Out of the blue I decided to get my Reverse T3 level checked as I’ve never had it done before and I was rather curious.
I have Central hypothyroidism.
I currently take 150 mcgs of Levo , 20 mcgs T3 and 10 mgs of hydrocortisone.
My most recent blood results were -
TSH - 0 ulU/ml 0.35 - 4.95
FT4 - 15 pmol/L 9 - 19
FT3 - 5.2 pmol/L 2.4 - 6
REVERSE T3 - ** 40 ng/dl 8 - 31
The Reverse T3 is very raised. Is this a concern?
Joesmum
What a shame you wasted money on this test. It really doesn't tell you anything that testing FT4 and FT3 together can. This test can tell you if your rT3 is high but not why it's high.
High rT3 can be caused by many things, only one of which has anything to do with the thyroid and that's when there is an excess of unconverted T4 and you will know this from the FT4 and FT3 results, you don't need a rT3 test to show this. Your FT4 is 60% through range so it's not high, it's just over half way through range, and cannot be the reason for your high rT3.
High rT3 could be caused by low ferritin, by an infection, by low-calorie diets, 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.
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
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. Cirrhosis of the liver. Fatty liver disease. Any other liver stress Renal Failure. A fever of unknown cause. Detoxing of high heavy metals.
Articles
thyroidpatients.ca/2019/01/...
zrtlab.com/blog/archive/rev...
verywellhealth.com/reverse-...
I understand that reverse T3 doesn't hang around long because it eventually converts to T2, etc, so it's not necessarily a problem. See article by Paul Robinson here:
paulrobinsonthyroid.com/rev...
that’s a wonderful reply thank you.
Could I ask…
Is it possible that I’m taking too much of either T4 or T3 which my body is then converting to Reverse T3 to prevent me from becoming overmedicated? Sort of an inbuilt monitoring system? Is that ridiculous?
Your FT4 is 60% through range and your FT3 is 77.78%. On combo meds we're all different as to where we need each individual hormone, some are fine with a lower FT4 as long as FT3 is in the upper part of it's range, some need them reasonably well balanced over half way through their ranges. Your results would be perfect for some people and may be perfect for you, you will know how you feel.
You don't have an excess of unconverted T4 so that wont be the cause of your high rT3. I would suggest that you don't worry about your rT3 result, as I mentioned it doesn't hang around for long. Have you read the articles linked to?
I know you posted this a while ago.Reverse t3 itself doesn't block the t3 receptor. It is the upregulated DIO3 enzyme, which in turn will degrade T4 into Rt3 and T3 into T2 and would prevent the cell to take any T3 in. So your high RT3 suggests you may have DIO3 enzyme working at a high capacity. You could benefit from reducing t4 and adding more t3 if that's the case. It depends how you're feeling etc. But if you're central hypo and take hydro, I'd say you'd have a hard time converting so much levo?
hello Incoguto,
Thank you for responding.
I don’t ever feel well. I ache constantly. My weight gain is astronomical, even though I’ve lost my hunger sensation. I’ve sort of given up on ever feeling well now.
I wonder if Hypopituitary folk ever do?
But thank you for taking the time to reply. I did, a few years ago feel much better on NDT but I don’t think that I’d be allowed to switch back to it now. My Endocrinologist was not concerned with the Rt3 result. He just said “ you're a poor converter and that’s why you’re on both T4 and T3.”
I’m very fortunate to have a great Endo but even with his great care, I don’t feel well.
My early morning Cortisol always comes in around 200 but occasionally it has dropped to below 100, hence the addition of hydrocortisone to compensate for the lazy ACTH production.
Perhaps I should ask my Endo about NDT again.
Many thanks
I believe you can feel well if on the right amount and balance of meds.Here are my thoughts, as your symptoms seems like a mix of hypo and maybe low cortisol too.
Your dose hydrocortisone is not high. Physiological dose is 25 mg. By giving you 10 mg you could have shut ACTH signalling more. You'd need to test to really know of course. Have you ever tried more than 10 mg?
Also, your dose is quite Levo heavy.
NDT works for me so much better than synth combo. Maybe talk to him? Of you felt on it better? And you can always add T3 to NDT. This is what I'm doing now.
Yes, you are a poor converter, but if you don't convert well, what's the benefit of giving you so much T4 you cannot convert?
You make some very good points. I wonder if I should drop down from
150 to 125 mcg levo
And raise my 20mcgs t3 to 30mcgs
I never considered that I was on a lot of levo. I have a friend on 200mcgs of levo. But she doesn’t take any T3.
We can only judge if it is a lot of Levo by the conversion, by having pituitary issues, by potentially high rt3 etc. Your friend might be different. My mum is on 62.5 levo doing so well. And I'm on a sofa everyday struggling with 85 t4 and 30 t3. But I have no tsh either.
If you drop, do it slowly, 12.5 levo and add 5 t3.
Which NDT do you take ?
As you are taking hydrocortisone this could be why rT3 is high
There’s nothing on your profile
You say you have central hypothyroidism
Is this why also on hydrocortisone?
Have you ever had both TPO and TG thyroid antibodies tested
Which brand levothyroxine are you taking
Are you on, or ever tried dairy free or gluten free diet
I have both Hashimotos AND Central hypothyroidism. I take hydrocortisone because I have a TSH deficiency and a partial ACTH deficiency in the pituitary .
I haven’t ever tried a gluten or wheat free diet or dairy free diet. I am beginning to think it might be a good idea as I never feel fully well.
I was firstly diagnosed with Hashimotos. My TSH never rose above 6.5 but my FT’s continued to drop below range. Central Hypothyroidism was diagnosed. My Endocrinologist said “ you have this at both ends” !
It has never been easy to find a balance.
I have always taken MercuryPharma Levo and T3 and my pharmacist ensures that I receive this.
Looks like you need a bit less medication to get your TSH back in range? I read for central having TSH of around 0.5 minimum is important?
HopefilledFuture
I read for central having TSH of around 0.5 minimum is important?
I've not heard about that, do you have a reference so we can check it out.
With Central Hypothyroidism the TSH is irrelevant, the pituitary or hypothalamus is at fault and can't send the signal (TSH) to the thyroid so when on treatment for CH it's FT4 and FT3 that should be taken notice of, the TSH wont respond.
hi hopefilledfuture,
Thanks for replying. Just to clarify Central Hypothyroidism is where there is an inability in the Pituitary or Hypothalamus to produce TSH or TRH respectively.
The amount of TSH produced by most Central Hypo’s is so minimal that it would be almost impossible to maintain any level of TSH once on medication.
Some with Central Hypothyroidism have total TSH deficiency.
I would be interested to read the data though stating otherwise.
X
Annoyingly I can't find it now, I will share if I find it. Im definitely no expert so may be wrong.
I recently had Graves for 18 months, (autoimmune hyperactive thyroid), so my TSH was very low, but during this I had also low T3 T4 which is unusual.
When the Graves was better the TSH was normal, but T3 T4 still low, so diagnosed with potentially central - but they found no cause so far. But apparently T3 T4 suppression can also come from some medications and also from something called sick euthyroid syndrome.
I find if TSH goes too low I can get shakey and anxious. In some cases can be damaging for the heart (I guess if the pituitary and hypothalamus are working normally and T3 T4 suppression coming from somewhere else?)
Some people with central have normal TSH with low T3 and T4... So TSH is present and working but something else is suppressing T3 and/or T4 that's what I have... In which case I have to be careful TSH doesn't go too low as I can end up with overactive TSH and underactive T3 T4... It's pretty confusing. Maybe it's not classic Central Hypothyroidism but don't know what else to call it.
I think if TSH was normal originally with low T3 T4 it seems more likely not pituitary or hypothalamus related?
Whereas if TSH negligible maybe more likely true Central Hypothyroidism
I hope I'm making some sense lol.
Sorry if I've confused things, I can see what you mean now. In true Central Hypothyroidism with pituitary or hypothalamus not working TSH would be irrelevant. I guess mine is slightly different.
Hopefully it may be helpful to some people to know Low to Normal TSH with Low T3 T4 is not always caused by Pituitary or Hypothalamus... although it leaves me pretty confused what is causing it for me lol
I understand what you’re saying but forgive me if I may help you phrase it in a less confusing manner so as not to mislead others.
A classic reading before treatment for Central hypothyroid could look like this……a within range TSH with below range FT4 and FT3.
BUT THIS IS NOT a ‘normal’ reading of the TSH.
It is deceptive. It only appears to be within range because the pituitary is malfunctioning and cannot produce more. It is in fact suppressed.
If this were primary hypothyroidism with no malfunctioning of the pituitary , the TSH result would be way , way above ‘normal’.
The word NORMAL can be very confusing and misinterpreted.
X
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