Thyroid UK
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Reverse T3 issue??

I have been having some hypothyroid symptoms and yet feeling wired/unable to sleep well. Blood test reveals...

TSH: 0.307

Free T4: 8.48 (12-22)

Total T4: 48.5 (59-154)

Free T3: 3.81(3.1-6.8)

Reverse T3: 8 (10-24)

Reverse T3 ratio 31.01 (15.01-75)

I take ndt one and a half grains daily and if I try to increase the dose I get very shaky and cant sleep at all. Obviously something is not right but I don't understand the reverse t3 readings, don't know if that will be the issue, nor how to sort it out. Any guidance would be much appreciated.

Thanks in advance.

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What are your levels of vitamin D, folate, ferritin and B12 like. If too low then it makes taking/increasing any thyroid hormones difficult

Low vitamin D is associated with insomnia

drgominak.com/sleep/vitamin...

Do you have Hashimoto's also called autoimmune thyroid disease diagnosed by high thyroid antibodies? If so are you on strictly gluten free diet?

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As far as I know reverse T3 does not cause any specific symptoms, the body naturally turns some of the T4 into rT3 and your ratio is within the normal range. I have had a similar problem with raising NDT (and still do) all my levels were low with a high TSH, I would have expected your TSH to be higher considering your frees are all low, but I am not an expert hopefully someone else can comment.

However, I associate 'tired and wired' with the adrenal glands, so it may be worth you having those tested, if they are out of balance it can certainly affect your thyroid as well as your pituitary (they all work together). The best test to have is the cortisol saliva test, but make sure it includes DHEA, cortisol and DHEA must be in balance. Perhaps your estrogen/testosterone levels are out of whack.

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My adrenals have been tested and are fine. Vit D is fine, B12 fine. I've recently added selenium and zinc to my regime so will see if that changes anything.

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The rT3 ratio is absolutely meaning less, waste of money doing it. And a low rT3 is due to your FT4 and TT4 being so low. You just don't have enough T4 to convert to rT3.

Seems to me like you're not absorbing your NDT very well. How do you take it? On an empty stomach, etc? Do you take any other medication or supplements at the same time?

If all your other ducks are in a row, and you still can't increase your dose, perhaps NDT just isn't for you. Have you ever tried anything else?

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I was on levothyroxine and felt wretched for years with lots of hypo symptoms. I'm a lot better since I have gone on to ndt but maybe combination therapy might be better still? I take my meds on an empty stomach at least 20 mins before food and avoid caffeine. I take Vit D, magnesium and have recently added zinc znd selenium to the mix. I react to some fillers so have to be careful which brands I take (of anything). Normally on wpthyroid but as it's not available atm I take Erfa.

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It would be better if you left 1 hour before food, then you wouldn't have to avoid caffeine.

Do you take your vit D and magnesium at least four hours away from NDT?

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No, about an hour for vit d. I take magnesium with meals

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Well, that is the cause of your poor absorption, then. Vit D and magnesium should be taken at least four hours away from thyroid hormone. :)

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Okay, I'll give that a go. Vit D I can take in the evening but what about the magnesium meant to be taken three times a day? Maybe a higher dose in one go?

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Yes, sometimes you have to compromise. Besides, nobody's ever told me to take it three times a day, people usually take it just before bed.

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I'll give that a go then. Thanks for tour advice. Any suggestion as to the dose of magnesium if it's in one go?

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I take 200 mg. But you can take up to 350 mg, I believe. :)

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