Do I have a RT3 Free T3 ratio problem?

[schmede]

I am trying to find a correct diagnosis.  I have all the symptoms of hypothyroid (except hair loss), But my levels are all quite normal.  My free t4 is in the low end at .09.  I am wondering if I might have a rT3 Free T3 ratio problem.  Here are my numbers, but I don't know how to find the ratio.

RT3= 235 pg/ml
FT3= 2.82 pg/ml

Any help is greatly appreciated!  I need to start feeling better :)

[schmede]

Thank-you very much!  I really hope I am on my way to feeling better.

[gimel]

Looks like my expectation was correct.  Your FT3 and FT4 are too low in the range, which is consistent with being hypo for many people.  Many members report that relief of their symptoms required that FT3 was adjusted into the upper part of its range and FT4 was adjusted to at least the midpoint of its range.  The best reason that I can give for this is that the ranges for FT3 and FT4 have never been corrected as was done for TSH over 8 years ago.

At that time the AACE recognized that there were far more hypo people than would be predicted from their TSH reference range of .5 - 5.0.  So they purged suspect hypo patient data from the data base and recalculated the limits at .3 - 3.0.  If the data bases for FT3 and FT4 were similarly purged of suspect hypo data, I estimate that the new range limits would be more like 3.2 - 4.3 for FT3 and 1.0 - 1.55 for FT4.  I believe this is why we hear from so many people with FT3 and FT4 in the lower end of the range yet they still have hypo symptoms.  

If your doctor tries to say that you are normal because of your TSH level, then you can explain to him that since TSH is a pituitary hormone that is affected by so many variables, it does not even correlate adequately with FT4, much less FT3 and symptoms.  On the other hand studies have shown that FT3 correlates best with hypo symptoms.  And of course symptom relief should be all important.  For those reasons you should be starting on thyroid meds to increase your FT3 and FT4 levels as required to relieve symptoms, without being constrained by resultant TSH levels.  If you want a support document on this to show to the doctor, then this is a link to an article written by a doctor.  

http://www.hormonerestoration.com/Thyroid.html

[schmede]

Thanks for your reply.  Here are my results including the reference ranges:

RT3= 235 pg/ml  (reference range 90-350)
FT3= 2.82 pg/ml (reference range 2.3-4.2)

I also had the following tests done at the same time:

FT4= 0.9 (reference range 0.7-1.48)
TPO=3.10 (reference range 0-9)
TSH=1.4967 (reference range 0.35-4.94)

Please let me know if you see anything "abnormal" or that would give rise to hypo symptoms.  Also, do you have any suggestions for what I should ask my doctor and what treatments I should ask him to prescribe (or that I could do on my own.)

Thanks!

[gimel]

Just having FT3 and FT4 results within the low end of the "normal" ranges does not mean that everything is okay for you.  The ranges are far too broad.  As they are, the ranges should really be considered as guidelines within which to adjust the levels as necessary to relieve symptoms.  Symptom relief should be all important.  If you will post the reference ranges for the FT3 and FT4, it will help us assess your status.  I can tell you that many members report that symptom relief for them required that FT3 was adjusted to the upper part of its range and FT4 adjusted to at least midpoint of its range.  

I expect that when we look at your FT3 and FT4 test results along with reference ranges we will see the most likely cause of your hypo symptoms, rather than being an RT3 problem.  However, since you asked, here is an old post from one of our knowledgeable members.
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The ratio of FT3 to RT3 is confusing due to the different units that can be used for each. Usually, the formula is FT3/RT3 * 100.  However, the "100" is a fudge factor to correct for the different units.  In your case, FT3/RT3 is 6.62, which I believe needs to be divided by 10 (0.662) to get the ratio, which should be roughly between 1 and 2, preferably closer to 2.  So, it looks like you have RT3 dominance...  

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If my math is still working at this time of night, your ratio would be 1.2.  Maybe not optimal, but I think that the bigger problem is with the low levels of FT3 and FT4.  Medication to raise the levels of the Frees might also benefit your FT3/RT3 ratio.