Thyroid UK
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Do you only get reverse T3 problems with T4?

Hi All

Sorry it's late in the evening (I know I should be in bed resting those adrenals!!) and I am probably being a bit thick here but .....

my tests results have always shown low adrenals, low dhea, low testosterone - basically adrenal fatigue. I am trying CT3M to tackle this.

I haven't had the specific reverse T3 test but have saliva/urine/blood adrenal and thyroid tests and these show weak adrenals etc - see results at the end of this mail. I just wanted to double check my understanding:

1) I am pretty sure I am not converting all T4 into active T3 and that this may be because of my poor adrenal function

2) I am trying to fix this by timing when I take T3 (currently on 40mg) during the day and I just take all my T4 (125mg) in the morning not with food

3) Do you only get reverse T3 /conversion of T4 into active t3 issues if you are taking T4. In other words if you only took T3 could you still get reverse T3/conversion problems or would that remove the conversion problem? Is that why some people only take T3?

I hope I am making some sense here...not sure that I am!

thanks for help from anyone willing to figure out what my foggy and tired brain is trying to ask....!


Blood tests & ranges

TSH 0.07 (0.3 to 4.5)

T3 free 3.64 (2.1 to 4.2)

T4 free 0.86 (0.7 to 1.8)

Testosterone 85 (150 to 600) this result doesn’t look good at all – is it linked to adrenals??

DHEA 41 (65 to 280) doesn’t look great either

Urine tests

T3 1770 (800 to 2500)

T4 2120 (550 to 3160) looks high here but is low in blood tests – why would that be?

Total 17 OH steroids 2.81 (3.17 to 8.63) I don’t know what this is either but doesn’t look good

20 Replies

lizanne, low adrenal can affect conversion of T4 to T3. Dr. Barnes and Dr. Jefferies thought it could also affect utilization of T3 at the receptor site. Paul Robinson pointed out that there are no studies to back this up. However, since I have great respect for them both and their ability to observe their patients I will continue to accept it until proven otherwise. Rt3 problems come from T4. Since your whole adrenal cascade is low, DHEA, testosterone, et al, I would suggest you give what you are doing some time and see how that affects you as you bring the levels back to normal. You might try adjusting the timing of your thyroid dose but I wouldn't try CT3M until you get DHEA and testosterone back up to normal range. CT3M works best when you are down to just the thyroid/adrenal axis. It will not fix the other problems i.e. DHEA and testosterone. See how the pregnenolone and DHEA do for you. You can't do this in a day, it takes some time. When they do a 24 hr urine they give you a fractionated 17 keto and a fractionated 17 hydroxy, or at least they used to. What you are showing is the fractionated 17 hydroxy results and they are low. Do not make too many moves at the same time or you won't know what is actually working. PR


Sorry to muscle in Lizanne, but I just want to ask PR4NOW - wouldn't CT3M help the adrenals? I'm not sure if you are saying that you need to fix the adrenal problems first, but where my understanding is at (and it is still more scant than I'd like) the CT3M will help flagging adrenals, so which comes first - I'm a bit confused?


Sorry I did not make this clear.

This is a blog Paul Robinson did recently on CT3M.

"1. The CT3M should only be used for someone suffering from cortisol insufficiency as determined by a cortisol test, e.g. ideally a 24-hour adrenal saliva test. Other tests for cortisol may be used but at least some form of laboratory testing should have been performed that provides clear evidence that the steroid cortisol is actually low. Treating low cortisol using the CT3M or with adrenal glandulars or a steroid hormone without having clear confirmation via a laboratory test is guesswork. The human body is complex and there are many reasons why someone might have symptoms reminiscent of partial adrenal insufficiency. Treating them without showing that cortisol is low is not sensible."


"The basic idea behind the CT3M is to address low levels of the active thyroid hormone (T3) in the adrenal glands when they are producing their highest volume of cortisol."

lizanne has a lot more than just low cortisol so the other problems should be addressed first. That is my take on it. I am not a doctor. I have worked with low cortisol. Maybe we could get Paul Robinson to comment. PR


Cheers for this.


Wanted to make sure you saw Paul Robinson's comment below.

He is the expert and I stand corrected. PR


Many Thanks.

I really appreciate all your input on this - I will read up on the whole post again top to bottom to ensure I understand it all!


I'm confused too - but will read through all the posts now as I see there are more comments.

I learn more on this forum than from any doctor!


.... Your urine results are way higher than mine! They do the urine test as its more sensitive....


FYI: The CT3M often improves both dhea and testosterone in women. It affects all adrenal hormones but it depends on how bad the adrenals are and if any areas of the adrenals are more affected than others, i.e. it is not a completely predictable response but it often raises all adrenal hormones. So, it many be worth considering CT3M as often the biggest issue is low FT3 in the adrenal cells. It may not work but it isn't harmful in any way either. PR4NOW contacted me and asked me to comment on this.

Best wishes,



Hi Paul - thanks for clarifying, good to know that CT3M wont be harmful and could well help/

I am also on DHEA and Pregnenolone as prescribed by my private doctor. He has prescribed those because he said they are 'base hormones' that help with the production of other hormones such as testosterone etc as well as supporting the adrenals.

So with those supplements and your view that CT3M often helps with DHEA and testosterone too, it sounds like it is all pushing me in the same direction re helping adrenals.


,,,,,,, and to confirm that rT3 is only converted from meds containing T4 - thyroxine and NDT,


Thanks Paul - to me that sounds like T3 is fairly fool proof and avoids reverse T3 issues and also avoids stressing the adrenals.

I had asked my doctor if I could switch to using only T3 rather than current T3/T4 combo that I am on in order to help adrenals as saliva and urine tests show adrenal problems and low DHEA.

He wasn't in favour as he said the thyroid naturally produces both T3 and T4 and that is what we should try and replicate with medication so I needed the T4 as well as T3. Also tests showed my T3 levels were really healthy, T4 was slightly lower which backed up his view

All a bit of a catch 22 from where I am sitting!


Well .... he could be right. It depends what your rT3 is doing and whether you are getting well with the T4 content. Some patients use T4/T3 but use a T3 only circadian dose for more effective support for the adrenals. Perhaps this could be a thing to try first .... may be something you could find some common ground on with your doctor who does actually sound quite supportive.


Adrenal stress can often come from too little FT3 .... so it is a balancing act. Too much T3 when the adrenals are terribly weak can be wrong but so can too little T3.


I think my free T3 is ok - latest results were

TSH 0.07 (0.3 to 4.5)

T3 free 3.64 (2.1 to 4.2)

T4 free 0.86 (0.7 to 1.8)

I have been taking the 125mcg of T4 in the morning on an empty stomach along with 20mcg of T3. Then I take my DHEA with food (along with Vit d3 etc) and have split my T3 dose by taking that first 20mcg in the morning with T4 and the other 20 mcg at bedtime. That has been my first attempt at doing a circadian dose of T3.

I think I may need to be more subtle with the T3 and look at bringing the morning dose in earlier and split into 2 or 3 dosages. The nighttime dose is great though - I sleep like a log and feel really refreshed in the morning, rather than dragging myself out of bed, so it definitely has a positive effect!

1 like

Free T3 is one thing but rT3 is another. Many thyroid patients find they need higher FT3 than this but if you don't have any more hypo symptoms maybe it is ok.

Given 40 mcg T3 and the T4 I'd be surprised if your rT3 isn't high - I'd have expected much higher FT3 than above. So, I remain with the question mark over rT3.


Thanks to Paul Robinson for adding his insight. He has worked with a lot of people and has a lot more experience than I do with this. I have learned something and I stand corrected. PR


Thanks PR - this has turned into a really useful discussion thread, not just for me but for anyone with adrenal issues who may be trying to find a way forward through conversion issues.

Much appreciated!


lizanne, in case you missed it pettals posted a good article by Dr. Linder about cortisol. PR


Thanks PR - I will read through the info on that link


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