So far, the advice I've seen is to stop T4 meds altogether and stay on T3 only meds until excess rt3 has been cleared. But this article mentions the need to raise FT3 levels and lower rT3 levels by reducing (not eliminating) T4 meds (be it thyroxine or NDT) while adding pure T3.
I find this very interesting as I have read so many times that pigs produce more T3 and less T4 than humans, and therefore the advice is often to add T4 meds to NDT in order to get a T3-T4 ratio of 1:10 rather than 1:4 (as in pig thyroid/NDT). This article recommends the very opposite, but what he is saying actually makes a lot of sense to me, especially what he is saying about more T4 making the problem worse.
I had top of range rT3. I had a conversion problem, shown by very over range FT4 and just mid-range FT3, and a thyroid urine test also confirmed below range T3. I added T3 to a reduced amount of Levo. When I retested, a few months down the line, my rT3 was a fair way over range.
I don't think anyone really understands rT3. The test can't tell us why we have rT3, it can be a conversion issue but it can also be connected with non-thyroidal illness, very low calorie diet, etc.
I have now sorted my conversion problem, I am on the right mix of Levo and T3 for me, and I don't see the point in spending money on testing rT3 again as it wont really tell me anything.
Just out of curiosity: can I ask what your right mix of Levo and T3 is? I know we are all different, but it's always interesting to get an idea of what works for others.
For me, at this current time, a ratio of 6:1 Levo : T3 is keeping my FT4/FT3 where they need to be for me to be optimally medicated thyroid-wise. This is after 2 years of tweaking doses and optimising nutrient levels.
112.5mcg Levo and 18.75mcg T3 and I am far better off now than when my GP had me on 200mcg Levo and no understanding of treating hypothyroidism (like most doctors).
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How much is that, exactly, in mcg?
When using a combo, do the t3/t4 ratios need to be similar to manufactured NDT ratio? 
Adding T3 to NDT?
What is this doctor really saying about NDT and reference ranges?
how long to feel better - my NDT was converting to RT3 had to lower my NDT suddenly and add in T3
