Does high RT3 matter on t4/t3 combo? - Thyroid UK

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Does high RT3 matter on t4/t3 combo?

Daisybellerose profile image
12 Replies

Hi there

I started on t3/t4 combo in June last year after finding out I wasn’t converting my T4 well. Im currently on 100ug T4 and 6.25ug T3 but still feel symptomatic. Here are my recent results:

T4: 20.1 (12-23)

T3: 5.22 (3.1-6.8)

Rt3: 23 (10-24)

FT3/rt3 ratio: 14.78 (15-75)

My doctor seems to think these results are ‘good’ and said ‘there’s not much you can do about the high RT3’ But I still feel quite hypo. Do I need to lower my dose of Levo to bring my rt3 down? Or will this just make me feel even more hypo?

I tried upping my t3 to 12ug a day and all my hypo symptoms eased off but ended up with an episode of palpitations and taccichardia over Christmas so have reduced back down to 6ug. As soon as I’ve reduced the T3 my aches fingers/tiredness/low mood/teary ness has come back. Not sure what to do next. Any suggestions would be most appreciated! Thanks in advance xxxx

12 Replies
Lalatoot profile image
Lalatoot

RT3 is a bit of a red herring. It doesn't do anything really. So I would not focus on that.

Your FT3 is low for being on T3 - most need it higher in the range.

Your FT4 is 92% through range and your FT3 57% through range.

I think you would feel better if they were more evenly balanced.

You can't change both at once though.

If these were my bloods I would be lowering my levo by 25mcg and in slower time upping my levo by 5mcg. Then waiting for 6 weeks and doing bloods again. Please understand that this is my personal opinion and that I am not medically qualified.

Daisybellerose profile image
Daisybellerose in reply to Lalatoot

Thanks very much for your advice. I was thinking of lowering my levo but how long would you wait before upping the t3?

Also when is the best time of day to do bloods? Isabella wentz advises early morning before t4/t3 medication (so TSH is highest stable value) but then will the T3 value not be a bit low then after 12+ hours???

Sorry but any advice much appreciated! Thanks

Lalatoot profile image
Lalatoot in reply to Daisybellerose

Probably 1 week or two. When I started lio I read up on here and some folk who were reducing their levo did so a week prior to starting their lio. It is all a bit of guesswork and trusting your intuition.

For upping lio we usually increase in 5mcg increments with 2 weeks between any increase. Once you reach a 20mcg or less if your prescribed dose is lower, stop and wait 6 weeks then bloods.

Lalatoot profile image
Lalatoot in reply to Daisybellerose

The recommended time is early morning fasting as this highest value for TSH. If you do this though you often need to adjust your dosing times the previous day to comply with the 8 hours and 24 hours.

My surgery does not give early morning appointments for thyroid bloods so I just make for when suits me and accept that TSH will be lower. The GPs are horrified at the result usually!

Daisybellerose profile image
Daisybellerose in reply to Lalatoot

That’s great thanks for the useful advice

Lalatoot profile image
Lalatoot in reply to Daisybellerose

You are welcome. We are all learning on here.

Daisybellerose profile image
Daisybellerose in reply to Lalatoot

Sorry just one last thing! Just to clarify -do you mean you adjust the t3 dose the day before so you’re taking it 8 hours before the blood draw?

Lalatoot profile image
Lalatoot in reply to Daisybellerose

Yes . You will get more exact advice as to how best to do this if you post that as a question. I don't adjust my tablets much as I time the appointment to suit my tablets as I can't get early fasting bloods done for thyroid at my surgery.

Daisybellerose profile image
Daisybellerose in reply to Lalatoot

Thanks x

SeasideSusie profile image
SeasideSusieAdministrator

Daisybellerose

High rT3 can be caused by many things. It could be caused by low ferritin, or high cortisol, by an infection, by low-calorie diets, etc

Things that can cause high reverse t3 include selenium or zinc deficiency, cortisol issues, stress, dieting, chronic illness, inadequate or low iron, chronic inflammation, high cortisol, or liver issues and any other chronic health issues. and probably several more things.

Conditions that contribute to increased Reverse T3 levels include: Chronic fatigue, Acute illness and injury, Chronic disease, Increased cortisol (stress), Low cortisol (adrenal fatigue), Low iron, Lyme disease, Chronic inflammation. Also selenium deficiency, excess physical, mental and environmental stresses. Also Beta-blocker long-term use such as propranolol, metoprolol, etc. Physical injury is a common cause of increased RT3, also illnesses like the flu. Starvation/severe calorie restriction is known to raise RT3. Diabetes when poorly treated is known to increase RT3. Lyme disease. Cirrhosis of the liver. Fatty liver disease. Any other liver stress Renal Failure. A fever of unknown cause. Detoxing of high heavy metals.

So I wouldn't worry about your rT3, it's not even out of range.

If those were my results (and I'm on combination Levo plus T3), I'd be reducing Levo slightly to bring FT4 down then adding in another 1/4 of a tablet of T3. Don't change both at once though.

Daisybellerose profile image
Daisybellerose in reply to SeasideSusie

Ok I’ll stop worrying about the RT3 I guess it will come down anyway if I lower the levo.

Thanks for the advice x

mourneadventurer profile image
mourneadventurer in reply to Daisybellerose

Worth considering some of the low hanging fruit mentioned in @SeasideSuzie response above. I have been paying attention and monitoring my own reverse T3 for the past year and thankful now to be at the lower end of the range. I reckoned it was important to remove as many blockages to T4/3 conversion as possible.

I’ve found the Microbe Formula/ Cellcore Biosciences (Amrita Nutrition) detox protocol to be effective and gentle on the system. The Full Moon protocol being a good place to start.

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