Reverse T3–do you have this problem in excess? Let’s talk!

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This blog post has been updated to the current day and time. Enjoy!

Most thyroid patients have heard about T4…the thyroid storage hormone, also called a pro-hormone. You’ll see it in literature as “thyroxine” or “l-thyroxine”–the latter as the name for a man-made T4.

And many know about T3…the active thyroid hormone which rids us of hypothyroid symptoms.

And as patients become more informed, they learn that the body not only converts T4 to T3 through what is called deodination, it also provides some of that T3 directly. That is an important distinction! The latter fact can be why thyroid patients report getting far better results with natural desiccated thyroid (NDT) like Naturethroid, NP Thyroid or other brands.

Patients might also learn that there are actually five thyroid hormones made in your body, which is also what’s found in NDT: T4, T3, T2, T1 and calcitonin.

Reverse T3

But in every individual, whether a thyroid patient or not, a thyroid can also convert T4 to the inactive RT3 (reverse T3). RT3 is an inactive thyroid hormone, as compared to T3 as the active thyroid hormone. And converting to RT3 is a natural and necessary process, even if there are consequences.(1) The body might convert T4 to RT3 as a way to clear out excess T4, or as a way to reduce your metabolic rate. It can happen if you go through any of the following:

  • surgery
  • a major physical accident
  • certain heart problems
  • intense chronic stress
  • restrictive low carbohydrate diets (2)
  • chronic inflammation

When Reverse T3 is a problem

Unfortunately, many thyroid patients make far too much RT3, as well, and patients with their open-minded doctors have been making cutting edge discoveries about this fact. Many patients have seen that their high levels of RT3 can be found with the following conditions:

  • high cortisol
  • low cortisol
  • low iron levels
  • possibly low B12
  • lyme disease
  • gluten intolerance or Celiac
  • other undiscovered and untreated underlying issues that can go hand-in-hand with being hypothyroid.

Why is a high level of RT3 is problem? That excess RT3 is making itself lazily comfortable on your thyroid cell receptor sites, preventing the active T3 thyroid hormone from doing its job on that same receptor to get you out of your hypothyroid state. It becomes akin to a clogged up drain to your organs and cells. So you stay hypo and symptomatic, in spite of seemingly “normal” other labwork.

The solution

Informed patients discovered they needed to discover and treat all the reasons contributing to their body converting to excess RT3.

Want to read more? All the below is based on patient experiences and wisdom to share and work with your doctor:

For those with the revised Stop the Thyroid Madness book, there is also more good detail in Chapter 12 called T3 is the Star of the Show, page 155, to continue your education. This is all good information to take into your doctor’s office.












Important notes: All the information on this website is copyrighted. STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website's information or outcomes. See the Disclaimer and Terms of Use.

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102 Responses to “Reverse T3–do you have this problem in excess? Let’s talk!”

  1. Barbara

    Had my thyroid out 2017 cancer nodules. Have 3 paras left since recall on 137mg Levothyroxin “Uthrox” and 25 mcg Levothirodine(cytomel) . Had covid Jan 2022 and have congestive heart failure. Don’t ignore heart palpation! Found adenoma on 1 adrenal gland FINALLY got a Saliva cortisol test. Only one morning test although asked for the 4 time test. Results not back yet. My other labs have gone up.
    Most recent July 2022 and January 2021

    T4 TOTAL 12.4 ug/dl 9.8 mcg/dl

    Total T3 178.5 ng/dl 191 ng/dl

    Free T4 1.39 ngdl 1.8 ng/dl

    Free T3 4.86pg/ul 4.04 pg/ul

    RT3 26ng/dl 22 ng/dl

    Tsh .008ulU/mL .007 ulU/mL

    This year has been rough with pulmonary hypertension congestive heart failure and a flash pulmonary edema event in April requiring hospitalization.

    What should I be teaching my new Doc about my labs?

  2. Sandra

    I am trying to figure out if I am pooling in addition to my high RT3.
    TSH 0.01
    FT3 3.7 (2.1-4.4)
    FT4 0.75 (0.93-1.70)
    RT3 17.9 (9.2-24.1)
    Iron Total 95 (40-160
    Ferritin 23.1 (13.0-150.0)
    Selenium 139 (93-198)

    I currently take 100mcg Tirosint and 40mcg Cytomel daily (divided)
    My FT4 has been consistently low for several months despite increasing Tirosint.
    I think my iron needs to be addressed and I have ordered a saliva cortisol test, waiting on it to arrive.
    What should my next steps be until I get that test? Can I start working on iron and reduce my T4 meds now?
    If I reduce my T4 meds, do I need to increase T3 meds? If so, by how much?
    My last RT3 before this test was 15.4 and we did not catch it to treat it. My doctor is working with me and is agreeable to STTM.
    I just need to advocate for myself and she is usually on board.
    I appreciate your help with understanding my labs better and deciding the next steps in my treatment.

  3. Lynn

    Hi Janie –
    I was reviewing my labs for the last couple of years that I have been trying different meds at basically the same strength and noticed that my RT3 would go high on Armour but lower with all other meds. I know I have a cortisol problem but I thought that was a weird pattern possibly indicative of my bodiy’s response to Armour. My hair loss has increased each time as well. Cortisol has not changed nor has iron.

    • Janie Bowthorpe

      Lynn, that’s not about Armour. You do have one or more of the causes of rising RT3: inflammation, low iron, high cortisol.

      • Lynn

        If I switch to another type of medication and the RT3 goes down without fixing the possible other issues, what does that indicate?

        • Janie Bowthorpe

          Lynn, not sure what medication you mean. A high RT3 is about low iron, inflammation, or high cortisol. Those will still be there. But with OTC Throvanz, we’ve seen a lot of people with high RT3 without those issues.

  4. Andre

    I just got my labs back:

    Free T3: 3.1 pg/mL
    Reverse T3: 23.6 ng/dL
    T3/RT3 ratio: 13.14

    My Reverse T3 is at the extreme end of the range (9.2 – 24.1) , while the rest of the markers seem normal according to the info on this site.

    Looks like I am hypothyroid & I have a Reverse T3 problem and need to go on T3-only medication? Will this eventually solve itself with medication? Any advise on next steps would be greatly appciated

    • Janie Bowthorpe

      Hi Andre. We as patients learned to start with discovering and treating the cause of the high RT3. Here’s an informational page:https://stopthethyroidmadnesscom/reverse-t3

      • Andre

        Thanks, I’ll check it out. Is TSH useful in this situation? Mine is 1.73

        • Janie Bowthorpe

          Your labs are an example of why we came to ignore the TSH. A TSH of 1.73 “looks” excellent, yet your RT3 was super high and your free T3 was nowhere near optimal.

          • Andre

            Yeah the Free T3 range in this test is 2.0 – 4.4, so 3.1 is exactly in the midrange.
            I will be tackling the cortisol side of things to see if it helps with the rT3, any tips on what to look for on adrenal saliva test and how to best reduce rT3?

          • Janie Bowthorpe

            And midrange is not optimal.

            All the adrenal info you need is in chapter 6 of the updated revision STTM book: 🙂 Same with RT3 in the same book.:)

        • Andre

          Thanks, I’ll be ordering the book. I’ve ordered the ZRT Adrenal Stress kit and will be doing it soon, how long should I be off Ashwagandha/Rhodiola before taking the samples? I just started Ashwagandha about 10 days ago and stopped taking it the past few days to prepare for the test. I also took 400mg Rhodiola yesterday to see how it affects me.

          • Janie Bowthorpe

            We’d need to be off both ashwagandha and rhodiola at least a week to make sure it’s out of our system.

          • Andre

            Ok thanks. Have you heard of anyone fixing high Reverse T3 buy addressing the cortisol issue on its own, or is medication required?

          • Janie Bowthorpe

            Three main causes of high rt3 we have noted in ourselves with hypothyroidism of any cause: low iron, inflammation, high cortisol. So it depends on the cause.

          • Andre

            Hey Janie, just got my Adrenal results back and I am low/very low across the board. I am starting treatment to raise cortisol levels. Is it OK to start using T3-only now to reduce my rT3?

          • Janie Bowthorpe

            So all four are super low? Though we as thyroid patients can definitely see that here and there, did your doc ever rule out Addison’s disease?

            The treatment we have learned to use for levels that low is hydrocortisone in a certain way. Did you study the information in chapter 6 of the updated revision sttm book?? It’s all important information in that chapter….how much we learn to start on (male versus female amounts), how to find the right dose with DATS, stress dosing etc

            Yes, even on the standard starting doses we learned of HC (25mg for women and 30 for men), it it seems safe enough to start raising T3. But we still have to find our right amount of HC by doing days.

            With all four cortisol results that low, did you test your aldosterone? Can be necessary. See info in chapter 6 also.

    • Andre

      Here are the results with the reference range next to them. I don’t have other symptoms of Addison’s disease.

      Morning – 4.9 (3.7-9.5 ng/mL)
      Noon – 1.9 (1.2-3.0 ng/mL)
      Evening – 1.0 (0.6-1.9 ng/mL)
      Night – 0.3 (0.4-1.0 ng/mL)

      • Janie Bowthorpe

        Ha. That’s exactly why I need to see the actually result. You definitely don’t have Addison’s. But you are also definitely low all around. And we learned over the years that those results need hydrocortisone. That’s where I send you to Chapter 6 in this book: Too much to explain here and it’s all in there.

      • Janie Bowthorpe

        And there’s a chance you also have low aldosterone, we have seen in each other when they are that low.

      • Ami Levy

        I have the book and will reread chapter 6. I have upped my Adrenal Cortex dosages to mimic the cortisol patterns I should be having, and have ordered Cynomel T3 to get lower my Reverse T3 levels. In your experience are these treatments temporary until I balance levels (while working on root causes) or will I have to take these meds long term?

        • Janie Bowthorpe

          ACE will usually only work for just slightly low levels. It’s quite weak. More than slight and years of experiences point to the use of HC.

          As far as weaning someday, yes, this is all temporary. But for a successful wean, we all have to correct anything and everything that continues to stress our adrenals, like hypothyroidism, mold exposure, lyme, chronic illnesses, chronic life stress. etc.

  5. Sophia

    Just got my latest labs back, i was getting suspicious that my RT3 problem is back as my hair is falling out alot more with gradual weight gain, so requested for Endo to add in it.
    Unfortunately, Ferritin was not added to the iron labs.

    FT4 : 18.32 (range 9.0-19.0)
    FT3 : 5.39 (range 2.43-6.01)
    RT3 : 35ng/dL (range 10-24)
    Calcium : 2.05 (range 2.1-2.6)
    Iron : 10 (range 11-27)
    TIBC : 59 (range 36-60)
    % Fe Saturation : 16 (range 14-50%)
    B12 : 285 (range 138-652)
    Vit D : 50.4

    My last RT3 labs back in 2018 was 31 (which Endo suspected it was due to my TT surgery).

    For this current result, Endo is suspecting it might be due to Naturethyroid potency issue (I’m not really buying it though). Endo is bringing in Erfa to replace Naturethyroid, but it will still take another 2 months.

    Currently on 2.5 grains of NatureThyroid 50mcg T4. Should I reduce my T4 dosage to bring down my RT3?

  6. Diana

    Hi Janie,
    I just want to thank you for changing my life for the better, and giving me the tools necessary to become a healthy person again. The following labs are my 18-year-old daughter. She is not on any thyroid medication. Can you please give me some direction?
    RT3 (18.6) reference range 9.2-24.1
    FT3 (4.0) reference range 1.17-3.71
    FT4 (.95) reference range .70-1.48
    Ferritin (78) reference 26-169
    Thank you so much for all that you do!

  7. Hayden Murray

    hey janie, I got my bloods done:

    Free T4 15.3 12.0 – 22.0 pmol/L
    Free T3 4.76 3.1 – 6.8 pmol/L
    Reverse T3* 16.0 10 – 24 ng/dL

    I really expected my RT3 to be much higher, but it still seems it’s not optimal. I have an appointment with my endo on tuesday, and I think he’s just going to say it’s perfectly healthy. Is there anything I can show him to convince him that it’s still somewhat high? Thank you!

  8. Diana

    Hi Janie, i have been on T3 only for 6 weeks now to lower my RT3 which was 21 and I am still trying to figure out the right dose of cydemel based on my basal temperature (BT). My BT has increased but i started to wake up in the middle of the night again. I stopped taking my cortisol manager because i want to get my saliva cortisol test to figure out what my cortisol levels are. My lab results changed drastically in 5 weeks. I reached 25 mcg but then my insomnia and heart palpitations issues started so i lowered the dose to 12.5 mcg and my BT is still within normal range. The only thing that was unexplainable is that my ferritin levels went down even down all my iron markers increased. That’s why i am atill losing so much hair. Do you have any idea why ferritin might have gone down? Here are the results from july 2020 to aug 2020: TSH from 1.08 to 0.19; FT4 from 1.2 to 0.4; FT3 from 2.5 to 3.3; RT3 from 21 to 8; RT3 ratio from 11.90 to 41.25; ferritin from 33 to 29, iron from 105 to 140, iron binding from 390 to 413 and binding % saturation from 27 to 34. As i mentioned i had to decrease my cydemel to half to 12.5. However, i still have insomnia issues.

    • Janie Bowthorpe

      We’ve never really based it on solely temperature. We base the amount of T3 on what puts are free T3 in the upper area of the range.

      But when problems ensue from raising T3 to get optimal, we’ve seen as patients that those problems (higher heart rate, heart palps, jitteriness, anxiety etc) are usually pointing to a cortisol problem. adrenal

  9. Patricia Moore

    What does it mean if you have both a high RT3 and a high free T3? I’ve tried reducing my NDT and adding more T3, but my numbers only worsened. My current doctor says that if I’m asymptomatic, I should stay on the same meds, but I’d rather see my numbers in a more normal range.

    My latest labs showed:
    RT3 – 34.2
    FT3 – 6.5
    FT4 – 1.1
    TSH 0.005

  10. Ivan Mihov

    I have the following readings:

    TSH S 1.74 µIU/ml 0.27 – 4.20 ECLIA
    Free Т4 (fT4) S 14.66 ng/l 9.30 – 17 ECLIA
    Free T3 (fT3) S 2.79 ng/l 2 – 4.40 ECLIA
    Reverse T3 S 232 pg/ml 90 – 215 RIA

    Due to the high reverse T3 I was advised to start T3 only, 5mcg and try to increase to 25. Do you think this is a good treatment for the case?

    • Janie Bowthorpe

      Yes, many do switch to mostly T3 to help get that RT3 down. But we also realized that we have to treat the cause of the RT3:

      And we don’t limited the amount of T3 like that. We find an amount of T3 which puts our free T3 to an optimal amount, which for most seems to be in the top area of the range. If in trying to find that optimal amount, we get a bad reaction, we don’t keep going up and see if our adrenals are the cause of a bad reaction.

  11. Erik

    Hello. Just purchased the book and reading it…but I have a question about my high reverse T3. Two months back I went on lemon master cleanse diet 10 days (pretty much very low calories water.. only fasting. Upon food introduction hell broke lose. I must say I had quite good energy before and no KNOWN thyroid issues, no medication etc. As I said my body crashed upon solid food introduction (extreme fatigue, all adrenal crash symptoms, dizziness, low blood pressure, body muscle pains). Two months after I am somewhat better. Just received my blood tests and saliva from functional doctor. Reverse T3 is very very hifg but I do not see T3 pooling…what is the issue here? What should I do? THANKS A MILLION !!!
    DHE SULFATE 266 (range 70-495 mcg/dL)
    VITAMIN B12 high 1145 (range 200-1100 pg/mL)
    T3 REVERSE, LC/MS/MS high 27 (range 8-25 ng/dL)
    T3, TOTAL 106 (range 76-181 ng/dL)
    T4, FREE 1.5 (range 0.8-1.8 ng/dL)
    T4 (THYROXINE), TOTAL 9.4 (range 4.9-10.5 mcg/dL)
    TSH 2.16 (range 0.40-4.50 mIU/L)
    T3, FREE 3.7 (range 2.3-4.2 pg/mL)
    VITAMIN D,25-OH,TOTAL,IA 43 (range 30-100 ng/mL)
    < 1 (range < or = 1 IU/mL)
    C-REACTIVE PROTEIN 0.7 ( range < 8.0)
    FERRITIN 89 (range 38-380 ng/mL )
    PROLACTIN 8.4 (range 2.0-18.0 ng/mL)
    ZINC, RBC low 8.1 (range 9.0-14.7 mg/L )

    My ZRT results:
    Morning 6.2 range 3.7-9.5
    Noon 2.6 range 1.2-3.0
    Evening 1.2 range 0.6-1.9
    Night 0.6 range 0.4-1.0

    • Janie Bowthorpe

      You’ve got an adrenal problem. Read chapters 5 and 6. Morning is low, night is slightly high. And it’s not just about ferritin. Big mistake. You need all four iron labs. They are mentioned in the Odds and Ends Chapter. Vit. D too low. And read why RT3 goes high. it is imperative for anyone to become VERY informed to counter the madness out there.

      • Rob

        Hi Janie, To remedy this gentleman’s low cortisol in the morning he should consider Adrenal Cortex? Or is he just mildly low and should first consider Circadian rhythm dosing first? For the slightly high bedtime should he turn off lights, wear blue blockers, maybe an adaptogen? Or would an adaptogen lower the morning level even more?

        • Janie Bowthorpe

          If only the morning is low, the CT3M could definitely work. It doesn’t always work for the other times if low for some people.

          Slightly high bedtime can easily be remedied with Holy Basil, 2 caps, about an hour before you want to go to sleep. If you wake up over the next 2 hours, 3 caps for a few weeks, then down to one less cap for a week, then down to nothing…the latter is how we do it.

          • Rob

            Thanks Janie! I know the dutch cortisol test can be unreliable but I thought their lab values were interesting, they have their highest lab range at 30 minutes after waking. So, if your cortisol is not hitting close to that 9.5 ng/mL at wake, maybe doing your saliva test 30 minutes after waking would give you a better indication of where you are at for the morning value? So, you Wake up, maybe move around a bit, go for a walk or something, get that full spectrum light / sunlight into your eyes for 30 minutes, then take your morning saliva test?

            Zrt’s lab range is:
            3.7 – 9.5 ng/mL Morning

            The Dutch is:
            1.6 – 4.6 ng/mL At Waking
            3.7 – 8.2 ng/mL 30 minutes after waking
            2.3 – 5.3 ng/mL 60 minutes after waking

          • Janie Bowthorpe

            Usually, the place we want the saliva result to be at the top part of the range is upon waking tho. But it can stay high over the next 30 minutes or so. Research seems to prove that.

          • Rob

            Hi Janie,
            Thanks for the insight! I just listened to your interview with Elle Russ it was really good! I think she is optimized on just 7.5mcg of T3 only which is kind of fascinating. That would be an equivalent to roughly a 1/4 to 1/2 grain of NDT. So, it seems if you are low carb or in nutritional ketosis you can achieve optimization on a very low dose. What are you seeing in terms of the free’s in your keto patients? Still FT3 upper part of the range? T3 only, still tip top part of the range? Are you seeing others like Elle?

            Dr. Steve Phinney talking about T3 Sensitivity when Keto: Time stamp: 23:39

          • Janie Bowthorpe

            Hi Rob. Glad you heard the interview…Elle is such a sweetheart.

            I have noted that it’s not common, but it can happen for some. 🙂 There’s even a contributor to the STTM II book–a very sweet doctor who sadly has since passed away, that was able to lower his NDT (though not get off) due to working hard to eat more healthy. So it’s always worth a try. Just remember that it’s still going to be important to see good frees in order to maintain the lower dose. 🙂 Some people say they are doing great on a lower dose, but their frees reveal they are not, and it’s only a matter of time before it backfires.

  12. Vladimir

    Very interesting. Although, I haven’t found any mention about the role of TSH in T4 to T3 conversion. I mean, there should be something which controls this process of T4 to T3 or T4 to RT3.
    Liver and kidneys can’t just go ahead and convert anything at capacity. Control mechanism is required. So, I searched the web and found this.
    At first I was shocked.
    So, there is a control mechanism!
    It’s TSH.
    BUT if you are on NDT, and take your optimal dose, this thing with conversion should not bother you as you rely on exogenous Ts.
    My question is really…what controls RT3 conversion from T4?
    I get it, iron, inflammation…all that, this is WHY it does happen.
    But question remains what is the control mechanism that the body uses for that purpose?

  13. Ella

    Hi, how should I treat high Reverse T3 and high insulin / blood glucose? I’ve read this article that T3 medication where there is a blood glucose insulin problem can make it worse I read it because I have just increased my T3 because my Reverse T3 labs increased… But I was feeling very bad, like I could pass out. Note: I have high insulin and blood glucose (GP says insulin resistance) also very high thyroid Antibodies.
    TSH <0.02 mIU/L (0.50 – 4.00)
    Free T4 21 pmol/L (10-20)
    Free T3 7.7 pmol/L (2.8 – 6.8)
    aThyro'gb 21 IU/mL (<60)
    aPeroxase 6200 IU/mL (<60)
    Serum Reverse T3 728 pmol/L (170-450)
    Insulin 22 mU/L fasting (<25)
    Glucose 5.8 mmol/L fasting (3.0-6.0)

    • Janie Bowthorpe

      That article about insulin resistance is poor. To the contrary, it’s hypothyroidism that makes insulin resistance worse. From “….the available data suggest that insulin resistance is present mainly at the peripheral tissues. Possible explanations hypothesized to explain this phenomenon span from the dysregulation of mitochondrial oxidative metabolism to the reduction of blood flow in muscle and adipose tissue under hypothyroid conditions.”

      And you are very hypothyroid with an RT3 that high. Read this entire page:

      You also have monstrously high anti-TPO if you typed in correctly. You badly need to read Hashimotos: Taming the Beast.

      Finally, your frees are quite high. Just that high FT4 can contribute to high RT3. Your free T3 is also high. So you may be taking far too much thyroid hormones, or the free T3 means you are pooling due to cortisol issues.

      • Ella

        Thank you Janie, not a typo. My anti body and RT3 levels were high before I started meds. I have dropped back to T3 25mcg (not slow release). I have ordered the book.. And will get my cortisol tested. I have gut issues and metal toxicity. And work stress. Thanks again.

  14. Aga

    Reading the information on the site, which is great btw, makes me confused about what’s happening to my an my labs. I’m only on 1 grain NP Thyroid and I can’t go lower because of cancer. My FT4 is rather low, so if my FT3, but my rt3 is very high. But how can I go lower with already low FT3 and FT4 and cancer suppression to get rid of excess rt3??? This is a real bummer. Does it make any sense at all? My labs are:
    rt3 0,35 ng/ml (0,09-0,35)
    FT3 2,99 pg/ml (1,71-3,71)
    FT4 0,87ng/dl (0,70-1,48)
    Thank you!!!!
    Any thoughts??

  15. Jodi

    I feel like I’m late to the game and hate being a newbie. I love this article but it leaves me confused. So my thyroid labs are WNL except Reverse T3 (which is high) so the only solution is to fix the cause?! Iron studies are WNL except low ferritin (I am supplementing). That’s underway but no easy task (hormone issues, chronic stress, lyme) and will take time. Meanwhile I have a goiter and the fullness is uncomfortable never mind the hypothyroid symptoms, help!

  16. Tracy

    once I finally got to doses that were right for me I have been doing great on my t3 t4 combo for a long time.
    However, I had a major surgery recently and now my t4 is higher my t3 is over range I am having hyper symptoms.
    Suspecting stress response to the surgery has ramped up the rt3 levels(not tested yet) and t3 now pooling.
    If this turned out to be the case what in your opinion would be the best way to tackle the issue?

  17. Danielle Bordeaux

    I have hypothyroidism. I’m on 200 mg Synthroid & 25mg Liothyroninine 2 x a day, iodine, vit b & d supplements. I have felt great until recently. Suddenly retaining tons of water and many other hypo symptoms. My bloodwork hasn’t changed with the exception of my RT3. It went up from 19 to 24 and my T3, free is 7.4 (My T3 has to be high for me to feel even remotely human) – I asked my Doctor today to take me off of Synthroid for 2 months on a trial and increase my T3 to 62 a day split dose. Also asked him to pull my leptin, all four iron indicators including ferratin and my cortisol and dhea since all my other labs came back “perfect”. I got back in two weeks for lab results. Crossing my fingers and hoping for results!

    • Janie Bowthorpe

      You are on the right track to get off that Synthroid when your RT3 is going up like that. And sounds like your free T3 is pooling. Yes, this can point to inadequate iron…and even a cortisol issue. We’re crossing our fingers with you!

    • Sandy Roth

      I’ve had Hashimotor’s for about 5 years but the last year I progressively felt worse (crushing fatigue, almost flu like, losing hair, etc.), I finally found a doctor who 3 months ago tested Reverse T3 and found my RT3 ratio was 11 (should be > 20) so he added 20mcg Cytomel T3 to what I was already taking (75 mcg Synthroid T4). He does not think we need to reduce or remove the Synthroid, although everything I read says I should!!! I’m feeling some better but still some really bad days. My iron is good but cortisol slightly low – have had every test under the sun including all functional test (food allergies, saliva, stool, etc.) My big problem I think is this RT3.

      Question is if most folks w my condition have better luck reducing the T4 (Synthroid). I’m about ready to just start taking a little less of it!

      • Janie Bowthorpe

        The #1 reason for RT3 to go up is inadequate iron, so you might want to have copies of all four iron labs (it’s NOT about just the ferritin–it’s serum iron you treat) and compare to this page: Because you may not be where you should be…

        The #2 reason is inflammation.

        And if your cortisol is “slightly low”, you’ve got a problem that will keep you feeling bad there, too. It’s about saliva testing and comparing to above link.

  18. Ashley

    My doctor flat out refuses to listen to anything I have to say. It’s been difficult finding a new one. Since getting a prescription for T3 to lower RT3 is off the table, is there something else I can do on my own?

    • Janie Bowthorpe

      If you strongly support your liver, such as Milk Thistle and other supps, that can help bring it down. But you’ll need to treat the cause of the high RT3, which is mostly common with inadequate iron, so it won’t go back up. Cortisol issues can do it, too.

  19. Tracy Taylor

    Awesome. How long did it take you to start feeling better on the T3? I see 2-3 months is average to clear the excess RT3 (groan) but I wondered if your hypo symptoms took that long to diminish or if they eased up pretty soon after starting T3. Last question, I promise! Haha

  20. Tracy Taylor

    Hi- Ive been on 300mgs of NDT for a couple years w/ 99% of all of my hypo issues resolving, and my doc and i started low and kept increasing until i felt better. My 3 page panel of labs went from red to green and I lost 40 lbs. We stopped increasing when my HR and BP went high and then finally leveled off. Now, I am dealing with hypo symptoms again and weight gain. Took a saliva test- sky high cortisol and almost NO DHEA. I have AI issues and am working on the inflammation. Just did an 8 page battery of testing today, to include the Rt3 and I am betting (from reading this amazing site) that my NDT has been too high too long and coupled with inflammation and high cortisol/ adrenal fatigue, i am dealing with Rt3 and probably pooling. Any thoughts?

    • Janie Bowthorpe

      My thoughts are that your thoughts are good. We always do labs to see where our free T3 and free T4 is on any dose…so if you didn’t, that can partially explain your problems. I say partially so as not to rule out anything else like Lyme, mold exposure, etc.

      • Tracy Taylor

        Thank you Janie. So I quit alcohol 18 months ago, opiates for pain from a pain center 6 months ago, caffeine and phentermine (i know i know) 6 months ago, plus started a good quality adrenal support formula and am eating as AIP as I can possibly adhere to to try and get my adrenals to recover. Do you think that too much NDT for 1+ years will drive up the cortisol and plummet the DHEA, even without the insult of caffeine/ stimulants, etc? I’m wondering maybe once the labs come in and hopefully confirm the high RT3, that cutting my armour in half and adding cytomel will help the cortisol/dhea issues resolve on their own?

        • Janie Bowthorpe

          Usually, going too high with NDT increases RT3, we’ve noticed (I did this to myself once, too) so it’s always helpful to get that RT3 down. Plus it could help get high cortisol down, yes.

  21. Sarah

    I believe I may have had a high RT3 due to overmedication with synthetic T4. Can it also cause iron deficiency (rather than being caused by it) and an elevated TSH?

  22. Jennifer

    I am confused on what’s happening to me. Started Armour 1 month ago at 60mg. After a week panic, jitters, and racing thoughts came out of nowhere. My general MD said to cut my dose in half, which I did. Symptoms went away after 24 hrs and I felt great for 2 weeks. Then achy joints started again so I decided to try 45mg of Armour. Took that for 2 days and the panic, racing thoughts and jitters came back again, this time way worse. Now I’m not sleeping well. I went down immediately. It’s been 3 days and the symptoms are still there. From reading STTM this sounds like pooling or too high of a reverse T3. Any ideas on why the panic went away so quickly last time and now it’s sticking around? Side twist: I’m 6 weeks pregnant and worried I’m negatively affecting the baby. ANY thoughts would be so appreciated!

    • Janie Bowthorpe

      Hi. A more detailed explanation is under #2 here:

      • Jennifer

        Ok. I ordered the iron and saliva adrenal test kit. In the meantime while I wait for the results, I’m wondering if you remember how long it took the pooling symptoms to reverse for you. I remember reading one of your comments about pooling happening to you on the site. Also, do you have ANY recommendations for a Dr., functional medicine Dr., etc that could work with me on these issues in the Twin Cities, MN? I feel like I should be on top of this and be monitored more since I’m pregnant.

        • Janie Bowthorpe

          Pooling will stop once we adequately treat our low iron (which can take several weeks into a few months) and/or our cortisol issue (which can be treated faster than iron). Here’s what can help for a better doctor:

          • Jennifer

            Thank you for your response. Pooling won’t stop simply because I stopped taking Armour? I’ve stopped completely as of 2 days ago. I ordered the STTM iron and saliva cortisol test, but I don’t even have the kit yet so it’s going to be awhile before I can start treating low iron or cortisol. I can’t imagine feeling this way for much longer, it’s so awful. I was feeling great until I went up to 45mg for two days – only two days! I can’t believe it’s producing this much of a reaction!

          • Janie Bowthorpe

            Well, we don’t usually stop what we need. We just lower. But yes, that’s pretty severe to happen at only 3/4 grain! That’s where we are so different. It appears most can get up to 1 1/2 grains without pooling, then if they go higher, bam!! Then there’s this very small bunch who can get up to 3 grains before it happens.

  23. Jenna

    Am I missing something here? What exactly are the symptoms of Reverse T3? I have searched this website and Google and only come up with pages explaining what it is..but not the symptoms. I don’t want to waste money testing for something I might not have. Can someone post a link that actually lists some symptoms? Thanks.

  24. Kim Fiorenzo

    Just reading up on RT3. Mine is very high, but so is my T3, and F T3. I take 3 grains Naturethroid. Sounds like I should have my dose lowered to maybe 1 or 1/2 grains and add T3? Can someone help me with this…its pretty confusing.

  25. Jill

    Have conversion issue identified after going too high on Armour and subsequent RT3. Managed to alleviate by deceasing Armour and increasing T3. Still working on optimal dose when RT3 hit again over the last few days. Am miserable. I am taking 60 Armour (can not handle more T4, if my FT4 goes above .8 I get RT3) and 30 mcg T3. Yesterday I split Armour and T3 as follows – morning 30 Armour 25 T3 and afternoon 30 Armour so I did decrease 5 mcg T3. I am very small and all of my dose increases are only 1/2 of what most people take so to get where I am, it took forever and am still hypo. I am seeing holistic doc to pursue adrenals since endo only did blood and urine and I believe this has been my problem from the beginning. What would you do with my current dose to help alleviate RT3? If I reduce any of the T3 now, will I have to increase up again slowly like I had in the past? Any advice would be greatly appreciated. Just wanted to mention, although endo was argreeable to Armour and T3, she does not believe RT3 causes any symptoms and is just a means to eliminate excess T4. She insisted on some T4 so that is why I kept the Armour.

    • Janie Bowthorpe

      Based on what we’ve observed and learned over the years, being unable to raise NDT without seeing a rise in RT3 usually points to a cortisol issue and/or inadequate iron. So yes, we go quite low with NDT since the RT3 is coming from the T4. Then some add in small amounts of T3 to try to somewhat alleviate the hypo. But we even have to be careful raising T3, because having pooling of T3 can also happen in the presence of a cortisol or iron issue.

      • Jill

        Thank you for your response. I can not raise the T3 because I feel that that is now causing the problem since I am on so little Armour/T4. I just took 12.5 mcg T3 and will take the other half later today and stop the Armour temporarily. I may also take 5mcg T3 later in the day but can’t have it interfere with my Floravital before dinner. To add insult to injury, had my first bone density, osteopenia, but can not even think of adding calcium to the mix until I get everything else sorted out. Approaching my 3rd anniversary living this nightmare (2 years of treatment refusal due to TSH “in normal range”!!!!).

        • Janie Bowthorpe

          By the way, it has not harmed people to be on low doses of NDT until they correct the cortisol and/or iron issue….i.e. the low T4 it causes. And we greatly empathize with your frustration towards TSH-obsessed doctors!

  26. Mary

    My latest labs are ft3 3.5(2.3-4.2) ft4 1.29 (0.90-1.80) t3 to t4 % uptake 29(21-35)
    Was on Tirosint 75 & cytomel 20. The doctor said these labs means I have high RT3 and he adjusted my meds to Tirosint 25 & slow release t3 28 mcg. Any input please ?

    • Janie Bowthorpe

      Hi Mary. We never just guess as your doctor seems to be doing. Because I’m not seeing anything that outright equals high RT3 without actually doing the RT3 along with the FT3.

  27. Hadassah

    Janie , I was tested for RT3 and it came back at 21.1 Reference Range 9.-0 to 27.0 and yes I have all the hypo symptoms . Very Low temp , fuggy thinking , low energy , cold hands and feet . I’m on 100mcg Synthroid and 5mcg Cytomel . I was wondering since Drs don’t know much about it . If you could perhaps please share with us who are going through with this problem how to deal and do about it ? I’m sure a lot of us are walking around with this problem who would very much appreciate it .

  28. Valerie Olson

    I have Hashimoto’s, with TPO antibody levels having been reduced from over 1000 to 116 by avoiding gluten, taking Westhroid Pure dessicated thyroid and 50 mg. Lugol’s daily. Supporting my adrenals with Dr. Wilson’s Herbal Adrenal Support has been a great help. I feel fairly stable compared to several years ago, but would like to know if anyone with a Reverse T3 of 15 or higher has tried T3 only in the sustained release form and found it to be more helptul than traditional dessicated thyroid. Dr. Mark Starr writes in his book, Hypothyroidism Type II: The Epidemic”, that he and his mentors consider it significant to have a Reverse T3 of 15 or higher, and can contribute to hypothyroid symptoms. By the way, the makers of Armour, to my knowledge, will not validate that their product is free from GMO corn. Westhroid Pure does not.

    • Janie Bowthorpe

      If you have an RT3 problem, you will need to find out why and treat it, first and foremost. i.e. Dr. Wilson’s Herbal Adrenal support may not be enough to get out of a cortisol issue, even though you feel better. Inadequate iron levels are another reason, we’ve noticed, for continued RT3 issues. In the meantime, patients with an RT3 problem will either be on T3, dosed 3 times a day and perhaps a 4th small dose at bedtime, or they will be on a small dose of NDT, such as 1 1/2 grains or less, then add T3 to it, multi-dosed as above. Once the adrenal and/or iron issue is corrected, they are able to move to straight NDT and feel wonderful again.

  29. marianne thode

    Janie, just happened to get into a site on asthma. Did you know they are discontinuing inhalers with epinephrine, both prescription and across the counter? Don’t know how politically correct you have to be, but you may want to get this word out.

    (From Janie: this really doesn’t apply to the topic of my blog post and RT3, but one mention may be ok. Here’s the FDA notation about it:

  30. Maria ; The Ever Frustrated Aussie Who Is Starting To Doubt Her Own Sanity!

    Hi all. Today I went to a new doctor. I won’t go into details else I will be here all night! BUT needless to say he belittled me and my opinion of my high Reverse T3 at 405 (I’m in Australia) as being, and I quote; “…a ridiculous American garbage test. Means nothing. There is nothing wrong with you. You have anxiety. I see it everyday here, believe me, I am an expert in diagnosing anxiety!”
    I asked if I could just prove HIM right by having it for a few months, and seeing what happens, then if it didn’t work I would concede defeat. He told me that I would NEVER get a supply of T3 in Australia because NO-ONE prescribes it, that he is not allowed to. (which I found out later was a total fabrication!) To stop wasting my time looking for an excuse to take my mind off my anxiety and learn to deal with it. That he was here to prove once and for all the simple T4 WORKS! (I have NO thyroid due to surgery.)
    He went on and on, even throwing the results at my friend who was with me, yelling, “SEE! They show she is NORMAL!” Needless to say, I left in tears, and I am a strong person! The fight to be heard is a difficult one! Now I know how the Suffragettes felt!
    Funny enough, another doctor (unrelated issue) told me her husband has Hashimoto’s and feels terrible on T4 only and can’t convince his doc’s of his symptoms either!

  31. Karen McLeod

    My sister has a very high reverse T3 (550) and was told she has a high heavy metal toxicity. She just sent in a urine test to Genova lab. Now I wonder if she’s wasting money on the test.

  32. Amy M

    I am curious about one aspect of T3-only replacement. For those who are planning on staying on this forever (like Val) do you have concerns about not replacing all your thyroid hormones the way desiccated thyroid does? I just wonder if this is a healthy way to go for long-term replacement…

  33. carolyn junter

    I was having problems with the REformulated Armour but did NOT know it was the cause until my mail order pharmacy told me they could no longer get it.

    Then, thru the internet, almost a year after the reformulation, I finally knew that others were ALSO having serious problems like me…with the Armour “changes” in their formula, and was almost to actually die…..I discovered this website and my eyes wee belatedly opened.

    I found the compounded natural thyroid did NOT work like the old original Armour and in desperation, I got the ERFA natural thyroid…and gradually ….I started to feel improved…little by little.increments ever so slowly….but it seemed to stop and reverse the scary downward slide to “oblivion”….sigh

  34. Lindsey

    Find a compounding pharmacist in your area!

  35. Jan

    I have high RT3. It hasn’t been fun at all, since I stay hypothyroid no matter my dose. I have hit some breakthrough with going up to 30mg of Hydrocortisone. I am still going through the “thyroid overdose” now as all that T3 is hitting my cells. It’s been a nasty ride trying to get well, so I am very happy to see more information about this. I do hope to tune in, if not I’d love to hear a summary or the recording.
    Thanks for all you do Janie and Val too!

  36. Allison

    Hi Janie,

    Is the call recorded and the transcript published?

    Hopefully I can tune in, but I’m from Oz so I’m not sure about the time difference (will have to check).


    (From Janie: if all works well, yes, it will be recorded. No published transcript.)

  37. Judy Abbie10

    location Indiana? I have three doctors and FB with one.
    another women uses the Health food store route or medical.
    20yr family doctor who has walked the walk with me.
    Started with synthroid now knows how much difference dessicated can make or adding T3. Internal med. MD, F.A.C.S Think I have letters correct believe it means he does medical traning and information up dating of knowledge..
    If wrong please correct me.

  38. Sandy

    Oh boy! My doctor’s office won’t even do a T3 and T4 test much less a Reverse T3. I just went yesterday for my regular blood draw & when I asked if I could have my T3 & T4 tested, the head nurse said, you can if you want to waste money; we only test those to make a diagnosis – we already know you are hypo, so we only do the TSH to regulate your meds. UGH! Last year, I found an “Armour” friendly doc, from the Armour list & he told me I need to take SYNTHROID. On top of that, he wanted to do a ‘full panel’ on me to make sure I wasn’t really peri- rather than hypo – because I was over 40 – to the tune of $600 in tests. I said no thanks & never went back.
    Any suggestions on how to find a doctor that is REALLY “Armour” or natural friendly? I’m going to see a new compounding pharmacy next week – maybe they will have suggestions. BTY, I tried to contact Armour, thru the website to tell them about this doc – no go, no e-mail address or form to fill out on the website.

    (From Janie: plus use patient groups: )

  39. Janet

    Oh, man! I hope I remember to tune in this week!! (Nighttime is my worst time of the day – I’m just a slug and my brain shuts down.) I just received results from VRP showing that I have sluggish adrenals. So, I NEED to remember this on Thursday!! Ahhh!


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