What is a reverse T3 problem?

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I mentioned I would tell you more about the Reverse T3 “problem”. I really don't know all that much more about it, but I've learned enough that I can explain somewhat coherently what I understand to be happening. I don't know why it's happening, but my understanding is that my body is not converting my T4 into T3, but into Reverse T3. This gives me the symptoms of hypothyroid, even though my T4 is higher than the range, which should make me feel hyperthyroid.

Here is an article from Wikipedia:

Reverse triiodothyronine (3,3′,5′-Triiodothyronine, reverse T3, or rT3) is a molecule that is an isomer of triiodothyronine (T3). It is derived from thyroxine (T4) through the action of deiodinase.

rT3, unlike T3, does not stimulate thyroid hormone receptors. However, rT3 binds to these receptors, thereby blocking the action of T3. Under stress conditions, the adrenal glands produce excess amounts of cortisol. Cortisol inhibits the conversion of T4 to T3, thus shunting T4 conversion from T3 towards rT3. As a consequence, there is a widespread shutdown in T3 binding across the body. This condition is termed Reverse T3 Dominance. It results in reduced body temperature, which slows the action of many enzymes, leading to a clinical syndrome, Multiple Enzyme Dysfunction, which produces the effects seen in hypothyroidism. Effects include fatigue, headache, migraine, PMS, irritability, fluid retention, anxiety and panic.

Here are some links that you can study to learn more about this issue.

Okay, in reading the article from Wikipedia, it says “under stress conditions, the adrenal glands produce excess amounts of cortisol”. When I had my saliva testing done in May, my cortisol levels were low. However, according to the Stop the Thyroid Madness site, high cortisol comes before low cortisol:

When biological stress is excessive, such as being on the inadequate treatment of T4-only or being held hostage to the lousy TSH lab test (both which keep you underdosed or hypo), your adrenal glands produce high amounts of cortisol to help you cope with ongoing hypothyroidism and lingering symptoms and conditions. The excess cortisol inhibits the conversion of T4 to T3,  and instead produces even larger amounts of RT3, creating an RT3 problem.

When biological stress is ongoing, your adrenals will eventually become fatigued, dropping from high cortisol to a mix of high and low, or all low,  and those low levels put you into the problematic state of adrenal fatigue, which causes chronic anxiety, poor coping skills, paranoia, easy nausea, sensitivity to light or sounds, psychological issues, etc. When you don’t make enough cortisol, thyroid hormones can pool high in your blood. So your body responds by converting the T4 to excess RT3.

I have been through a great deal of stress this entire year. Apparently at some point in time (maybe for years?) my body was producing high cortisol to keep me going, but because the stress kept up my adrenals became even more fatigued and dropped to all low levels. It seems this is when I began to wake in the middle of the night with panic and anxiety. The practitioner who explained my saliva test results told me my adrenals were in a maladaptive state.

This site shows a series of diagrams of The Physiological Effects of Stress on the Body. The diagrams show the stages of Adrenal Fatigue, which range from Stage 1 to Stage 7. I would say I've been at Stage 4 for a while, and beginning to veer into Stage 5; however, I am supporting my adrenals so I hope to not deteriorate any further. The problem is that my thyroid is not being supported, so I am essentially “underdosed” and my hypothyroid symptoms are worsening.

With the mention of leptin resistance, I have been studying Dr. Jack Kruse's website and blog, where he has a program for resetting leptin resistance to leptin sensitivity. I believe I am leptin resistant just by the description he offers, plus Dr. Kruse says, “A high reverse T3 is a biochemical marker for leptin resistance.” Also, regarding Vitamin D,  “Many current day leptin resistant folks find out their vitamin D levels are low when they finally test for it.” My blood tests came back showing I'm below the normal range. I would never have guessed living in sunshine blessed Arizona.

Last but not least… how do you find if you have a reverse T3 problem? You must have these two tests done using blood from the same draw:

  • Reverse T3
  • Triiodothyronine, Free (or Free T3)

When you have the results of those tests, go to this page to learn the mechanics behind and how to figure the ratio: WHAT IS MY REVERSE T3 RATIO (HOW TO CALCULATE YOUR FREE T3 : REVERSE T3 RATIO)

Or, if you want to have the ratios calculated automatically, there is a calculator at the Stop the Thyroid Madness website here: reverse T3 ratio calculator.

You're looking for your ratio to come in less than 20, to indicate a reverse T3 problem.

My Reverse T3 was 329, and my Free T3 was 4.4. Note that the reverse T3 is a whole number, while Free T3 has a decimal point. Because of this, we need to convert the Free T3 number into a whole number. The site I mentioned above explains more.

We convert my Free T3 number into a whole number by multiplying it by 1000. Thus my ratio:

4.4 x 1000 = 4400

4400 / 329 = 13.37  (under 20, not good)

This post feels to me to be a hodge-podge of information. It is hard to coherently put everything together that I've learned, and there is more that I want to document.

Maybe just look at this as documentation of my research on this topic.

In the end what does this mean for me? When I started writing this post, I thought there was no way to fix a reverse T3 problem with diet, but then I started learning more about the leptin reset program. The “diet” is definitely GAPS friendly, just a few tweaks from full GAPS.

Any thoughts?





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3 thoughts on “What is a reverse T3 problem?

  1. Thank you so much for these posts you have been doing about this problem! Because of them, I have been learning about this too, and I think I may have this problem too. I need to have my Free T3 and rT3 checked as the thyroid labs I had done recently they only did free T4 and TSH even though I asked them for the whole panel! I have yet to get to the leptin reset info, but intend to look there after more researching the rT3 stuff.

    Thank you so much! Our struggles really can help others!

  2. @Tiffany, thank you for the encouragement. I feel like I’ve slid into some underground world. LOL. Definitely check the Stop the Thyroid Madness site for recommended tests. http://www.stopthethyroidmadness.com/recommended-labwork/ Also, if you have a reverse T3 problem, you will need to know your ferritin levels, so an iron panel will help, too. I would suggest checking 25-hydroxyvitamin D levels, too. So much to learn about this stuff! Oh do I want to jam my head in the sand! But I’ve come this far! Dr. Kruse’s theory is pretty interesting. I figure it can’t hurt me too badly, it’s real food! 🙂 I’m so glad you are finding my posts to be helpful. Thank you again. 🙂

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