Thyroid Lab result question

[tpre]

I have Hashi's and can't seem to get levels stable.
FT3 / RT3 ratio is really high. (0.44) The last two times I have tested my RT3 keeps dropping

FT4 1.08 NG/DL ref range 0.80-1.90
FT3 4.6 PG/ML ref range 2.2-4.2 HIGH
RT3 10.4 NG/DL ref range 9.0-27.0

[flyingfool]

I think rile of thimb is for  it D to be 60 or above, ferritin over 60 to 100 so that looks good.

Your B12 is low. Many countries the bottom of the range is 500 and many people dont feel well until over 700 if not 1,000. So you have plenty of room to improve safely with B12

Reverse T3 ONLY is made via the conversion of T4 to T3.

So having  high RT3 may cause blocking the cell receptors for active freeT3. Just another controversial theory. But possible given the F3/RT3 ratio.

RT3 increases with stress, either mental or physical or both. More investigation of cortisol makes sense as it is a stress hormone.  

Are you an extreme as in like marathon runner or athlete?  Have you gained or lost a large amount of weight over a short time recently? I ask those questions as these things can cause an inability for FT3 to penetrate the cell walls. At least that is what I have read in at least one cedible study.

T3 pooling I don't know much about but also sounds plausible.

[gimel]

I identified a couple of possible causes for your symptoms in consideration of your test results, so please review those.  In turn please post a link to the information about about hyperparathyroidism possibly being related.  

[gimel]

IIn the words of an excellent thyroid doctor, "in tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range".   Your latest set of labs is not too different from that description except that you still have all the hypo symptoms.  This makes me think of two scenarios.  One is that you have Thyroid Hormone Resistance (THR) and may need to add some T3 to your med to see if that improves symptoms.  The second one is "pooling of T3 in the blood" so that it is not getting into cells.  The two main causes of pooling that I have read about are low iron and high/low cortisol.   That is why I asked about those tests.  

You said, "The last time checked it was at 13.2 @ 8 AM".  Assuming that is cortisol , what was the reference range shown on the lab report.  

Also, I have a couple of links for you to review, related to "pooling of T3 in the blood".  That scenario is somewhat unusual, but it seems to be a possibility, in view of your symptoms and test results.  Note in the second link a high/normal  ferritin with low serum iron, indicating that you may need to get a full iron panel.  You may also want to get a diurnal salvia cortisol panel of 4 tests.  If your doctor won't do that you can find online sources that will send you a kit to collect samples.    

https://eaware.org/thyroid-gland/

http://www.thyroidrt3.com/tissue.htm

[tpre]

Sorry yes it was 8 AM Cortisol 13.2 UG/DL Ref range 4.8-19.5 I went back and looked at the last 4 blood test over a year and the FT3 / RT3 ratio for the 3 test prior all looked ok with high FT3 but this last one has me so confused. I am not finding any information on-line as to the scenario for this. The only scenario I found was due to hyperparathyroid.

[Red_Star]

Excerpt from Dr Western Child's article "REVERSE T3 TREATMENT GUIDE + HOW TO “FLUSH” IT OUT OF YOUR BODY & START FEELING BETTER...

"What about Low Reverse T3?

Though I didn't anticipate this would be a big question, people have been asking me about low reverse T3.

So let's talk about this for a second:

Is Low reverse T3 a bad thing? Does it need to be treated?

In order to answer the question we need to consider what low T3 actually means.

Low reverse T3 means that you have LESS thyroid binding competition at the cellular level.

Low reverse T3 means that free T3 will be able to bind to nuclear receptors and turn on genetic transcription that influence the changes associated with thyroid hormone.

So is having low reverse T3 a problem?

For a short period of time, I don't think that having low reverse T3 is a problem and in fact I think it's actually a good thing.

But like all good things, too much can be a problem.

Remember that reverse T3 is created by your body as a compensatory mechanism which is meant to throttle back thyroid hormone in times of need!

You don't want to completely shut off this system by FORCING reverse T3 as low as you can go forever.

Instead a better approach is to "flush" the system out, lower reverse T3 levels for a short period of time, and then allow your body to naturally balance out T3 and reverse T3 levels.

Persistently low levels of reverse T3 may cause hyperthyroid symptoms if left suppressed for a long duration of time."

[gimel]

Please post the actual test results for the C, B12 and ferritin.  Also, have you ever been tested for cortisol?

[tpre]

I had a real scare with my adrenals 10 yrs ago so we check levels a couple times a year if I feel it may be a problem.
The last time checked it was at 13.2 @ 8 AM, I'm doing fine with the adrenals.

Vit D   52
B12   556
Ferritin   103

[tpre]

I must say that 2 yrs ago they found thyroid nodules and so this may be a clue, I'm just not finding any information with low RT3 low normal FT4 and HIGH FT3,

[tpre]

I currently take 227.5 mg of Nature-throid

[gimel]

The most important consideration is always symptoms.  So please tell us what symptoms you have, if any?  Also, what time was the blood draw for those tests, and did you take your thyroid med the morning of the test?  What is your thyroid med and dosage?   If tested for Vitamin D, B12 and ferritin please post those results as well.

[tpre]

My symptoms mimic hypo.. weight gain, freezing hands and feet, slight depression and dizzy but not extreme. The blood draw was 8:30 am fasting and no meds for 24 hours. Vit D, B12 and ferritin are good. My last labs 3 mo ago reflect the same scenario so I lowered my dose a little. Previous labs
FT4    1.32
FT3     5.2  High
RT3     18.2
I have never had this happen so it is concerning, My FT3/RT3 ratio has always been a little high (28 to 32) but this really has me puzzled.