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High Reverse T3, High Cortisol, Normal Iron Serum, Low Ferritin
In June of 2012, I finished 6 months of Accutane. In June of 2012, I also started experiencing dramatic diffuse hair loss. It is now 8 months later, and it hasn't stopped. I simply do not know what to do. I've already posted something on another website and received invaluable help --I was hoping that I could receive even more feedback so I can be more prepared for my doctor's appointment on Friday.

Results from 8/1/2012 Lab Test (through primary doctor)
Iron, total--> 160 mcg/dL (40-175)
Tibc--> 425 mcg/dL (250-450)
Transferrin Saturation--> 38% (15-50)
TSH-->2.16 mIUL (0.40-450)
T4, total--> 11.8 mcg/dL (4.5-12.0)
T3, total--> 121 ng/DL (76-181)
Ferritin--> 26 ng/mL (10-154)
Vitamin B12--> 849 pg/mL (100-1100)
Folate serum--> 18.0 ng/mL (>5.4)

I went to a hair loss specialist who confirmed that I have normal miniaturization associated with my hair follicles, so she believes its tellogum effluvium rather than alopecia due to the Accutane and should pass within 6-8 months. She recommended that I begin taking iron supplements to raise my ferritin. I've been taking 29mg of elemental iron since then. Well, I'm on month 8 of the hair loss, feel absolutely awful. I decided to privately get lab work done.

Results from 2/1/2013 Lab Test (dont privately)
Cortisol, AM --> 21.5 ug/dL (6.2-19.4)
Cortisol, PM --> 10.3 ug/dL (2.3-11.9)
TSH --> 3.080 uIU/mL (0.450-4.500)
Thyroxine (T4) --> 13.0 ug/dL (4.5-12.0)
Trilodothyronine, Free, Serum (T3) --> 3.7 pg/mL (2.0-4.4)
T4, Free (Direct) --> 1.55 ng/dL (0.82-1.77)
Reverse T3, Serum --> 31.0 ng/dL (9.2-24.1)
Vitmain D, 25-Hydroxy --> 28.7 ng/mL (30.0-100.0)
Iron, serum --> 105 ug/dL (35-155)
Ferritin, serum --> 18 ng/mL (13-150)  

Results from 2/14/2013 (2 weeks later, I received another lab to check for anemia and thyroid antibodies)
Iron, Serum--> 120 ug/dL (35-155)
Ferritin, Serum--> 27 ng/mL (13-150)
Transferrin--> 336 mg/dL (200-370)
Iron Bind.Cap.(TIBC)--> 367 ug/dL (250-450)
UIBC-->247 ug/dL (150-375)
Iron Saturation-->33 % (15-55)
Reticulocyte Count-->0.4% (0.6-2.6)
Vitamin B12--> 673 pg/mL (211-946)
Folate (Folic Acid), Serum-->16.4 ng/mL (>3.0)
TSH-->2.450 uIU/mL (0.450-4.500)
Thyroxine (T4)-->11.8 ug/dL (4.5-12.0)
Triiodothyronine,Free,Serum-->3.6 pg/mL (2.0-4.4)
Reverse T3, Serum-->24.0 ng/dL (9.2-24.1)
Thyroid Peroxidase (TPO) Ab---> 7 IU/mL (0-34)
Antithyroglobulin Ab--><20 IU/mL (0-40)

I've been taking 29mg of Iron since 8/1/2012 so I do not understand how my ferritin is almost exactly the same since then; 3000 IU's of Vitamin D since around 8/1/2012 so I don't understand how my Vitamin D is so low; just added Ashwaghanda. Symptoms: Dramatic diffuse hair loss, rashes that come and go on my chest, I feel like my heart is beating out of my chest (esp in the morning), constipation, I lost 25 pounds despite stopping exercise (I'm 5'6" 120lbs).

I'm just tired of crying.
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1756321 tn?1377771734
Iron deficiency and vitamin D are both estimated to affect at least a billion people or more.  Co factors for vitamin D absorption are magnesium (most important), vitamin K, vitamin A, zinc, and boron.  Co-factors for iron absorption are copper and cobalt. The most common example of cobalt is vitamin B12.  Vitamin C facilitates iron absorption.  Also look for minerals in chelated form to help with absorption.

Iron deficiency is a common cause of elevated RT3.  Your RT3 has dropped after iron and ferritin has increased.  Hair loss, constipation, heart palpitations, weight loss, fatigue are a few of the many possible symptom of iron deficiency. Ferritin levels needs to be at least 50 ng/mL to help replenish hair but you should aim for 70 ng/mL or higher.
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