High RT3 and Cortisol

[Wattsea]

Hi there, can someone give me their interpretation of my recent lab results including high RT3- 24 (range 10-24) and TSH 3.8. I get occasional weird feeling in my head like the wired have been disconnected temporarily. I also feel that swallowing is more noticeable and I’ve got a slightly enlarged neck in the thyroid area. I’ve been on thyroxine 100mcg for about 10 years.

[Lalatoot]

What has caused your rt3. There are many reasons for rt3 only one of which is thyroid related . High rt3 therefore doesn't mean that it is connected to your thyroid.

[greygoose]

Did you have anything else tested? Your TSH is suggesting that you are under-medicated, but can't know for sure without seeing the FT4 and FT3. I would imagine that, given the high TSH, they are low. In which case, the high rT3 has nothing to do with your thyroid. There are many, many causes of high rT3 - although yours isn't over-range.

Other 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

* Selenium deficiency

* Excess physical, mental and environmental stresses

* Beta-blocker long-term use such as propranolol, metoprolol, etc.

* Physical injury is a common cause of increased RT3

* Viruses, such as flu

* Starvation/severe calorie restriction

* Mistreated diabetes

* Cirrhosis of the liver

* Fatty liver disease

* Renal Failure.

* Fever of unknown cause

* Detoxing high heavy metals levels

* Etc. etc. etc.

But it's nothing to worry about. rT3 is inert and only stays in the body for a couple of hours before being converted to T2.

[Wattsea in reply to greygoose]

Thanks for your reply. My cortisol level is high so I guess this might be pushing the RT3 over the top? Anyway, other results are FT4 - 19.2 (ref range 12-22) FT3 - 3.16 (ref range 3.1-6.8) and T4 - 97.9 (ref range 66-181).

[greygoose in reply to Wattsea]

OK! So, your FT4 could be high enough to cause high rT3. You are a very poor converter and your FT3 is very low. So, any symptoms you are experiencing will be due to the low T3.

[Wattsea in reply to greygoose]

Thank you for your reply. So Should I start taking selenium for better conversion? Or look to supplement with T3 (which I assume I will need to obtain privately?)

[greygoose in reply to Wattsea]

You could try selenium, but your conversion is so bad, it's unlikely to help that much. Have you had your vit D, vit B12, folate and ferritin tested?

[Wattsea in reply to greygoose]

Results of Vit D - 104 (optimal range 75-200) Ferritin - 131 (ref range 13-150) Serum Folate - 36.10 (ref range 8.83-60.8) and B12 - 779 (ref range 145-569) so this is high.

[greygoose in reply to Wattsea]

Don't worry about the high B12, it's not that high, it's the range that stops too low. A lot of ranges go up to 1000! The others are good, so it's not low nutrients causing poor conversion, by the look of it. I think you really need to obtain some T3.

[Wattsea in reply to greygoose]

Thank you very much greygoose. Do you know where I can get hold of T3? I understand that doctors are not prescribing this any more?

[greygoose in reply to Wattsea]

You have to get an endo to prescribe it to begin with, then the GP should take over. So, first step is to get a referral to an endo to begin with - preferably a T3-friendly endo.

I don't live in the UK, so cannot advise on who will send T3 there and who won't since Brexit.

[SlowDragon Administrator]

Have you had vitamin D, folate, ferritin and B12 tested

On levothyroxine we need OPTIMAL vitamin levels

What vitamin supplements are you currently taking

[radd]

Wattsea,

Your elevated cortisol levels could well be the sole factor or contributing to elevated RT3 levels by inhibiting good T4-T3 conversion but it could also be any number of other factors such as gut issues, elevated oestrogen, inflammation, etc …. Also sounds like you have elevated thyroid antibodies causing Hashi attacks regarding an enlarged neck.

FT4 is high & FT3 is low meaning you are converting poorly but with that high cortisol doesn’t mean you are necessarly a poor converter per se, just that your abilities are impaired in this moment of time, ie you lower cortisol levels and thyroid hormones start working more effectively for you. And I would definately not recommend adding T3 meds until other issues (such as elevated cortisol) are rectified.

Your iron and nutrients look great. Selenium is good (as is zinc) but I would be looking at lowering cortisol levels through a healthy life style (ie adequate sleep, good diet, etc) and may be adding an adaptogen and a load of Vit C.

Adding T3 to a mix that is already not working can make things a whole lot worse, as you need to find the reasoning for your high RT3 levels for future meds to work.

[Wattsea in reply to radd]

Thank you Radd. I have just started addressing the high cortisol by taking out coffee and chocolate and not watching the news! My diet is generally good with lots of salad, veg and fruit, but notice even a small amount of sugar can give me a rush, so my weakness for cake will also have to be addressed. I guess after I have made these changes I should maybe re-test in a couple of months. Immunology looked ok Antithyroid peroxidase abs 12 (ref range <34) and Antithyroglobulin Abs 12 (ref range <115)

[jamjar67]

I take a combo of T4 and T3, my cortisol was all over the place making me feel tired but wired amongst other things, this happened on T4 only and got worse with each increase, it also happened whilst on T4/T3 combo when my endo increased my T4 again. I have recently reduced my T4 and so far kept my T3 the same, I feel so much better already!! I still have a few weeks left before I level out and may need to add more T3, but one thing I’m certain of is my body doesn’t like a lot of T4. I did find out that I am heterozygous for DIO1 & DIO2 genes which means I don’t convert aswell and also my body may not clear RT3 as efficiently as it should, you can get these genes tested via Blue Horizons, it’s expensive but definitely helped me with my Endo and GP getting T3 prescribed.You should check out Paul Robinsons FB The Thyroid Patients Manual - he’s written some really good blogs which through trial and error on my part, make more and more sense as I go thru my thyroid journey. He explains how RT3 can affect the effectiveness of active T3 in the cells (but you would have to read his blogs as it’s too complicated for me to reiterate)

Good Luck, I hope you find your answers.

[Wattsea in reply to jamjar67]

Thank you Jamjar67 that’s very useful, I will certainly check out Paul Robinson. I have in fact had a gene test done through 23andMe but couldn’t see any problems with the DIO1 & DIO2 SNPs.

[SlowDragon Administrator]

High cortisol…..Adrenals try to compensate for lack of Ft3

high cortisol should slowly reduce with addition of T3