Please help with my test results, esp the Reverse T3 ratio

[cat_alli]

Hello, This is the first time I've had the full thyroid tests offered by Blue Horizons Medicals. I know I have Hashimoto's and have been gluten free since 2015, and also last December cut out cow dairy, yeast, egg and brazil nuts following test results from Medichecks which show I'm producing antibodies when I eat these foods. I would be grateful for any advice, especially on the highlighted items TSH, Reverse T3 ratio and TPO antibodies. I am not taking any supplements, but was supplementing Vitamin D until April this year. I'm on 100mcg levothyroxine daily. I feel okay right now, but had a horrible three months at the end of last year when I couldn't cope and felt depressed, which prompted me to have these tests. Thank you.

TEST RESULT NORMAL RANGE UNITS

Biochemistry

HbA1c-(IFCC) 37 20 - 42 mmol/mol

hs-CRP 2.10 <5.0 mg/L

Ferritin 90.1 13 - 150 ug/L

Magnesium 0.98 0.7 - 1.0 mmol/L

Hormones

Insulin 33.8 <173(Fasting) pmol/L

Thyroid Function

TSH L <0.005 0.27 - 4.20 mIU/L

T4 Total 87.8 66 - 181 nmol/L

Free T4 20.20 12.0 - 22.0 pmol/L

Free T3 4.72 3.1 - 6.8 pmol/L

Reverse T3* 23.0 10 - 24 ng/dL

Reverse T3 ratio L 13.36 Normal >15 Ratio

Borderline 12-15

Low <12

Immunology

Anti-Thyroidperoxidase abs H 291.0 <34 kIU/L

Anti-Thyroglobulin Abs 21 <115 kIU/L

Vitamins

Vitamin D (25 OH) 57 Deficient <30 nmol/L

Insufficient 30 - 50

Consider reducing dose >175

Vitamin B12 277 Deficient <145 pmol/L

Insufficient 145 - 300

Consider reducing dose >569

Serum Folate 28.70 8.83 - 60.8 nmol/L

[cat_alli]

Sorry, this post has crunched all the results and ranges together, despite me typing it all up in columns. The first figure is the result, the next figures are the normal range, and then the units are given. I hope you are able to read it. Thank you.

[greygoose]

It's readable, but would be clearer if you put the ranges in brackets - (3.1-6.8).

Your antibodies are high because you have Hashi's, not because you eat cow dairy, yeast, egg and brazil nuts. And, there's no proven benefit to lowering antibodies once they're high.

You're a poor converter, like a lot of Hashi's people. So, it's probably the high FT4 that is causing high-ish rT3. Although there are a myriad of other possible reasons. But, as it's not over-range, I wouldn't worry about it. The rT3 ratio is pretty meaningless, so I would ignore that, as well. They say it shows how well you convert, but you don't need that to show you don't convert well - just compare your FT4 and FT3 results and it's clear. All in all, the rT3 test isn't worth bothering with.

[cat_alli in reply to greygoose]

Thank you for the advice, I wanted the RT3 result when I felt so bad earlier, in case it was blanking out the T3. Very helpful, thanks.

[greygoose in reply to cat_alli]

No, rT3 doesn't blank out anything.

[cat_alli in reply to greygoose]

This is what I meant by using the words 'blanking out' ...."T4 is not a potent thyroid hormone – to affect the body’s metabolism it must convert to T3 (tri-iodothyronine) which has a more pronounced effect on the body’s tissues. It does this by the removal of an atom of iodine - hence T3. Reverse T3 (rT3) is also made by the same process but in this instance a different atom of iodine is removed. This creates not only an inactive version of T3, but one which can compete with T3 for the receptors on our cells,[ii].

T4 normally converts to both T3 and rT3 (but more T3 than rT3) so it is completely normal to have some rT3 in our blood. However, there are some circumstances when the body starts to convert more T4 to rT3 instead of T3, inhibiting the amount of T3 available to our cells."

[greygoose in reply to cat_alli]

Ahh, you've been reading out-dated information. That's what used to be believed. We now know that rT3 has its own receptors, and doesn't complete with T3.

Also, T4 doesn't 'normally' convert to more T3 than rT3. It's equal - 20% to T3, 20% to rT3.

[cat_alli in reply to greygoose]

Thank you.

[greygoose in reply to cat_alli]

You're welcome.

[Angel_of_the_North in reply to greygoose]

I though it was usually more rT3 than T3

[greygoose in reply to Angel_of_the_North]

Helvella said it was normally equal. It's more rT3 if your FT4 goes too high.

[Angel_of_the_North in reply to greygoose]

It depends what studies you read (and it has to add up to 100%). This says: "In normal adults, rT3 circulates at roughly 40 times the level of free T3 (reference range in normal adults for rT3 is about 9-25 ng/dL, while for free T3 it is 2.5-6.5 pg/mL, i.e., 0.25-0.65 ng/dL)" Ok that's not conversion, it's circulation, but still: zrtlab.com/blog/archive/cle... I think it depends on the state of your deiodinases.

[greygoose in reply to Angel_of_the_North]

Ah, now, you have a good point there. But, as far as I can remember, Rod didn't mention the missing 40%, so perhaps it's just excreted. But, he did say 20% to T3 and 20% to rT3. But, he was talking about euthyroid people, so presumably there was no problem with the deiodinases. Perhaps he could enlighten us further? helvella ?

[Angel_of_the_North in reply to greygoose]

Pilo's study showed T4 to t3 conversion rates ranging from 42.9% down to 16.6% of T4 output, so, in healthy people, lots of variation

[Angel_of_the_North in reply to cat_alli]

That quite wrong and out-of-date. RT3 and T3 have DIFFERENT receptors and don't complete. All the time, all day, if you have a thyroid, it produces some T4 and some T3. The T4 gets converted to rT3 and T3 in varying amounts according to what the body needs (if you are healthy, at any rate) - if you have a chronic illness or don't eat many calories, for example, you'll convert a higher percentage of T4 to rT3 than T3 to slow down your metabolism and keep you alive. After a few hours, rT3 is converted to T2 (so is T3), then T1 and then it's gone. Not enough research has been done to find out exactly what T2 and T1 do.