high reverse t3

[weddingcake]

HI, I posted a question a while ago about suspecting high levels of reverse t3.
Here are my results:

Reverse t3 351 ranges 90-350
Free t3 2.5 range 2.0-4.4
Free t4 1.41 range 0.82-1.77

I try to calculate the ratio between the Rt3 and the Ft3 and come up with a number 14.04, I don't know if I did it right, anyone knows how to do the conversion? I took it from the STTM book but now sure if the number I came up with is correct. Any help would be greatly appreciated. Oh I'm on 100mcg of levoxyl, always was and was doing fine till I got hemorrhoids and got to be treated with hydrocortisone supps,  1 month later my hair started to shed like crazy and my levels were all over the place. My "normal" levels before were freet4 1.58, free t3 2.5 and my tsh  0.021, always low.

[Tomiro1]

Hello, I live in the Uk, and I was wondering if anyone could help interpret my blood work results. I seem to be exhibiting hypothyroid symptoms, but my docs says I have normal thyroid function, but my hair is falling out I have gained 30lbs and can't seem to shift it with diet and moderate exercise, I am losing some hair eyebrow eyelash foggy memory really bad. Please help if you can. Need to know if iam rt3 dominant and leptin resistant. Also I have some nodules in both sides of my thyroid.
Bld work
Hematology
Active b12.                               124 pmol/L
Folate(serum).                          10.8 ug/L

Biochemistry
Magnesium.                              .87mmol/L
Ferritin.                                       101ug/L
Serum zinc.                                14.6umol/L
Selenium.                                    123ug/l

Endocrinology
T4.                                               114nmol/L
TSH.                                             1.22mIU/L
Free thyroxine.                             14.7pmol/L
FreeT3.                                         5.0pmol/L

IMMUNOLOGY
Thyroid antibodies.                      
Thyroglobulin antibody.                  26.6IU/mL
Method used for anti_tg: Roche modular
Thyroid peroxidase antibodies.      22.5 IU/mL
Method used for anti-TPO: Roche modular

Endocrinology
Triiodothyronine (T3).                      2.1nmol/L

Special pathology
Reverse T3.                                     22.8ng/dL

Endocrinology
25 OH vitamin D.                              85 nmol/L

Special pathology
TSH receptor antibodies.                .43. IU/L

Please help. Tired of my doc looking at me like I am imagining things.

[weddingcake]

I'm seeing a family physician, he's open minded that's why he suggested I had a saliva test for my adrenals but he feels I don't need to treat them with this numbers, he said they are fine that he only gives hc when is needed and in my case he doesn't think so. He also put me in naturethroid last year but that didn't work for me and I had to go back on levoxyl. I'm not confortable about t3 only treatment to be honest with you and I don't think he is qualified to do it, also I heard it doesn't work for everybody and I don't want to put myself through something that I'm not sure is going to work, I rather introduce t3 and reduce my t4 and see how that works, like I said before, is just my hair shedding that gave it away, I don't have any hypo symptom whatsoever other than that.

[weddingcake]

I don't feel hypo at all, just the hair was what it gave it away, other than that I'm just fine.

[stella5349]

forgot... if T3 meds can be used... it would be best to only go the route of regular T3 not extended release.

Timing is very important on dosing when you need to support these adrenals.

[stella5349]

yep this is a catch 22 on the bases of RT3 and Ft3 w/ the adrenals being effected.

You dip hard at noon and raise in the evening again. That is very hard.

Taking any combo form of thyroid medication and/or a ssolid T4 medication might not work right for you until you adrenals are put back into shape.

Big symptom with your hair falling out like that w/ the adrenal numbers you have.

What type of doctor are you seeing right now? Would they consider you on adrenal support treatment and utilizing just T3 medication for 6 weeks or so until things straigten out some.

I think your going to have to start from the ground up with these labs and meds.

[goolarra]

You have to remember that as far as RT3 and FT3 is concerned, it's the ratio that's important.  If your FT3 is low and you're comfortable, that's fine.  If FT3 is low and RT3 is low, no problem.  Conversely, when FT3 is high and RT3 is high, also no problem.  The problem comes in when FT3 is low and RT3 is high.  Even though your FT3 now is not a lot different from when you were well, if your RT3 is now much higher (we can only guess), your cells will not be able to utilize the FT3 because the RT3 is blocking it.

I don't know much about adrenals, so can't comment on those.

So, are you having hypo symptoms now besides hair loss?

[weddingcake]

My adrenals test result back at the end of january were:

morning 7.1 ok  ref 3.7-9.5
noon 1.4 ok ref 1.2-3.0
evening 1.1. ok ref 0.6-1.9
night 1.1 H ref 0.4-1.0

My doctor didn't seem to think that there was a problem because of the slight point high at night, he said he didn't want to prescribe me with hc unless it was necessary.
I started Ashwaghanda a couple of weeks ago and my temperatures are stable in the 98.3 range, before that I took Licorice Root for 4 weeks.
My free t3 always was low, even when I was on naturethroid for 3 months the highest it went was 2.7 with 3 grains, I never had a problem with this low ft3 before as long as my ft4 was about 70% it worked for me just fine,  but now since the hc supps everything changed, other than the hair shedding I feel great to tell you the truth so I don't know what to do, I have to see the doctor on april and we'll see what his approach is.

[goolarra]

The formula is FT3 divided by RT3 times 100, so in your case:

2.5 / 351 * 100 = 0.71

I believe the reference range for the ratio is roughly 1.0 - 2.0 with a preference for the upper end of the range.  Yours is less than 1.0, so clearly shows RT3 dominance.  You could also calculate it the other way round (RT3 / FT3 / 100), which would result in a different range, but this is the one I've seen.

You can also just look at the numbers...RT3 is over the top of the range, FT3 is in the bottom quarter...a lot of RT3 there.  FT3 should be higher in its range than RT3 is in its range.

Are your adrenal hormones back to normal?  If not, you want to get those in line before attempting to treat the RT3 dominance.