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New Labs, major problems- adrenals- rT3

Me again. Back in April I had felt the best I had in a very long time, it was a long road back. My levels were a tad over range, but I felt great. Here's the link to that thread if you want to see those levels:

http://www.medhelp.org/posts/Thyroid-Disorders/MY-latest-labs-7-weeks-on-Acella-NP/show/1713908?personal_page_id=2042079

Just after that posting, I had some very stressful events one of which was moving. The week I started tovpack, I DID start to feel a bit hyper so I backed off from 3 1/12 grains nP Thyroid to 3gr and still felt fine. The week after I moved I felt like I got hit by a truck and realized the move had me cranked up before and now had me wiped out. Then some more stress. Spent a month waiting for my system to go back to normal and also had to wait a month to see a doctor who doesnt even know how to treat thyroid issues. Had gone back up to 3 1/4 grains at that point.
Then I remembered a friend who had seen a chiropracter that had diagnosed her Hashi's and got in to see him this week, had tests done just before. This also makes me worry about how we are all tested as I wasnt quite buying the hospitals FT4, so I had it redone at Labcorp 2 days later. I got a lot of tests, here are the pertinent ones:

TSH         .04     (.34- 5.60)
T4Free    1.16   (.61- 1.12)   LABCORP FT4: 1.59  (.82- 1.77) wtf?
T3 Free    4.1     (2.0- 4.4)
REVERSE T3   44.3   ng/dl  (13.5- 34.2)***
Antithyroglobulin ab  <20   ui/ml    (0-40)

I am seriously low in Vit D, Protein, Iron and some others, can post those if needed. Somehow my liver is great.
Doing the saliva test today where he is testing my adrenals and hormones and I am thinking this guy was dropped out of the sky into my lap!! Too weird to find someone who looks at adrenals----have to go to a chiro to get proper testing???

Does that antibody test say I have Hashis though?? I was feeling so good, then had to go and move. Although I do know that those low vitamins, iron and protein were gonna catch me eventually. I think he is going to wait for saliva tests to come back before doing anything but is there anything I can do myself to get that reverse t3 back down? I also have to go on a diet of sorts....no wheat....sugar, etc.....a lot ahead.....can't catch a break. Any input would be apprecaited as always :)
Best Answer
Avatar universal
In your other post, you said you thought this doctor was "Hashi-happy", and although elevated TGab has to be disproven to rule Hashi's out, I think you're probably right about his Hashi-happiness.  That's because most chiros treating thyroid are following a protocol developed by a chiro named Datis Kharrazian.  His whole premise is that Hashi's shouldn't be treated as hypothyroidism alone, but the underlying autoimmune disease should be treated.  Mainstream medicine says there is no way to treat the autoimmune component. If you google his name, you will find plenty of marketing for the protocol.

So, if you don't have Hashi's, then you don't fit their protocol...or do you?  K says that not everyone with Hashi's tests positive for antibodies.  Does that mean they can "make" you fit into their protocol?  IDK, but I'd do some serious reading with a very critical eye.

Bear in mind that the more diagnostics performed, the higher the probaility of generating treatment.  If you're the one distributing these treatments, then there's a money trail to follow.

As far as your RT3 is concerned, stress is one of the major factors in raising it.  It's a natural reaction that protects the body in times of crisis.  There are only two ways for the body to purge excess T4, either convert it to T3, which in times of stress can create too high levels, or convert it to RT3, which is inert.  It's the body protecting itself, and it should be a self-righting condition once the stressor is removed.  It's only when it becomes chronic that it's a problem.

As to the recommendations from the STTM site, I'd be very cautious about #2, especially doubling the recommended amount of anything except under a doctor's supervision.  Both T3 and RT3 are converted predominantly by the liver.  The two enzymes responsible for catalyzing that conversion are both selenium based, so you mess with one, you mess with the other and you can let a whole lot of toxins loose in your system in the process.

Just do your homework...  



  
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1756321 tn?1547095325
Do you have your thyroid peroxidase antibodies results?  High levels of reverse T3 can be seen with conditions such as high or low cortisol (stress hormone made in the adrenal gland), low iron/low ferritin, low B12.  Interesting with the free T4.
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1756321 tn?1547095325
Excerpt from Stop The Thyroid Madness "Reverse T3 (also called Reverse Triiodothyronine)...

"What do I do about excess RT3?"

Patients have had success with three strategies:

1. Identifying the causes and treating them:  Since we know what has been causing our excess RT3, one obvious strategy is to treat what’s causing it. Since it can take time to raise low iron or B12, or improve low cortisol,  or lower high RT3, one strategy for some has been to lower the desiccated thyroid, which lowers the T4…and all the while treating the causes.  Changing your lifestyle can be key, as well, such as greatly improving your food choices, facing an alcohol addiction, stop smoking, and avoiding high stress.

2. Using a good liver cleanse/support product, plus Selenium:  Since the bulk of RT3 is made in the liver, some have lowered their high RT3 by using a good liver cleanse, especially those with Milk Thistle. You may have to DOUBLE the recommended amount to get the lowered RT3.  Milk Thistle can supposedly lower ferritin, so patients are adding iron to their supplementation, or raising what they are already on. Also make sure your Milk Thistle comes from the seeds. Milk Thistle not from the seeds can have an estrogenic effect. Also, there is a lot of research which proves that low selenium can increase RT3.  So patients supplement with Selenium to stop that fact.

3. Going on T3-only:  T3-only dosing can have its challenges since you have NO storage T4 to do the job of providing T3 for you.  But it can work, and is especially important if you haven’t succeeded it lowering your chronic RT3 in any other way. Cytomel is a very popular brand of T3, as is Mexican Cynomel, for patients."
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Avatar universal
Thanks to you both for taking the time to answer this! When all this came down, I really have been too worn out to process the whole thing. I have gone through a lot in the past 2 years and really did think I was on my way. I am doing the 24 hour saliva test today. I feel I have had low vitamins, protein etc for some time but back in early April when i posted my just-over-range tests, I honestly felt the best i had in a year and a half---lots of energy, everything was great......then I moved and had a boat load of stress, I think thats what tipped it. In all the years of hypo life, I have never felt this bad, EVER. I have been quite honestly too tired and addle-brained to really research too much. Can't say enough how much it helps you both answered.
Goolarra, I really did get the hashis-happy feeling there, but feel lucky my friend sent me to him as who the hell else would have tested my RT3?? Most don't seem to know what the hell that is. Don't worry, not falling into any traps. I am just disgusted at what we all have to deal with.  I am/was desperately trying to find a way, on my own, to alleviate this horrible way I have been feeling. I moved 2 MONTHS ago and only feeling worse. Although last night I ate a huge filet-mignon and a giant portobello mushroom and feel semi-decent today, or better than usual but again, even with an ft3 of 2.0 a long time ago, I dont remember ever feeling this bad.
I think I am going to lower my dose of NP Thyroid (on 3 1/4 grains), seems like the way to go if I am on my own, and kind of am. I need to get a job, should have 2 months ago but couldnt....now I have no idea how much to lower it by or for how long but at least I know what dose makes my numbers right....which leads to....
QUESTION: if my reverse t3 is so high, does that skew my other numbers? I feel like those last ft3 and ft4 #'s were about perfect even though I felt good when they were higher too.
I ramble.
RED_STAR, my TPOab was  6  -(0-34)
Can't thank you guys enough---this has been a bit scary.....
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Avatar universal
PS....
those FT4 tests, one was done at the local hospital, one at labcorp just days apart, same time of day, same circumstances. I flipped out when I saw the one that was over, had never seen those ranges before and my ft4 has never been over without my ft3 being over.....so for my own peace of mind, I got the labcorp one done and was glad I did! Makes me wonder about their other tests....
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Avatar universal
I have elevated RT3 whenever I take T4 meds.  Right now I am on 50 Synthroid.  I do not know what to do.  I know my RT3 is not above range, but lets just say I gained 25 lbs within TWO months of starting on Synthroid and my RT3 went up 7 points.  I am afraid to raise my meds anymore because I will get more RT3 and gain more weight.

Have you gained any weight because of the elevated RT3?  How much?  What is your game plan?  Can you hande T3 meds?  I cannot..  

Here are my latest labs:

03/27/12 Lab Tests

TSH 2.77 (Range: 0.40 - 4.50)
Free T4 1.2 (Range: 0.8 - 1.8) (40 percent of range)
Free T3 3.5 (Range: 2.3 - 4.2) (63.2 percent of range)
Reverse T3 27 (11-32)

24 HOUR SALIVA TEST RESULTS (Date: 05/15/2012):

Cortisol Morning is 13.02 nmol/L **WITHIN RANGE** (range 5.1-40.2; optimal range 18-35)
Cortisol Noon is 2.94 nmol/L **WITHIN RANGE** (range 2.1-15.7; optimal range 6-12)
Cortisol Evening 6.62 nmol/L **WITHIN RANGE** (1.8-12; optimal range 4-8)
Cortisol Night 0.98 nmol/L **WITHIN RANGE** (0.9-9.2; optimal range 2-6)
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Avatar universal
With your thyroid levels, I would be hypo, but thats just me. I don't think I have had a TSH over 1.0 in over 5 years either. I opted to use dessicated thyroid over Synthroid as I knew people who could not lose weight on it and have done very well in the past with T3. I have very recently gained 5-8 lbs but was under-weight anyway so not a big deal unless the weight increase would continue. You may want to start your own thread so that you can get your questions addressed and so that I might continue to get advice in this thread. I wish I knew more to tell you, but that's why I posted here too. Good luck!
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Avatar universal
No, I don't think your RT3 is skewing your other tests in any way.

It will be interesting to see what your cortisol is doing.  Note in the link I sent you that high cortisol can cause RT3 to rise as can iron deficiency.
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Avatar universal
BOTH antibody tests would seem to indicate that you do NOT have Hashi's. As neither were elevated.

If you felt well before the stress and now you don't.  AND you know you are low on other vitamins.

It would make me think that maybe waiting a bit longer and taking the other vitamins may help things balance out again.

You say you don't feel well, and have felt worse than before.  But I don't see what symptoms you are specifically having.  I assume Hypo.

Your FT3 is testing at 88% of the range.  Your FT4 is testing at over 100% of range in one case (pretty narrow range) or 81% in the lab corp range.  So it appears you are getting PLENTY of T4.  Maybe too much and your body is trying to get rid of it by converting to RT3.  However this then plugs the receptors of the cells and causes you to feel hypo at the cellular level despite all that T3 in your blood.  

Can you tolerate synthetic T3 medication?  One possible thing to try would be to lower your dissected thyroid meds to reduce the amount of T4 and then add some synthetic T3.  This may need to be temporary until you can "clear out" the RT3 from your system.

Just a thought to consider.
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Avatar universal
Thank you Goolarra, got it!
Flyingfool...that's how out of it I am- I didn't even state my symptoms. Bad Hypo and adrenal fatigue symptoms, I used to read the stories here about people not being able to get out of bed etc. and think...wow, how does that happen? Well, now I know. I CAN get out of bed, but that's about it most days. I have a profound tiredness mostly. After the move i was extremely happy, mentally but then had some MAJOR stress and there is no such move that doesnt cause some stress. On top of that I have had 2 wicked periods that about killed me. I went off the pill last year and my periods had been alright, then none, then bad ones. My boobs hurt all the time. Of all the tests that were just done, not one had to do with female hormones that I know of. Otherwise, I feel like I weigh a ton, very weak. I have gained some weight, but had lost some before so ok for now. Memory issues, joint pain- just plain wiped out- depressed. Can't do the things I need to do- like i said, I should have had a job 2 months ago! I had been waiting a month to get into a DO, found out she doesn't do FT3 or RT3 testing so got into this chiro and now see the DO in just over a week. I have taken Cytomel, a long time ago and I don't think I was able to take it for too long. Thanks for mentioning the Hashis also, I realize I could eat better, but no gluten free diet for me, thank you.
I did lower my NP Thyroid dosage yesterday, but have no idea really how much I should knock off, was on 3 1/4 grains. Also no idea how long to do all that and worried that major hypo symptoms will appear especially the weight. I may be able to get some cytomel before the next dr. appt but not sure how much I would take...and quite sure that doc wouldn't not know either.
It was Goolarra who answered my post back in April when I was worried about being over range and I honestly felt great, so I agree the stress had to be the major factor. The tricky part now is the only person who would test all of that cannot prescribe, tells me I have Hashis and to go on a gluten free diet and hasn't even checked my estrogen etc. I feel that times' a wastin' and nobody (drs.) care that you lose months or years of your life. I believe my adrenals had crashed end of 2010 and into '11 so I was predisposed to crumble under stress.
I am starting Vit D, B12, B6, Zinc etc. today, didn't before due to that saliva test. Did I mention I had to do the saliva test in 2 days because I got a migraine? Funny, it was my first one in 6 months and it was the day after the chiro did something to my neck that he said would HELP my migraines....go freaking figure. I wrote this while waking up, sorry if it's a bit disjointed- thanks for sharing with me- makes a big difference.....
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Avatar universal
Did you do your saliva test in two days and not one?  I am not so sure that is a good idea.  It may provide inaccurate results.  You might want to call the lab company and check.  Just wanted to let you know.
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Avatar universal
....just spending time reading things in the link you sent, thanks so much....so helpful!! I think I will do a reduced dose of NP Thyroid until my saliva tests come back, in addition to some vitamins and some good foods and go from the saliva tests.
Thanks again to Goolarra and Flyingfool for your thoughts on Hashis :)
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Avatar universal
I talked to the lab already. I had no choice as I had to take migraine med after first 2 vials (Midrin) and that drug would probably have messed with the test. I did the 2nd day vials under the same circumstances and times I would have on the 1st day. Again, had no choice and half the test already done so had to make the best of it.
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Avatar universal
I have done some reading on Hashi's, RT3 etc...and female hormones. Wondering if with simple Hypothyroid if people do have to go up in dose from time to time. That's one of the things that stood out to me about hashis....I was on 2 grains from diagnosis in '06 until beginning of 2011 had to go to 3+ grains.

Weird too, been on a lower dose of NP Thyroid for 3 days now with addition of vitamins and foods with iron and protein etc and actually have more energy and in a better mood. Seems like I have been in a haze for 2 months and starting to think almost normally. Is that weird? Am I just imagining that??? lol
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Avatar universal
Even if the cause of your hypo is not Hashi's, whatever the cause was might still be progressive.  You might lose more and more thyroid function as time goes on, even if it's not the little critters (antibodies) chomping on your thyroid doing it.  Also, many factors affect our requirements...aging (just try to stop that one!), stress, trauma, general health, surgery...the list goes on.

Were you on 2 grains of the same brand that whole time ('06-'11), or did you have to switch during the shortages and reformulations as so many people did?

Certainly, what I eat affects how i feel day to day.  There are times of the day that my energy just drops, and I know I have to go scarf down some protein...nothing else works, and carbs almost make me feel worse.

Glad to hear you are feeling better.  
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Avatar universal
Thanks so much, so glad to feel a bit better...lost some time there.
I was on 2grains (give or take) Armour Thyroid from '06 to very beginning of '11. I was living down south and couldn't get it there until summer of 2010 (was having it shipped from Ohio) as soon as it was available in the south, I started getting it there and it seems thats where my problems started. I lost 20 lbs, had a crazy elbow pain like carpal tunnel, boils that wouldn't heal, etc. and within months went a bit nuts. Went thru losing my job and a breakup and BAM. Was too busy working to address weight issues and had a crappy doctor. When he finally tested, he tested TSH only, had to beg for the others----he had me cut down med based on TSH, but by other levels I was extremely HYPO. I freaked- went to another doc who put me on Compounded and I could tell the difference almost immediately. Went up to 3 grains of that. To this day, I do not know what occured then as no one would address my adrenals. I did go off the pill a year ago so my body would absorb my thyroid med better, but that came with it's own set of problems. I had no idea about the Armour situation until I got really bad in Dec '10. Seems everyone else went hypo and GAINED weight.

What you said about age makes sense. lol....I am 47....and I have been eating like an alley cat, well an alley cat who likes sweets and carbs! Thanks again!
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Avatar universal
So, was it about the time of the reformulation that you started having to increase so much?  Could you not get it due to the shortages caused by reformulation?

Cats only eat protein...maybe the alley cat analogy is trying to tell you something!  LOL
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Avatar universal
lol...
I never ran out of Armour, my old pharmacy up here must have had a big supply, but it seemed that things changed when I COULD get it down there in the summer of '10. The second doc said that I lost weight because of the new fillers in Armour, which may or may not be true. I have no way of knowing if I was getting the old Armour or the new Armour from Ohio until June '10, but I never ran out. The switch to compounded (Feb '11) seemed to to the trick for me and i do feel like the new Armour is now poison to me.
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Avatar universal
My bet is the Ohio meds were the old formula, and when it became available again locally, you were getting the new formula.  A lot of forum members had a TERRIBLE time with the reformulation, and how it affected them seemed to be all over the place.  Your doctor might be right.  The huge increase from 2 to 3.5 grains makes a lot more sense now...
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Avatar universal
You know, I was swearing back then that I MUST have been getting OLD Armour from Ohio! Sometime in Jan '11, I was just racking my brains about what could have changed. I suddenly realized all my problems started when I stopped getting my Armour in OH the previous summer. i even called my pharmacist up there asking if he had any idea. he didn't know. No one thought it possible for me to still be getting OLD Armour into 2010, but now I think that was the case too. That has been nagging at me for a long time!! I think my adrenals were involved at the time as well.I am dying to know what my saliva tests say. Thanks a lot....that had continued to bug me :)
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Avatar universal
To anyone reading this thread, when I was on Armour at 2 grains, I took the whole dose at once and did alright with one dose. In hindsight, I may have benefitted from splitting the dose- but again, I did great in any event.

When I went on Compounded and got up to 3 grains, I realized that dose was just too much to take at once and have been splitting my dose ever since.
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Avatar universal
"I did great in any event"

should have said, up until the reformulation.... :(
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Avatar universal
Ok, game plan (IF I can bend someone to my will :) :

This is my fourth day of a much lower dose of NP Thyroid and the change in my thinking alone makes me know the main culprit has been my RT3, also not as weak, sleeping less (which is good) and better spirits. The thing is, on only 3+ days of less NP, I have a boil coming up so far and can expect REAL hypo to hit at any moment. When I lowered this, I had NO real game plan, was just waiting for my saliva tests to get done and get back to the Chiro and into the  D.O. in a week ....I simply needed to feel better QUICK. Thanks for the input, and I have done a lot of reading. I was offered an appointment with the DO's nurse pratctitioner originally and turned it down. Now that the fog is clearing, I realize that if I go to the N.P. with info (and I am told this very N.P. basically looks things up on the internet that she isn't familiar with) and tell her I want about a month of time release T3 (compounded, from my old pharm)- I might be able to get what I want. It took me a year and a half to get what I feel are my perfect ft3 and ft4 and I don't want to blow it now.
Tell me if I am wrong, but I believe that I would get an equal amount of T3 time release to the amount I have shaved off my dose of NP Thyroid: I would have about the same amount of T3 as my optimal dose, just less T4.
I can then work on adrenals if there is a problem....and already working on my Vit D, protein, iron etc.
The past dew days have been a blessing. Best I have felt since before my move. A long way to go, I think but I would be alone in all this if not for this board. These are some tricky problems that most doctors don't seem to know about. Thanks to all here who share their experiences and knowledge with others-  it has made all the difference to me and to many others.

PS. The chiro was supposed to email me about our 1st appt (tues.), I asked him to since I was having memory issues. He didn't. I then called when I noticed he wasn't even testing my female hormones at all, not even in the saliva tests---I asked him to call that lab and ask that to be added. Nothing. I made it clear to him that while I could pay for some tests and office calls, that I had no insurance and limited resources at the moment and also made it clear I had my own vitamins etc......and now nothing. Yup.
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Avatar universal
Tough question.  

Mathematically (theoretically) I suppose that's what you'd do.  I don't know how much good the time release is going to do you because the T3 in your desiccated is not time released.  Perhaps regular T3 would work as well???  Do I remember correctly that you take your desiccated all at once?  Perhaps taking regular T3 away from your desiccated would balance out your day better?  I don't know...just something to think about.

I'm afraid the chiro doesn't really surprise me.  I've always felt that there's a money trail there that's plain as day.  The author of the book I mentioned actually says in the book that treatng thyroid is a good way for chiros to "jump start" their practice.  Well, i guess that makes it pretty clear!  
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