RT3/FT3 Ratio Question

[cats87]

Hi, I haven't been on here for over a year. I have Hashi's and FM amongst other probs. I have issues with my symptoms not going away with 100 mcg levo daily. Getting worse lately. I have a feeling that I have RT3 blocking the T3 uptake into my cells and that is why I feel so bad. Thyroid resistance?

I have a quick question, how do I figure the ratio of these two values if they are measured in ng/dl and pg/dl? Please help. I have a follow up endo appt next week and can't wait...
REVERSE T3 RANGE 11-32 ng/dL - RESULT: T3, Reverse: 35 (H)
FREE T3 WITH TRACER DIALYSIS RANGE 210-440 pg/dL - RESULT: Free T3: 232

By the way, here are my other results:
TSH 1.55 - RANGE: 0.35-4.00 uIU/mL
T4 FREE 1.30 - RANGE: 0.81-1.48 ng/dL
T3 129 - RANGE: 58-159 ng/dL
CHOLESTEROL 218 - RANGE: <200 mg/dL
TRIGLYCERIDE 119 - RANGE: /=40 mg/dL
LDL CALCULATED 113 - RANGE: <100 mg/dL
CHOLESTEROL/HIGH DENSITY LIPOPROTEIN 2.7  - RANGE: <4.3  

[cats87]

Hi - I still have hypo symptoms except that I was getting overheated really easily (sweating just doing stuff around the house, etc). My hands and feet are not as cold but not normal either. I am not AS tired but not normal. Some heart palps, more than normal but expected with T4 med increase. Just after my endo increased the T4 in March, I started taking CLA Extreme which is a type of fat burner (with endo approval). I attributed the overheating to the CLA and backed off & only take about 4 pills a week. Once I get the 3's back from the Lab I will post the results. Thanks!

[goolarra]

1) If your RT3 is still high and FT3 still low, your body is converting too much T4 to RT3 and not enough to FT3.  Your FT4 is above range, so, it appears you are taking too much T4, AND it's not doing you any good because it's not being converted properly, so is not available to your cells.

2) I'm no CMP expert by any means, but all your values seems to be "in range", except RBC, which are slightly low.  However, as I said, I don't know much about this, so take it for what it's worth.

Are you hyper?  Do you have hyper symptoms?  Unless your FT3 has changed dratstically since the last labs, I doubt you have hyper symptoms since FT3 correlates best with symptoms, distantly followed by FT4, and TSH does not correlate.  If you don't have hyper symptoms, then you're not hyper.

You'll know a lot more when FT3 and RT3 come in.

Are you still having hypo symptoms?

[cats87]

Hi, Got labs done Friday. Still waiting for Free T3 and Reverse T3 but got everything else back. Liver and Lipid panel are ok. I am expecting that I will still have a high Reverse T3. I think my labs look hyper. I have a couple questions: 1) If I still have high RT3 and my T4 is now high, does that mean that I am taking too much T4 and it's not being converted properly? 2) Am I anemic? Here are my results so far:
Component/Your Value/Standard Range
TSH 0.64 0.35-4.00 uIU/mL
T4 FREE 1.53 0.81-1.48 ng/dL
T3 141 58-159 ng/dL
WBC'S AUTO 6.5 4.0-11.0 thou/mm3
RBC, AUTO 4.13 4.2-5.4 mil/mm3
HGB 12.9 12.0-16.0 g/dL
HCT, AUTO 38.4 37-47 %
MCV 92.9 81-99 fL
MCH 31.3 27-35 pg
MCHC 33.6 32-37 g/dL
RDW, BLOOD 12.7 11.5-14.5 %
PLATELETS, AUTOMATED COUNT 227 130-400 thou/mm3
MPV 10.2 7.4-10.4 fL

[goolarra]

Ooooh (heavy sigh).  I wish I could agree with your endo, but I see all kinds of holes in his logic.  First, he doesn't usually test RT3 (with the exception stated), only did because you requested it, so is going to ignore it since it wasn't his idea???  He obviously believes it can be an issue, and your test has proven it is for you, but you're not in the hospital, so it's okay???

Your blood levels do NOT show that your body is converting T4 to T3 properly.  FT4 is at 73% of range (upper third), and FT3 is on the floor of the range (9%).  FT3 should be higher in its range than FT4 is in its range.  Target for FT4 is midrange and for FT3 upper half to third.  You are not converting properly, and we know from your RT3 test that it's because of RT3 dominance.  Your labs are classic RT3 dominance labs.  I don't know how he can look at your FT3 and FT4 and say your "...body is utilizing the T4".  

Increases in T4 meds in the presence of RT3 dominance usually make the situation even worse since T4 can actually cause an increase in production of the enzyme that converts T4 to RT3 and a decrease in the enzyme responsible for converting T4 to FT3, creating a vicious cycle and sending RT3 even higher.

I wish him a lot of luck getting your TSH down to 0.3 using just T4 meds in your situation...he's going to need it.

Six weeks is a lot of time to waste.  I guess it's a matter of how bad you feel and if you can put up with it for another six weeks before you even START to work on the problem.  Has he indicated how he would "address" it in six weeks if still an issue?  I think I'd be interested in what he has planned if I were you.

Anxiety/stress/depression can be symptoms of hypo.  It could very well be that getting your thyroid hormones back in line will help to relieve those as well, not make them worse. Also, the fibro may greatly improve...

Do you have any known heart issues?  With some heart problems, Cytomel should be avoided.  However, if yoiur heart is healthy, this is not an issue.  Many, many people on this forum take Cytomel.

Let us know how this goes...very interesting.

[cats87]

Update from endo appt today: Endo says typically high RT3 is in sepsis patients in a hospital setting and that he never tests for it and only tested me since I asked for it. He said that my body is utilizing the T4 and that my blood levels show that (see labs on this post). He said if we started T3 it would only confuse my pituitary gland and that it would stop making T3 on it's own. He increased my T4 from 100 mcg to 112 mcg and wants me to get TSH down to 0.3. He said that he will recheck all labs (tsh/ft4/ft3/rt3) in 6 weeks. He said that at that time if there's no change in the ft3/rt3 that we can address it at that time. Am I doing the right thing? He said that since I have anxiety/stress/depression/amongst other issues...that I will be extremely sensitive to the T3 side effects and he is trying to avoid any damage to my heart...does this seem right? I want to believe him but I am just so tired of being sick and tired every day. The symptoms are severe and are ruining my life.

[goolarra]

This is a really interesting link on RT3 dominance.  The treatment is T3-only (Cytomel) temporarily until the RT3 clears your system.  T4 meds are then re-introduced, either alone or in combination with T3.

http://www.custommedicine.com.au/blog/2007/04/17/reverse-t3-dominance/

[cats87]

Thanks for the info! I just wonder what I can get on to reverse it and how long it will take to see changes. I have been asking my endo for Cytomel for over 2 years and maybe now he will give it to me. I am just done with feeling so sick and tired all the time.

[goolarra]

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...  

[cats87]

correction to labs not working dont know why; HDL 81, that is the only reason my Chol/HDL ratio is good. I am concerned with the Chol and others that are above normal. Don't know how to get them down when I am already working out and eating clean in the first place!

[cats87]

CHOLESTEROL 218 - RANGE: <200 mg/dL
TRIGLYCERIDE 119 -  RANGE: /=40 mg/dL
LDL CALCULATED 113 - RANGE: <100 mg/dL
CHOLESTEROL/HIGH DENSITY LIPOPROTEIN 2.7 - RANGE: <4.3