can someone help me interpret the rt3 on this test

[Brucergoldberg]

please ignore the tsh level :)

tsh   12.11     .40-4.5
ft4      1.1     .8-1.8
ft3    2.6    2.3-4.2
RT3  14       no ranges given

can anyone do the math on this?   i don't know the formula.    

thank you

[gimel]

When taking iron supplements it is best to take magnesium as well.  Also, Vitamin C can help prevent constipation when taking iron.  The ferritin level is very important, so you should find a way that works for you to take iron supplement if necessary to get your ferritin up to about 90 minimum.  

I am sure that if I looked hard enough I would find something about your cortisol, but have you had the 4 panel saliva cortisol tests?

[Brucergoldberg]

solgar gentle iron - I get really constipated from it, i don't want to go into details, but think about "mud"  and stomache issues :)

My B  is 950  ranges 600 to 1100

My D is 95  ranges 25  to 100

I am taking 62 of t4   and about 25-30 of t3  and I'm still EXHAUSTED.   Today i thought i accidentally took an ambien instead of the t3 i got so tired around 11 am, then i got up and saw that it was t3 i took  but it felt like i took ambien.

[gimel]

Yes, that conversion factor does give a rough idea of the equivalent amount.  Its main value is for modifying meds and dosages.  However, when carried to extreme,  would you expect that taking zero T4 and 40 mcg of T3 would work the same as taking 200 mcg of T4 and zero T3?  Don't think so.  The whole purpose of changing meds/dosages is to reach levels for Free T3 and Free T4 that relieve hypo symptoms.  Sometimes symptom relief also requires that other important vitamins and minerals are optimal also.  So you really need to know your B12 and ferritin, along with Vitamin D.  B12 needs to be in the upper part of its range, and ferritin, for men, needs to be about 80 - 90.  Vitamin D is reported best around 55-60.

What do you mean that taking iron turns your stomach to mud?  What type of iron supplement were you taking and how much?

[Brucergoldberg]

if t3 is really five times stronger than t4,  in reality i am taking 200 mcg?  ( 62 of t4 and like 27 of t3)

of course i would never be able to take this much t4.  but is this right?

[Brucergoldberg]

i need to get that re-checked its been a while.   but taking iron turns my stomache to mud so if its low I'm not sure what to do.  Do you think there is a point of too much t3?

[gimel]

Ferritin level?

[Brucergoldberg]

Good now.  In fact the d was too high ranges 25 to 100 mine was 95 they told me to cut back

[gimel]

Vitamin D, and ferritin levels?

[Brucergoldberg]

Thank you Gimel.    I inject b every week and my level is good.

I completely started a new protocol which seems to be helping.   The ringing is getting better too.    Call me crazy but I seem to be a little better and barely any fatigue.  Still not out of the water

Old routine:    112 t4

New routine as of a week ago.  68 t4 and 27 t3.    I just cut a 137 in half.   Then I take that with 12.5 cytomel.    Then after lunch 12.5 cytomel.   Then about 4 I take 2.5 cytomel for a total of 27.    If I feel better with this combination, I shouldn't be concerned with such a random dose?

I was getting really bad crashes since switching from night dosing to morning.   The I started taking the t3 with the morning dose and I get zero crash in the morning now.   Night and day from before.  Lesson learned.  The crash after taking synthroid (or any t4) has been a big challenge for me.   The t3 has helped.

[gimel]

Two things I see in the lab results.  Your Free T3/Reverse T3 ratio is 2.6 times 10 divided by 14, which calculates to be 1.86.  The recommended level is 1.8, or 2.0 minimum, depending on which source you read.  Red Star's mention of 20 is obtained by multiplying by 100, instead of 10.  Evaluation is the same.  

Your ratio does not appear to be a concern.  Your Free T4 is a bit low.  Recommended level is the middle of the range, minimum.  Your Free T3 is also a bit lower than that found with most people without any thyroid issue.  So there is room to increase your Free T3, along with your Free T4 level, as necessary to relieve symptoms.  

In addition, I don't recall your Vitamin D, B12 and ferritin levels.  Those are also important for hypo patients.  Have those been tested lately?  

[Brucergoldberg]

gimel,

This test was done unmedicated.   I tested at 8 am and the last time i took any hormone was 8 am the day prior to testing.  

i completely changed my protocol since this test was done which will be my next question but I'm curious to see what the RT3 means.  It didnt show out of range on the quest lab, but i understand there is a different method to this.
thank you

[Red_Star]

Excerpt from Tired Thyroid - Reverse T3: Side Effects of T3-only (or why you need T4 too)...

"High reverse T3 (rT3) levels or a “bad” reverse T3 ratio (Free T3 divided by rT3 is less than 20) are said to be the cause of stubborn hypothyroid symptoms even while one is taking an ample amount of medication. If the ratio is less than 20, then the treatment touted by some is to take 75-125 mcg of T3 only split throughout the day, and no T4 whatsoever. Some people can tolerate these high doses of T3, others cannot.

Why do so many experience side effects on the T3-only protocol? The reasons are explained in detail below, but here is a quick summary of what follows, which basically proves that the reverse T3 ratio theory is based on faulty premises.  Recent research in cellular and molecular biology shows that:

rT3 does not block the receptor at all; neither rT3 nor T3 is in the receptor, that's the problem

T4 is more than a prohormone and is essential for healthy hair, brain, and other functions

Excess T3 will cause an imbalance in other hormones (it raises estradiol, which can be problematic, especially for men)

Excess T3 (desiccated thyroid has a high amount of T3) can trigger high reverse T3

Desiccated thyroid contains rT3, because rT3 is found in a normal thyroid gland [desiccated thyroid contains T4, T3, rT3, but little T2 or T1]

The reverse T3 ratio is a nonsensical number because the ratio can be low when Free T3 is high or Free T3 is low. A high FT3 and a low FT3 are different conditions and should not be treated the same way."

[gimel]

Hi Bruce.

Before doing the FT3/RT3 calculation, please tell us whether you took any T3 med before the blood draw for tests.