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Elevated Reverse T3: Should I increase my meds or not?
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Elevated Reverse T3: Should I increase my meds or not?

I have elevated RT3 whenever I take T4 meds.  Right now I am on 50 Synthroid.  I do not know what to do.  I know my RT3 is not above range, but lets just say I gained 25 lbs within TWO months of starting on Synthroid and my RT3 went up 7 points.  I am afraid to raise my meds anymore because I will get more RT3 and gain more weight.

Have anyone else gained any weight because of the elevated RT3?  How much?  What is your game plan?  Can you hande T3 meds?  I cannot..  

Anyone have some advice for me?  I do not know what to do.  Some people say I need to get on HC to get better.  I am so terrified I will never get my life back and be able to live a normal life with normal energy.  I am debilitated by this.

I know some people are going to chant: "Get on NDT!  Get on NDT!  Get on NDT!"  Well, when I have tried anything with T3 in the past, it does not work well for me and I get major anxiety.  I can try the NDT again, but if I get terrible anxiety - what will my options be?  It seems like I am a good converter of T4 to T3.

Here are my latest labs:

03/27/12 Lab Tests

TSH 2.77 (Range: 0.40 - 4.50)
Free T4 1.2 (Range: 0.8 - 1.8) (40 percent of range)
Free T3 3.5 (Range: 2.3 - 4.2) (63.2 percent of range)
Reverse T3 27 (11-32)

24 HOUR SALIVA TEST RESULTS (Date: 05/15/2012):

Cortisol Morning is 13.02 nmol/L **WITHIN RANGE** (range 5.1-40.2; optimal range 18-35)
Cortisol Noon is 2.94 nmol/L **WITHIN RANGE** (range 2.1-15.7; optimal range 6-12)
Cortisol Evening 6.62 nmol/L **WITHIN RANGE** (1.8-12; optimal range 4-8)
Cortisol Night 0.98 nmol/L **WITHIN RANGE** (0.9-9.2; optimal range 2-6)
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According to some sites, your Free T3/Reverse T3 ratio is too low.  It is about 1.3, where something closer to the 1.8 or even 2.0 is supposed to be the target, depending on the info source.  You can look at your ratio as being due to both RT3 that is in the high end of its range and FT3 that is in the low end of the "functional" range that typifies healthy people with normal thyroid levels. That functional range is more like 3.3 - 4.3, rather than the range used by most labs.  

So you can work on the ratio by increasing your Free T3 level, or by trying to reduce the conversion of T4 to RT3.  As for taking T3, you stated that you had major adverse reactions to T3 in the past.  What med and what dosage?  Did you split the dose and take half in the morning and half in the afternoon?

As for RT3, there are some factors that can contribute to excess conversion to RT3.  Having good levels of iron, selenium, zinc, and Vitamin A are all essential for normal thyroid hormone metabolism.  Have you been tested for all of these?  If so, please post results and reference ranges.  

Thanks, Gimel.

I am raising my iron.  My ferritin was 30 (Range: 10-154) at my last blood draw.

I have taken 30 mcg Acella NP Thyroid.  It crumbles if you split it.  I have had that mentioned to me many times before to split it up, but it never works well.  Each day that I take it I feel progressively worse on the T3.  I also tried 5 mcg Cytomel.

Now that we have that explanation out of the way, what do you think I should do?  My original question was whether or not I should raise my medicine (Synthroid).  

Do you think I should consider HC (hydrocortisone)?  Should I take an adrenal glandular/cortex supplement?  

Should I get off Synthroid entirely?  I question this because years prior to my thyroiditis, my thyroid levels were almost exactly what they are now, when I am off thyroid meds, and I felt fine.  I FEEL like my symptoms are all adrenal, as in adrenaline surges, fatigue, etc.

Here were my labs WITHOUT the influence of thyroid meds:

TSH 2.79 (Range: 0.40 - 4.50)
Free T4 1.0 (Range: 0.8 - 1.8) (20 percent of range)
Free T3 2.8 (Range: 2.3 - 4.2) (26.3 percent of range)
Reverse T3 20 (11-32)

In 2006 and 2009 I also had thyroid labs done at my internist's office.  My labs (TSH, FT4) were almost exactly what they were without the influence of my thyroid meds (above).  So, sometimes I think I recovered from my subacute thyroiditis and now simply have an adrenal problem.

Also, here is my saliva test from last October.  My morning cortisol was much better then: 16 vs. 13 is what it is now.  I started back on thyroid meds 02/15/12 so maybe not supporting my thyroid made my adrenal fatigue worse?  I do not know.  I do not know what else could have made my cortisol worse.

24 HOUR SALIVA TEST RESULTS (Date: 10/30/2011):

Cortisol Morning is 16.43 nmol/L **WITHIN RANGE** (range 5.1-40.2; optimal range 18-35)
Cortisol Noon is 4.96 nmol/L **WITHIN RANGE** (range 2.1-15.7; optimal range 6-12)
Cortisol Evening 1.12 nmol/L **LOW** (1.8-12; optimal range 4-8)
Cortisol Night <0.28 nmol/L **LOW** (0.9-9.2; optimal range 2-6)

You mention symptoms, but other than weight gain, I don't see any info on other symptoms.  What symptoms are are a concern to you?

Also, I am sure you must have been tested for Vitamin D, and B12.  What were those levels and ranges?  

As for ferritin, have a look at this info I found.

"I  frequent another board where the role of iron in the metabolism of thyroid hormone is discussed. Along with selenium, iodine, L-tyrosine, zinc and other vitamins/minerals/amino acids, iron plays an important role in the conversion of the less inactive T4 form of thyroid hormone to the more bio-active T3 form.

I've seen iron discussed a bit on this board but not so much about ferritin . I thought you might be interested in what I found. Ferritin levels often begin dropping before serum iron levels become critically low or before full-blown anemia becomes apparent.

Many hypothyroid patients find that having good ferritin levels improves their use of thyroid hormone (their own body's or supplemented). The range of 70-90 is quoted as optimal for hypothyroid patients. Someone on another board asked me if I knew of any research she could show her doctor to support this. He wanted her to stop supplementing iron when she raised her ferritin from 17 to 44.

Here's some of the research I found that suggests a minimal ferritin
range of 50-70 and an optimal range for hypothyroid treatment of 70-90. I have read that in Dr. Gillespie's book, "You're Not Crazy, It's Your Hormones", she advises a ferritin level of around 100. I haven't read her book, so I can't confirm the research basis for her recommendation, but the experience of many hypothyroid patient certainly bear her out.

Improving ferritin levels can be beneficial for both reducing or eliminating hair loss & unexplained fatigue. Both of those are also frequently associated with hypothyroidism."

Also, have you been tested for zinc, selenium and Vitamin A?  The reason I ask again is that  " there are some factors that can contribute to excess conversion to RT3.  Having good levels of iron, selenium, zinc, and Vitamin A are all essential for normal thyroid hormone metabolism."

Sorry if I am bouncing around a bit, but if it were only one simple thing, I'm sure you would have identified the problem long ago.  
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