Low Free T3 and Reverse T3


Could someone please help with my results ,

My TSH is 2.5 range is 0.50-5.00

Free T4 is 19.0 range is 11.0-21.0

Free T3 is 2.8 range is 3.1-6.0

Reverse T3 is 202.0 range is 230.0-2.200

Does anyone know what I should if anything should be taking? I am on no medication at moment but lots of supplements including a seaweed iodine mineral drink. I went GF and DF 6 months ago and has helped ,but I still get a lot of pain around gallbladder and liver both front and back, rashes,dry skin everywhere and my face is so tight every morning and eyes mouth so dry too, I have aged about 10 years on the skin on ,y face in about 6 months and have new lines etched on my face everyday! I wasn't flash to start with ;)

my antibody results are

TP ab <10.0 range 0.0-35.0 iu ml

AG?ab <10.0 range 0.0-115

TSH receptor ab <1.0 range 0.0-0.15

I would be so grateful

Many Thanks JLat :)


51 Replies

  • Others will leave more complete replies but you obviously need to redress the balance between yr Ft4 which is rather high and your low FT3.

    Also, your TSH is ,'normal' but optimal is generally regarded as under 1.

    Some sort of thyroid medication is required. 

    Antibodies suggest you don't have Hashimotos. But you may have it and he seronegative. 

    Hope others can help you further. 

  • Thank you look forward to more advice

  • password

  • you might find this link helpful thyroidpharmacist.com/artic...

    also 6 months is still quite early in the gluten free aspect of diet. my daughter had similar and it seemed that she was T3 resistant, which seemed to come about after a reaction to Malarone (anti malaria drug)

    Do go over to shower gel that does not contain sodium laurelsulfate and sensitive type washing liquids etc - I expect you probably have done already.

    Others will be able to decipher your blood test results better than me

    I do wish you luck as it can be a long and uncomfortable road, but there is hope! x

  • Thank you so much , yes I have tried to eliminate chemicals etc , thanks I will keep my hopes up :)

  • You should not take a seaweed iodine drink.  This can cause all sorts of problems including hypothyroidism.  I'd throw the drink wa way and do another blood test in a few months time.  An rT3 assay isn't any use, so I wouldn't bother with it unless it is cost free.

  • Cost $250 privately, took 1 month for results , am I hypo with these results or do you think liver gallbladder pain common with thyroid problems?

  • You are hypo because your FT3 is so low. And gallbladder problems are common for hypos.

  • I wouldn't bother with the rT3 test again as it is an unnecessary expense.  High iodine intake can cause hyper and hypo-thyroidism.  With your iodine supplemtation I wouldn't trust your blood test results, the high iodine may distort them, or more likely reflect your body's response to excessive iodine.

    Gallbladder pain can be very misleading.  With abdominal pain it is impossible to know for certain where the pain is coming from, the pain is usually 'referred'.  If you get a chronic dull ache it is more likely to be IBS, which might arise from hypothyroidism.  If you get sudden sharp pains it could be due to passing a gall stone.  If you get a severe attack of pain it would be useful to have a blood test (liver function test - LFT) done at the time.  If the pain is due to gall bladder of liver problems this test will show it very clearly as the numbers will go sky high.

  • Thanks so much for your reply def low grade pain and not sharp .ALK slightly elevated but rest in range. Pain most days, dull and can be related to eating, sometimes not :( so confusing

  • Oh and my body temp is 35 degrees up from 34 degrees sometimes up to nearly 36 some days.

    Is this an indication also please

  • Yes, that is also an indication.

    Don't forget that if you want to reply to someone, they will only get notification if you click on the green 'Reply' button at the bottom of their post. :)

  • Oh ok thanks will do in future :)

  • Did you have any nutrients tested before starting suppléments? Or did you just launch into it in the hope of finding something that would help the way you feel?

    Iodine really isn't a good idea if you Don't need it. And you will only know if you need it by getting tested. As for other things - whatever they are - how did you know how much to take?

    Your TSH is not at all 'normal', and shows that your gland is beginning to struggle. But you won't get any help from doctors until it goes over the stupid range. However, your FT3 is Under-range, so this should give them a clue that something is wrong! (Being sarcastic here :) ) Oh, and there's something wrong with your rT3 result and ranges, they Don't correspond. Think there's a rogue decimal point in there somewhere.

    I imagine you had these done privately, yes? Have you shown them to your doctor? What did s/he say? If you haven't shown them yet, then when you do, point out that your TSH is in range, but higher than desirable (someone with not thyroid problem at all has a TSH of between 0.8 and 1.25) and that your FT3 is Under-range which is causing you a lot of symptoms. You have to point these things out because doctors just tend to look at the TSH, and if it's anywhere in range, just dismiss you as 'normal'.

    Looks like you're making a lot of rT3, which is weird for someone not on thyroid hormone replacement. But, could have something to do with the suppléments your taking. It would be a good idea to give a complete list of what you're taking, with quantities, and test results if done.

    When you ask what you should take, I imagine you mean you're considering self-treating. But no-one here can just tell you what to take, we're not medically qualified. And your results are rather strange. We would need much more detail before we could even hazard a guess.

    Do you still have the metallic taste in your mouth? Could be the iodine drink!    

  • Hi Grey goose Thankyou so much , metallic taste has gone :), as for results the decimal points in right places , I just checked , my Dr has not seen these private results , I want going to go back to him , the results were ordered from herbalust/nutitionist , I take vit c 2000 multi vit b picnogenol ginkgo vit d 2000 liver herb tablet and digestive enzymes , I have had ultrasound on liver and gallbladder shows 1 cyst on liver that Dr us not worried about a polyp on gb Dr not worried about but I have polyps almost in every organ , and I wonder what on earth I'm doing wrong for my body to have ALL these things happening ?

  • "Reverse T3 is 202.0 range is 230.0-2.200" That range? Two hundred and thirty to two point two? Or two hundred and thrity to two thousand two hundred? If the latter, then your result of two hundred and two is low. If it's low, it's nothing to worry about. It's when it's high that there's a problem.

    OK, I understand the suppléments, now. People like herbalists/nutitionists think that all you have to do for a thyroid problem is to throw some iodine at it. And it's just not true. We Don't know what is causing your thyroid problem, but iodine will only help it if it's due to iodine deficiency. We hear so many people say 'but iodine is good for thyroid'. Well, no. Iodine is one of the raw materials that go to making thyroid hormone. But, if your factory has burnt down, throwing more raw materials at it isn't going to increase production, is it? Your problem obviously isn't low iodine, because you are making plenty of T4 - T4 contains four atoms of iodine. Your problem is converting that T4 (the storage hormone) into T3 (the active hormone).

    So, why are you having that problem? Well, first thing to look at is nutritional deficiencies. But that doesn't mean throwing a fistful of random suppléments at it. It means first getting tested for vit D, vit B12, folate and ferritin. These are the basics, and they all need to be optimal - not just in range. So, first things first: get those tested, get a copy of the results and post them here, and then we can take it from there. :)

    Oh, and drop the iodine drink! 

  • Thankyou soooo much Grey goose will do and report back

  • You're welcome. :)

  • I did have ref range incorrect :( reverse T3 230.0 to 540.0 and my reading was 202.0 sorry

  • Ahhh that's better! lol But it's still nothing to worry about. A certain amount of rT3 is normal, it's when it's high in range/over-range that it can become a problem. :) 

  • greygoose metallic taste. Is that a sign of Vit D toxicity as well?

  • Indeed it can. But the OP didn't mention vit D, so... anyway, it appears to have gone now. So, that's ok. :)

  • Wow, didn't  know that, thanks. I got a metallic taste in my mouth when I upped my Vit D intake, never knew what it was.

  • Thank you I have had  bronc stress for approx 24 months and then my mum died in December , strangely enough I feel less stress since she died , but soooo much sadness if that make s sense contradictory really , but I don't have that constant shake on the inside feeling.

  • Will check out links too many thanks :)

  • Much of the above quoted article is correct.  However the statement:-

    "This becomes a vicious cycle as rT3 competes with T3 as a substrate for the 5-deiodinase enzyme. This inhibits the conversion of T4 to T3, with more T4 being converted to more rT3."

    is completely wrong.  It might just be a typographical error.  T4 is the substrate not T3.  If T3 were the substrate in question the deiodinases would break it down into T2 etc.  (which does also happen).  Only if T4 is the substrate will you get conversion to T3.  If you deiodinase T3 you get a molecule with fewer iodine atoms such as T2 or T1.

    We should be careful about taking these unverified statements at face value, especially when they come from a source that markets fT3 assays.

  • I can't provide reference for these comments, it's down to elementary logic.  As I noted there may be a typographical error.

    The deiodinaase enzymes act on T4 and T3 to remove an iodine atom.  If T3 is the substrate then the enzyme will act on it to make T2.  If T4 is the substrate then the enzyme will act on it to make T3 or rT3.

    If they meant to say "rT3 competes with T4 as a substrate" then that would make sense (although I've never read anything to this effect).  Indeed if rT3 was the substrate then rT3 would be deiodinased and the levels of rT3 would fall.  The sentence just doesn't make sense.

  • I'm not chastising you, I'm pointing out that the information supplied by a company that markets rT3 assays to the public is dubious.  We need accredited information.

    Deiodinase means to remove iodine atoms, if you remove one from T3 or rT3 you will end up with a molecule with two iodine atoms.  rT3 does compete with T3 and so will be deiodinased in preference to T3, this would lead to lower rT3 levels.

    I've never heard of "This inhibits the conversion of T4 to T3, with more T4 being converted to more rT3."  Either it inhibits deiodinase or it doesn't.  If there was a vicious circle rT3 would increase ad infinitum.

    "Wilson's syndrome" is not a recognised condition.  Wilson sought fame by naming it after himself causing much confusion with the existing "Wilson's disease".  Wilson was struck off after causing the death of a patient.  We need accredited information.

    I'm simply saying we need to take documents produced by a company with a vested interest with a pinch of (iodised) salt.

    I'm just expressing a word of caution about taking comments found on the internet at face value, especially if they have a marketing content.

  • 80% of the thyroid hormone T4 is handled by gallbladder and liver and converted into T3. If the gallbladder and liver are not working properly, the amount of T3 will be less. I would personally give a go for purified Bile Acids/Salts (same thing) as a supplement. It's good to start carefully and see if there are side effects. Bile helps with the absorption of fat-soluble vitamins. Without enough bile one does not convert enough T4 into T3 and one doesn't absorb fat-soluble vitamins properly.

    As for the dry skin. Try organic butter, extra virgin olive oil and eggs for vitamin A. If one has a dry skin, vitamin A deficiency is to a large extend to blame. Also it's good to make sure you get enough omega 3. And if one doesn't have enough bile, not enough of vitamin A would get absorbed. Other symptoms of vitamin A deficiency would be eyes drying, poor eye sight at night and hair drying.

    If you have also upper back and neck issues on the right side, this would confirm gallbladder issues with either not enough bile. Another very important thing for the liver is lots and lots of fresh, raw whole vegetables (at least 500g per day, which is still a bit on the low side), all vegetables, but especially cruciferous vegetables like broccoli, kale, cauliflower and fermented vegetables like Sauerkraut. But if any vegetable causes stomach pain or bloating, eating that is not a good idea. Vegetables help the liver to function properly.

  • Perfect I will do that and up my raw veges,I have been dairyfree for 6 months so will use the oil instead of Butter if that is ok? Thanks :)

  • Yes, the extra virgin olive oil is fine.

  • Satu -am intrigued...you mention 80% conversion is done in gallbladder as well as liver. I didn't know about the gallbladder -please could you show me some references or links to this. I'm due a gallbladder op to remove -not something I want but seems I might have to. Obviously am now worried about your comment that the gallbladder converts thyroid hormones.....thought it was the liver. Am told the gallbladder is just a holding bay & has no other function by the medics so would be interested to know more. 

    Spent ten years sorting out my thyroid meds don't want it messed up if gall bladder removal will affect conversion of thyroid hormones.....argggh!! 

  • Sorry, maybe I wasn't too clear. If the gallbladder is not working properly ie. there's not enough of bile, the conversion won't happen. The thyroid produces 80% T4 and 20% T3. So partly it is already produced by the thyroid, but the rest of T3 becomes from the conversion. Gallbladder and liver work together. Gallbladder is a small sack below the liver where the liver stores bile for later use.

    I would refer you for more info to Dr. Eric Berg from Virginia. He's dealt with these lots.

  • I had my gallbladder removed last year - its removal has caused many problems for me but my thyroid bloods were exactly the same afterwards as they had been for a few years previously. I've never heard or read anywhere that the removal of my gallbladder might affect my hypothyroidism? As it turned out my GB was in okay fettle but for one super large gallstone. It had become lodged up against my liver slightly so its removal sent my liver into orbit for about six months. I did get a severe post op wound infection and blood poisoning from the cholecystectomy though so removing it was a source of regret retrospectively. Some have no choice but I did.

  • We must be twins twitchy my gb gives me back ache most days even with restricted diet and no alcohol and gf and df :( ah the joys... I won't get mine out too nervous...I don't have stones but do have a polyp

  • I did have a very negative experience but this was due to duff hospital/ surgeon and my gb was not infected. They misdiagnosed drug induced pancreatitis twice and so I agreed to get it removed having had the stone for many years. I never had the symptoms you describe from it though. I have less gastritis since its removal but my previously undiagnosed and untreated Sjogrens symptoms have simply progressed since. So hard to measure the impact really. If you do need the op then you would be very unlucky to have as bad a time as I did it so don't be too fearful. X

  • It used to be thought that most T4 to T3 conversion was done by type-1 deiodinase (D1), mainly in the liver but it is now thought most T3 is produced by type-2 deiodinase (D2) which occurs in many organs including the heart and brain.  D1 produces equal amounts of T3 and rT3 and occurs when there are high levels of T4, probably in order to conserve iodine and protect against thyrotoxicity (too much hormone).

    The gall bladder has no role in thyroid hormone homeostasis.  When mine was removed I noticed no difference, other than an absense of occasional severe pain.

  • Gosh, this is a difficult request, it's such a complicated subject.  Note my comment 'is is now thought'.  I wanted to convey there is no certainty in this area.  However, a couple of papers to get you started:-

    Graham Williams and Duncan Bassett have written an excellent review of the deiodinases, see joe.endocrinology-journals.... .  They state that most of the circulating T3 comes from DIO1 (I prefer the term D1 to differentiate it from the DIO1 gene).

    This paper press.endocrine.org/doi/ful... (which I haven't read for some time) mentions evidence that D2 is the major source of circulatiing T3.

    Going from memory, it seems that the more recent research (as opposed to reviews) seems to be in favour of D2 being the major contributor.  Nobody is certain, the research is inconclusive.  However, this relates to circulating T3 as opposed to intracellular T3.  Since D2 takes place close to the cell nucleus it is likely it has more effect on T3 levels at the receptors (in those cells with D2) and thus D2 is probably more important.  Also, remember D1 produces equal amounts of rT3.

    If you want to read up more about deiodinase this website deiodinase.org/ belongs to one of the major research teams.

  • i would agree with all that and my dr told me that adrenals being taxed causes aging like that and he put me on a adrenal glandular supplement.....but i have 5 years out.....and was the first dr to tell me this although i knew from stress i my adrenals were taxed....

  •  thank you :)

  • Yes, too much cortisol causes aging. Exhausted adrenals can cause also issues with the thyroid. I would personally use adrenal glandulars only short term as taking it will further reduce the ability to produce cortisol to cope with stress. It's a good idea to recharge the adrenals. Relaxation, relaxing walks, some supplements and generally lowering all stress.

  • Thanks Satu ,good advice and a face lift would certainly help ;)

  • Hi jLat,

    Interesting and informative thread.  Wishing you luck with the next stage of discovery and recovery. Even a struggling thyroid hormone output can cause all sorts of weird issues that you could track right back to all your symptoms. I know when my levels are low my stools go pale and my liver plays up. Re the liver/gallbladder bile aspect, here's some more info.  In short, it's looking like looking after bile acid production is crucial for metabolizing thyroid hormone as well as staving off diabetes and metabolic syndrome.


  • Just an aside.  If your stools go pale (biscuit colour) and urine very dark, this is a sign of biliary obstruction, such as a trapped stone.  In this case you should speak to your doctor, or if in severe pain seek urgent medical attention.

  • Thanks jmh11 -I appreciate your info and reassurance that removing your gall bladder did not cause a problem with thyRoid conversion. What a relief!! And also it's good to know that many parts of the body are involved with thyroid hormone conversion -frankly that makes sense.....

    The body is a very complex being -am fascinated by a piece of recent research that I can't quote you it source am afraid....but it has found there are several feedback loops systems not just one where the thyroid is concerned, any of which if breaks down has the same outcome but may not show up through assessment in the same way -am sure this will ultimately explain why we all vary so much and why the blood tests have limits, missing a huge chunk of people. One day....certain endocrinologists will have to acknowledge that it is NOT all in our heads.....I do hope it's in my lifetime!  

  • Thank you so much the information and support from such an intelligent group of informed people, it is so reassuring and your knowledge never ceases to amaze me. Thank you all very much :)

  • Thanks hell bell. Fortunately with a gallbladder removal they connect the tube from the liver directly into the small intestine thereby the bile acids are still delivered but as a continuous process rather then in surges as the gall bladder would do. 

    I've found cutting the carbs down from grains and potato to be the only way to stop my waist growing and what would inevitably lead to diabetes in the end. It's a relief to find a food plan that works without great effort, hardship and with reasonable ease. I believe Dr Peatfield recommends this approach -seems that hypothyroid people do not process carbohydrates well .....should've listened years ago. I am now!! And since doing so am two stone lighter 😊 Feeling much better

  • Thanks for the encouraging news 😀

  • Well I've learned something very interesting from you @Waveylines - I never knew that they had reconnected the tube from my liver directly into small intestine? Always wondered where my bile acids were going now!! Thanks for this

  • Lower your T4.  Excess T4 will create rT3.   Start taking T3: 1mcg for each 3-4mcg T4 that you drop.   Are you taking more T4 than the Abbott estimate for T4-only full replacement of 1.7mcg/kg body weight?   This is a syndrome I've seen where a doc who doesn't know what they are doing, continues to increase T4 without regard to how much the body can use/tolerate.

  • Eddie, the OP is not on any thyroid hormone replacement. :)

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