Help w RT3 result please

[puncturedbicycle]

I'd be grateful for help interpreting my bloods, esp rt3 which I know little about (and recently read something here about how rt3 may not be significant at all?). I'm on alternating doses 75/100 levo and 10 t3. My main bugbear is **fatigue** but am also having a hard time w emotional reactivity to stress, like I can't control these pesky spurts of adrenaline in response to what I'd consider mildly stressful events. It seems like almost everything registers at 11 on the adrenaline dial regardless of significance.

Blood draw was done at 10am on an empty stomach. There was a 27hr gap after thyroid meds.

My vits and mins are a bit sad because I stopped supplementing in preparation for the blood draw and then there was a much bigger time delay than I had intended (many weeks rather than a week or two), so w heavy periods, winter etc everything just dropped. Won't do that again. Surprised my vit d is not more awful considering I don't see much sun. Went back on supplements (iron/vit c, d, self-injected b12) immediately after blood draw.

I was on ldn when this test was taken and can see that it was doing nothing for my ABs (nor did a full year of being gf). Glad I'm off it now, I had side effects. Planning to add in selenium next to see if that helps.

ENDOCRINOLOGY

Thyroid Function

THYROID STIMULATING HORMONE 0.27 mIU/L 0.27-4.2

FREE THYROXINE 16.0 pmol/l 12.0-22.0

TOTAL THYROXINE(T4) 100 nmol/L 59-154

FREE T3 4.8pmol/L 3.1-6.8

REVERSE T3 * 25ng/dL 10-24

REVERSE T3 RATIO*12.3

15.01–75.00

ThyroidAntibodies

Thyroglobulin Antibody* 376.2IU/mL 0-115

Method used for Anti-Tg: Roche Modular

Thyroid Peroxidase Antibodies * 234.1 IU/mL 0-34

HAEMATOLOGY

Vitamins

Vitamin B12 136 pmol/L 25.1–165.0

Folate (serum) 7.9 ug/L 3.9->20.0

25 OH Vitamin D 50 nmol/L 50-200

Interpretation of results:

Deficient <25 nmol/L

Insufficient 25-49 nmol/L

Normal Range 50-200 nmol/L

Consider reducing dose >200 nmol/L

BIOCHEMISTRY

Inflammation Marker

CRP-High sensitivity 1.8 mg/l 0.0-5.0

Iron Status

FERRITIN 26 ug/L 13-150

Optimum Ferritin level for females : >27 ug/L

Thanks in advance all.

[Clutter]

PB,

I don't know how significant it is to have rT3 mildly over range but the usual recommendation for reducing rT3 is to reduce the amount of Levothyroxine taken. Adding a small dose of T3 to a reduced dose of Levothyroxine or NDT will stop you becoming hypothyroid.

Gluten-free doesn't help everyone reduce antibodies. Marz said it took more than 3 years g-f before her antibodies dropped.

B12 and folate are okay but vit D and ferritin are pretty low and are probably causing your fatigue.

[puncturedbicycle in reply to Clutter]

Thanks Clutter. Just to be clear do you mean reduce levo and add a bit more t3?

I hear what you're saying re d and ferritin and of course I'm happy to keep taking the supps but I didn't feel any better after months of supplementing. That's what's getting me down. Hoping it is a magic combo of managing to get everything in the right place simultaneously.

Will adjust meds, order another test for eight weeks from now and cross my fingers.

[Clutter in reply to puncturedbicycle]

PB,

Yes, reduce levothyroxine by 25mcg and increase T3 by 6.25-12.5mcg.

Good vitD supposedly helps conversion of T4 to T3 so it's worth supplementing anyway.

[puncturedbicycle in reply to Clutter]

There are dozens of reasons to stay on top of vit d and I can monitor myself now (I have spot test cards at home).

Ok, will try adjusting meds and carry on w supps (won't pause them until my next blood draw is in the diary). Thanks for your help.

[SeasideSusie Remembering]

puncturedbicycle rT3 is something I've been looking into recently and I don't agree that it's of no significance, but that's just my opinion.

Your rT3 is just over range (and I would want it lower in range anyway, that's what I am aiming for) and the ratio should be over 20.

From your results, FT4 is slightly lower than mid range (not unexpected when taking T3, and your FT3 could be a fair bit higher BUT that will be a false low for your FT3 as you should only leave 12 hours between last dose of T3 and blood draw. If those were my results, even taking into account the false low FT3, I would be increasing T3 (but I am self medicating T3 alongside my prescribed Levo with no doctor intervention​).

You seem clued up on vits and mins so you probably know what you need to do .

I'm not sure I agree with "Optimum Ferritin level for females : >27 ug/L"

Isabella Wentz states in this article thyroidpharmacist.com/artic...

"Normal ferritin levels for women are between 12 and 150 ng/mL. According to some experts, Ferritin levels of at least 40 ng/ml are required to stop hair loss, while levels of at least 70 ng/ml are needed for hair regrowth. The optimal ferritin level for thyroid function is between 90-110 ng/ml."

Ng/ml is the same as ug/L

I have seen many times that the recommended level for females is 100-130, with a minimum of 70 for thyroid hormone to work properly.

[puncturedbicycle in reply to SeasideSusie]

Yeah that's bonkers, Idk how they come to that conclusion re ferritin but of course they do. Since taking t3 my hair grows like billy-o but I still get a fair bit of hair fall so I'll keep an eye on it after I boost my iron.

I couldn't figure out how to leave a gap of 12hrs when I was taking my meds at 7am so I figured the best thing was just to miss them out the morning of the blood draw. I guess I could have taken them at 10pm the night before - ? But that would have required adjusting my whole schedule well in advance. How do people leave 12hrs without everyone needing to take their meds at night?

Ok, I'll give it a think and adjust meds (reduce t4, raise t3). What are your thoughts about reducing levo? Reduce to 75 daily and add in an extra 5mcg t3? I'm a little scared to add more t3. I just feel so bad, I'm really dragging, and little to no difference between now and when I'd been taking supps for months.

Thanks for your help.

[SeasideSusie Remembering in reply to puncturedbicycle]

puncturedbicycle I take Levo plus T3, normally both together early morning, full T3 dose in one go. When I'm doing a blood test, I roughly know what time I'm doing it so adjust the timing the day before (usually only an hour or so) and take my Levo plus half my T3. I take the other half of T3 in the evening, 12 hours before I know I'm doing the test. It's easy enough for me to rearrange timing as I'm retired so don't have a strict schedule.

Personally (this is not medical advice, just what I would do after my own experience of adjusting meds ) I would reduce your Levo to 75mcg daily and add in an extra 5mcg T3 and see how that goes.

I was really cautious about adding T3, far slower than I needed to have been but it is quite daunting when you're going it alone. I never had any quick reaction to T3 like some people do, which is why I tried taking one dose instead of divided doses. I can't say that I felt anything for quite a while, and then suddenly it would dawn on me that I wasn't as tired, or I felt better than a few weeks ago. It's a long drawn out process

[puncturedbicycle in reply to SeasideSusie]

When t3 was added I felt great for almost six months, then I did go a bit hyper (t3 over range) and although I had a lot of energy and physical strength I also felt emotionally incontinent. Trying to avoid that as I'm already feeling pretty fragile (and visiting my mum for two weeks so would be better if I don't act like a b*$%h while I'm here).

That is a good idea re staggering your meds before the test. I've started taking mine at night now so that might make it easier anyway but will keep your method in mind.

Many thanks.