Tag Archives: reverse T3

How to Treat a reverse T3 Problem

Over the years I've suspected I had a thyroid problem, and I always thought it would be so simple. Find the right doctor to test appropriately and then go on natural thyroid replacement, namely Armour.

But now I know that Armour is roughly 80% T4 and 20% T3 and since my T4 levels are high, taking Armour would not be the right solution. I might feel better for a little while, maybe because my body would be getting some T3, but eventually I would feel worse because my body would be getting too much T4.

So… the course of treatment suggested at Stop the Thyroid Madness is to take a prescription drug called Cytomel. This page explains how this reverse T3 problem is treated with Cytomel. Cytomel is a name brand product… the generic is not recommended by patients at Stop the Thyroid Madness. Apparently the generic is less effective, some say they felt nothing different when taking it.

In reading this page at Stop the Thyroid Madness, I learned some things that need to be in addressed before I even  even consider starting on Cytomel (T3). “You will also need to correct what is causing the excess T3 in the first place, whether ferritin/iron or adrenals. Without correcting these, you will be asking for trouble with the very powerful T3.”

Correcting Adrenal Dysfunction

I've been taking my temperature faithfully for the past week, and will continue to do so because it is an effective way to confirm what is happening on with adrenal and thyroid function. I believe I have stabilized my adrenals because my temperatures are steady from day to day. In the past seven days I've had mostly 98.3°F.

Correcting Low Ferritin Levels

You should also be looking at Iron Binding Capacity (TIBC), UIBC, Iron Serum and Iron Saturation percentage, and The Stop the Thyroid Madness site talks about low ferritin/iron levels.

Here are my results from September 30:

  • Iron Binding Capacity (TIBC) 284  range 250-450
  • UIBC 130  range 150-375 (mine is lower than the range)
  • Iron, Serum 154  range 35-155
  • Iron Saturation 54%  range 15-55
  • Ferritin 195 range 130-150 (mine is higher than the range)

In looking at these three sources, I have found that the numbers should look like this: Thyroid RT3: Iron, Adrenals Web Ferritin and Iron; Stop the Thyroid Madness Ferritin, Iron and Hypothyroidism.

  • Iron Binding Capacity (TIBC) 259 is good 250-450
  • UIBC 165 is a good number 150-375
  • Iron, Serum 154  should be at least 90 range 35-155
  • Iron Saturation should be between 35% and 45%
  • Ferritin should be 70-90

My ferritin levels are high.

Stop the Thyroid Madness says this about high ferritin:

What if I find my ferritin is super high? High levels of ferritin can point to an iron overload, such as the inherited disorder called hemochromatosis, which you can read about here. Your doctor will usually direct you to give blood in order to lower these harmful higher levels. With hemochromatosis, you can have a low TIBC or UIBC.

Are men different than women in their iron lab results? Yes. Men normally have higher levels of ferritin than women without having an infection. It’s common to see healthy men with a ferritin over 100.

Well, I'm not a man, and my ferritin is 195, almost double what is seen in a “healthy” man, so I'm thinking my level is “super high”.

And my UIBC is low, but I don't think I have hemochromatosis. I went in to have more blood drawn this past Friday, and two tests we are running are to look for inflammation. One is CRP (C-Reactive Protein), the other is ESR (SED Rate).

According to Dr. Kruse, the Leptin Reset will fix this reverse T3 problem. I am hoping it works for me. I would still like to get the Cytomel from my doctor in case I decide to try the protocol outlined here. I spoke with my doctor's partner last week since she is on vacation, and he is reluctant to prescribe T3. He does not think I have thyroid problems, because I do not have two of the most common symptoms: cold hands and feet, and hair loss. I am a little frustrated by this because I believe I've had low thyroid issues for at least two decades, and when you don't address thyroid problems your adrenals have to take up for them, which eventually exhausts them. So I believe it would be a mistake to continue to only address my adrenals, without looking into my thyroid.

On the other hand, maybe the Leptin Reset will fix me right up. I found this very interesting explanation for what Leptin Resistance is, how to fix it and the signs of Leptin Resistance and Leptin Sensitivity in the comments at Dr. Kruse's blog: Leptin for Dummies.

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What is a reverse T3 problem?

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?





GAPS DIET JOURNEY is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to AMAZON.COM. GAPS DIET JOURNEY is an affiliate for several companies and may be compensated through advertising and marketing channels. Therefore, this post may contain affiliate links.

I Don’t Have Graves’ and Trying to Reduce Stress

Well, it turns out I don't have Graves' Disease. At least that is the consensus of my doctor's front office staff, and this site:  ClinLab Navigator. If it's really true, that's a good thing, since that means I don't have an autoimmune disease. I say, “if it's really true” because as I've learned, the opinion of patient experts, those “in the trenches” can be far different than the medical field's. For example, when I asked my doctor if I had a reverse T3 problem, she shook her head sadly and said “no”. But according to the ratio between by Free T3 and Reverse T3, I do have a reverse T3 problem.

I've been doing a lot of research over the past week. I've been reading about leptin resistance over at Dr. Jack Kruse‘s website and blog, and have no doubt that I have leptin resistance. My husband keeps asking me, “What's leptin?” and I can't really tell him. I'll be researching and learning more, and I'm starting here: Mark's Daily Apple: A Primal Primer: What is Leptin?

But I'm getting ahead of myself… last weekend I found out why I'm getting more tired and exhausted. In one of the groups I'm on, a lady posted saying she was feeling more fatigued and it could have been me writing, our problems and situation so similar. She and I started on hydrocortisone about the same time, started to feel better as a result of being on it, we had recently spent an entire Saturday in bed, we both have the reverse T3 problem, we both are waiting on medication… the answer she received was that when she started on the HC it allowed her body to use more thyroid function, but waiting so long to get medicated with T3 has caused her to become more hypothyroid. So that answered why I've felt so much worse lately, and I decided I need to get moving on the next step. Medication. Even though I don't want to, I don't want to, I don't want to!

I tried to get myself to call my doctor's office on Monday, but never could work up my nerve. Finally I called on Tuesday, and asked when she would be back from vacation, and was told it would be November 21st. Then I told them that she had said she would start me on T3, and I'd like to let her know I have decided I do want to get started on it. They told me she does call to check in on occasion and they would let her know. They also at this time let me know that my test results for Graves' came back negative.

Later that day I received a call from the doctor's office, they told me my doc had not written anything on my chart about starting me on T3, so her partner was looking over my records and wanted to know if I was on any thyroid medications when taking the tests. I told them I wasn't.

I had a terrible night and hardly slept at all and was so wiped out I could not get to work on Tuesday. Not to mention my vehicle which went up in smoke on October 4th is still broken down, and I don't have my own vehicle to drive but dependent on my husband's vehicles which he uses interchangeably and so I never know from one day to the next which one I'll be using. He was supposed to get the flat fixed for me. I ended up working from home on Tuesday. On Tuesday night, while applying my hydrocortisone I realized that in beginning to use a different sized syringe on Monday I had accidentally given myself twice as much HC Monday night, hence my inability to sleep. And I realized I had probably been overdosing myself by just a little bit all day Tuesday. I had trouble sleeping Tuesday night also.

I dragged myself to work on Wednesday, finally getting there around 11:30! Actually my husband drove me in, I was so exhausted and he still had to get the tire fixed on his van so that I would be safe driving it.

When I finally arrived at work I went to my boss' office and proceeded to tell her what had been going on for the last few days, and also I told her I had an idea for something that I hoped would help me reduce some of the stress I'm having. I'll tell you honestly what caused me to consider this idea is that I've been looking into the leptin reset idea and I couldn't figure out in my mind how I could do it and still get up at 4am.

I told my boss, since I have 50 days of vacation accrued, and I accrue two days every month, what did she think about my going to six hour days, and taking two hours vacation each day? I work four days a week, so this would mean I would be taking one vacation day a week. I could do this for a year and still have vacation time left. I can't ever take a regular vacation for a week or two weeks, so this would make the powers that be happy that I'm not accruing a ton of vacation, and maybe this will give me some much needed relief. She was more than thrilled at my suggestion, and told me I wouldn't be any good at work or at home unless I take care of myself, and she even told me to set my own hours! Isn't that wonderful?

The only trick is going to be how am I going to get my work done in six hours, when it seems I have been unable to do so in eight hours? When I spoke to my boss, I assumed the T3 medication would be in my hands within days. I figured I'll soon be able to think more clearly, so I will be able to concentrate and I'll be able to work more efficiently and will be able to get my work done in six hours without any problem.

Later in the day I called the doctor's office to ask them if they would fax my results over and they said they would.

They never did, so on Thursday I called back and while they had me on the phone they told me they wanted more tests run, since they had looked at my labs and my T3 “looks stable” so they didn't think I needed T3 after all. Uh, hello? I have a reverse T3 problem, people. So I asked the lady if she would please have whoever is looking into this for me to please look into reverse T3 problem. And I briefly explained that I have too much T4, my body isn't converting it into T3 but reverse T3 which is why I am having the hypothyroid symptoms.

After that conversation it felt like my brain went on vacation for about ten minutes. I couldn't think, I couldn't concentrate. Essentially I heard, “We're not going to prescribe this medication for you, so there is no hope of your improving” and it really made me feel helpless and deflated.

Later in the day I faxed over information about reverse T3 and asked the doctors to please review the information. I have not heard back from them, and I did not call the laboratory to see if I was supposed to get blood drawn. If they want me to have more blood drawn, I will agree, but they need to at least test me for the two tests necessary to get the ratio. Reverse T3 and Free T3.

I've spent the weekend trying to relax. I've known this, but the Stop The Thyroid Madness book tells us it is so important to laugh. I caught part of a movie on satellite television last weekend and I laughed and laughed and decided to order it so that I could watch the whole movie. I should warn you there is some profanity and adult humor, it is National Lampoon's Christmas Vacation. National Lampoon's Christmas Vacation  My youngest son and I watched it this weekend and an hour into the movie he said he had to take a break because his face was hurting from laughing so much. I showed my husband a few parts that were funny and he laughed, and he agreed to watch it with me sometime soon.

Speaking of my husband… he has been home the last three nights and I have been able to sleep well without worrying about where he is. We also have been discussing my health situation a lot, and we have come to the conclusion that his main business is literally killing us both, so he has agreed to finish up the jobs he has outstanding and then become super selective about taking any work, while concentrating on his other business.

So I am slowly but surely removing some of the stressors in my life, which should help me heal.



GAPS DIET JOURNEY is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to AMAZON.COM. GAPS DIET JOURNEY is an affiliate for several companies and may be compensated through advertising and marketing channels. Therefore, this post may contain affiliate links.