I have at last got my RT3 results.
Free T3 - 3.51 pmol/L (3.10 - 6.80)
Reverse T3 24 ng/dL (10.00 - 24.00)
Although the results are within range, can anyone advise if having readings at opposite ends of the scale has any negative meaning ?
Sorry if I appear niave but I find the T3 & RT3 functions quite confusing & wondered if they should be more inline ?
Many Thanks
retrieverK9
Taking your other results posted 3 weeks ago
TSH - 5.44 mIU/L 0.27 - 4.20
Free Thyroxine - 16.400 pmoI/L 12.00 - 22.00
Free T3 - 3.96 pmoI/L 3.10 - 6.80
Was the rT3 done from the same blood draw, and why is FT3 different now
Free T3 - 3.51 pmol/L (3.10 - 6.80)
Reverse T3 24 ng/dL (10.00 - 24.00)
Hi there, thanks for getting back to me. I also noted the T3 results were different.
The initial blood test broke down and they were unable to do the RT3 test. They sent me a new bloods pack for further bloods so they could do the RT3. Had them done on 1/11/18, starving BT & stopped Levo for 24hrs before the test.
retrieverK9
You are undermedicated. Are you still only on 50mcg Levo?
The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well.
You need to go back to your GP and ask for an increase of 25mcg immediately, followed by a retest in 6 weeks, another 25mcg increase followed by another retest, until your levels are where they need for you to feel well.
To support your request, use the following information from NHS Leeds Teaching Hospitals:
pathology.leedsth.nhs.uk/pa... and scroll down to
Thyroxine Replacement Therapy in Primary Hypothyroidism
TSH Level ...... This Indicates
0.2 - 2.0 miu/L ...... Sufficient Replacement
> 2.0 miu/L ...... Likely under Replacement
and
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine:
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
Total T3 isn't normally tested, but Free T3 should remain in range.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
Hi SS, thanks for that, I am currently on 75mcg of Levo, expecting to have another blood test through my GP in about 3 weeks. I'll definately have a look at the article, thanks for the link 
There is no direct correlation between T3 and rT3. So, no, they shouldn't be more in-line.
T3 is the active hormone - T4 the storage hormone.
There are three types of T3:
FT3, which is free and available for the body to use.
Bound T3, which is bound to protein carriers and cannot be used by the body until it is freed from the carriers.
rT3, which is inert, and used as a break on the energy levels of the body. When you are ill, for example, the T4 will convert to more rT3 than T3, whereas normal, it's in equal quantities.
rT3 only stays in the body for a couple of hours before it is converted to T2.
T3 has a half-life of 24 hours in the blood, but the T3 that is absorbed by the cells stays there for about three days.
There are many reason for T4 to convert to more rT3 than T3. One of them is poor conversion, when the FT3 stays low, and the FT4 goes to the top of the range. This would not appear to be your case because your FT4 only appears to be less than mid-range. So, it must be due to other things, like low ferritin, or high cortisol, and infection or low calorie intake. Do you have any of those things?
Hi greygoose
My ferritin is high 189 ug/L (13.00 - 150.00). GP said we need to keep an eye on it, I'm not supplementing with iron, have a good healthy diet, I'm currently trying to follow a Gluten free, Dairy Free diet which hopefully will help with the Hashi's. Don't know if I have high Cortisol ? I have been suffering with a cold recently & at the moment have bad nasal/throat Catarrh which I have suffered from for years & seem to regularly get it around this time of year, it has ruined many a Christmas.
Yes, I used to get the catarrh every Christmas, too! Until I was optimally treated for my Hashi's.
Having a cold could be a reason for your rT3 increasing. But, it's not even over-range, so really nothing to fret about.
That's good to know. Although the many symptoms are still there, it is somehow a little satisfying to have learned why & what is causing them, I know now I am not a hypochondriac. I have just looked up symptoms for high cortisol.. I pretty much have most of them, hey ho.
Thanks for all your help & advice its really appreciated.
Just been reading your post from a while ago on Appendix, very interesting, had mine removed when I was about 34.... 32 years ago.
Well, I'm not surprised you have symptoms with that low T3. But, ask your doctor to do an early morning serum cortisol test. That's a start. If that doesn't look good, perhaps you could treat yourself to a 24 hour saliva cortisol test.
One of our Advisers, now deceased, stated the following in one of his talks:-
" 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.
toopoopedtoparticipate.com/...
Thank you shaws, much appreciated
Can I jump into this thread?
Thank you shaws, although I e been doing a lot of reading over the last year, I really like that explanation.
I know about testing for the possible gene mutation, but is it possible to have low levels of the 5’deiodinase enzyme? And is the only treatment for this to take T3?
I ask as I’m now on the highest dose of T4 I have ever been, and while I think it is helping, I still have the same levels of muscle weakness that I did before, despite many of my other symptoms improving. I personally think maybe I need some T3 but at the moment Dr Toft seems to think just increasing my dose will help.
I intend to test rt3 at my next blood test as I’m curious to see how well I’m using the higher level of T4.
Thanks, sorry for butting in!
There's no rules that we cannot have an input in a thread. Sometimes it jogs our memory and we want an explanation if possible.
If you're on a high dose, it could be beneficial to take a combination T4/T3 although T3 is getting rarer toget prescribed. Quite a few Researchers have found that people who don't do well on levo can improve on a T4/T3 combination.
I find it surprising that the Specialists of certain conditions don't seem to appear to read Research which could improve their patients lives.
I am not medically qualified but am sure nearly every one on this forum knows more than the basic knowledge that doctors seem to have.
Thank you shaws , I know there’s no rules and that’s exactly what happened, I just don’t like to interrupt!
I am quite sure with my previous background in research science, and the amount of reading and learning I’ve done in the last year (a fair bit of it from here!), I now know way more than my gp!
Re the deiodinase thing... can you ever tell if this is low/problematic?
I agree, my gut feeling now is that a ‘topping up’ with T3 might help. Dr Toft has asked that I see him again in dec and I don’t know what his thoughts are, but as we were communicating over email until now, I wonder if he has something more than a dose increase he wants to talk about.
At least I’m hoping, it’s a very expensive dose increase otherwise!
I think Dr T isn't adverse to prescribing some T3 the only thing is it is now so expensive and I don't know whether he'll presribe on the NHS.
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