I was recently diagnosed with Hashimoto but Synthroid is not giving me much relief of my symptoms and recently I requested my doctor to test my T4 Free, T3 Free, T3 Reverse since I read that this would indicate if my system wasn't converting T4 into T3. My lab work is showing my T4 Free being 2.6, my T3 Free as 4.6 and my Reverse T3 as 44 which all reflect in "red" but truthfully I'm not sure what this means. I assume that it means that my T4 isn't converting into T3 and in my upcoming doctors appointment I am debating if to ask for my medication to be changed from Synthroid to Armour or to ask my doctor instead to just add Cytomel to my Synthroid.
T4 Free shows 0.8-1.8 ng/dL ==> 2.6H
T3, FREE shows 2.3-4.2 pg/mL ==> 4.6H
T3 REVERSE, LC/MS/MS 8-25 ng/dL ==> 44H
Any suggestions or guidance would be appreciated.
Written by
Sherberlie
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For anyone to comment, we need to see the reference ranges alongside your results please. Without the ranges, the results are meaningless unfortunately.
I assume that it means that my T4 isn't converting into T3
On the contrary. If your T4 wasn't converting to T3, you would have a high FT4 and a low FT3. Both are over range so there is no conversion problem indicated with those results. Was TSH tested, I expect that was very low, maybe suppressed.
You do have high reverse T3 - which often shows poor conversion when FT4 is high with a low FT3 when we make rT3 rather than FT3. However, high rT3 can be caused by other things, not just poor conversion. The test tells us our level, but can't tell us why it's high. Have a look at this article on stopthethyroidmadness.com
2) You may have just had a Hashi's Hyper-swing which has caused your hormone levels to peak.
Have you looked into Hashi's? This is where the immune system attacks the thyroid and gradually destroys it. When the attack happens, the dying cells dump a load of thyroid hormone into the blood and this can cause TSH to become suppressed and Free T4 and Free T3 to be very high or over range. These are called 'Hashi's flares' or 'swings'. You may get symptoms of being overmedicated (hyper type symptoms) to go along with these results that look as though you are overmedicated. The hyper swings are temporary, and eventually things go back to normal. Test results settle back down and hypo symptoms may return. Thyroid meds can be adjusted slightly at these times if necessary, but will need readjusting when hypo symptoms return.
You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies. It would be advisable to test the following:
Yes that was my diagnosis, Hashimoto and that is why I was started on the Synthroid but its been 3 months and I don't feel better. I don't know what else to do.
So you don't think I am having any issues converting the T4 to T3?
No, those results don't show a conversion problem, I explained that FT4 would be high and FT3 would be low if you did.
I just don't know why my symptoms haven't improved with the Synthroid...
Most likely because you have Hashi's and this needs addressing, results and symptoms will fluctuate with Hashi's as explained above. Read through the links I gave to undersand all about Hashi's.
Supposedly the doctor addressed it by putting me on Synthroid but I am not sure if maybe the dose is not enough... I would have thought that after being on it for 3 months I would feel better...
Supposedly the doctor addressed it by putting me on Synthroid but I am not sure if maybe the dose is not enough
Your doctor is addressing the hypothyroidism by prescribing Synthroid. There is nothing doctors can do about Hashi's, there is no treatment, all they can do is treat the resulting hypothyroidism.
Your immune system will continue to attack your thyroid until it is destroyed. Each attack results in less of your thyroid gland, so theoretically the attacks should lessen as more of your gland is destroyed.
By addressing the Hashi's I mean you have to do this yourself. Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
I have mentioned a gluten free diet and supplementing with selenium, and I have given you links to articles about Hashi's. Please read them so that you can understand how Hash's works and how it will affect you, your symptoms and your test results.
If you are on a PC, look to the right and under TOPICS you will see HASHIMOTO'S. Have a look through some of the posts. If on another device, I expect you may need to scroll down to see the Topics.
There usually is a reason for the R T3 being too high... low iron, cortisol, inflammation etc. And can take up to 12 weeks for the R T3 to resolve. During that time, you lower your dose of NDT (if that is what you are taking) to 1 - 1.5 grains (60 - 90 mgs) and add in some T 3. Some sufferers take T 3 only. One of our moderators on a USA site took T 3 only for two years. Here is a iink with some good suggestions/information. You do need to find out what is causing the R T3 or it will return. stopthethyroidmadness.com/r...
I had a total thyroidectomy and was given only synthroid for years, and the whole time I was in thyroid hell. A different dr. finally did the tests you mentioned, which are the ones you need. I was making tons of RT3 also. I now take a small dose of levoxyl, not a generic T4, and cytomel, T3, not generic, which is what T4 is converted into so your body can actually use it, 3 times a day. RT3 as I understand it it is also made from T4, so I now make less and feel much better. NO more thyroid hell after almost 20 years. Your system makes RT3 to slow down your metabolism when you are sick or have any number of chronic illnesses. It is not helpful, I have found, with most chronic illnesses, to have your metabolism slowed when you are taking a thyroid drug to do the opposite. There is a ratio calculator online for T3/RT3. Also, synthroid has acacia as its main binder, which is a potent allergen for a lot of people, myself included. When I was changed to levoxyl and cytomel the hay fever and sinusitis were at least 80% better. The literature for synthroid states that the patient should be tested for acacia allergy before it is prescribed. No one ever tested me, not even the endocrinologist that was the best one around. (!) In my experience, having your immune system constantly compromised by an allergy condition interferes with conversion, which is not good once your thyroid gland has been removed because most conversion takes place in the thyroid gland, with some in peripheral tissue.
Great Information . I too had TT and was put on Synthroid and had terrible reactions for years from it . I was like you switched to Levoxyl with NDT for my T-3 mix . It made a GREAT difference for me . Take home lesson if it doesn't feel right question question question . It's not always the dose but the fillers and or dyes that can cause problems .
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Thyroid test results 
Cytomel (T3) only or along with NDT (T3&T4)?
