T4/T3 advice for ongoing symptoms?: 1st time post... - Thyroid UK

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T4/T3 advice for ongoing symptoms?

1st time post-:

Could anyone who knows about T3 & T4 please help with the following results? I currently take T4 & T3, and had been increasing the T4 (on advice from Endo), to relieve ongoing symptoms. Pulse, temps both normal for me.

These are very recent private blood results. I see the Endo again next week. My Vid D, Vit B12 within normal limits and supplement with them. I tested Rt3 & DI02 as read about them on here.

TSH - 0.015 mIU/L (0.27-4.20)

Free Thyroxine - 19.000 pmol/L (12.00-22.90)

Free T3 - 5.86 pmol/L (3.10-6.80)

Reverse T3 - 24 ng/dL (10.00-24.00)

Reverse T3 ratio - 15.9 (15.01-75.00)

DI02 - Heterozygous genotype TA

Advice, especially regarding Reverse T3 much appreciated!

Added results:-

Thyroglobulin Antibody - 12.200 IU/mL. Range 0.00-115.00

Thyroid Peroxidase Antibody - <9.0 IU/mL Range 0.00-34.00

Active B12 - 89.700 pmol/L range 37.50-188.00

Folate (serum) - 18.17 Range 3.89-26.80

25 OH Vitamin D - 115 nmol/L range 50-200

Ferritin - 97.2 ug/L range 13.00-150.00

CURRENT MEDS:- T4 - 87mcg (3.5 tablets), & T3 - 15mcg (split into 3 doses).

10 Replies

Perhaps you should be increasing your T3 not your Levo - the Levo is being converted to reverse T3. You may need T3 higher in the range. You probably don’t need T4 as high in the range as it is, but we are all different. Have your symptoms been relieved? If they have then stay on current dose, if not increase T3 (and probably lower Levo). Good luck

1 like

Thank you Aurealis. I don’t understand the Rt3 and ratio part.

I have symptoms that did subside slightly but are now back as increased T4 meds. Such as really weak and slack muscles, tiredness, weight gain, brain fog to name a few. T3 meds’ have remained the same.

Really believed as increase in T4 meds would help, however, as I’ve read on here - check everything!

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There's nothing to understand. Not as far as the ratio goes, anyway. It's just pseudo-scientific mumbo-jumbo with no meaning or use whatsoever.

rT3 is one of those tests that tell you if there's a problem, but doesn't tell you where it is. Yours isn't yet over-range, but it is high, and that's probably because you have more T4 in your system than you need. If you can't convert it to T3 - and presumably you can't, so that's why you started taking T3 - then it's got to go somewhere. So, as the body doesn't want to waste the component parts, it's converted to rT3, then to T2, then T1, and then recycled. Reduce your T4 and the rT3 will more than likely go down. However, I'm sure that's far too complicated for an endo to understand. lol Most of them have never even heard of rT3.

But, I agree with Aurealis, you probably need your FT3 a bit higher, so try reducing the levo by 25 mcg, and increasing the T3 by 5 mcg.

Also, have you had your vit D, vit B12, folate and ferritin tested? If your nutrients are low, they will be adding to your symptoms, and your body won't be able to use thyroid hormone efficiently. :)


Hi Greygoose,

Thank you for that information! Very helpful! I’ve posted me other results now at the bottom of my first post. If you have time would you mind taking a look for me please?


Well, your B12 is a bit low. What are your on-going symptoms? They could perhaps be due to low B12.

1 like

What about folate and ferritin

Can you add your most recent actual results for vitamin D and B12 too

How do you take your T3?

Some of us need to take as split dose 2 or 3 times daily

How much T3 are you taking

How much T4


Hi SlowDragon,

Thank you for taking the time to reply. Much appreciated! I’ve now edited my post to include this information. Any advice gratefully received.


Perhaps try adding 5mcg to first T3 dose of the day

And reduce Levo by 25mcg

My endo recommends 10mcg on waking, 5mcg mid afternoon and 5mcg before bed (dose every 8 hours)

Your vitamin levels look good

Antibodies low, but were they high in past?


Also do you have Hashimoto's, also called autoimmune thyroid disease diagnosed by high thyroid antibodies?


I had my antibodies checked in November 2017.

Results below:-

Thyroglobulin antibodies <10 range 0.00-115.00

Thyroid Peroxidase 10.50 Range 0.09-34.00


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