Fasting Insulin Is the Thyroid Marker Standard Panels Miss, Says Dr. Amie Hornaman

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NAPLES, FL - October 03, 2026 - Dr. Amie Hornaman, known to her audience as The Thyroid Fixer, holds a clinical position that puts her at odds with routine practice. Her view is that fasting insulin, a test absent from most standard panels, identifies the metabolic problem in Hashimoto's patients years before fasting glucose or A1C register anything, and that a thyroid patient told her sugars are normal has often been under-tested rather than reassured.

"I have lost count of the number of women who were told their labs were normal for a decade before anybody measured their fasting insulin," said Dr. Amie Hornaman. "Glucose and A1C are the last markers to move. If you only order the last markers, you will only ever find the problem last."

The marker that moves first

The mechanism Dr. Hornaman describes is one she has published on her own site. Low or poorly converted thyroid hormone makes cells less responsive to insulin. The pancreas compensates by producing more of it, and that compensation can run for years while fasting glucose and A1C stay inside their reference ranges. Fasting insulin measures the compensation itself rather than the point at which it fails. In her published position, many Hashimoto's patients have normal fasting glucose alongside a high fasting insulin, which is the earlier marker, and the everyday signals that go with it are the ones patients are most often told to ignore.

"An afternoon crash that demands sugar, heavy legs by the end of the day," said Dr. Hornaman. "Those are not willpower failures. They show up years before a glucose test flags anything, and I want that patient's fasting insulin long before I want a lecture about calories."

Where sleep enters the same cascade

The second half of her position concerns sleep. In her published guidance, a 3 a.m. waking in a thyroid or hormone patient is frequently a cortisol spike that pulls the patient out of sleep, and a small protein-and-fat snack before bed can prevent it. Approached only as insomnia, that waking attracts remedies aimed at getting a patient to sleep rather than at what is waking her at the same hour every night. Approached as part of the metabolic picture, it points back to the same thyroid and insulin question. Dr. Hornaman treats thyroid, insulin and sleep as one cascade rather than three complaints for three different specialists, which is why her clinic evaluates thyroid and hormone status together rather than in sequence. Its testing position is the same one it applies throughout, that it does not stop at TSH and evaluates Free T3, Reverse T3 and antibodies as a matter of course.

The resources behind the position

Existing resources on Dr. Hornaman's site cover the connection between Hashimoto's and blood sugar, the role of insulin resistance in autoimmune thyroid disease, and the hormone side of disrupted sleep. Dr. Hornaman notes that her site is an educational resource rather than a substitute for a licensed healthcare provider, and that diagnosis and treatment belong in a clinical relationship.

About Dr. Amie Hornaman

Dr. Amie Hornaman is a Doctor of Clinical Nutrition and thyroid specialist, a practicing hormone optimization specialist, and the host of the podcast The Thyroid Fixer. She is CEO and founder of the Advanced Thyroid & Hormone Clinic, an international telehealth practice serving patients across the U.S. and Canada. Her work follows her own experience of being misdiagnosed and undertreated, and it centers on patients who have been told their labs are normal but who continue to experience fatigue, brain fog and hormone-related symptoms. Learn more at dramie.com.

Media Contact

Advanced Thyroid & Hormone Clinic Dr. Amie Hornaman info@dramie.com [mailto:info@dramie.com] 412-212-6499 https://dramie.com/contact-us/
Media Contact
Company Name: Dr. Amie Hornaman
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Phone: 412-212-6499
City: Naples
Country: United States
Website: https://dramie.com/

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