Thyroid UK
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Very low temperatures with reverse T3 ratio at 0.2


I was wondering if any of you could help me. I have Hashimotos Thyroiditis. I take Armour 2 grains daily plus loads of supplements.

Over the past couple of weeks I have experienced really bad chills as well as a very low temperature.

For example yesterday my temperature was 34.6 at 10am. I had to go to bed to get warm with a hot water bottle, heat beads, socks, a duvet and a blanket. By 2 pm I had managed to get my temperature up to 36.6. I took it again at 17.15 and it was 36.5. Today, at 10.30 my temperature was 35.6. At 15.01 it was 35.1 and at 18.45 it was 36.3.

My recent blood tests show the following:

Free T4 10.62 12 - 22 pmol/L

Free T3 4.34 3.1 - 6.8 pmol/L

TSH 0.57 0.27 - 4.20 IU/L

Reverse T3* 16.0 10 - 24 ug/L

T4 Total 82.8 64.5 - 142.0 nmol/L

When I did my RT3 ratio it said it was 0.2 which seems ludicrous

My ferritin is high at 182.7 20 - 150 ug/L but it is not unusual for me as mine is always high.

Vitamin B12 471 Deficient <140 pmol/L Insufficient 140 - 250 Consider reducing dose >725

Serum Folate 23.15 10.4 - 42.4 nmol/L

So does anyone know what might be going on?

My next endocrinologist appointment is not until 10th April although I have left a message with her secretary.

Thank you so much.

6 Replies

Is the reverse t3 too low or? I tracked my rt3 for 16 months. Each time, i lowered my t4 meds, my rt3 went down. I realized that i could only take about 25 to 35 t4, with a free t4 result, waaayyy under range, in order to get my rt3 under 15. So i stopped all t4, because it just made no sense. Well, i still feel feel really bad. Apparently whatever caused my high rt3 ie WHY i feel bad.

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Hello Faith,

My Reverse T3 is fine and I have discovered that I was calculating my ratio incorrectly. I have spoken with my Endo this morning and we have a plan of action. Thank you so much for replying and I hope you start feeling a whole lot better very soon Faith :-)


I'm guessing that you used the calculator on the STTM website. Depending on the combination of units being used it sometimes comes out with absolutely nonsensical results like yours. It isn't very reliable.

When I looked at a different set of instructions :

Your ratio turned out to be (4.34 x 100) / 16 = 27.125.

Your reverse T3 is slightly below mid-range which looks good.

I suspect it looks good because you have low Free T4, low in range Free T3 (it's only a third of the way through the reference range), and with such low T4 there isn't enough raw material to allow reverse T3 to become a big problem.

I think you need a higher dose of armour. But if your dose is being controlled by an endocrinologist I don't know how s/he would feel about your TSH falling below the range which it might well do.

Your high ferritin suggests you may well have a problem with inflammation. Have you got a recent level for CRP or ESR? Do you have any other medical conditions that might cause inflammation? E.g. arthritis, gut problems, gluten intolerance, other autoimmune conditions?

Have you ever heard of Anaemia of Chronic Disease?

The link explains why your ferritin may be high. A single ferritin level isn't conclusive evidence for anything though - you would need more tests to be sure.

You might find this link helpful too :

Your B12 is too low. The Pernicious Anaemia Society recommends people have a level of 1000 ng/L.

Your folate isn't too bad.

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Thank you so much Humanbean. You are always so helpful and detailed in your replies. This has helped me so much and brought be immediate peace. Thank you. I have had my appointment with my Endo this morning who was very willing to raise my Armour to alternate 2 grains with 2 1/2 grains. I am happy with at least some change in the first instance and she will review me in 6 months.

She wants my GP to do my ESR to find out if that is high and if so she will refer me to a Rheumatologist as she suspects I might have polymyalgia as well. I was bitten by a tick in 2007 and treated for Lyme disease so I want to check with my LLMD whether I can take a small amount of prednisolone if I test positive for polymyalgia. I have a sneaky suspicion that prednisolone is contraindicated with Lyme Disease (if it is still a continuing problem with me)

Your information on iron disorders was EXTREMELY interesting.

Thank you again SO much.

1 like

I'm glad you found it helpful.

I've always had a tendency to waffle. The people who know me would describe it as one of my less endearing character traits. :D


Well it was an absolutely perfect answer for me :-) Thank you SO much Humanbean :-)


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