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.

JanieSignature SEIZE THE WISDOM

 

 

 

 

 

 

 

(1) http://press.endocrine.org/doi/abs/10.1210/jcem-41-6-1043

(2) http://press.endocrine.org/doi/abs/10.1210/jcem-42-1-197

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Important note: 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.

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

  1. 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?

    Reply
  2. 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!

    Reply
    • 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!

      Reply
    • 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!

      Reply
      • 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: http://stopthethyroidmadness.com/lab-values 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.

        Reply
  3. 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?

    Reply
    • 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.

      Reply
  4. 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

    Reply
  5. 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?

    Reply
    • 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.

      Reply
      • 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?

        Reply
        • 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.

          Reply
  6. 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?

    Reply
  7. 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!

    Reply
    • Janie Bowthorpe

      Hi. A more detailed explanation is under #2 here: http://www.stopthethyroidmadness.com/ndt-doesnt-work-for-me

      Reply
      • 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.

        Reply
        • 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: http://www.stopthethyroidmadness.com/how-to-find-a-good-doc

          Reply
          • 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.

  8. 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.

    Reply
  9. 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.

    Reply
  10. 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.

    Reply
    • 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.

      Reply
      • 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”!!!!).

        Reply
        • 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!

          Reply
  11. 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 ?

    Reply
    • 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.

      Reply
  12. 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 .

    Reply
  13. 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.

    Reply
    • 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.

      Reply
  14. 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: http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM182381.pdf)

    Reply
  15. 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!

    Reply
  16. 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.

    Reply
  17. 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…

    Reply
  18. 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

    Reply
  19. Lindsey

    Find a compounding pharmacist in your area!

    http://www.iacprx.org/site/PageServer?pagename=lookup_survey

    Reply
  20. 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!
    Jan

    Reply
  21. 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).

    cheerio

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

    Reply
  22. 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.

    Reply
  23. 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: http://www.stopthethyroidmadness.com/how-to-find-a-good-doc plus use patient groups: http://www.stopthethyroidmadness.com/talk-to-others )

    Reply
  24. 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!

    Reply

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