High RT3: I have had subclinical hypothyroidism... - Thyroid UK

Thyroid UK

122,564 members143,131 posts

High RT3

Miss81 profile image

I have had subclinical hypothyroidism for years. For the past 2 years I have been wanting to get pregnant and even though I had regular periods, I was put on clomophine 50 for two cycles. After that my amh dropped to 1 and fsh increased to in the 20s. My period stopped for the first time ever. I was put on levothyroxin 50mcg and period came however during the 2 years on Levo I was told by the endo I had fine levels even though now I have learnt I was not converting T4 into T3 but rather into RT3. My T4 was at 19, T3 at 3.6 and I also developed irregular periods while on the T4 only treatment. Last week I did bloods and my RT3 is 37 or 466pmol. So I started taking 7.5 mcg of T3 leonthyonine and dropped dose of levothyroxin T4 to 25mcg. My morning saliva cortisol was low at 11.

My question is - Are my irregular periods due to the high RT3, as a result of being on T4 only meds for 2 years? And am I on the right meds combo T4/T3 now? As I am trying to correct (lower) the high RT3 and get my periods back to being regular again!

Please help.

99 Replies

Hi Miss81, welcome to the forum.

I'll try and answer your questions. :)

Are my irregular periods due to the high RT3, as a result of being on T4 only meds for 2 years?

No, absolutely not. rT3 is inert and only stays in the body for a couple of hours, before being converted to T2. It doesn't cause any symptoms. We always have some rT3 in the body, because T4 naturally converts to 30% T3 and 30% rT3. High rT3 is the result of poor conversion, not the cause.

Your irregular periods are due to the low FT3. T3 is the active hormone that causes symptoms when there's not enough of it, or too much.

And am I on the right meds combo T4/T3 now?

Only you can know that. It's good that you are now taking T3, but how much you should take, and how much levo, depends on how you feel. You'll have to experiment with different doses to find what's right for you. It's all trial and error.

As I am trying to correct (lower) the high RT3 and get my periods back to being regular again!

As I said before, high rT3 has nothing to do with anything. What needs correcting is your low FT3 - it needs increasing, because that is the cause of your irregular periods. :)

Miss81 profile image
Miss81 in reply to greygoose

Thank you for the response greygoose. My T3 is around 5 ish now. Do you know how long it will take to get my periods being regular again? I have been on the T3 added meds for 20 days now and still no period.

The reason why I though high RT3 might have something to do with it is because high RT3 can give symptoms of hypothyroidism even though T4 and T3 levels are good. Hence irregular periods due to hypothyroid symptoms. No?

greygoose profile image
greygoose in reply to Miss81

I have absolutely no idea how long it's likely to take. But, I would say, a lot longer than 20 days. Probably more like months. Nothing happens fast with hormones.

As I said before, rT3 is inert, so cannot cause any symptoms. So, no, high rT3 is not the cause of your irregular periods.

SlowDragon profile image
SlowDragonAdministrator

I was put on levothyroxin 50mcg and period came however during the 2 years on Levo

50mcg levothyroxine is only a STARTER dose

What were your thyroid results and ranges on just 50mcg levo

Bloods should be retested 6-8 weeks after any dose change or brand change in levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

When were vitamin levels last tested

What vitamin supplements are you currently taking

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. Both are autoimmune and generally called Hashimoto’s.

In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease (and they usually ignore the autoimmune aspect)

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

On T3 or NDT - day before test split daily dose into 3 smaller doses, spread through the day at approx 8 hour intervals, taking last 1/3rd dose 8-12 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Miss81 profile image
Miss81 in reply to SlowDragon

On 50 mcg levothyroxin my T4 was 20, T3 3.6 and TSH 1.7.

SlowDragon profile image
SlowDragonAdministrator in reply to Miss81

Please add ranges on these results

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

ESSENTIAL To regularly retest vitamin D, folate, ferritin and B12

Guidelines on dose levothyroxine is to increase the dose slowly upwards in 25mcg steps until Ft4 is in top third of range and Ft3 at least 50% through range

Typically dose is around 1.6mcg per kilo of your weight per day

Likely you were very under medicated

When under medicated, low Ft3 this results in low stomach acid, leads to poor nutrient absorption and low vitamin levels as direct result

Low vitamin levels tend to lower TSH

Levothyroxine doesn’t top up failing thyroid…..it replaces

Miss81 profile image
Miss81 in reply to SlowDragon

Read comments above pls.

SlowDragon profile image
SlowDragonAdministrator in reply to Miss81

What are the ranges on Ft4 and Ft3 Figures in brackets after each result

Ft4 20 (ranges?)

Ft3 3.6 (ranges)

Was last dose levothyroxine 24 hours before test

Miss81 profile image
Miss81 in reply to SlowDragon

Blood tests were taken before taking medication in the morning.

Blood results when I was on 50mcg of levothyroxin daily.

FT4 was 19 (9-22)FT3 was 3.6 (2.5-6.5)

TSH was 1.7 (o.5-5)

Once I added T3 of 5 mcg results changed to

FT4 17

fT3 4.6

TSH 1.2

SlowDragon profile image
SlowDragonAdministrator in reply to Miss81

On just 50mcg levothyroxine

Ft4 77% through range

Ft3 28% through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

Next step should probably have been to increase levothyroxine to 75mcg daily or 75mcg and 50mcg alternate days

Retest in 6-8 weeks

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Essential to test vitamin D, folate, ferritin and B12

For good conversion of Ft4 to Ft3 we need optimal vitamin levels

Always worth trying strictly gluten free….but get coeliac blood test BEFORE cutting gluten out

Miss81 profile image
Miss81 in reply to SlowDragon

And what do these percentages mean? Anyways I disagree about increasing dose for levothyroxin in my case

SlowDragon profile image
SlowDragonAdministrator

tsh was high at 3 (just before I started meds) but the meds didn’t help infact made fsh go even higher to 20’s and never came down.

Not surprising if you were left on only a starter dose levothyroxine

Likely were left under medicated

Approx how much do you weigh in kilo

Miss81 profile image
Miss81 in reply to SlowDragon

I used to be 58kg in these two years in levothyroxin I have become 63kg

I think one problem regarding rT3 is that many sites (also sites run by functional/alternative doctors) talk about rT3 dominance and how it wreaks havoc on the body...it would seem that theory has now been debunked and it has been proven that rT3 does NOT cause hypothyrodism in patients on T4 only drugs but, unfortunately, many sites have not been updated to reflect that. They still provide advice on how to "flush out" high rT3 from your body by taking T3 only drugs or using their very pricey supplements. I recently read (I think it was on the excellent Canadian thyroid site often referred to here) that hypothyroid people tend to have higher rT3 levels than hyperthyroid people...it should be the other way around since free T4 is high in hyper patients and low in hypo patients.I agree with greygoose that your symptoms are most likely caused by low/suboptimal FREE T3 levels.

Miss81 profile image
Miss81 in reply to PurpleCat71

Thank you for the reply. Yes you could be right and either way T3 supplementation as addition to the T4 is the way to go. However, high RT3 was caused due to the levothyroxin only therapy. As the reason for high RT3 is because of low conversion from T4 to T3. But you have to know that without meds my conversion is fine hence no high RT3, but when I am on meds and only T4 meds the conversion is bad and all T4 goes to RT3. Hence why when on meds my RT3 is super high. So....🤷🏻‍♀️

In addition, when I was not on meds my T3 was ranging from 3.6-4.2 and T4 14-15 and I had regular periods. You would say my T3 was in the same ranges on meds and without meds but the period issue is different. I was regular when not on meds and irregular when on meds. 🤷🏻‍♀️ How do you explain this?

PurpleCat71 profile image
PurpleCat71 in reply to Miss81

However, high RT3 was caused due to the levothyroxin only therapy. As the reason for high RT3 is because of low conversion from T4 to T3. How do you know that levo only therapy was the reason for your high rT3? And how do you know your conversion was fine before meds? It´s logical that since you now take levo, the higher FT4 levels result in higher rT3. But, once again, that would only be a problem if rT3 is really doing the things it has been said to do (blocking the action of free T3 by preventing the latter from entering cells, thus causing hypo symptoms).

Anyway, the theory behind rT3 dominance is to go off levo for at least 8-12 weeks and take T3 only during that time. Simply adding T3 to T4 may not solve the problem if impaired T4 to T3 conversion is the problem as you would need to know exactly how much levo to take before too much is converted to rT3 instead of free T3. Also, if your high rT3 levels are caused by impaired T4 to T3 conversion, continuing to take levo would only perpetuate the problem.

Vitamin and mineral defiencies can cause impaired T4 to T3 conversion.

Miss81 profile image
Miss81 in reply to PurpleCat71

So what do you suggest I do? My rationalisation is to drop levothyroxin to 25mcg and take 9 mcg of T3 leothinonine.

P.S. my conversion was fine before meds because I did blood work and had regular periods. T4 meds impaired conversion. Makes sense. Also those alternative doctors don’t say take only T3, that’s an option. They also say drop T4 and increase T3, as another option.

greygoose profile image
greygoose in reply to Miss81

Forget about rT3. It's a total red herring.

There are many, many reasons for high rT3, such as:

* 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.

And the only reason that has anything to do with thyroid is when your FT4 is too high - maybe due to poor conversion, maybe just due to over-medication. It's a safety mechanism, to stop you going 'hyper'.

You have reduced your levo, so the rT3 level will now decrease. And, as you've added in T3 to your dose of levo, the FT3 should rise. Now what you have to do is find the right dose of T3 for you, and you do that by slowly increasing your dose. Extra high doses of T3 do not 'flush out' rT3, how would it? That's a myth. But, rT3 is irrelevant, anyway, so forget it. :)

Miss81 profile image
Miss81 in reply to greygoose

Yes that makes sense and it’s what I am doing. Thank you. 🙏

greygoose profile image
greygoose in reply to Miss81

You're welcome. :)

Marinaaa profile image
Marinaaa in reply to PurpleCat71

Yes, you´re right. I also found many sites explaining how RT3 caused sympthoms, and was worried because it has increased in my case as I was introducing T3 meds. So it is very confussing.

I suggest you rule out mineral and vitamin deficiencies first (see SlowDragon´s post above). While it´s true that some people do best on T3 only therapy, for various reasons, I think it´s too early for you to decide that levo does not work for you. Also, the theory behind rT3 dominance is that taking HIGH doses of levo causes this syndrome. You are only on 50 mcg which is unlikely to be enough to cause rT3 dominance. You need to optimise levo along with vitamin and mineral levels before you can decide that levo is not working for you. A rough guideline is that you should take 1.6 mcg of levo per kilogram of body weight. If you weigh 63 kgs, you need +/- 100 mcg of levo daily (possibly more). So, you are likely undermedicated and therefore symptomatic.

Miss81 profile image
Miss81 in reply to PurpleCat71

You could be right however 100mcg of levothyroxin would make my T4 above 22. It was 20 when on 50 mcg dose, so not sure how you make sense to add more T4 meds to already high T4 bloods...?

greygoose profile image
greygoose in reply to Miss81

Do you have Hashi's?

Miss81 profile image
Miss81 in reply to greygoose

I didn’t however after clomophine my antibodies rose to 200, TSH was at 3 and my period stopped for first time ever. That’s when they put me on levothyroxin 50mcg . My antibodies went away on their own and I haven’t had them since then, two years no antibodies. Why do you ask? ☺️

greygoose profile image
greygoose in reply to Miss81

How very strange! I've never heard of that happening before. Is that the TPO antibodies that were high?

Miss81 profile image
Miss81 in reply to greygoose

Yes antibodies. They were 200 and then went away. But I am still on medication. Not sure if the medication made them go away or??

greygoose profile image
greygoose in reply to Miss81

There are many, many different types of antibodies. And they all have names and specific jobs to do. The antibodies for Hashi's are TPO and Tg. Which ones were tested?

Doubtful that levo made TPO antibodies go away. That's not its job. Levo is a replacement thyroid hormone. Thyroid hormones themselves have nothing to do with TPO antibodies. Although they could lower Tg antibodies, I've heard.

Miss81 profile image
Miss81 in reply to greygoose

Yes TPO antibodies were 200 then went away straight away within a month or so they reduced slowly to 15

greygoose profile image
greygoose in reply to Miss81

Have you ever had an ultrasound on your thyroid?

It does sound as if you have Hashi's, even if your antibodies are now in-range. If so, you certainly should not be taking iodine. Hashi's and iodine just don't mix.

Miss81 profile image
Miss81 in reply to greygoose

Endo said that once you have antibodies you have hashimoto. I did ultrasound all is good but endo said thyroid is a bit smaller than normal.

But if Hashi and iodine don’t mix there is also iodine in the medication itself no? Should I stop taking iodine then? I have attached my urine results for you below. Thanks!

greygoose profile image
greygoose in reply to Miss81

Well, endo is probably right. But, technically, if your thyroid has shrunk, it's not Hashi's you have, it's Ord's. Not that that matters, the treatment is the same. Ord's is just Hashi's without the goitre.

It's not so much that there is iodine in the 'medication' - levo/T3, thyroid hormones, not drugs - it's that iodine is one of the ingredients of thyroid hormone. 1 molecule of T4 contains 4 atoms of iodine. One atom of iodine is removed when T4 is converted to T3, and recycled within the body so that the thyroid can make more thyroid hormone from it. Your thyroid is not making thyroid hormone anymore because you are taking levo/T3. So, your body needs less iodine, not more. You are already getting iodine from food, and now iodine from your levo/T3, so doubtful that the Lugol's is useful too you. And, as I said, excess iodine is dangerous.

I can't tell you to stop the iodine - or even suggest it - but I think you should do some research and then have a long conversation with your doctor that is prescribing it.

Marinaaa profile image
Marinaaa in reply to Miss81

Hi, my sister is having a similar experience to yours which you can read in some old post of mine, as she was given iodine when starting to concieve, which resulted in her TSH remaining and even going higher at 10 and not responding to medication on levotiroxine. She was given levo and iodine in a multisuplement at the same time. Her thyroid levels before medication were similar to yours but because she was trying to concieve and she did have antibodies for years she was given the medication.

I did my own research about iodine and thyroid patients in order to advice her, and tried to convince her withoug much success to stop the supplement, which she only did half a year after, and she has now managed to get a TSH under 2. (she started with a TSH of 2.5, sth like that....)

Well, a year later, she´s ended up in an IVF treatment and lets see how it goes, because it has already been cancelled once. She has never been tested T3 since she started on levo, no endo in my city does that and private labs in my city dont test FT3, they only test T3. If your endo asks you to do it, then they do it, but only after a number of calls complaining because they didnt do it in the first place,

As you can see, it is a bit complicated but, besides, my sister still trusts her doctors and she isnt worrying about the T3 thing.

But i´m going away from my initial point, and what I wanted to say is that I did my throughout research then and I found out that the iodine thing is nearly a fashion nowadays as its considered a necessary way to avoid defects in babies but that it is quite a new thing, and that up to the 2000 very few people were given idoine for pregnancy and I dont think there ara so many subnormal human beings around... (please dont make jokes here... heehehe😀

Well, I also understand you urine sample appeared low, but I suppose thats a sample for a single day. I´d recommend you to search online the contents of iodine in food. As you were said earlier, its everywhere, but as a way to find out if you are really deficient. If you are to increase it, I would do it through food, better. And consider that thyroid hormones count as part of that iodine dose as you were explained earlier. In doubt, repeat the urine collection test but try to be consistent with what your diet usually contains.

I understand you have been trying to concieve for a while now but you must be even more patient now until you adjust your meds.

PurpleCat71 profile image
PurpleCat71 in reply to Miss81

If you mean anti-TPO antibodies, no, levo won´t make them go away. First of all, in autoimmune thyroiditis, antibodies can fluctuate, so it´s of limited use to test them regularly. Once you have had raised antibodies, you have autoimmune thyroiditis, even if future tests reveal antibodies in range. Thyroid hormone replacement does not affect the process, it just replaces the hormones the damaged gland can no longer produce. Antibodies can also drop in range once there is no thyroid gland tissue to destroy; however, it would be surprising if that only took two years, espcially if your TSH was no higher than 3. A completely destroyed thyroid gland with no meds would likely result in a much higher TSH. You mentioned being diagnosed with subclinical hypothyroidism; is that when you had your antibodies tested?

From what you say, I´d say your doctor was open-minded to put you on levo with a TSH of 3 (so technically still in range) and raised antibodies if your free T4 still in range. You also said your doctor wanted your TSH <2 which is also rare as many doctors seem happy with a TSH anywhere in range. Most doctors won´t treat you until your TSH is well over range and your free T4 below range, so your doctor seems more knowledgeable than the average physician.

PurpleCat71 profile image
PurpleCat71 in reply to Miss81

I saw that clomophine is used to increase fertility. Were you diagnosed with subclinical hypo before that? Hypothyroidism can cause infertiltiy, so I am bit curious why your thyroid condition was not treated before you were put on clomophine? Was it the same doctor who prescribed both drugs?

Miss81 profile image
Miss81 in reply to PurpleCat71

Yes doctors fertility doctors and gynaecologist prescribe clomophine or letrozole to subclinical hypothyroid Patience even if not on medication. So no I was not on any medication when give clomophine. I had regular cycles too. Which now I don’t!! Same doctor.

PurpleCat71 profile image
PurpleCat71 in reply to Miss81

Well, I hope members who have had the same problems will reply!

You cannot know that a given dose of levo will result in above-range FT4 levels. Your thyroid hormone levels are not static, they change all the time. Also, you cannot look at your FT4 levels only. You need to know your TSH - if it´s above 2, you are still undermedicated. And you need to look at your FT3 levels to know how well you convert. If you are a poor converter, you would need to optimise vitamin and mineral deficiencies and, if that is not enough, adding T3 would be warranted.Anyway, you would not be going from 50 to 100 mcg in one go. You would add 25 mcg first (possibly only as little as 12.5 mcg) to see how your react, and then retest in 6-8 weeks to know where you stand.

This article debunks the rT3 dominance myth; it´s a bit long and technical at times but well worth reading:

thyroidpatients.ca/2019/11/...

Miss81 profile image
Miss81 in reply to PurpleCat71

My TSH was 1.7 which is below 2 on 50 mcg thyroxin, so I don’t see how increasing T4 would apply for my case considering everything I mentioned above. Thanks for the article though I will read it.

SlowDragon profile image
SlowDragonAdministrator in reply to Miss81

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

It is not clear from your original post whether you are self-diagnosing and self-treating? Did you decide to add T3 on your own? Did you diagnose rT3 dominance on your own? Are you under the supervision of a doctor?

Miss81 profile image
Miss81 in reply to PurpleCat71

I was under the supervision of an endocrinologist who only was interested in tsh levels being below 2. And left me like that for 2 years FYI. Now I am seeing what I can do to get out of this mess caused by levothyroxin only medication.

greygoose profile image
greygoose in reply to Miss81

The majority of hypos are on levo only, and are not in a mess. Levo is not the problem. The problem is that your body cannot convert it correctly.

Your endo was right and he was wrong. The TSH certainly should be under 2 - a euthyroid TSH is around 1, never over 2. But, once the TSH reaches 1 it ceases to be of any use for the purpose of dosing. The TSH cannot tell you how well you convert. You need to see the FT4 and FT3 tested at the same time to know that. But, anyway, now you are on the right road, so things should improve. But, would be a good idea to get your nutrients tested, because the body cannot use thyroid hormone correctly with sub-optimal nutrients. :)

Miss81 profile image
Miss81 in reply to greygoose

Ok, what nutrients should I test for? I am taking prenatals, fish oil, magnesium, probiotic, cq10 . I know I am low on selenium and iodine and have heavy metals. So now I am taking one drop of iodine and 25ug selenium which I am not sure is enough what do you think?

greygoose profile image
greygoose in reply to Miss81

I think the iodine is a very, very bad idea! That could be one of the things that is wrong. Iodine is anti-thyroid. How low was your iodine level, using which form of testing? You should never, ever self-treat with iodine.

Prenatals are another bad idea. Nutritional supplements should not all be taken at the same time as the are in a multi-vit - and prenatals are multi-vits - because they can cancel each other out.

Fish oil, probiotic and ca10, fine. But, how much magnesium are you taking? And, what is in the prenatal exactly?

You should get vit D, vit B12, folate and ferritin tested, for starters.

How low is your selenium? If it's very low, that could be a reason for your poor conversion.

Miss81 profile image
Miss81 in reply to greygoose

My naturopath ordered my urine tests. I do not do anything on my own. I only take one drop of iodine now that I know my iodine result cane back low as well as selenium. I take prenatal as I am trying to get pregnant and they are with methylated B’s as I have MTHFR single copy gene. Do you think 25ug of selenium is enough or should I increase the dose?

Also I take now and again 400 mcg of magnesium but not regularly. My D3 levels are good, 130. Iron is all good now. I take spartone as a supplement.

greygoose profile image
greygoose in reply to Miss81

I don't like the word 'good'. That is an opinion, not a fact. Always far better to give the actual numbers: results and ranges.

Your naturopath obviously is unaware of the dangers of excess iodine. Your level may have been low - although without the numbers we don't know how low - but you are taking 50 mcg levo and 5 mcg T3 (?) so, from that you will be getting about 35 mcg iodine daily. Doubtful if you need any more than that, because now that you are taking thyroid hormone replacement, you need less iodine, not more.

Yes, I understand why you are taking prenatals, but that does not make them a good thing to take. Is it just B vitamins? No vit C or anything else?

I think 25 mcg selenium daily is possibly a little too much. 20 mcg might be better. What form is it? Is it l-selenomethionine?

Miss81 profile image
Miss81 in reply to greygoose

I take half a spoon of vitamin c also. Selenium I take the Mineral Matrix with selenium from orthoplex.

The prenatal that I take are Naturobest preconception for woman.

Iron results were : Ferratin 160, s iron 16, trf 2.5, trf sat 20.

Saliva test
Miss81 profile image
Miss81 in reply to Miss81

Sorry it’s a urine test that I did not saliva ☺️

Miss81 profile image
Miss81 in reply to greygoose

And the other urine test that shows low iodine, selenium, etc... let me know what you think pls?

Saliva test
greygoose profile image
greygoose in reply to Miss81

Did your naturopath doctor not consider that your low iodine was the cause of your hypothyroidism, and try optimising that BEFORE putting you on levo? Taking levo will muddy the waters on that score. Seems to me that should have been tried first.

Iron results were : Ferratin 160, s iron 16, trf 2.5, trf sat 20.

Results are meaningless without the ranges. Ranges vary from lab to lab, so we need the ranges that came with your results.

So, Naturobest preconception for woman pretty awful, like all multi's, for several reasons:

* It contains B12 and vit C. These too should be taken at least two hours apart because vit C blocks the action of B12 in the body.

* It contains more iodine - enough said on that subject.

* It contains zinc, which is another mineral that should be tested before supplementing. When you are hypo, your zinc could be too high or too low. You need to know which before taking more.

* It contains vit D, but no vit K2-MK7. The two should be taken together.

* However, no need to worry about any of the above because it also contains iron, and iron will block the absorption of EVERYTHING. Iron should be taken at least two hours away from everything except vit C.

* What's more, you won't even get the iron out of it, because it contains calcium. Calcium binds with iron - basic 'O' level chemistry. So you won't absorb either the iron or the calcium. Calcium should be tested before supplementing, anyway, because it's rare to be low in calcium in the west.

So you're paying top money there for nothing at all. You might just as well throw that money directly down the drain.

Miss81 profile image
Miss81 in reply to greygoose

Ok good advice! Makes sense! So what do you suggest I take pls?

Also, my ivf fertility doctor which has nothing to do with my naturopath had put me on levothyroxin and as you know they don’t test iodine levels ☺️

greygoose profile image
greygoose in reply to Miss81

No! I did not say you need one drop of iodine daily!!! Most definitely I did not say that. I've more or less answered that question above.

Pity your fertility doctor and your naturopath don't compare notes. How can you get optimal treatment when they're both pulling in opposite directions?

If you are hypo, you need thyroid hormone replacement: levo/T3/NDT. You cannot live - and you certainly can't conceive - without them. It's very doubtful that you need extra iodine.

Miss81 profile image
Miss81 in reply to greygoose

I get you all is well.

What do you suggest regarding prenatal as a replacement ?

greygoose profile image
greygoose in reply to Miss81

What do I suggest you take? Well, you're already taking iron, and vit C - best to take them at the same time - you need good levels of iron when you're pregnant.

What you need to do now is get your vit D, vit B12 and folate tested. Then people can suggest what you should be taking, based on the results.

Miss81 profile image
Miss81 in reply to greygoose

Ok I will do those and get back to you.

I just don’t understand this though. Above you said that low iodine was the cause of my hypo and why was I not taking iodine supplements rather than being on Levothyroxine. Then later you explained that if I have hypothyroidism I have to be on medication to live and to convince. I could be wrong in the understanding of what you said so I apologise if I have misunderstood something.

In any regard, thank you very much for your help I will be in touch with you shortly re my B12 and folate etc.

greygoose profile image
greygoose in reply to Miss81

Above you said that low iodine was the cause of my hypo and why was I not taking iodine supplements rather than being on Levothyroxine.

No, that's not at all what I said. I said: Did your naturopath doctor not consider that your low iodine was the cause of your hypothyroidism, and try optimising that BEFORE putting you on levo?

I didn't say it WAS the cause, I asked if your naturopath hadn't considered that it might be the cause. That's entirely different. It's rare in the west but some people, in low iodine areas, do become hypo due to iodine deficiency. I don't know where you live, I just asked if your doctor had thought about that.

But, I said that before I realised that you had Hashi's. Low iodine is not the cause of Hashi's - quite the opposite. And, it would appear that Hashi's is the cause of your hypothyroidism.

I think, actually, you misunderstood just about everything! lol

Then later you explained that if I have hypothyroidism I have to be on medication to live and to convince.

Unless your hypothyroidism is due to low iodine, then yes, you do have to be on thyroid hormone replacement. And, it would seem - as far as one can tell - that you are hypo due to Hashi's/Ord's, which is slowly destroying your thyroid. So, iodine wouldn't help with that in any way.

Hope that's cleared everything up. :)

Miss81 profile image
Miss81 in reply to greygoose

Yes it did thank you very much! 🙏☺️ But if I was hashis I would have high levels of iodine in the urine and it appears the opposite so it’s a bit confusing...? No? I live in Australia btw but most of teen and adult life I have eaten himalian salt which is low on iodine.

greygoose profile image
greygoose in reply to Miss81

Oh dear. Who told you that? I've never heard of Hashi's people have high urine iodine. Why would that be?

Salt isn't the only source of iodine. Far from it. There's iodine in the soil and lots of iodine in the sea, so anything that comes from the sea or the soil contains iodine. I've never heard that Autralia is low in iodine - unless you live right in the centre?

greygoose profile image
greygoose in reply to greygoose

I've just found this:

Higher urinary iodine concentration was associated with increased risk of HT, and this association was near linear, indicating that increased urinary iodine has a continuous and graded impact on HT risk. Moreover, the iodine-HT association was not modified by genetic predisposition to HT. Interestingly, urinary iodine concentration was significantly associated with increased risk of hypothyroidism.

liebertpub.com/doi/10.1089/...

And, it looks like, as usually happens - if it was a doctor that told you that - the medical profession has again put the cart before the horse!

It's not saying that having Hashi's causes high levels of iodine in urine. It's saying that the higher the level of iodine in the urine, the greater the risk of developing Hashi's.

It's well-known that excess iodine can trigger Hashi's, so I think that that's what that's all about. BUT, there are many, many other causes of Hashi's, so you don't have to have high levels of iodine in your urine to have Hashi's. :)

Miss81 profile image
Miss81 in reply to greygoose

Ok got it. Wow, thank you so much for your explanation. Amazing. 🙏

greygoose profile image
greygoose in reply to Miss81

You're very welcome. :)

Miss81 profile image
Miss81 in reply to greygoose

Can I take L-tyrosine with thyroid meds?

greygoose profile image
greygoose in reply to Miss81

Not at the same time, no. Thyroid hormone should be taken on an empty stomach, at least one hour before food or drinks other than water, and at least two hours away from other medication or supplements.

But, why would you want to take L-tyrosine anyway?

Miss81 profile image
Miss81 in reply to greygoose

Naturopath is giving it to me with some other proteins in a compound. Why do you ask???

greygoose profile image
greygoose in reply to Miss81

Tyrosine is one of the ingredients of thyroid homone. Just taking tyrosine isn't going to do anything to help your hypothyroidism. And, besides, if your thyroid is failing/has failed, increasing tyrosine isn't going to give you more thyroid hormone - doesn't matter how many eggs you add, if your oven doesn't work, you won't get a cake out of it.

Naturopaths in general tend to have some very weird ideas about treating thyroid - some of them quite dangerous. Why is he giving you this compound? And what else is in it?

But, if you take anything it has to be at least two hours away from your thyroid hormone. For vit D, calcium, iron, magnesium and oestrogen it has to be four hours away.

Miss81 profile image
Miss81 in reply to greygoose

She is giving me the compound as she thinks I would benefit from it. ☺️It has phenylanine, glycine, l-theanine, l-carnitine-tartrate, l-tyrosine. I take it right after food twice a day. It is hours away from the meds.

PurpleCat71 profile image
PurpleCat71 in reply to Miss81

I don´t know what all that stuff is, but I do know that l-theanine is included in supplements such as "Cortisol Calm" the aim of which is to lower high cortisol levels.

greygoose profile image
greygoose in reply to Miss81

As I said, naturopaths have some very weird ideas about thyroid and how to treat it. You would be well advised to research all the ingredients carefully before taking it. Naturopaths often do more harm than good.

Miss81 profile image
Miss81 in reply to greygoose

Hello. I have attached Vit D, folate and B blood tests with ranges. Can you please advise if my numbers are ok or?

Vit D
greygoose profile image
greygoose in reply to Miss81

Are you taking any supplements? If so, vit D could be higher. B12 is good, but folate is rather worrying. It's very high.

Miss81 profile image
Miss81 in reply to greygoose

Yes I am taking supplements, the prenatal I told you about earlier is what I take for folate and bs and everything else.its two capsules per day. Suggestion for improvement? What is ideal number for folate and bs and vitamin d?

greygoose profile image
greygoose in reply to Miss81

You're still taking that, then?

Miss81 profile image
Miss81 in reply to greygoose

Yes have been for some time now 6 months plus

greygoose profile image
greygoose in reply to Miss81

Well, you know what I think about that. I explained it all in detail.

Miss81 profile image
Miss81 in reply to greygoose

Ok so now that you know what my results are what do you suggest I take?

greygoose profile image
greygoose in reply to Miss81

I suggest you take a maintenance dose of vit D, 800 IU. With magnesium and vit K2-MK7.

And that you leave the B vits for a few months, then retest to see what the levels are.

You didn't give a result for ferritin.

Miss81 profile image
Miss81 in reply to greygoose

Iron studies

Iron studies
greygoose profile image
greygoose in reply to Miss81

That doesn't seem too bad. So, I would leave that for now and retest in a few months.

Miss81 profile image
Miss81 in reply to greygoose

Thanks for your assistance ☺️

greygoose profile image
greygoose in reply to Miss81

You're welcome. :)

Miss81 profile image
Miss81 in reply to greygoose

I wanted to ask you this. I want to switch taking the thyroid meds from morning to night. How do I do this in terms of dosing? For example, this morning I took 30mcg of T4 and 7 mcg of T3 and I usually take another 5mcg if T3 at 2pm. So now I want to start taking my thyroid meds at night before sleeping. How much do I take tonight?

And tomorrow night do I take my full dose all at once? As now I split the T3 morning and early afternoon.

greygoose profile image
greygoose in reply to Miss81

You can take as much as you like before sleeping. But if I were you, I'd take it slowly, and take your second dose this afternoon as usual. Then, tomorrow, just take 7 mcg T3 in the morning, 5 mcg in the afternoon, then the levo before sleeping. The next day, take nothing in the morning, 7 mcg T3 in the afternoon, and 5 mcg T3 before sleeping with your levo. Stay on that for a while to see how you go. It's all trial and error, anyway.

Miss81 profile image
Miss81 in reply to greygoose

Thank you so much you really explained that so well. Amazing thank you 🙏

greygoose profile image
greygoose in reply to Miss81

Glad you liked it. :)

Miss81 profile image
Miss81 in reply to greygoose

Hi I have 2 questions pls. So can I take 45 mcg of levothyroxin with 7mcg of T3 at night before bed and then take 7mcg of T3 in the morning? It seems it makes more sense to take in the morning then afternoon to keep with the morning cortisol graph etc.

Also when I kept my T4 low at 30mcg a day and was raising the T3, the TSH is coming at 3 pmol (0.5-6) when T4 is at 13 mark in bloods, ranges (12-22). That’s why I think I need to increase T4 to 45mcg now but keep in mind I am trying to lower the high RT3.

Thoughts?

greygoose profile image
greygoose in reply to Miss81

Yes, you can. Try it and see if it suits you that way.

No, you are not trying to lower the high rT3 because rT3 is irrelevant. I thought we'd been through all that and you'd decided not to bother about it.

Miss81 profile image
Miss81 in reply to greygoose

Ok thank you

Miss81 profile image
Miss81 in reply to greygoose

RT3. Hi I know you say not to worry about RT3 but would you be so kind to let me know what would be the ideal number for it. In less than a month it has dropped by 50 as you can see in attachment. So having increased the FT3 and reduced the T4 did the trick. Let me know what you think would be ideal number? As doesn’t a high RT3 number block the FT3 to get into the cells? Also trying to improve my amh maybe this has something to do with it?

RT3
Miss81 profile image
Miss81 in reply to greygoose

Folate and b

Folate and b

Miss81,

Iodine is important in maintaining normal thyroid function and having adequate levels (together with FT4, FT3 and low TSH) will ensure baby develops normal thyroid function and general healthy development. Even a mild to moderate iodine deficiency can cause learning difficulties and impair physical development.

With that low iodine result I think you should be taking iodine. Here in the UK there are now many pre-natal supplements containing iodine due to the high incidence of iodine deficiency in pregnant women, and I read the same is true in Australia (just google something like australia + pregnancy + iodine for many articles and research papers on the subject).

However, having said that if you have high TPOAb’s iodine is thought to drive them higher by increasing activity in the thyroid, and elevated TPOAb’s have been found to be associated fertility issues & increased miscarriage. All this is further compounded by you medicating Levothyroxine that contains a certain amount of iodine but may not be quite beneficial enough for a deficiency prior to conception.

You are between a rock and a hard place.

Also elevated RT3 could be indirectly influencing your menstrual cycle by creating low FT3 levels. RT3 itself is inert but the enzymes that converts T4 to RT3 congruently convert our precious T3 to an inactive form called T2. Elevated RT3 should be avoided but the problem is in establishing what is driving it.

Have you got ranges (numbers in brackets) for cortisol result. It is looking low as mornings should be the highest reading of the day.

Also ranges for iron results. Low iron is a big cause of RT3 on this forum.

TSH is low (which is great for conception). Thyroid hormones are a good level after introducing T3, although I agree with gg in that I would have initially added further Levo because with conception in mind it will be the T4 levels that are used as guide for the further increments required for a healthy pregnancy.

Miss81 profile image
Miss81 in reply to radd

Thank you for answering. It helps a lot. You seem to also be quite knowledgeable so thank you. My saliva morning cortisol level was 11 (Range 13-25) so it’s very low.

I can not comprehend how I was left on just levothyroxin and didn’t know I wasn’t concerting it properly from t4 to T3 and the endo didn’t say anything! That caused my high RT3 my low cortisol and my irregular. Cycles , missing cycles, and high fsh in 20s and 35 oestradiol level on day 2 when before any of this I was normal. 🤦🏻‍♀️😢please help.

radd profile image
radd in reply to Miss81

Miss81,

Many do well on Levothyroxine but equally many do not and so find their way to our forum.

What does your endo say about your deficient cortisol level?

Have you got iron test ranges?

Miss81 profile image
Miss81 in reply to radd

I am not seeing any endo atm they are a lost hope.

I did iron transfusion recommended by doctor results are above somewhere seem ok.

radd profile image
radd in reply to Miss81

Miss81,

I can't see any iron ranges, only that others have already asked you for them.

An iron transfusion would indicate previously deficiency. Adequate iron levels are notoriously hard to maintain with previous deficiency in the presence of low thyroid hormone because you have only addressed the deficiency and not the cause.

Both low iron and low cortisol risk impairing good thyroid hormone function that would be driving RT3 higher.

Miss81 profile image
Miss81 in reply to radd

But I fixed the iron and I am not even sure it needed fixing ferratin was 50 now it’s 150. I am also on spartone to make other iron levels high. Anyways, my RT3 was tested 3 months after iron transfusion and it’s very high so not sure iron has anything to do with it

radd profile image
radd in reply to Miss81

Miss81

Ferritin is only a protein to store iron and can be very mis-representional of actual iron levels themselves.

Clearance of excess RT3 is dependant upon all health conditions & deficiencies being addressed and usually takes many months.

Miss81 profile image
Miss81 in reply to radd

Also it’s all so confusing. You say “risk impearing good thyroid function” but on the other hand I am on meds which suppress your thyroid and not add onto it. Is my thyroid even functioning at all when on meds?

radd profile image
radd in reply to Miss81

Miss81,

Yes, it is immensely confusing because hormones interact and influence each other. No hormone works in isolation and FSH may elevate or reduce in hypothyroidism depending upon degree and duration, and other hormonal state.

I wrote 'good thyroid hormone function' because we need adequate levels of certain cofactors to make hormones work effectively. The paradox is the very nutrients we need to make meds work effectively are the very ones that hypothyroidism encourages deficiency in, ie iron, VitB12, folate, and Vit D.

Your thyroids ability to secrete hormone is dependant upon degree of gland damage/atrophy and amount of thyroid hormone replacement med, as yes, meds can suppress function.

It is possible to have under-range cortisol levels without an adrenal insufficiency diagnosis because I have been there too. It is concerning and needs addressing otherwise it will be difficult to get everything else working correctly. On those results you should ask for a referral to an endo and be offered an SST to assess adrenals response to ACTH.

You have received a huge amount of good advice above but if you can't supply test results and ranges it is difficult for members to suggest options or offer you their experiences. Reread above and especially SlowDragons reply that refers to the very basics in trying to recover good hormones levels and encourage better well being.

You may also like...