I have had Hashimoto's for 30 years and am currently on 100 mg of Synthroid and 5 mcg of Cytomel. I have been a mystery to my providers because I still have hypo symptoms (cold, hair loss, constipation, brain fog, low blood pressure 93/48, low pulse 46, low body temp) yet my current blood test results show my TSH I should be hyper .025. My free t4 is good at 1.57 ( mid to upper range) and my free t3 is 2.8 (a little below the mid range) but my reverse t3 is off the chart high at 24.8. Does anybody have any luck with switching to Armour or NP and lowering their reverse T3? Or doing T3 therapy only?
Thank you SO much!
Annamaria
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amburke1965
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my current blood test results show my TSH I should be hyper .025.
Hyper is not just a low TSH - that one's not low enough for hyper, anyway - it's high thyroid hormones - T4 and T3. So, no, your blood test results are not showing you should be hyper.
Can you give us the actual numbers for the ranges, please? Just saying high or low or mid-range doesn't tell us much. And 'mid to upper range' tells us nothing at all.
There are many, many reasons for high rT3, and only one of them has anything to do with thyroid. And that would be when you have a conversion problem and the FT4 is high, and starts converting to more rT3 than T3. So, you see why we need the actual numbers?
But, rT3 itself is not a problem. It is inert and only stays in the system for a couple of hours before being converted to T2. It is the result of a problem, not the problem itself. But T3 only, or even lowering the dose of levo and adding in some T3, will get reduce it if the problem is conversion/high FT4. But if it's due to 'something else', that won't help.
We are all medical mysteries on this forum but the truth is we are normal, it’s just medical science hadn’t caught up with us yet but it is, slowly, slowly. Sorry to hear you remain so symptomatic.
It is old and misguided thought that switching to T3-only med’s will reduce excess RT3 and make you well. This is because RT3 isn’t the main problem but the deiodinase enzyme type 3 (D3) that drives it. Once this enzyme is up-regulated it will also convert T3 to an inactive form of T2 alongside converting FT4 to RT3. D3 does not differentiate between the two hormones but converts them congruently.
Therefore, it is better to address the cause of the up-regulated D3, and on this forum common reasons are: iron deficiencies; chronic inflammation caused by autoimmune disease or intolerance to gluten; over dosing of all thyroid replacement meds; medicating Levothyroxine mono-therapy when converting abilities are poor; cortisol/adrenal issues; etc, etc.
It is better to focus on improving thyroid med’s efficacy rather than on solely reducing excess RT3 levels as these will reduce naturally to healthy levels as thyroid meds work better. In your previous post you sound under medicated and although this is not a direct cause of excess RT3, it will cause (or contribute to) the issues that then raise RT3 levels. Remember because of the way D3 works elevated RT3 can also indicate low FT3 and when so symptomatic it is prudent to assume your low ‘total’ T3 is likely to result in a low ‘free’ T3 that is now evidenced here.
You are on good combo that works for many but you likely need a 5mcg T3 dose raise and splitting the dose can be more sympathetic to a struggling body. Also to assess all essential cofactors required to improve thyroid meds efficacy: gut health (is it working well or is there pain/wind/bloating), diet (is it clean/healthy, are intolerances well managed); lifestyle (good sleep, managed stress levels, exercise); iron and vit levels (are insufficiencies being addressed? are you supplementing selenium known to aid improved conversation and been shown to reduce thyroid antibodies).
Your new addition of LDN should help regulate the immune system, and there is no research to prove LDN reduces RT3 because there remains little research regarding LDN and Hashi, and theories are mainly based on clinical observations. However, because LDN helps suppress inflammatory cytokines, if your high RT3 levels are inflammatory driven, it may well help reduce excess RT3 levels in time.
I successfully medicate NDT + Levo, as find it a smoother ride and easier to dose (only once a day) than synthetic T3. You might benefit also. T3-only meds are usually a last resort as the short half life can make it tricky for some. And I agree with greygoose regarding a low TSH. It is usual when medicating any form of T3 for TSH to reduce and does not indicate you are ‘hyper’, as only over range FT3 & FT4 can do that.
For me NDT was the thyroid treatment that worked best for me. That was after trying levothyroxine then levo and Liothyronine. Most importantly no thyroid hormone replacement will work well unless your Vit D, folate, ferritin and B12 are optimal - not just in range. So it's definately worth having these checked and optomised. For me GF was really important too and others find this but not everyone.
Unconverted T4 naturally becomes reverse T3 - and it's the body's way of loosing surplus T4 hormone - it is a natural process within the body of rid itself of excess T4 .
I have Graves post RAI thyroid ablation and was treated with 100/125 mcg daily T4 -
I became very unwell - around 10 years later - and started researching for myself.
The NHS did not not recognise my private blood test for ' reverse T3 as being as issue ' -
My reverse T3 was way over range - as you might expect after Graves and likely compounded further when very unwell some years later.
The logical solution would be to reduce the T4 intake by switching the patient to either a T3 / T4 combo, Natural Desiccated Thyroid with I believe T3 only being the last resort.
Without a thyroid I find NDT the better option as it feels softer and a much smoother ride on my body and I am much improved but am having to self medicate as I could not find any help through the conventional channels and refused both NDT and T3 through my doctor and the hospital where all my treatment for Graves was undertaken.
Your TSH is not a reliable measure of anything - and was originally introduced as a diagnostic tool to help identify people dealing with hypothyroidism.
The TSH was never intended to be used once the person was a patient.
Once taking any form of thyroid hormone replacement we should be dosed and monitored to restore T3 and T4 thyroid hormones back to a level that works for the patient and gives them back their ' you ' .
P.S. Are you noticing any benefits from adding in this small dose of Liothyronine - was your T4 reduced when introducing the T3 - what were your Free T3 and Free T4 blood test results and ranges that decided this dosing strategy ?
Hi and thanks for your response. Prior to the addition of the t3, I was on .125 of Synthroid only but my free t3 was anywhere from 1.5-1.8 and the range was 2 - 4.4. It took me about a year to convince my doctor to add it so he lowered my Synthroid to 100 mcg and added the .5 mcg of Cytomel. It helped me with my sleep and some puffy face and energy levels but I am still not optimized
If these results are from being on 125 mcg T4 monotherapy :-
Your T4 is coming it at around 79% - with a T3 coming in at around 33% - and generally when T4 is in the top quadrant of it's range we would be looking for a T3 tracking behind at around 60/70%. - so yes your conversion of T4 is not optimal and your T4 building unconverted into reverse T3.
No thyroid hormone replacement works well until the core strength vitamins and minerals of ferritin, folate, B12 and vitamin D are up and maintained at optimal levels - which are much higher than normal - so please furnish us with actual results and ranges if you have them.
Conversion of T4 into T3 can also be down regulated by inflammation, antibodies, any physiological stress ( emotional or physical ) depression, dieting and ageing - so though not as easily managed but needs saying.
Your antibody reading is over range so - was this explained to you - it's likely Hashimoto's - a thyroid auto immune disease - which you might like to read around on if you don't know of the research and suggestions of Dr Izabella Wentz - thyroidpharmacist.com.
I doubt your symptoms will be relieved on just 5 mcg T3 with 100 mcg T4 - and if this is the blood test after being on this T3/T4 combo you will likely need to consider small increases in the T3 - possibly spaced out throughout the day with T4 likely reduced further.
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