trying to understand thyroid results

hi i wounder if any one knows about results cause i'm lost right now with trying to work this out.8 months ago i had a 24 hour urine test test done for t3 and it was extremely low so the doc told me i need ndt. i've now been on this for 3 or 4 months i've got up to1.5 grains i cant seem to go much higher cause i felt bad if i do i've tried to go up many times but end up coming back down and im stuck on 1.5 grain and latly ive been feeling hypo again and my moods are up and down and have bad foggy head. i resently had and full thyroid test done while i was on 1.5 grains.what i dont get is why is my t3 high when im only on 1.5 grains and the urine so low? some 1 did think ive got reverse t3 dominance going on.ive ordered some t3 cause it looks like i might have some conversion problem goin on here. ill put the 2 test here at the bottom thanks mark .

urine t3 was 553 ref range was 800-2500

urine t4 was 1130 ref range was 550-3,160

t3 to t4 ratio 0.49 range 0.50-2.00

more resent

CRP 0.90 <5.0 mg/L

Ferritin 166.9 30 - 400 ug/L

Thyroid Function

TSH L 0.05 0.27 - 4.20 IU/L

T4 Total 115.0 64.5 - 142.0 nmol/L

Free T4 19.31 12 - 22 pmol/L

Free T3 H 6.93 3.1 - 6.8 pmol/L

Reverse T3* 24.0 10 - 24 ng/dL

Reverse T3 ratio L 18.80 >20 Ratio


Anti-Thyroidperoxidase abs 7.7 <34 kIU/L

Anti-Thyroglobulin Abs 12.6 <115 kU/L


Vitamin D (25 OH) 79 Deficient <25 nmol/L

Insufficient 25 - 50

Consider reducing dose >175

Vitamin B12 591 Deficient <140 pmol/L

Insufficient 140 - 250

Consider reducing dose >725

Serum Folate 17.41 10.4 - 42.4 nmol/L

31 Replies

  • Have I understood this correctly markgreenhill ? It's getting late and I may be misunderstanding.

    Your question is:

    "what i dont get is why is my t3 high when im only on 1.5 grains and the urine so low? "

    Your current serum thyroid tests were done a couple of weeks ago (I'm assuming that is right from your last post). You say your urine thyroid test was done 8 months ago. You can't compare tests done so far apart. Also you are on a different amount of medication now than eight months ago so that would make a difference to the result.

    Plus you can't compare a urine test with a serum test, that's like comparing apples with oranges. You would need to do another urine test to compare with your old urine test or you'd need the result of an old serum test to compare with this current one.

    I hope this explains what I'm trying to say:

    In the last twelve months I've done both serum and urine tests. They were done one month apart and my medication was the same each time.

    Serum FT4 was 28.59 (12-22) which is 165% of range and serum FT3 was 5.14 (3.1-6.8) which is 55% through range. FT4 was showing way over range and FT3 mid-way.

    Urine FT4 was 1590 (550-3160) which is 40% through range and urine FT3 was 691 (800-2500) which is -6.4% (minus). FT4 was showing less than half way through range and FT3 below range.

    You can see the results are very different and you can't compare them figure-wise.

    I don't understand the science behind the urine test but believe it to be a useful tool in addition to serum tests and although you can't compare them where actual figures are concerned, what is obvious is that my serum test showed a conversion problem and this was confirmed with the urine test results.

    Your Vit D needs to come up to 100+

    Your B12 needs to come up to around 1000 (according to the Pernicious Anaemia Society 1000 is optimal).

    Your folate should be half way through range so around 26 would be better for you.

  • Mark, your T3 is not working and you cannot feel good when that happens. Sometimes pooling of T3 can skew the ratio as well. This article explains. You do have low ferritin and low folate. You should supplement with methylfolate and methylcobalamin B12.

  • hi i fell a sleep last night sorry. im very confused now lol cause debs from the yahoo forums told me last week i have high iron and proberly have some kind of infection. some where im not sure what to do now. ive reposted the result below cause the first time i think the look confusing do you think they stil look low and what about the iron thanks mark.

    Vitamin D (25 OH) 79

    Deficient <25 nmol/L

    Insufficient 25 - 50

    Consider reducing dose >175

    Vitamin B12 591

    Deficient <140 pmol/L

    Insufficient 140 - 250

    Consider reducing dose >725

    Serum Folate 17.41

    10.4 - 42.4 nmol/L

    Ferritin 166.9

    30 - 400 ug/L

  • It's more than likely cortisol issues at the base of your problem.

  • i do have high cortisol i but isnt that caused by the low t3 in the first place? ive just ordered some holy basil and Phosphatidyl Serine ill have to go all out now.

  • This may help. In fact, go to you tube and watch all 24 very short.

  • Mark,

    I don't think adding further T3 is your answer and you don't have a conversion problem. Although serum test results only measure what is in your blood stream and not what is cellularly active, your T3 result is above range ! ! .. RT3 is also at top of range ...some advocate this to block the activity of T3 so you would feel hypothyroid even with a high level.

    Dr P wanted to raise your T3 level and you have. Although 1.5 grains is not a large dose, it may be yours. It is more a case of making the meds work for you. You had high cortisol levels so have you addressed this by supporting adrenals and lowering ? ? You can also convert to RT3 when there is an excess of thyroid hormone with a congested liver because it has nowhere else to go.

    Prolonged cortisol elevations can decrease the liver’s ability to clear excess hormones from the blood and decrease thyroid hormone receptor sensitivity. If you are too high in one hormone you are usually too low in another. Testosterone, DHEA & estradiol are commonly low in men with low thyroid hormone which can alter TBG (thyroid binding globulin) levels.

    Thyroid hormone has to be cleaved from TBG to become "free" and able to activate cellular receptors. If there is excess TBG, thyroid hormone become too bound and unable to enter the cells for activation. If there is not enough TBG, there is too much available "free" thyroid hormone which can shut down receptor sites and cause hypothyroid symptoms, despite high free T3 levels. You could discuss having sex hormones tested with your GP.

    Of course there is something called thyroid hormone resistance where patients require high levels of T3 to function well but given your initial good response to NDT, I would say it is (more likely) to be an inbalance in one of the multifactoral conditions that (for some) need to be balanced//optimal for thyroid hormones to work well.

    No thyroid antibodies ... lucky you .. ;o))) .... Iron & nutrients are just adequate. You could raise Vit B12 & folate a little by supplementing with a B complex to keep balance. I take 3 grams of Vit C daily to support adrenals, an adrenal glandular and practice yoga//meditation. Something like tai chi or even an absorbing hobby like gardening can help lower your heart rate, BP and stress hormones. It has taken me a year to see noticable improvements and I was chilled to start with ! ! ...


    Could be something similar.

  • ... [ ... Because the actions of T3 can be inhibited by many factors, including polyunsaturated fatty acids ... ] .... ! ! ...

    Great article Justina. Lots of new pointers ......

    .. [ .. During the night, at the time adrenaline and free fatty acids are at their highest, TSH usually reaches its peak. TSH itself can produce lipolysis, raising the level of circulating free fatty acids. This suggests that a high level of TSH could sometimes contribute to functional hypothyroidism, because of the antimetabolic effects of the unsaturated fatty acids .. ] .. Skewed if you follow a ketonic diet ! .. Lol.

    .. and very interesting ... .. [ ... A few people who had extremely low levels of pituitary hormones, and were told that they must take several hormone supplements for the rest of their life, began producing normal amounts of those hormones within a few days of eating more protein and fruit. Their endocrinologist described them as, effectively, having no pituitary gland. Extreme malnutrition in Africa has been described as creating “. . . a condition resembling hypophysectomy,” (Ingenbleek and Beckers, 1975).

    Let food be thy medicine and medicine be thy food.

  • I found this article some time ago and I found it very interesting indeed. I honestly believe there is relatively large group of people suffering from purely functional hypothyroidism that can be fixed in the end quite easy.

  • Oooh .... I wish I were one of them. Imagine just having to increase your fruit intake to feel well.

  • :D me too. I tried it. Didn't work.

  • yh i wish i was one also lol ill take a lol thanks for that :)

  • Achilles reflex test mentioned here as well as in other sources ... Could be used more often?

  • I seriously question why this isn't done if it used to be very important diagnostic tool. Endos I have seen does knee jerk not achilles which troubles me a bit. Or maybe I am just stupid :D

  • Doctors feel sooo dignified with computer printouts and numbers

  • > ... had a 24 hour urine test test done for t3

    Congratulations for having the (almost) only meaningful test on T3 actually getting to your cells. (Metabolic rate measurement might be another, an appreciated thyroid doctor relies on homocysteine readings).

    Professors Schersten, Arfors and Borgstrom strongly recommend this urine test in the Swedish Magazine "Medicinsk Access" 07-2012

    But do try to get a fresh test! And check ferritin, B12, D and folate. Cortisol is a less common cause

    Edit: "urine t3 was 553 ref range was 800-2500". Clearly too low

  • eljii,

    If you can read urine T3 tests results ..... what does this one tell you ? ? ..

    Do share .....

    Justina's article describes alternative ways of measuring thyroid hormone activity (or not ).

  • Eljii do you mean low t3 in urine when high in blood shows peripheral tissue resistance? please explain more about why urine test is best?



  • ("Medicinsk Access" 07-2012 (from pages from 6 and 20) is in Swedish language. On page 21 some good points are made: 1. Correlation to cells' T3 intake is found to be very good. 2. Urine gives 24h average instead of a momentary situation. 3. Proteine bound T3 is excluded

  • hi i read a article last night about reverse t3 (look below) its says you can work out if u have it by looking at the ratio and it says if the ratio is lower than 20 then i have reverse t3. my t3 is high at 6,93 and the ratio is 18,80 and this is when i was only on 1.5 grains maybe i should have waited til i got up to 2 grains or higher the i should have tested i bet it would have show better evidence of reverse t3 is causing not the only way to control rt3 is do go to t3 only??

    o, What Is This 'Reverse T3 Ratio'?

    Because reverse T3 and normal T3 amounts can vary from test to test and from lab to lab, a more accurate method of determining whether reverse T3 is a problem is to work out the ratio between these two readings, called the 'Reverse T3 Ratio'.

    This is done by dividing the FT3 (free T3) result obtained from one's blood test, by the reverse T3 amount, which should give a figure of greater than 20. If that ratio is lower than 20, this can indicate that rT3 is a major component to one's hypothyroidism, or why 'normal' hypothyroidism treatment is not working as it should, due to thyroid resistance.

  • Mark,

    The trouble with reverse T3 is it is so multifactorial that just identifying the ratio is usually not enough. Most endos and doctors stay well clear because it is immensely complicated.

    It is a start, if you wanted to progress down that road but I still think other hormone levels are at play here and even knowing you have elevated RT3, what are you going to do ?.

    Raising T3 levels even higher could also elevate RT3 levels further if RT3 is due to high thyroid hormones. When you don’t make enough cortisol, thyroid hormones can pool high in your blood. Your T4 is high in range as well and your body can respond by converting the T4 to excess RT3.

  • unfortunately i haven't got a doc and have been forced to fix this problem on my own :( initially i was under doc p but what can i say to be nice. he was a big let down he let me down when i most needed him he even let me book a telephone consultation with him and when i phoned at the time he never answered and then couldn't get hold of his secertery and when i did she promised to call me back and never did!! im lost what to do i really need a doctor but theres none i can find here in the uk if anyone that knows of a good doctor plz let me know and i mean a doc who understands about thyroid and not a typical endocrinologist. lol cause they havnt really got a clue.some 1 like doc p but reliable. im even up for just having a telephone meeting. thanks mark

  • Mark,

    You can email for a list of sympathetic endos//doctors that members have had positive experiences with or repost a question asking members to PM you good doctors in your area.

    A local GP should be able to conduct sex hormone tests and knowing these results will either help identify part of the problem or eliminate that possibility.

    Ask for testosterone, etc, and TBG to be tested.

    It is a shame but Dr P is elderly now. I have heard others mention the same experience as you had.

  • ok ill drop her a email and see if she can send me the list thanks rad. oh i just wondered if this sounded like a good plan my adrenals where very high in the morning and after noon and was normal on the evening b4 bed i was thinking maybe i could take my ndt b4 bed while the cortisol was at its lowest so that might help with the conversion and also take supplements to lower it in the morning etc is this a good idea?

  • Is this a recent result or the one from seven months ago ! ? .. I guess if you are sleeping well it could indicate nothing has changed too much ..

    Mark, your plan is cunning and possibly an answer but .... I really have no idea.

    Good luck, hope you feel better soon.

  • Hi mark, I like taking my NDT at bedtime since working around calcium, iron, and food are difficult to work around. I also took my T3 at bedtime as I read it has more efficiency that way. I don't know the technicalities. If you can understand it, this brings out the importance of dieodinases which are the enzymes that are needed by thyroid hormone.

    Resistance is talked about in this article by the National Academy of Hypothyroidism

  • ok thanks very much heloise

  • Mark,

    More thoughts ....

    It's not just about adding more thyroid hormones until they work. Your thyroid hormones are adequate, even a little over replaced so you don't need to raise NDT but the ratios of T3/T4 in NDT do not always suit everybody. It also contains a little RT3 (which you are high in.)

    Some need to add a little T3 or T4 to their NDT to find a balance that suits but you are high in T3 and additional T4 might elevate RT3 further.

    Reducing NDT and retesting in 6 weeks would be prudent. Addressing cortisol levels may help meds to work better.

    You appear to convert OK but it's about getting the T3 to bind with the nuclear receptors and activate inside the cells. This is what gives you wellbeing. Otherwise you could consider a synthetic T4/T3 combo.

    Not sure if you mean you don't have a GP ? ?... but most endo's require a GP referral.



  • hi thanks for replying.i got a email form Louise from thyroid uk with a good doctors list and im going to book an appointment with dr willis soon,in the mean time ive got some t3 and im gone do a trial of t3 only to see how i feel because im convinced i do have rt3 dominance going on.

    i know this cause my temps are very low still and my metabolism is slow very nails and beard seem to have slowed down more since i started this ndt and im really moody lately and i feel toxic at times and bad brain fog etc so it worth a try dont u think?? can i lower this rt3 with ndt and t3? if i do go the t3 only route whats should i start on i really want to only take this once a day or if i have maybe twice ill use have to try and see what happens i guess.and yh i dont have a gp cause according to them there nothing wrong with me and ive got multiple chemical sensitives in which im allergic to gas and fumes and any thing chemical i i get very red eyes if im near them. i bealve this to be connected to the low body temp and my metabolism.

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