High RT3. T3/RT3 ratio 11.6. Would really like some advice.

[Emily78]

Hi everyone,

I have just got my RT3 results back and I think I have a bit of a problem :-(. I can't say I'm surprised as I've been feeling pretty dreadful.

RT3: 353 pmol/L (153 - 368)

FT3: 4.1 pmol/L (3.5 - 6.5)

According to the STTM calculator, my ratio is 11.6. A lot less than 20...

I currently take 100mcg T4. I've been taking this for 1.5 years now. Only thing I've ever done differently is add T3 for a week, at 5mcg/day but felt even more hypo so stopped (RT3 probably stopped it getting to my cells).

Other test results done at the same time:

FT4: 17.9 (12-22)

TSH: 0.03

B12: 825 (211-911)

Folate: 23.2 (3.4-15.8)

Vitamin D: 149.7 (50-200)

Ferritin: 40 (22-322)

Transferrin Saturation Index: 29% (15-50)

Serum iron: 19 (9-30)

So, I know my ferritin is low, and I am working on correcting this. But I am not sure of the best way to treat the RT3. Should I stop T4 entirely for a short while, and introduce some T3? Or just reduce T4? Or, could I try a small amount of NDT instead of T4? Ultimately I'd like to switch from T4 to NDT but am aware it contains T4, so might not be suitable till my RT3 is down?

I had my cortisol/DHEA checked recently and it was a good result. However I am not ruling out adrenal problems and will test again along with my sex hormones in the near future.

Finally, should I be taking something to support my liver? Like milk thistle?

Advice on an action plan would be so much appreciated.

Thank you!

[Clutter]

Emily78,

TSH is suppressed, FT4 is just over halfway through range and FT3 is lowish in range. I'd have another go at adding T3 to 100mcg Levothyroxine. Why not try 10mcg if you felt hypo with 5mcg?

Your rT3 is within range so it's not too high and you don't need to do anything about it. It's a myth that high rT3 blocks T3 receptor cells.

Read this about rT3 ratio tiredthyroid.com/rt3-3.html

B12, folate and vitD are good.

Ferritin is optimal >70 but you're not deficient as iron and transferrin are good.

[StarFlower2 in reply to Clutter]

Clutter, I’m finding the link you’ve posted in your reply to Emily78 very interesting...thank you.

[Emily78 in reply to Clutter]

Thank you Clutter. That's all really useful. I do admit I find the contradictory information on the net utterly confusing regarding RT3.

I am still unsure about simply adding T3 to my 100mcg T4. I am worried for a couple of reasons. Firstly as I explained to Lynn-2 below, I seem to have much lower FT3 now my FT4 is higher. I can't help thinking I do better when my FT4 is about 16 (certainly feel better), even though this is barely mid-range. Secondly, I happened to have a blood test a couple of days after starting the 5mcg T3. I hadn't taken the T3 for 24 hours before the blood test, yet my FT3 had shot up to 4.9 (it was 3.4 two weeks before), which is the highest I've seen it. It shouldn't have been in my system a day later should it? After only 2 doses? I just felt like I was taking it, but it was 'pooling' somehow. And I stopped after a week, because I was feeling more and more exhausted by the day.

So although I really want to increase my T3, I am not sure the best way to do it. I feel trying to lower T4 first then adding a small amount of T3 might be worth a shot?

[Clutter in reply to Emily78]

Emily78,

T3 doesn't 'pool'. T3 is in your system for up to 3-3.5 days after last dose.

If you reduce T4 dose FT4 and FT3 will drop.

If you want to increase FT3 level either increase T4 dose which will raise FT4 and FT3 or add T3 to T4 dose.

[StarFlower2]

I’m in a similar position to you Emily78. I’ve had times in the past when my RT3 has been over range. I self medicated with L-T3 only to suppress it. Now I’m back on a small amount of Levo prescribed by my Endocrinologists and a bit worried it will push my RT3 up as my T4 is high in range. I’m very interested in following your thread to see any posts that might help me too.

I’m currently taking 25mg Levo but adding in 6.25mg L-T3. I’ve messed about with my meds recently by dropping levo and upping L-T3 but have felt worse. I’m now back on a combination and keeping my fingers crossed.

I agree it’s important to keep and eye on our cortisol levels. Medichecks do a cortisol saliva test x 4 which I’m going to order.

Good luck.

[Emily78]

Hi Lynn-2. You might be better ordering the adrenal stress profile from Geneva for cortisol as they test DHEA as well, and the cost isn't much more:

gdx.net/uk/product/adrenal-...

If doing tests through Geneva though, you need to quote the Thyroid UK code when ordering. The info is here:

thyroiduk.org.uk/tuk/testin...

I recently did this test with Geneva and it was all straight forward.

I agree the link Clutter provided is very interesting. It's just not that straight forward for some getting T3 to that mid-range is it? For me, I have found that a lower T4 gives me more T3 and not the other way round. When my T4 was around 16, my T3 was 4.6. Then when I got my T4 up to around 18, my T3 went down to 3.4... I can't help thinking I should lower my T4 back to 16ish then maybe try some T3 again...

Are your ferritin levels where they should be? It seems iron and cortisol are the two big factors. Have you had cortisol checked before? I think I got mine done at the wrong time in my menstrual cycle. I did it when my progesterone levels would have been higher (mid-cycle onwards) which can skew the results apparently...