Thyroid UK
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Do I need t3? "Normal" test results

Hi guys,

Looking for a little advice. I'm diagnosed as CFS but I'v got zero faith in that diagnosis (it's a symptom, not a cause). My symptoms include: fatigue, hypoglycemia, twitchyness, low libido, cold extremeties, abdominal pains, pins and needles, muscle cramps, sensitivity to light/sound (occasional).

Test results as follows:

TSH 1.6 mIU/L 0.27 -4.20

FREE THYROXINE 14.5 pmol/L 12.00 -22.00

TOTAL THYROXINE(T4) 79.8 nmol/L 59.00 -154.00

FREE T3 4.8 pmol/L 3.10 -6.80REVERSE T3 21 ng/dL 10.00 -24.00

REVERSE T3 RATIO *14.88 15.01 -75.00




VitaminsACTIVE B12 *169.6 pmol/L 25.10 -165.00

FOLATE (SERUM) 13.82 ug/L 2.91 -50.00

25 OH VITAMIN D 89.2 nmol/L 50.00 -200.00


Inflammation MarkerCRP -HIGH SENSITIVITY 3.9 mg/l 0.00 -5.00

Iron StatusFERRITIN 241 ug/L 30.00 -400.00


So the NHS endocrinologist is hiding behind the "normal levels" scenario and refuses a trial of treatment. I'm due to go to my GP and ask her to prescribe t4/t3 (good luck yeah!).

So I'm swiftly going to be at the point where my levels are "normal", my symptoms aren't, and I cant get medication in the UK.

Looking at my results, the RT3 is at the top end of the range which surely cannot be good. The rt3 ratio obviously looks bad too (out of range).

Based on those results & symptoms, is it worth self medicating with imported t3/ndt? How badly wrong could it go if indeed I don't need the meds?

4 Replies


TSH is low-normal, FT4 is low in range at less than mid-range and FT3 is just shy of half way through range. rT3 is comfortably within range, not high. rT3 ratio is meaningless, see

Thyroid antibodies are negative for autoimmune thyroid disease (Hashimoto's).

Your thyroid levels are euthyroid (normal) and there is no indication of thyroid dyfunction. You don't need any thyroid replacement. I'm sure your GP won't prescribe a trial of Levothyroxine or Liothyronine after your endo has refused. NHS won't treat until TSH is over range or FT4 below range. You really should investigate some other reason for your symptoms.

Active B12 is high so you can reduce supplementation or even stop supplementing for a while.

Folate is optimal halfway through range. You can raise folate by eating more leafy green veg or supplementing a little folic acid or methylfolate.

VitD is good in the replete range >75.

Ferritin is good.

You could supplement magnesium citrate to see whether that helps with muscle cramps and twitches. Try magnesium oil spray on your skin too and Epsom Salts in the bath.

If the abdominal pain is accompanied by gas, bloating, diarrhoea and/or constipation try eliminating gluten from your diet for 3-4 weeks to see whether symptoms ease and improve.

Ask your GP to test HbA1c in case the hypoglycaemic episodes are diabetes or pre-diabetes and calcium to rule out hypocalceamia causing the cramps, twitches, pins and needles.

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Your fT4 is pretty lowish in range while your rT3 is higher in range. Technically you are perfectly fine, but in some circles you might benefit by trying a little T3.

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Some of your symptoms fit with a magnesium deficiency, which is extremely common. There is a blood test for magnesium levels, but it is not a good test and is rather pointless. The body steals magnesium from the body's cells and puts it into blood to maintain an optimal level in the blood. But you could be dreadfully deficient, and the test wouldn't show it. In a healthy person who has sufficient magnesium, only 1% of their total magnesium is in the blood.

The body disposes of excess magnesium through the kidneys. If your kidneys are in reasonably good health then you would be safe to supplement. But if you have very sick kidneys it would be wise to avoid magnesium unless you have checked it is okay with a doctor.

For help in choosing a magnesium supplement read these and choose one that appeals to you :

Some kinds of magnesium supplements may act as laxatives, which some people find helpful, some don't - choose wisely. Magnesium also has a tendency to make some people sleepy, so take it in the evening.


Other causes of twitching and cramps and benign fasciculations are :

(Search for "benign fasciculations" on Youtube to see what they are and whether they are relevant to you.)

Low iron : but your ferritin level is fine, so you shouldn't supplement iron.

Low potassium : Not a good idea to supplement this without testing. And supplementing potassium generally isn't a good idea. If you get it wrong and take too much it can affect the heart rhythm, and could be fatal. The best thing to do is to eat some foods every day that are rich in potassium. There are many lists of potassium-rich food on the internet.

Low vitamin D : This can cause general muscle and joint pain but yours is good, so supplementation is not required.

Vitamin B12 : Your level looks very good. Excess vitamin B12 isn't poisonous. However there are people who can't make use of vitamin B12 properly. To be absolutely sure that your body is making use of the B12 in your bloodstream you could get your levels of Methylmalonic Acid and Homocysteine measured. The NHS are unlikely to do this for you, and your doctor might never have heard of either of them. But the testing is available privately. Unfortunately it isn't easy to test these two things - the patient usually has to go to the lab for the blood draw and the blood must be put on ice immediately. For more info on this, you could ask questions from the Pernicious Anaemia Society forum here on HU :

A link you might find interesting :

It sounds as if your gut isn't very healthy. You could read some of the posts on here about gluten, coeliac disease, non-gluten sensitivity, improving the gut microbiome, water kefir and milk kefir, fermented vegetables, eating a low carb-high fat diet, ketogenic diets, low fodmap diets - what works for one person won't necessarily work for another. Gut inflammation is very common.


Hi Humanbean, thanks for the detailed response.

I'm already aware of the magnesium stuff & have been supplementing for a few years now. I will look into the gut health aspect more closely (have done keto diet and didn't improve), and I'll look into the b12 related minerals.


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