Dr. Angela Mazza Brings Clarity to a Misunderstood Gland
From the Spring 2025 recording of the LEVELS podcast with Mike Haney
Few glands in the body spark as much confusion—and misinformation—as the thyroid. Sitting quietly in the neck, this butterfly-shaped organ influences nearly every cell through the hormones it produces. When it falters, the consequences ripple across metabolism, energy, mood, and long-term health. In a Spring 2025 conversation on the LEVELS podcast, integrative endocrinologist Dr. Angela Mazza explored this complexity with host Mike Haney. The discussion traced her journey into thyroid medicine, unpacked the physiology and testing of thyroid function, and outlined an integrative framework that blends conventional endocrinology with functional approaches.
A Career Rooted in Hormones and
Whole-Person Care
Dr. Mazza entered endocrinology through a personal connection: diabetes runs in her family. But as her career unfolded, she found herself increasingly drawn to thyroid medicine. Early in practice, she became the physician handling ultrasounds and biopsies, naturally accumulating a large thyroid patient base. What she discovered disturbed her—patients were being missed, mismanaged, or left dissatisfied.
This realization propelled her toward integrative endocrinology. By founding the Metabolic Center for Wellness, Dr. Mazza committed to merging traditional hormone science with functional insights into nutrition, gut health, stress, and lifestyle. Her philosophy is not about fixing numbers on a lab sheet; it is about helping people feel well now while preserving health decades down the road.
Why the Thyroid Matters
The thyroid produces hormones—primarily T4, which is converted into the active T3—that regulate metabolism at the cellular level. As Dr. Mazza explained, metabolism is not simply burning calories; it is the sum of thousands of chemical reactions occurring every second. When thyroid hormone levels tilt too high or too low, the imbalance reverberates through the cardiovascular, skeletal, neurological, and immune systems.
She describes the thyroid as the body’s thermostat: a regulator that sets the tone for countless other hormonal and metabolic processes. Dysfunction can therefore be both a cause and a consequence of disturbances elsewhere in the body.
The Two Extremes: Hyperthyroidism
and Hypothyroidism
Hyperthyroidism, often triggered by Graves’ disease, places the body in a hypermetabolic state. Patients may feel anxious, shaky, or plagued by palpitations, sleep disruption, and gastrointestinal changes. Contrary to popular belief, weight loss is not inevitable; stress-driven cortisol surges can foster insulin resistance and paradoxical weight gain. Eye complications—from lid retraction to vision-threatening inflammation—can make the disease especially disruptive.
Treatment begins with stabilizing symptoms, usually through beta-blockers, and then choosing among anti-thyroid medications, radioactive iodine, or surgery. Yet Dr. Mazza’s integrative practice often allows her patients to avoid the latter two irreversible options. Stress management, gut health support, and antioxidant therapy form part of her toolkit, enabling many patients to discontinue medication over time.
On the opposite side lies hypothyroidism, most commonly associated with Hashimoto’s thyroiditis. Its symptoms tend to creep in gradually—fatigue, brain fog, constipation, mood changes, menstrual irregularities, high cholesterol, and visible signs such as dry skin and hair loss. Diagnosing hypothyroidism requires more than a single blood test. While the screening marker TSH is valuable, Dr. Mazza stresses the importance of looking at free T4, free T3, antibody profiles, and sometimes reverse T3. She also integrates nutrient testing, since iron, selenium, magnesium, and iodine deficiencies can mimic or exacerbate thyroid dysfunction.
Beyond TSH: A More Complete
Picture
The conventional reliance on TSH alone as the diagnostic gold standard is, in Dr. Mazza’s view, limiting. TSH is an indirect measure reflecting brain-thyroid feedback loops. Optimal levels vary among individuals and may even shift with age. Some patients present with normal TSH but clear hypothyroid symptoms—a scenario where examining circulating hormone levels, antibodies, and nutrient status becomes essential.
She also defends the value of reverse T3 testing, once dismissed in training as irrelevant except in hospitalized patients. Elevated reverse T3, she notes, may indicate cellular stress, mitochondrial dysfunction, or overtreatment with T4-only therapy. For patients on thyroid replacement, this marker can reveal whether the therapy itself is inadvertently counterproductive.
The Role of Imaging
One of Dr. Mazza’s clinical hallmarks is her use of ultrasound imaging. While blood tests reveal biochemical function, ultrasound shows physical changes in the gland. With real-time visualization, she can distinguish between Graves’ disease, Hashimoto’s, and other thyroiditis patterns, or detect nodules that warrant closer scrutiny.
Nodules are remarkably common—up to half of adults harbor them, though the vast majority are benign. Size, composition, vascularity, and the presence of microcalcifications guide biopsy decisions. Even benign nodules, however, may cause cosmetic or mechanical problems, from visible neck swelling to difficulty swallowing.
Innovation in Treatment:
Radiofrequency Ablation
Traditional surgical removal of nodules often creates more problems than it solves. Without a thyroid, patients face lifelong medication challenges, and not everyone converts synthetic T4 to active T3 efficiently. To address this gap, Dr. Mazza has championed radiofrequency ablation (RFA)—a minimally invasive office procedure that uses targeted energy to shrink nodules by up to 70% within months.
Patients remain awake, their vocal cords monitored in real time to avoid nerve damage. Compared with surgery, RFA preserves thyroid tissue, minimizes recovery time, and allows the gland to continue functioning. In cases of small, slow-growing thyroid cancers such as papillary microcarcinomas, RFA is emerging as an attractive alternative to both surgery and passive surveillance.
Personalization in Hormone
Replacement
For patients who lose thyroid function entirely, hormone replacement therapy becomes necessary. The conventional approach relies on levothyroxine (T4 alone). Yet genetic variations mean roughly 15% of people cannot adequately convert T4 to T3. These individuals often experience persistent fatigue, mood issues, or metabolic challenges despite “normal” labs.
Here, combination therapy—whether through synthetic T3 plus T4 or natural desiccated thyroid extract—can restore quality of life. Dr. Mazza points out that historically, thyroid extracts containing both hormones were standard until synthetic T4 took over mid-20th century. Now, the pendulum is swinging back toward individualized regimens tailored to patient response.
Hormones in Context: Women’s
Health, Adrenals, and More
Thyroid function never exists in isolation. Adrenal health, sex hormones, and systemic inflammation can all alter thyroid balance. For women in perimenopause and menopause, shifts in estrogen and progesterone profoundly interact with thyroid physiology, complicating both diagnosis and management.
Dr. Mazza emphasizes that addressing thyroid health may require parallel attention to cortisol rhythms, reproductive hormone transitions, or insulin resistance. Her philosophy reflects the broader systems biology approach increasingly recognized in modern medicine: no gland or organ operates alone.
Tackling Misinformation and Myths
Social media and online forums abound with thyroid advice—much of it misguided. Among the most harmful myths Dr. Mazza counters are:
·
The “temperature method”: once
popularized as
· The “magic weight loss cure”: while thyroid dysfunction influences metabolism, hormone replacement alone rarely produces dramatic weight changes. Lifestyle, insulin sensitivity, sleep, and stress remain central.
· The “subclinical” label: patients with symptoms and borderline labs are sometimes dismissed as having “subclinical hypothyroidism,” implying no intervention is needed. Dr. Mazza argues this ignores lived experience and the progression of autoimmune thyroid disease.
Her corrective is both practical and empowering: pair careful laboratory and imaging evaluation with open acknowledgment of patient symptoms.
Lifestyle, Nutrition, and Prevention
If there is a theme woven through Dr. Mazza’s teaching, it is agency. Patients are not powerless against thyroid dysfunction. Lifestyle choices can profoundly influence resilience and outcomes:
· Sleep: A non-negotiable seven to nine hours stabilizes cortisol rhythms and supports thyroid function.
· Stress management: Chronic stress distorts cortisol curves, undermining thyroid balance. Techniques that calm the nervous system are protective.
· Nutrition: Micronutrients such as selenium, iodine, zinc, and iron provide the raw materials for thyroid hormone synthesis. Two Brazil nuts a day can supply selenium needs; pumpkin seeds add zinc. Whole, minimally processed foods protect against inflammatory triggers.
· Detoxification: From household chemicals to plastics, endocrine disruptors are unavoidable. Supporting the body’s natural detox pathways—hydration, antioxidants, and even daily sweating—can lighten the load.
· Movement: Exercise not only boosts metabolism but also improves insulin sensitivity, an underappreciated determinant of thyroid health.
These habits, she stresses, are not elaborate “protocols” but steady, sustainable practices that reinforce thyroid stability and long-term well-being.
Looking Ahead
Dr. Mazza’s voice on the LEVELS podcast carried both authority and humility. She blends rigorous endocrinology training with the openness of integrative medicine, recognizing that no single perspective holds all the answers. Her vision of thyroid care is deeply personalized, evidence-based, and compassionate, rooted in the conviction that patients deserve more than a prescription slip or a dismissive “your labs look fine.”
By educating audiences on the nuance of thyroid physiology and the promise of individualized care, she is helping dismantle misconceptions that have long hindered patients. From radiofrequency ablation to personalized hormone replacement, her clinical work demonstrates how innovation and empathy can coexist.
Conclusion
The thyroid may be small, but its influence is vast. As Dr. Angela Mazza made clear in her 2025 conversation with Mike Haney, caring for this gland requires seeing the bigger picture: hormones in context, labs in conjunction with symptoms, and treatment integrated with lifestyle.
Her message is both cautionary and hopeful. Cautionary, because oversimplification—whether by clinicians or online influencers—risks leaving patients untreated or mistreated. Hopeful, because with the right blend of science, integrative strategies, and patient empowerment, thyroid disorders can be managed, and often improved, without compromising quality of life.
In the end, Dr. Mazza’s vision of thyroid care is less about chasing numbers and more about fostering resilience. It is an approach that reminds us that medicine is not just about glands and hormones—it is about people, their stories, and their capacity to thrive when science meets compassion.
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