Seeking advice on latest blood test showing high Reverse T3

[Freda656]

My gastric ulcer is now healed and I've been supplementing, including B12. I waited a month after stopping the PPI (to heal the ulcer) and then had a blood test done.

Results are attached. This is the first time I've had Reverse T3 tested and I'm seeing my GP next week to discuss the results, as I think its time I was referred to an Endo, something my GP has previously refused to do. It looks like I'm not converting, so any advice or suggestions will be very appreciated.

My CRP has come down since August, when it was 19 and I had the ulcer, I'm not sure why it's still above range and I'm not aware of any infection.

Many thanks.

[Freda656]

Sorry - I should have added that I'm diagnosed hypo (since 2005) and take 150mcg of Levo daily. I've never tried T3 or NDT, but am considering doing so.

[SeasideSusie Remembering]

Freda

Although your rT3 is very high and your ratio very low, don't hold your breath because NHS doctors don't seem to know about rT3.

Your FT4: FT3 ratio is 4.08 : 1 and good conversion takes place at 4:1 or less so you're not too far away. Supplementing with selenium and zinc can help conversion but you might want to test levels first.

[Freda656 in reply to SeasideSusie]

Thank you SeasideSusie - I had bought Selenium and have been taking Zinc Carnosine for a while, I'm also making and taking Kefir daily which I'm convinced has helped heal my digestion problems.

I don't know anything about FT4:FT3 ratios, so thanks for giving me something to look into, I'm encouraged that mine is so close and will start taking the Selenium regularly. I've been away and didn't take it with me, because it's a liquid and that can be troublesome when flying! I continued taking Zinc capsules.

I'm hoping that my doctor will look at the high RTR and refer me to an Endo, and then I'll insist on seeing the closest one to me from the list... and pray!

[greygoose in reply to Freda656]

High rT3 isn't harmful. And I doubt that even an endo would know what to do about it. I would just ignore it, if I were you.

When you've been reading on here for a while, you get to realise that endos also lack knowledge - knowledge of simple basics! - and can often do more harm than good! Do be aware of that before insisting on seeing one, and go prepared. You could end up worse than you are now!

[Clutter in reply to greygoose]

GG,

Yup, another new member has been told to reduce dose from 175mcg to 25mcg to "start again" because her TSH is 0.02 although FT4 and FT3 are within range. I suspect some of these idiots are trainee registrars who aren't adequately supervised. I hope to goodness they aren't consultant endocrinologists.

[greygoose in reply to Clutter]

The situation seems to be getting worse and worse! Or is it just that more people are joining forums and talking about it?

[Clutter in reply to greygoose]

GG,

It feels like it's getting worse. I've seen some terrible things in the past few weeks.

[greygoose in reply to Clutter]

Yes, me too.

[Freda656 in reply to greygoose]

Thanks greygoose - high rT3 may not be harmful, but does it mean I'm not getting the active hormone to where it is meant to be? I still have many hypo symptoms and just want to do what it takes to get well. I know GPs and Endos lack knowledge, my own GP has told me I'm a hypochondriac and has written a report stating that I have unconventional ideas, but I'd like him to recognize there is a problem and to support me in working on a solution. There is an Endo on the list who works for the Nhs and is not too far away from me, so I'd like a chance to see him before taking the plunge completely and going down the self-medication route.

Thanks for the warning, I know it can make things worse :~( but since I want to get better I have to risk it!

[greygoose in reply to Freda656]

The idea that rT3 blocks T3 receptors and stops T3 getting into the cell, has been debunked, because rT3 has it's own receptors. Besides, it only stays in the blood for a matter of hours before it is converted into T2. So, no, the rT3 is not the cause of your hypo symptoms. The symptoms are more likely to be due to the fact that your FT3 is still too low for you, because you are a poor converter.

RT3 is the result of poor conversion, not the cause.

[Kell-E in reply to greygoose]

Endocrinology;101(2):453-63

A study of extrathyroidal conversion of thyroxine (T4)

to 3,3’,5-triiodothyronine (T3) in vitro.

Most endocrinologists believe that reverse T3 (3,3’,5-triodothyronine) is just and inactive metabolite with no physiologic effect. This is an erroneous belief, however. This and other studies demonstrate that reverse T3 (rT3) is a more potent inhibitor of T4 to T3 conversion than PTU (propylthiouracil), which is a medication used to decrease thyroid function in hyperthyroidism. In fact, rT3 is 100 times more potent than PTU at reducing T4 to T3 conversion. Clearly demonstrating that rT3 not just an inactive metabolite, but rather an potent inhibitor of tissue thyroid levels. The authors conclude, “Reverse t3 appeared to inhibit the conversion of t4 to T3 with a potency which is about 100 times more than PTU…”

[greygoose in reply to Kell-E]

Would you care to put a date and/or a link to that? I'm talking about the latest research on rT3.

[Kell-E in reply to greygoose]

Greygoose,

Sorry, I figured it was easy enough to Google and find the study. Do you have a reference for the latest rT3 research that you feel disproves the concept that rT3 is an inhibitor of conversion?

[Kell-E in reply to greygoose]

ncbi.nlm.nih.gov/pubmed/944...

Adverse effects of reverse triiodothyronine on cellular metabolism as assessed by 1H and 31P NMR spectroscopy

1997

[Freda656 in reply to Kell-E]

Thanks for the research scottbnk - it seems like the researchers were onto something, but attributed the cause of poor conversion to the rT3 rather than recognizing the rT3 as the result. Thanks again, you have inspired me to go looking for more recent research...

[Kell-E in reply to Freda656]

I wouldn't say rather than...possibly in addition to. Those two things are not necessarily mutually exclusive.

[Freda656 in reply to greygoose]

Thanks for that greygoose - I'd like to know why I'm a poor converter, but regardless, the rT3 indicates that my T4 only meds are not adequate and therefore I want to try adding some T3, or NDT. I looked for the research quoted by scottbnk and it was from 1977.

[greygoose in reply to Freda656]

You can be a poor converter for so many reasons. And it could even just be a temporary thing, due to your recent ill health. But, it's certainly not something that any doctor is going to look for/research, They're don't have the expertise, and are not that interested, either! Sometimes, some things, we just have to accept and work round.

[Kell-E in reply to greygoose]

Greygoose,

What do the rT3 receptors do?

[Clutter]

Freda656,

TSH is very suppressed but you are not overmedicated because FT4 is in the upper range but not high, and FT3 4.58 is a typical value for someone taking Levothyroxine only. You are converting. FT3 4.58 is not low.

T4 converts to T3 and rT3. rT3 can be high if overmedicated but your FT4 and FT3 aren't even top of range let alone over range so you are not overmedicated. The other reason for rT3 being high is ill health. rT3 can be high to slow the body down to allow for recovery. It is quite possibly related to the ulcer which may also be why CRP is still high. A month seems a long time but in reality healing takes place over many months. rT3 isn't tested on the NHS and probably isn't covered in medical school. I would be surprised if a NHS GP or endo had even heard of rT3 let alone knows anything about it.

Active B12 is high so you can stop or reduce your B12 dose. High B12 isn't dangerous but there's no point in peeing out expensive supplements.

Folate and ferritin are good.

VitD 82 is replete but 100-150 is optimal and some supplementation is desirable Oct-Mar to maintain levels. 1-2,000iu daily should be sufficient. Take vitD tablets or capsules 4 hours away from Levothyroxine.

[Freda656 in reply to Clutter]

Thank you Clutter. I hadn't realized that ill health could cause high rT3. I was puzzled that my FT4 isn't even at the top of the range. The accompanying letter with my results states "your FT3/rT3 ratio is low which could suggest that you are not getting sufficient free triiodothyronine (FT3) into your cells" . I'm wondering if additional T3 or NDT will help?

I've sourced some NDT (1 grain/60mgThiroyd) and wonder if introducing 1/4 tablet might help to reduce my hypo symptoms - I'm guessing I won't know unless I try, but want to make sure everything is optimised before I do. Should the high rT3 come down as my body heals? - it's such an expensive test I don't want to have to check it every few months!!

I'm encouraged that my folate and ferritin are good - I was working on improving those. I have been taking Vit D (3000 to 6000 iu daily) and Vit K2 (100mcg daily), so I probably need to up those doses, specially over winter!

It will be interesting to see how my GP responds to these results - I phoned the surgery earlier today and the GP who triaged me said I would need to go in for a discussion, but that I should be referred to an Endo - I'm not holding my breath, but that is progress considering that earlier this year a different GP told me it wasn't necessary to have an Endo referral.

Since joining this Forum I've been taking my Levo at night so that it is well away from any other meds, food or supplements - something no GP had ever told me. I'm so grateful for the help and support I've gained from Health Unlocked.

[Clutter in reply to Freda656]

Freda656,

rT3 is very high which is why the FT3/rT3 ratio is low. My advice is to stick with your current dose as FT3 is not low. Recent thought is that high rT3 does NOT block receptors and cause cellular hypothyroidism. NDT contains T4 and T3 and increasing T4 may raise rT3. If rT3 is elevated because of your ulcer it should start dropping now the ulcer is healed.

Adding NDT or T3 to your current dose will further suppress TSH. Your GP may already be troubled by it being suppressed. Endo referrals can be a mixed blessing. Great if you get a good endo but a nightmare if you get a dud who thinks suppressed TSH means you must be taken off Levothyroxine or have your dose reduced to 25mcg. Email [e-mail] for a list of member recommended endos and ask for referral to one of them.

VitD 3,000 - 6,000iu should be ample to maintain your vitD level at 82.

[Freda656 in reply to Clutter]

Thanks again Clutter - I had such a bad reaction to reducing my Levo from 150mcg to 125mcg that I was unable to work for 8 months this year, and the pain medication was the cause of the ulcer. Thankfully the gastrologist told my GP to increase the Levo again and things began to settle down, so I think it unlikely they will force me to reduce my dose again. I got the list earlier this year, but every time I requested a referral my GP denied it was needed. I'm hoping this high rT3 result will provide a strong enough reason for a referral to be made, to an Endo from the list who works in the same county as I live.

[Clutter in reply to Freda656]

Freda656,

Think carefully about seeing an endo because they will treat in isolation and if you get one who is a bit of a TSH fascist and thinks TSH must be in range your dose will be reduced.

[Freda656 in reply to Clutter]

Thanks Clutter, it seems like I'm dammed if I do and dammed if I don't. Do you think self-medication by trial and error would be a better choice?

[Clutter in reply to Freda656]

Freda656,

Why would you need to self-medicate?

What is it you think an endo will do better than your GP? I've already told you it is highly unlikely a NHS endo or GP will have any knowledge of rT3.

[Freda656 in reply to Clutter]

Clutter - I'd self-medicate because I want to feel better, I want my energy back and to feel like I have a life again instead of waking up and wishing I hadn't every day. If the rT3 isn't the cause of my symptoms I want to know what is and the best way to improve my health. An Endo could prescribe something other than T4 and the local one from the list is private as well as NHS, and has been mentioned (a year ago) on this forum as being brilliant...

healthunlocked.com/thyroidu....

[Clutter in reply to Freda656]

Freda656,

If you can get a NHS referral to SZ that is worth doing.

[Freda656 in reply to Clutter]

Clutter, it's what I'm hoping for

Thank you so much for your sharing and caring, not just on my post, but on all the others where I so often see you offering support. I'm very grateful for this website :~)

[Clutter in reply to Freda656]

Freda656,

Thank you I hope you get the referral.

[Kell-E in reply to Freda656]

At this point I don't think anyone can say with absolute certainty what rT3 actually does or does not do. The one thing it seems to indicate is that your body feels it has too much T4, so it is turning a higher ratio into rT3 and less into T3. On that score alone it would make sense to change what you are doing. Many on here self-medicate (or find a cooperative GP/endo) You will notice that many need to use a combination of T4/T3 supplementation. Some have to use T3 only as they cannot tolerate any T4.

[Freda656 in reply to Kell-E]

Thanks scottbnk, I know from experience how drastically ill I get when I reduce my T4 dose by just 25mcg, so I'm not keen to try that again, so I'm hoping for a referral to an endo who has been reported to be "brilliant" on this forum. If that doesn't happen I will start to self-medicate. As you say, there doesn't seem to be any definitive evidence about rT3 and what it does :~(

[Kell-E in reply to Freda656]

Freda656, Sorry, I didn't mean reduce your T4 dose without adding some T3. I'm not sure if you've tried that before. Hopefully you will get the referral and the endo will be as brilliant as advertised.