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T3 only advice please. Should I start adding NDT back? rT3 was elevated (I'm NEW here)

Hi Thank you for all the valuable patient feedback here! My first time posting. WARNING: VERY long and detailed!

Summary: I started on T3 only (Tertroxin) 20 mcg middle of June, slowly built up to 40mcg (which I took around 4.30 am a few times Ct3M), but now as soon as I wake up around 7 am.

It just doesn’t feel like enough - My resting heart rate came up a bit to around 60 when I started but now again 56. Basal temp 36.3 C or so - steady low.

Some days I take half tablet (10 mcg ) around lunchtime but I’m still sluggish. Don’t want to go up too much/too fast as I have had 3 episodes of atrial fibrillation requiring cardio version. (i take anti coagulant apixaban to lower stroke risk)

I'm guessing Rt3 should have cleared by now after 6 weeks and am wondering whether to increase T3 or rather add 1 grain NDT back or do something else. Am trying to go by symptoms rather than retesting too soon.

Details: Diagnosed hypothyroid in August 1994 when starting to miss periods at age 33. TSH then was 4.18 (Range 0.23-4.0). Antibodies were negative. Started levothyroxine 50 mcg. Got pregnant 2 or 3 months later!

Was on Levothyroxine (Oroxine/Eltroxin 100mcg) until about 2007 - but never felt amazing and continually battling weight gain etc.

Saw an integrative general practitioner and requested to go on NDT. I think I started on 1 grain. I remember my adrenal function was very low (all cortisol levels low.) Over the years took some progesterone cream as my “bad” oestrogen was high. Iodine was very low — only excreted 30.4% Took iodine for a few months. Never retested. Increased NDT to about 2 grains and did well with new integrative dr after moving to another town. Dr no 2 not stressed about suppressed TSH, and my T3 was middle of range and T4 upper end of range.

Gradually picked up weight, moved to another state, got older and increased NDT as feeling more and more tired. New integrative GP insisted on cutting back on NDT especially as I had third episode of atrial fibrillation requiring electric cardio version in November 2017 after surgery. Cardiologist not concerned and doesn’t think it was brought on by excess T3, but by stress from operation.

The last year’s results:

26/09/2017 I think I was taking 2.75 grain Naturethroid then

TSH 0.01 mIU/L (0.5 - 5.5)

FREE T4 10 pmol/L (9.00 - 19.00)

FREE T3 4.8 pmol/L (3.10 - 6.00)

27/12/2017 On around 2.6 grain Naturethroid

TSH 0.02 mIU/L (0.5 - 5.5)

FREE T4 9 pmol/L (9.00 - 19.00)

FREE T3 3.9 pmol/L (3.10 - 6.00)

LATEST RESULT 02/05/2018 On 2.5 grain Thyroid S and Thiroyd (mixing both as one was easier to cut in half without crumbling. Naturethroid out of stock) Also some leftover Armour 2.5grains.

TSH 0.03 mIU/L (0.5 - 5.5)

FREE T4 11 pmol/L (9.00 - 19.00)

FREE T3 3.7 pmol/L (3.10 - 6.00)

So endocrinologist wanted to further reduce NDT in spite of T3 and T4 trending lower and my bone density scan showing very good bone for my age (57) Now postmenopausal.

I got GP to prescribe T3 only instead as my Reverse T3 was going up. (But she doesn’t know about dosing)

Reverse T3 on 27/01/2015 was 210 pmol/L (Range 140-540)

Reverse T3 on 02/05/2018 was 417 pmol/L (Range 140-540) So I calculated ratio of Rt3 to T3 as 8.9 (which should be over 20?) According to STTM Rt3 should be under 165 with this range.

I did have quite a few of these causes of high rT3 over last year which probably contributed.

* Chronic inflammation, whatever the cause, has risen RT3 in patients. I guess my iron studies show inflammation and I had a big operation to my gut so I only use half my small intestine now.

* Physical injury, a common cause of increased RT3 (surgery counts?)

* Starvation/severe calorie restriction is known to raise RT3. See this study. I had very low calories for a few months after surgery.

* Cirrhosis of the liver (page 38 here) I don’t have liver cirrhosis - but do have “fatty liver” My liver function tests have been high since surgery in November 2017 (gallbladder removed and SIPS (SADI-S) procedure as I could not lose weight even after lapband in 2006 and gastric sleeve in January 2016.

Liver function 0n 2.5.2018 (I don’t drink)

AST 45 U/L (10-35)

ALT 84 U/L (5-30)

ALP 169 U/L (30-115)

GGT 41 U/L (5-35)

Last Iron studies on 2/5/2018: (?showing inflammation)

Iron 14 umol/L (5-30)

Transferrin 33 umol/L (25-40)

Saturation 21% (10-45)

Ferritin 191 ug/L (30-500)

My ferritin used to be very low like 29 , had iron transfusion end of 2015 when it was around 41-44. Was 147 on 26/09/2017

MCV: 92

RDW:13.4%

WCC: 7.8

Vit D:

2/5/2018 25 OH Vit D 86 mol/L (51-150) I believe goal should be over 100. I had strong Vit D injection in March so this is afterwards.

I have lost some weight after surgery so my Type 2 diabetes is in remission but am unable to lose more weight (still have at least 20 kg to go) and am always freezing cold and terrible brain fog. Can’t eat too much fat now, craving carbohydrates especially sugar!

My saliva cortisol levels were all low when I did them in 2010, but when I repeated them on 21 June 2018 just when I commenced T3 only, the morning one is too low, midday one too high and afternoon and evening OK.

Morning: 17.5 mol/L (6-42)

Midday: 15.3 H (2-11)

Afternoon: 7.2 (2-11)

Evening: 4.8 (1-8)

My organic acid test on 18/6/2018 shows too low Vit C, Vit B 2 and B12

Blood test Vit B12 on 2.5.2018 was 661 pmol/L (139-651) I take methylcobalamin and occasional adenocobalamin ( MTHFR heterozygous for both genes 677 and 1298)

Serum folate: 19.6 ug/L (=44.4 nmol/L) (range over 3.8 ug/L)

Homocysteine: 7.8 on 5.2.2018 (7-7.5)

Copper 17.7 (13-25)

Zinc 11.5 (9-19)

Ratio I think copper too high?

I tested negative for coeliac.

I still have my thyroid.

Anyway thank you if you read all the way to here!! I started on T3 only (Tertroxin)20 mcg middle of June , slowly built up to 40mcg which I took around 4.30 am a few times, but now as soon as I wake up around 7 am.

It just feel like enough - My resting heart rate came up a bit when I started but now again 56. Basal temp 36.3 C or so - steady low.

Appreciate your time and help!!

Thank you very much.

60 Replies
oldestnewest

I only used T3 for a short period of time and it put me into a hyper state and when you have too much T3 it will raise the rT3 levels. The body tries to hold on to some T3 so that your body doesn't get too much at one time. Are you still taking NDT or just T3?

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T3 is absorbed directed into the T3 receptor cells. It's work then begins and one dose lasts between on to three days. RT3 is converted from T4 (levothyroxine) and then into T3 the only active thyroid hormone.

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I think the wording of your last sentence is meant to say RT3 as well.as FreeT3 is converted from T4; but your sentence makes it read that FT3 is from RT3. Unless this is a new finding.

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This is a better explanation:

Under normal conditions, cells continually convert about 40% of T4 to T3. They convert about 60% of T4 to reverse-T3. Hour-by-hour, conversion of T4 continues with slight shifts in the percentage of T4 converted to T3 and reverse-T3. Under normal conditions, the body eliminates reverse-T3 rapidly. Other enzymes quickly convert reverse-T3 to T2 and T2 to T1, and the body eliminates these molecules within roughly 24-hours. (The process of deiodination in the body is a bit more complicated than I can explain in this short summary.) The point is that the process of deiodination is dynamic and constantly changing, depending on the body's needs."

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Do you think there’s much value in checking for a mutation in the DIO gene (?) - the one that affects deiodination of T4 to T3?

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Thanks! I’m definitely not hyper. I’ve only been on T3 only for 6-7 weeks to try and clear my rT3.

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I believe you need to be on t3 only for 12 weeks to clear rt3.. Well thats the advice I was given and what I tried to do but only made it to 11weeks. My blood pressure on synthetics sky rockets upwards so back on NDT 🙂

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rT3 only stays in the body for about 2 hours before it is converted to T2, not 12 weeks. And, as long as you fix the problem that caused it, won't come back.

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Too much T3 will not raise rT3 levels - nor will rT3 convert to T3! It's high FT4 - plus a multitude of other things - that causes high rT3.

And, no, the body doesn't try to hold on to some T3 so that you don't get too much at one time. T3 stays in the blood for about 12 hours and then, what hasn't entered the cells is excreted.

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Too much T3 only can be toxic to one's brain. Can cause a hyperthyroid type dementia. Our brain's need T4.Dr. Lowe was definitely playing with fire with such a high dose of T3. Plus he.probably had a MTHFR gene defect or defects which can cause brain hemorrhage /stroke. He might've fallen down AFTER the event and then hit his head. Too much T3 causes lots of side effects muscle weakness /wasting, memory problems etc.

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Is anybody suggesting that anybody take too much T3? No, they aren't. So I don't understand the point of your post.

Or were you trying to respond to jpar, rather than me?

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Levothyroxine alone i.e. T4 - which is an inactive hormone and converts to RT3 and then into T3.

T3 itself is the hormone and doesn't need conversion and is the only Active Thyroid Hormone.

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Shaws, rT3 does not convert to T3. It converts to T2.

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This is from Dr. Lowe:

"Dr. Lowe: Some readers will not be familiar with reverse-T3, and I know from experience that many others harbor misconceptions about the molecule. Because of this, I have summarized in the box below what we know about reverse-T3. I've answered your question below the summary.

Conversion of T4 to T3 and Reverse-T3: A Summary

The thyroid gland secretes mostly T4 and very little T3. Most of the T3 that drives cell metabolism is produced by action of the enzyme named 5'-deiodinase, which converts T4 to T3. (We pronounce the "5'-" as "five-prime.")

Without this conversion of T4 to T3, cells have too little T3 to maintain normal metabolism; metabolism then slows down. T3, therefore, is the metabolically active thyroid hormone. For the most part, T4 is metabolically inactive. T4 "drives" metabolism only after the deiodinase enzyme converts it to T3.

Another enzyme called 5-deiodinase continually converts some T4 to reverse-T3. Reverse-T3 does not stimulate metabolism. It is produced as a way to help clear some T4 from the body.

Under normal conditions, cells continually convert about 40% of T4 to T3. They convert about 60% of T4 to reverse-T3. Hour-by-hour, conversion of T4 continues with slight shifts in the percentage of T4 converted to T3 and reverse-T3. Under normal conditions, the body eliminates reverse-T3 rapidly. Other enzymes quickly convert reverse-T3 to T2 and T2 to T1, and the body eliminates these molecules within roughly 24-hours. (The process of deiodination in the body is a bit more complicated than I can explain in this short summary.) The point is that the process of deiodination is dynamic and constantly changing, depending on the body's needs."

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Well, he says exactly the same as me! Nowhere does he say that rT3 converts to T3. He says that T4 converts to rT3 and T3, and they both convert to T2. I don't understand your point.

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This is how I understand it too. That’s why I didn’t want to increase my NDT dosage when my rT3 was going up as I was worried about taking in excess T4 in the NDT. I listed the things that I thought may have also contributed to my elevated rT3 such as surgery, stress and low calorie diet. Just want to clarify if you think I should increase my Liothyronine (T3) dosage for my continued hypo symptoms or rather add some NDT to the T3 only or ask dr. for combo synthetic T3T4 (I’d rather avoid the synthetic T4 to be honest) or look at something else. Thank you!

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Impossible to know in advance what you should do. You just have to try things and see how well they work. It's all trial and error. :)

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This is a response from Dr Lowe (deceased) re the action of T4 etc:

"Under normal conditions, cells continually convert about 40% of T4 to T3. They convert about 60% of T4 to reverse-T3. Hour-by-hour, conversion of T4 continues with slight shifts in the percentage of T4 converted to T3 and reverse-T3. Under normal conditions, the body eliminates reverse-T3 rapidly. Other enzymes quickly convert reverse-T3 to T2 and T2 to T1, and the body eliminates these molecules within roughly 24-hours. (The process of deiodination in the body is a bit more complicated than I can explain in this short summary.) The point is that the process of deiodination is dynamic and constantly changing, depending on the body's needs."

ShinyB Tile

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About your cortisol your results are very similar to mine and after a couple of didn't works I tried Holy Basil and it really helped. I still take it during stressful times. About an hour before the high was the advice given to me and thats what I do. Check for interactions with anything you take first obviously. 😊

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Thank you! I did take Rhodiola for a few months before I had the surgery. So I’ll try the Holy Basil around 11 am .

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There are an awful lot of myths surrounding rT3. One of the biggest being that taking T3 clears it.

What clears it is getting rid of the problem that caused it in the first place. Very often, it's high levels of FT4 that cause it, but, as you noted, it can be caused by all sorts of other things. And, if your high rT3 is caused by a low calorie diet, taking T3 won't fix it.

Besides, rT3 only stays in the body for about 2 hours and is then converted to T2. And, it doesn't block receptors, or do anything else nasty, as far as we know. So, having high rT3 is not the catastrophe it's made out to be.

No reason why you shouldn't add some NDT back to your T3. As you're on T3, the FT4 is unlikely to get high enough to cause high rT3 again. But, have you fixed the other possible causes? Are you now eating a reasonable amount of calories? Is your ferritin optimal? I should think you're over your op by now, so that wouldn't still be a cause.

I think you're barking up the wrong tree with your cortisol. It's not that you need to lower your midday cortisol, it's that you need to increase your early morning cortisol, and then the rest will fall into place. When the adrenals start struggling to make the early morning cortisol, they continue struggling into the day until they've made their quota, meaning that cortisol is too high later in the day. If you help your adrenals make enough cortisol early in the morning, then they will go back to making a normal amount at midday. If you start taking stuff to reduce cortisol, you're going to completely upset the whole system. So, give your adrenals some TLC : high protein breakfast as soon as you rise; plenty of B vits; lots of vit C; and make sure you get enough salt - especially in this hot weather where we sweat our salt out.

It's not that your copper is too high. It's that your zinc is too low - which is usual for hypos. Just take some. :)

Don't know if I've missed any points in your post, but if you have any other questions, don't hesitate to ask them.

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Ah Thank you ! Didn’t see this when I replied above.

Yes eating more than enough calories now! ( too many carbs though! )

Please comment on my iron studies. Ferritin a bit high now I think.

I take quite high dose of B Complex with correct folate , B6 and B12 for MTHFR.

Also take whole foods Vit C every now and again and magnesium malate in the morning and magnesium glycinate at bedtime.

I’ll start up my zinc again.

I love my salt - Celtic sea salt on everything! ( LOL we’re freezing here in Australia at the moment - so definitely no sweating here!)

Eggs for breakfast most mornings.

I won’ t start the Holy Basil then.

Thank you for the sensible practical tips. Looks like I don’t need to stress about rT3 too much then! I used to be on 2 ½ grains NDT. So shall I try adding 1 grain to the 40 mcg T3 ? And split time?

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Sorry, didn't know you were in Australia. :)

Sounds as if you're doing all the right things, but you could increase your vit C consumption.

I'm not the right one to ask about iron, but it looks OK to me. However, your vit D is a bit low.

Your FT3 in very low considering how much you're taking. Do you take it on an empty stomach, leaving at least one hour before eating or drinking, etc? Just like levo?

No, you don't need to stress about rT3. But, I don't think adding 1 whole grain to your T3 is a good idea. Start with 1/4 grain. You can add 1/4 grain every two weeks until you get to 1 grain, then hold for six weeks and retest. :)

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Thanks!

The blood test showing low T3 and T4 were done in May before I commenced the T3 (when I was on NDT 2 ½ grains)

I do take the T3 only on empty stomach between 6 and 7 am. Usually get up around 7 am.

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Well, it would be a good idea to get tested again before adding in NDT.

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Ok - will do. Thanks

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You're welcome. :)

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How can RT3 only stay for 2hours? Why even test for it? Let's not downplay this test it lowers for lots of reasons and can make one feel sluggish etc. even when FT3 is in range.

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Dr Lowe was an expert in the use of T3 being a scientist and researcher and an expert in Thyroid Hormone Resistance - in which the patient only recovers with the use of T3 alone. I shall link you to a response above.

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Did Dr Lowe know about MTHFR defects and T4 converting B2 to FAD? Maybe not. So his 40/60 theory may not be up to date. There is another use for T4 have to look it up. They will continue to find more uses for T4 because obviously why would the body produce so much T4 and so little T3.

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I am unable to ask Dr Lowe as he is deceased but I think he'd know all about how the thyroid gland functions as the majority of endocrinologists and supposed to be 'experts' don't. He was also a critical analyst which means he could dissect others' theories and put them back together again. So being a genius I am sure he'd know everything there is to know about how the body functions as a whole.

www2.southeastern.edu/Acade...

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Because it is converted into T2. And I agree with you, why test for it? I wouldn't waste my money. It will only tell you if there is a problem, not where the problem lies. Lot's of things can cause high rT3, not just conversion problems. Things like high cortisol, low ferritin, starvation diets, infections, etc. How will you know what is causing it just by testing the rT3? You'd have to test everything else, as well. :)

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Your blood test results indicate that you need higher Free T3 and the best way to achieve this is by taking T3. It is best to take this as a single daily dose. It you gradually increase the amount of T3 you should see your free T3 rise until it is in the higher part of the normal range.

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Thank you! The blood test was in May when I was on NDT. I also thought the best way to get FreeT3 up was to start T3 only which I did on 14 June and gradually increased. I am now on 40 mcg. Haven’t yet

retested .Thought I would give it time to work. Still feeling hypo so was just wondering whether to retest first or to increase or add a little NDT. Sounds like a bit of trial and error. Thanks

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I would suggest staying with T3 rather than NDT. Trial and error is probably the best approach, monitoring symptoms to avoid overstimulation.

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I've not read your whole post but just wanted to reply that I've been told on the T3 support page on facebook that it takes a full 12 weeks to clear rT3 from the body. Sorry not read the rest - part brain fog and part need to get off the computer as got someone coming round! Good luck :)

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I will link you to an excerpt from Dr Lowe - an expert in the use of T3 which above. There are lots of rumours about T3 and most seems to be guesswork. It makes people nervous and I suppose the medical profession don't mind as they prefer to only prescribe T4.

He himself took 150mcg of T3 daily as he had Thyroid Hormone Resistance.

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What did Dr Lowe die from?

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He fell which caused a bleeding in his brain.

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Too much T3 is TOXIC to your brain. Our brains NEED T4. Dr Shaw taking EXCESS T3 without T4 probably one of the causeesof his brain hemorrhage especially if he had MTHFR defects that can bring on bemorrhage. Maybe he had a brain bleed or stroke and then fell. Too much T3 can cause hyperthyroid type dementia and cognitive decline. T3 excess can also cause muscle wasting and weakness and fatigue.We don't want T3 going to high esp.without T4 to put the brakes on. Reverse T3 can also be protective.

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Please do not make up stories of a person or a condition you know nothing about. Or theories which seem to be plucked out of thin air.

Dr Lowe had a bad fall. So don't make up conclusions for something we've no clue about. Even though he was bed-ridden he still worked on his papers.

Are you aware that levothyroxine converts to RT3 before it becomes T3? T4 has no purpose except to convert.

Too much of any thyroid hormones or any 'medication' could make us unwell and would be unable to function at all. Therefore we would reduce on our own account.

He was an expert on T3 and was an exceptionally clever person. I have no idea what this phrase means because T4 is an inactive hormone.

"We don't want T3 going to high esp.without T4 to put the brakes on. Reverse T3 can also be protective."

What are your qualifications? The final word from Dr Lowe which I quote as follows:-

"Dr. Lowe: Some readers will not be familiar with reverse-T3, and I know from experience that many others harbor misconceptions about the molecule. Because of this, I have summarized in the box below what we know about reverse-T3. I've answered your question below the summary.

Conversion of T4 to T3 and Reverse-T3: A Summary

The thyroid gland secretes mostly T4 and very little T3. Most of the T3 that drives cell metabolism is produced by action of the enzyme named 5'-deiodinase, which converts T4 to T3. (We pronounce the "5'-" as "five-prime.")

Without this conversion of T4 to T3, cells have too little T3 to maintain normal metabolism; metabolism then slows down. T3, therefore, is the metabolically active thyroid hormone. For the most part, T4 is metabolically inactive. T4 "drives" metabolism only after the deiodinase enzyme converts it to T3.

Another enzyme called 5-deiodinase continually converts some T4 to reverse-T3. Reverse-T3 does not stimulate metabolism. It is produced as a way to help clear some T4 from the body.

Under normal conditions, cells continually convert about 40% of T4 to T3. They convert about 60% of T4 to reverse-T3. Hour-by-hour, conversion of T4 continues with slight shifts in the percentage of T4 converted to T3 and reverse-T3. Under normal conditions, the body eliminates reverse-T3 rapidly. Other enzymes quickly convert reverse-T3 to T2 and T2 to T1, and the body eliminates these molecules within roughly 24-hours. (The process of deiodination in the body is a bit more complicated than I can explain in this short summary.) The point is that the process of deiodination is dynamic and constantly changing, depending on the body's needs."

ShinyB

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Blal blah. T4 is NOT INACTIVE that's has been proven. We need T4 to convert B2 to FMN and FAD to go into our MITROCHONDIA and for Folate Methylation Did Dr Lowe ever bring this up? <comment edited by admin to remove unnecessary negative remarks>

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You often mention B2 - do you mean B12 ? FMN & FAD I am not familiar with - please explain - thanks !

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Marz. I've been talking about VIT B2 not B12. Even though both are needed to properly drive the folate methylation process. VIT B2 needs T4 to convert to FMN and FAD to get into our mitrochodria and to supply energy. FAD helps breakdown folic acid and food folate to methylfolate. Our brains need both T4 and T3 (not just the pituitary gland). People with MTHFR gene defects which are common in thyroid disease (and even in the general population) especially need to keep folate methylation up to par. This is how we get rid of toxins and heavy metals that buildup in our brains and body.

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What does FMN and FAD stand for - I am aware of of the need for thyroid hormones and the brain and about gene defects. I am also aware of the efficiency of methylation - the only things I am not sure about is the meaning of FAD and FMN - also asking for the benefit of other readers who may also not know. helvella keeps a list of such things - so may need to add :-)

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Marz GOOGLE: Vit B2 FAD FMN FOLATE METHYLATION. I'm.not a walking search engine. It's 5:37am too tired.

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Thank you for your Reply ...

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sandwalk.blogspot.com/2007/...

i googled as instructed and the above link appeared. Yikes 2007 - some 11 years ago. Have things moved on since then ? No wonder you did not want to explain - those meanings have very long words ...

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Sorry I get tremendous information when I google. Come to the USA and google.

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At least you know why it isn't that easy to explain or spell. Wish they discussed the T4 connection.

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Try mthfrdoctors.com. They have a thyroid section and discuss the need for T4 to convert VIT B2 to FAD. Flavin adenoside dinucleotide. This isn't the original info I read but it's on many MTHFR sites and on youtube videos.

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Tile,

Please do what Marz asks and explain what FMN and FAD are. It is unacceptable to expect our members to understand abbreviations without explanation. These are not even the more common ones here.

Further, if you are making a direct claim such as here, please add some reference(s) to help members understand what you have posted.

If you are trying to be helpful, then failing to give people the means to understand seems self-defeating.

Marz

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Apparently we are meant to google :-)

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Tile,

Regarding your response: I'm.not a walking search engine.

No-one is asking you to be a walking search engine. We are asking you to explain the abbreviations in your own responses.

As doing a search on these terms brings up such a large number of sites, some suggestions of ones that you might know seems entirely reasonable.

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Think youYour serum folate should be as high normal as possible. You need to take more folate esp with your MTHFR 677T and 1298C. A RBC folate test is more accurate than serum folate. T4 is needed to convert B2 to FAD which helps your mitrochondra/energy levels also FAD is part of the whole methylation process and your B2 is low. T4 isnt inactive it's needed esp for energy and methylation.

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Ps Your homocysteine by your range given is too high.i never saw such a short range. More methylb9 will help lower homocysteine. T4 will help with B2 to FAD and methylation process. You should also have an active B12 done.

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Sorry Tile. You are right about homocysteine range! The correct range at lab is 5-15 umol /L . I typed the optimum range I was given which was 7.0-7.5 where I was high at 7.8 . This test was done on 5 February. I take 400mcg folate (as Lmethyltetrahydrofolate calcium salt)most days.1000mcg some days.

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How do I ask for active B12 blood test? Is it also a RBC test instead of serum?

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Just ask for active B12 test.

Your homocysteine isn't high it's quite good. Some people have it in the 40s or more!! Plus you are taking a low dose of methylfolate for MTHFR but your homocysteine is good. Maybe try taking 1200 instead of only 400/1000. But repeat homocysteine test bc you don't want to drive it down too much...which can cause depression etc. Once again T4 isn't inactive it's needed to convert B2 into FAD which supports your mitrochondria/ energy levels and is part of the folate methylation process. Saying that T4 converts to 60pc T3 and 40pc RT3 cannot be correct bc T4 is ACTIVE.

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Ps When T4 isn't adequate in one's body it can cause methylblocking...this is when serum B12 and Folate are very high and above range (not from taking high amounts of B12 and Folate). This can lead to health issues and may also increase homocysteine.

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