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Avatar universal

high Rt3, ratio, and out of range labs

Brand new to site and new to detailed Thyroid info. labs out of range/ratio. Very confused. Help please!

History: diagnosed LADA (T1 diabetes) 3 years ago. On insulin and metformin. Started thyroid meds about same time.
Currently on Tirosint 88 and have been on this amt for over 1 yr.
Recent past FT3 labs (two separate testings over the last month or so) came back:
2.2 L        (Range 2.3-4.2) with
TSH .875  (Range: .350-5.500)

Dr. prescribed 5 cytomel without much more info. Started some reading re thyroid. Did not start cytomel as I wanted additional testing. So...

Redid FT3 test again with additional tests last week. These most recent labs came back as follows:

TSH: 0.337 L (Range .350-5.500)
FT4:  1.65     (Range: .89-1.76)
FT3:  2.4       (Range:  2.3-4.2)

Anti-TG  <20  (Range <41)
TPO       33    (Range <61)
Thyroglobulin (TG)  2.4  (Range: <55)

RT3:    443 H   (Range: 90-350)

Iron Serum: 67 (Range:30-170)
TIBC: 284        (Range: 250-450)
Ferritin: 48       (Range: 10-291)

Vit B12:  1219 H  (Range: 211-911)
Vit D 25:  50.5     (Range: 30-100)

What does all this mean--the very high RT3 and Vit B!2, especially? My Dr. keeps saying I have Hashi's, but do the labs indicate this? interpretation and some direction would be so appreciated!!

Thank you!
27 Responses
Avatar universal
Three years ago when you were started on thyroid med, what were your test results at that time?  On what basis did the doctor decide you needed to go on thyroid med? What symptoms, if any, were you having then?  
Avatar universal
TSH was 2.441 (Rr: .350-5500)
Thank you for replying!
Worried I should never have gone on Thyroid meds in first place!
Avatar universal
Oh, and TPO and anti-TG results were very similar to most recent ones (posted above). Only symptom would have been an afternoon crash (4pm tired), however who knows whether that was due to blood sugar swings untreated at that time,
At the time, Dr. mentioned Hashi's and also said my thyroid was not in "optimal" range.
I hope I have answered your questions.
1756321 tn?1547098925
Your doctor would suspect Hashimoto's thyroiditis even with negative antibody levels as you have type 1 diabetes. And since you have high vitamin B12 serum another suspect is autoimmune pernicious anaemia (see study below on this*). This may nor may not be the case but it is something to consider since these autoimmune diseases are genetically linked. I found an article on causes of reverse T3 and insulin dependant diabetes is a listed cause of elevated RT3.


"Most patients with Hashimoto’s thyroiditis have measurable antibodies in the blood, with ~90% of patients having positive TPO antibodies and ~50% of patients having positive thyroglobulin antibodies. About 5 % of patients with a diagnosis of Hashimoto’s thyroiditis based on clinical grounds or by ultrasound appearance have no measurable thyroid antibodies." - Patients with Hashimoto’s thyroiditis and negative thyroid antibodies have a milder form of the disease - Clinical Thyroidology for the Public > Vol 7 Issue 9 > Vol 7 Issue 9 p.10-11


"Other causes of reverse T3 dominance include: leptin resistance, inflammation (NF kappa-B), dieting, nutrient difficiencies such as low iron, selenium, zinc, chromium, Vit B6 and B12, Vit D and iodine, Low testosterone, low human growth hormone, Insulin dependent Diabetes, Pain, Stress, environmental toxins, Free radical load, Hemorrhagic shock, Liver disease, Kidney disease, Severe or systemic illness, severe injury, Surgery, Toxic metal exposure." - Custom Medicine - Reverse T3 Dominance


The following info is from the book "The Everything Guide To Thyroid Disease" by Theodore C. Friedman, MD, PhD and Winnie Yu Scherer:

"Although the majority of people with Hashimoto's will not develop any other disorders, it's important to know what some of these autoimmune conditions are in case you do start to experience symptoms. Keep in mind, too, that you may be more likely to develop Hashimoto's if you have one of these other conditions.

Type 1 diabetes
Pernicious Anaemia
Addison's Disease
Celiac Disease
Alopecia Areta
Systematic Lupus Erthematosus (SLE)
Rheumatoid Arthritis
Sjogren's Syndrome
Inflammatory Bowel Disease
Multiple Sclerosis (MS)"


*Excerpt from The New England Journal Of Medicine - Spurious Elevations of Vitamin B12 with Pernicious Anemia:

"Within a 3-week period, two women, 46 and 48 years of age, presented with peripheral neuropathy and associated pancytopenia with macrocytic anemia. Clinical suspicion for pernicious anemia was high, but vitamin B12 levels were 1644 pg per milliliter (1228 pmol per liter) and 1321 pg per milliliter (975 pmol per liter), respectively (reference range, 246 to 1320 pg per milliliter [181 to 974 pmol per liter]).

On subsequent bone-marrow evaluation, specimens from both patients showed profound megaloblastic features. Additional findings on laboratory tests included elevated levels of homocysteine and methylmalonic acid combined with detection of intrinsic factor–blocking antibodies and antiparietal-cell antibodies, which further supported the diagnosis of pernicious anemia."


This is my info I found online from various sources that I put together...

Increased vitamin B12 serum may be due to:

* Supplementing with vitamin B12/high dietary intake of vitamin B12
* Active (functional) vitamin B12 deficiency
* MTHFR genetic defect
* Polycythaemia Rubra Vera  
* Leukaemia:
- Chronic myelogenous leukaemia aka chronic granulocytic leukaemia
- Acute myeloblastic leukaemia
- Acute promyelocytic leukaemia
* Hypereosinophilic syndrome
* Myelosclerosis
* Carcinomatosis
* Liver disease:
- Acute hepatitis
- Cirrhosis
- Chronic liver disease
- Hepatic coma
* Non-leukaemic leucocytosis
* Chloral Hydrate

Avatar universal
Thank you for your reply, Red Star.
You are very helpful and kind to take so much time to provide info. Honestly It's so much information. I'm wondering what my next steps should be. I would love some guidance.

More info that might be helpful:

1. Was supplementing with a multi B and B 12 vitamin. Have cut that back since high B12 result;
2.. Have an appt with an integrative Dr (instead of my regular endo), to address thyroid, as I'm concerned over endo's handling of thyroid. Since last result, cut my Tirosint to 75 (since I had some left over from before Dr. increased me to 88 a long time ago);
3. Diet/lifestyle is healthy: exercise, don't drink, eat real unprocessed foods, and due to T1 diabetes--low carb. (I did read that low carbing can cause lower T3, but not sure of extent.) Prior to T! diagnosis, was a bit underweight (5'5" at 104lb). With insulin I've climbed to 112.

Thank you!
Avatar universal
Immediate concerns are High B12 and Hyperthyroidism

I would have them drop back your thyroid hormone just a little bit and Have them run a Folate RBC.
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1756321 tn?1547098925
Queensland, Australia
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