Low Total t3 with free t3 in bottom of range

[Zeton]

Should low Total t3 be treated possible hypothyroid

My Total t3 keeps coming back low.
total t3   52    range  74  - 180
free t3   2.5    range  2.3 4.9
tsh   1.3
total t4 7.2
free t4  1.33     range .82 - 1.77
reverse t3    15    range   8 -25
low rt3/t3 ratio

Symptoms:
morning back stiffness
burning in palms of hands
poor circulation in feet while standing. Bottoms of feet turn blue
cold hands and feet
extreme dry forehead skin
morning fatigue
muscle cramps in legs

all symptoms started after exposure to high amount of Vinyl  Chloride

Previous labs when I had no symptoms where checked for routine checkup and where all normal
total t3    86
Free t3   3.4

Question?
I see my tsh is normal but
my total t3 keeps comming back low  52, 60
my free t3 keeps coming back on the bottom of range  2.5, and 2.4
my rt3/t3 ratio is low

could these numbers be causing my symptoms?
Should this be treated?
Does anybody else get these symptoms from lower t3?

any help would be great...

[gimel]

Nothing to be concerned about with that Reverse T3.  The ratio is somewhat lower than is recommended by some, due to the low level of your Free T3.  So I think the best approach is to emphasize your hypo symptoms to the doctor and your relatively low Free T3 level, as a result of apparent poor conversion of T4 to T3.  Then ask for a trial of T3 med adequate to gradually raise your Free T3 level to the upper third of the range, or as needed to relieve symptoms.  Remind the doctor that when you were feeling good your Free T3 was 3.4.

You might also make use of this quote from a good thyroid doctor.  In the words of a good thyroid doctor, ""The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

[Zeton]

Thanks again
All three were tested at the same time

Total t3       =  52   ng/dl    range 76 - 181
Free  t3       =  2.5  pg/ml  range 2.3 - 4.2
Reverse t3  = 15    ng/dl   range 8 - 25

[gimel]

It is good that your ferritin and selenium were at those levels.  I would ignore the Total T3 and pay attention to the Free T3.  I would not expect Free T3 levels to fluctuate like that.  There is a reason why your Free T3 sent down, and it is much too low now.  One thing that comes to mind is that it would be a good idea to test for Reverse T3 and see if your system is converting T4 to too much RT3 instead of Free T3.  If you can do that I would have both Reverse T3 and Free T3 done at the same blood draw.  

[Zeton]

Thanks so much for the Reply

I just wonder how much Free t3 can fluctuate from day to day. Since the TSH and T4 was normal, maybe I just caught the Free t3 on a bad day...or should free t3 always stay normal in upper range everyday?

I am a little afraid to go throwing a wrench into the thyroid feedback loop..

I failed to mention I eat very healthy and am very thin and yet my LDL cholesterol came back at 200.  Triglycerides  were low and HDL was 58. I have read that about hypothyroidism.

Ferritin was normal at 71
Selenium was upper range of normal

from what I read, the vinyl chloride released a lot of endocrine disruptors that as you said can cause a trouble with converting t4 to t3.  

the lower free t3 levels seem to correlate well with the lower total t3 levels.

Multiple docs and Endocrinologist keep saying the my labs are normal but they don't know what to make of the low total t3

Have you heard of super dry forehead and pool circulation as a symptom?
Should I just ignore the total t3?
can Free t3 fluctuate between 2.4 and 3.4 from day to day?

[gimel]

The most important of those tests are Free T4 and Free T3.  Your Free T4 is adequate, but your free T3 is too low in the range, which leads to hypo symptoms for many people.  Free T3 correlates best with hypo symptoms, while Free T4 and TSH do not correlate.

I don't know if the exposure to Vinyl Chloride would effect you like that.  But clearly your Free T3 was much higher back when you had no symptoms.  Currently your Free T4 is at about 54% of its range, but your Free T3 is only about 8 % of its range.  That is indicative of inadequate conversion of T4 to T3.There are a number of potential causes for poor conversion.  Among them are low ferritin and low selenium.  So it would be a good idea to test for those and see if they are too low in the range.  

Even if that is the case you should talk to your doctor about a trial dose of T3 med to raise your level as needed to get back to at least the 3.4 level that seemed to be good for you.