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Assistance Interpreting Reverse T3?

Hello all, I had had some blood work interpreted on here a couple months ago and just last week got some more done (and just received the results). Anyways, as I'm very new here and just recently diagnosed with Hashimoto's Disease, I really have no idea on how to interpret this and would like to ask assistance;


BLOOD WORK FROM APRIL (this doesn't need to be interpreted--I just included it here to refer back to/compare)

TSH (mIU/L)   1.17  Standard range wasn’t listed with this but it was marked as normal in the "Result comments"
T3, FREE (pg/mL)               2.5             [2.3-4.2 Standard Range]
T4, FREE (ng/dL)                1.0             [0.8-1.8]
TG Antibodies (IU/mL)         1               [< or = 1]
TPO Antibodies (IU/mL)       93             [ or = 20 Years    0.40-4.50     Reference Range]
T4, FREE (ng/dL)                   1.0             [0.8-1.8]
T3, FREE (pg/mL)                  1.6             [2.3-4.2] **Flagged as low**
T3 REVERSE LC/MS/MS       25             [8-25 ng/dL]

*Also, as a note, the second round of blood tests was at 9:30 in the morning while fasted, previous one was around 3 or 4 and I had not been fasting. Both were taken sans thyroid medication as I was not prescribed any yet.
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1756321 tn?1547095325
Reverse T3 is the "emergency brake". If you are ill, the body will decrease metabolism and conserve energy. This is called euthyroid sick syndrome - labwork shows low free T3, high reverse T3, normal TSH and normal T4. Your reverse T3 may not be over the range but it's too high at the top cut off range.  SIBO is a listed cause of elevated reverse T3.

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2 Comments
Ahhhhh that makes a lot of sense with the SIBO and reverse T3!
Thank you so much for your explanation Red_Star!
:)
Avatar universal
Wow, you sure do have lots of symptoms that are frequently related to being hypothyroid.  In addition, your TPO ab result  is consistent with Hashimoto's Thyroiditis, although your TSH level is atypical of Hashi's, so there may be something else that is keeping your TSH low even with the low levels of Free T4 and Free T3.  TSH, however, is useful as an indicator only at extreme values.  Symptoms are the most important indicator, followed by levels of thyroid hormone.  

From the first test results, even though your Free T4 and Free T3 were in the range, that does not mean they were adequate for you.    The ranges are far too broad, due to the erroneous assumptions used to establish those ranges.    I have no explanation for the significant change in your second Free T3  test but obviously it is even worse than the first test.   In addition your Reverse T3 is right at the high limit of its range.  Combining that with your low Free T3, the ratio of Free T3 to Reverse T3 is only .64.  Recommended levels are 1.8, or in some sources, 2.0.  So you can see just how low your ratio is.  

I hope that your doctor is not one that only pays attention to TSH.  If there is any hesitation about starting you on thyroid med,  click on my name and then scroll down to my journal and use the one page overview, and the link included, to try and get your doctor to treat clinically, by adjusting your Free T4 and Free T3 levels as needed to relieve hypo symptoms, without being influenced by resultant TSH levels.   Most of us have found that we needed Free T4 at least mid-range, and Free T3 in the upper part of its range, and adjusted from there as needed to relieve symptoms.   In view of your low Free T3 in the last test, I would ask the doctor for a desiccated type of thyroid med containing both T4 and T3, like NatureThroid or Armout Thyroid.  

Also, hypo patients are frequently deficient in Vitamin D, B12 and ferritin.  So you need to get those tested and then supplement as needed to optimize.  D should be at least 50, B12 in the upper end of its range, and ferritin should be at least 100.  All three are very important to a hypothyroid patient.    Low D and ferritin are also  factors in excess conversion of T4 to Reverse T3.   You can read about Reverse T3 in the link, Recommendation 11 on page 12.  
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5 Comments
Thank you for your response! No my doctor is actually a very god internist and has taken everything into account here. I believe the drop in fT3 is due to my SIBO treatment I'm currently going through--the antibiotics I'm on make me extremely nauseous and I am unable to eat much at the time.  

Yes! I absolutely was Vitamin D deficient and am supplementing presently as well as B12 (which was in range, but probably not as high it should be for me), ferritin was 31. Thank you for the link! I will absolutely need to read up on that!

What do you recommend for raising ferritin levels?
The best supplement for ferritin is Vitron C.  It contains vitamin C to prevent stomach distress from the iron.  
Gimel, where did you read vitamin C prevents stomach distress from iron supplements? I know vitamin C increases iron absorption but no mention of anything else in regards to iron. I was taking Ferrograd C tablets which is a modified-release tablet and iron is released slowly over the day to reduce the digestive side effects.
Yes, the Vitamin C helps with absorption, and in doing so it is reported that the iron  does not stay in the digestive tract any longer than necessary causing irritation.   I have seen numerous mentions from people taking iron that also taking Vitamin C or just orange juice helped them to avoid stomach distress.
That's understandable. Vitron C states this in regards to stomach upset: "If stomach upset occurs, you may take this medication with food. Avoid taking antacids, dairy products, tea, or coffee within 2 hours before or after this medication because they will decrease its effectiveness."
Avatar universal
There is much to discuss, but first please tell us about symptoms that you have.    
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1 Comments
Of course! The symptoms that I started having in late beginning of 2016 were/are; Recurring constipation (regardless of fiber/water in take) and an overall sensation of slow digestion (now known to be SIBO), weight gain (went from 113lbs to 131lbs), dry skin and dandruff, always cold (even in upper 70's F), raynauds phenomena, gluten and lactose/dairy intolerances, weak fingernails, orthostatic hypotension (low blood pressure), I've noticed my heart rate (via my fitbit) to be as low as in the 40's, overactive bladder, recurrent migraines, acne (the last two may also be SIBO rather than Hypo), random joint and muscle aches/pains, feeling of numbness in fingers, heart palpitations (I've had these as long as I can remember though), this weird pain or soreness at the front of my neck, dry eyes and throat (always, no matter how much water I drink), irregular menstrual cycles (often lasting 8-10 days in length), terrible "brain fog" and inability to concentrate, vertigo/dizziness sensation of weakness and an EXTREME sense of fatigue...sleeping like 10-11 hrs a night and feeling like I can barely make it through the work day fatigue (I used to go to the gym every morning before work but I haven't been able to do this the couple months out of fatigue, extreme weakness and general malaise--though some of this is due to my SIBO treatment).
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