our mood, our mental clarity, our metabolism, it can be life changing when you find that person who really needed that. And to not be constipated is probably not a bad thing either.

Right. You want to feel better in that regard. So let’s talk about how this, this kind of protocol. If you’re saying, OK, yes, you’re going to take T4, how does that fit in with all the other lifestyle factors that we so often talk about? We always talk about sleep. We talk about stress management, exercise, nutrition. How do these things all fit together as part of a comprehensive approach?

Simply giving thyroid hormone and expecting you to feel better. If we’re sleeping four hours a night, not going to happen. So we need, so we can function better in general and have lower cortisol levels and lower stress levels, we need to get the sleep. If we’re eating a nutrient, poor diet, yeah, your metabolism is better, but you’re not healthier. So working on the nutrients.

And then exercise, because that dovetails nicely with thyroid hormone. Because now I have energy, I can exercise, which is going to lower my blood sugar level. It’s going to improve my muscle mass and my strength, and now I feel like going out and doing more.

Yeah. Are there, when it comes to the nutrition and supplementation, targeted things that you can do that are more specific for the thyroid?

That would be your iodine, selenium, tyrosine, but then something like ashwagandha, which is an adaptogen herb for the adrenal glands, but it also helps to improve thyroid function. And so there’s that. Those would be t the main things I would pull out.

The main ones for those. Ok, so we moved quickly through that. I think it’s so interesting to see how the pituitary gland with TSH to the adre — or to the thyroid, and then T4 to T3. I mean, everything is such a, like, OK, this affects this affects this. Plus it’s got all these other hormones and things coming in from across the body. Did we miss anything? I mean, of course, we did, but anything that you want to make sure that we cover in this episode around thyroid.

Just making sure that if people are feeling fatigued, their metabolism is off, that at least it’s part of the workup. We should always be looking at thyroid hormone. Whether we’re looking at blood sugar, hormone balance, like sex hormone balance, we should be looking at thyroid function, because it does change with age. And making sure that we address the autoimmune issue. Don’t ignore the gut. We have to take care of that.

And not simply accepting somebody saying, well, your TSH is the only thing I’m willing to check, and it’s normal. Well, maybe you have an autoimmune issue. Maybe your TSH is barely normal. You have almost no T4 and T3. Because that crosstalk may not be appropriate. And that’s where the stress hormone may be playing a role that a provider that’s only looking at TSH won’t appreciate that.

And that’s what I was just going to add, is making sure to ask for — you sometimes have to ask specifically for the T4, T3 testing.

You do. And especially the antibodies. You need to ask. Now, something we didn’t touch base on, there is something —

Awesome.

—something called reverse T3. So reverse T3, to make it brief, is our body turns T4, which has four iodines, into T3, which has three iodines. So there’s an enzyme that pulls one of the iodines off at T3. Well, there’s an enzyme that pulls the opposite iodine off, and it’s reverse T3.

OK.

So reverse T3 is an inactive form of thyroid hormone, inactive T3. And so it doesn’t work. It plugs into receptor but doesn’t do anything. You might think, why would I make inactive T3? Why would the body do that?

Yeah.

Think about it like our emergency brake. Reverse T3 is made in times of starvation and massive stress. When every calorie counts, you do not want to waste any bit of energy.

You’re struggling for survival. And so the body will flip that switch. Reverse T3 goes up, maybe floods the system, plugs your thyroid hormone receptors, your metabolism slows to save your life.

Now, that’s really productive then, but some of us become conditioned to make too much reverse T3. How do we get that? Yo-yo dieting, because we’re putting our body in starvation mode, and then we’re eating and then we’re starving. And we can condition the body to crank up that reverse deiodinase enzyme.

So it is a real thing. It’s not a super common thing, but it’s a real thing. And if you know someone’s reverse T3 is elevated, we have to approach the thyroid replacement in a different way. You just throw T4 at them, they’re just going to make more reverse T3 and you’re none the better.

Yeah, it’s not really doing anything. You’re in the same situation you started in.

Correct.

OK. OK, I’m glad we got to that. OK, now, anything else? Any last minute thyroid thoughts? Yeah.

No, it’s, really, as we talked with a lot of things, it’s being your own advocate. Saying, I think I have a concern. And ask the question because the worst that’s going to happen is we’re going to look at a thyroid panel and go, well, it would been an easy thing to fix if that was the problem, but it’s not the problem. But at least we know. Ignoring it doesn’t make it go away.

So being your own advocate, asking for the testing, making sure your provider is doing a complete evaluation, and then following through with the lifestyle stuff. Because like all things, we simply take a hormone, and we’ve got all these symptoms and we’re behaving poorly, we’re not going to feel better. We’re not going to be the optimal person we could be.

And again, we want to have the longest health span in our lifespan, and this is one thing that we can, again, look at to ideally feel better for the long-term.

When you think about the number of things that thyroid hormone impacts and how those things like metabolism impact our long term aging, it’s huge.

Yeah. All right, Greg, thank you so much for joining me again. If our listeners and viewers want to learn more, they can visit miora.lifetime.life. And that’s what we’ve got. So thank you.

Oh, my pleasure. Thanks for having me.

See you again soon.

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