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Euthyroid woes
This forum pops up a lot when googling, so I thought I'd take the liberty of asking my own question, since there seem to be some knowledgeable members here.

Basically, I've been trying to find a reason for my "non-specific" symptoms for years now, which look something like below. I have a history of stress and horror nutrition, which I've addressed successfully over the last 18-months with, incredibly, absolutely zero results. Before that I went the usual routes through the NHS, physiotherapists etc.

- Carpal tunnel syndrome (debilitating)
- Cold hands and cold intolerance
- Fatigue and brain fog/low concentration
- Trouble getting to sleep and getting up
- Irritability
- Underweight (5'10", 60kg) but still have stubborn belly fat
- GERD, bloating and sluggish digestion
- Hair loss inc. thinning eyebrow
- Reduction in libido
- Palpitations/night-time adrenaline rush (recent one)

It occurred to me that a lot of these are consistent with hypothyroidism, so I got a full panel done.

TSH 1.20
FT4 14.3 (10-22)
FT3 3.3 (2.8-6.5)
RT3 0.39 (0.14-0.48)
FT4/FT3 4.3
RT3/FT3 8.5
Antibodies well within range

I'm no expert, but the ratios seem pretty bad, despite everything being "in range". I've researched what I can, and have focused nutrition further e.g. selenium, more protein etc. Stress isn't a problem any more, I don't do cardio, I don't diet or go hungry and keep blood sugar stable, I eat something carby around bedtime... I'm not sure what else I can do to lower RT3.

I began experimenting with sub-physiologic doses of T3 (2mg every 1-2 hours) based mainly on pulse and mental cloudiness. That kind of dosing is too haphazard though, and I ended up taking up to 18mg/day which I think was too much and made my palpitations worse (didn't feel hyper at all though). I did build up from about 1-3mg/day over 2-weeks, and I noticed improvements in energy, cognition, temperature, pulse etc before the palpitations.

I'm certainly not asking for medical advice, but I'd really like to hear people's thoughts on (general) treatments for high RT3/low T3. Maybe there's some conversion factor I'm overlooking, and maybe T3 or even combined meds can be a temporary part of the process. Maybe my labs are actually fine and I'm insane for taking T3? Any help would be much appreciated. Thanks in advance.
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1756321 tn?1499064984
There should be twenty times as much T3 as RT3 so a healthy FT3/RT3 ratio is 20 or higher.  Treatment usually involves prescribing slow release T3.  Contributing health factors should also be addressed (listed below).  

One of the functions of the liver is to convert T4 into T3.  As you can see on the list below, impaired liver function is one of the causes of RT3 problems.  Most studies show the herb Milk Thistle, also known as St Mary's Thistle and Silybum Marianum, improves liver function and prevents and repairs damage to the liver from toxic chemicals and medications. This is one product that may help with your thyroid symptoms.

Causes i have found for reverse T3 issues...

Extreme dieting
Nutrient deficiencies:
- iron (including ferritin)
- selenium
- zinc
- chromium
- vitamin B6
- vitamin B12
- vitamin D
- iodine
High cortisol
Low cortisol
Insulin dependent diabetes
Impaired liver function/liver disease
Burns/thermal injury
Chemical exposure
Cold exposure
Chronic alcohol intake
Free radical load
Haemorrhagic shock
Kidney disease
Severe or systemic illness
Severe injury
Toxic metal exposure
Leptin resistance
Inflammation (NF kappa-B)
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Sorry for not replying for so long. Your post was very informative. Of the problems you mentioned, the one that stands out to me is low cortisol. In addition to what I listed above, I can't tolerate caffeine and I'm very sensitive to light and sound, which makes me suspicious.

I've read that cortisol plays a role in the uptake of T3, and after recently reading an article about hormones and pain (link below), I'm interested in getting a picture of my steroid health. The suggested labs after thyroid are DHEA, pregnenolone, cortisol, testosterone and androstenedione. I know the first two can be supplemented safely, but I wonder about the others, particularly cortisol. I'm planning on seeing a private doctor if the results show anything.

Do you have any experience with low cortisol levels? Should I get the 24-hour saliva test as well as a serum one? Is there anything else that could give me some clues about my symptoms? Thanks again for the reply.

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