Reverse T3 Treatment Guide + How to "Flush" it out of Your Body

Reverse T3 Treatment Guide + How to “Flush” it out of Your Body & Start Feeling Better

Reverse T3 could be the missing link to finding out why you still have hypothyroid symptoms despite taking thyroid medication. 

Or why you feel terrible with "normal" lab tests...

The crazy part is that most Doctors don't even order Reverse T3 and even if they do most aren't sure what to do with the results. 

And high levels of Reverse T3 could be acting to slow down your metabolism, reduce thyroid function at the cellular level and result in full-blown symptoms of hypothyroidism.

That's why it's so important for you to understand the basics of Reverse T3 and thyroid function so you can be informed when you see your Doctor. 

And don't worry:

I am going to make this easy on you by giving you all of the information you need to know about Reverse T3 including:

  • How to tell if you have too much Reverse T3 in your body
  • What blood tests you need to have your Doctor order and how to calculate your Free T3:Reverse T3 ratio
  • What causes high levels of Reverse T3
  • How to "flush" out high levels of reverse T3 and how I treat patients with Thyroid resistance and high levels of Reverse T3 in my office


What is Reverse T3 Anyway? 

Are you new to this whole thyroid thing?

No worries, I'm going to make this easy on you.

There's a lot of information out there (much of it conflicting), and it's easy to get lost in the sea.

What it boils down to is this:

Reverse T3 is a hormone metabolite that is created from the T4 thyroid hormone (1). And it looks something like this: 

Thyroid hormone metabolism

Your body basically has the option of converting T4 into the ACTIVE thyroid hormone T3 or the INACTIVE thyroid metabolite Reverse T3. 

Much like the image above, it's sort of like a fork in the road. Your body is constantly deciding which direction it is going, left or right. 

If most of the T4 in your body goes down the ACTIVE T3 pathway, then your tissues get the thyroid hormone they need and everything is good.

If too much goes down the INACTIVE Reverse T3 pathway, then the active thyroid hormone is BLOCKED and you may become symptomatic

Sounds pretty simple right? 

T3 hormone = Good

Reverse T3 metabolite (in high amounts) = Bad

Now that we know what we want the body to do, let's focus on doing the things that help your body convert T4 into the active T3 hormone and NOT the inactive Reverse T3 metabolite. 

Download my Free Resources:

Foods to Avoid if you have Thyroid Problems: 

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

How to Calculate "Optimal" Free T4, Free T3, & Reverse T3 Ratio: 

Calculating these ratios is important because it can help you determine if your efforts are on the right track and whether or not your medications are working. 

Download more free resources on this page

Why does your Body even have Reverse T3? 

That's a great question and answering it will help you understand why, in certain situations, your body will create too much of it.

Reverse T3 is meant to be there acting as a "Brake" on your metabolism (2) during times of EXTREME stress.

Let's look at chronic illness as an example:

When your body is recovering from an illness (like pneumonia or a bloodstream infection) does it make sense for your body to increase the metabolism and provide energy to your muscles? 

Of course not! It makes more sense to conserve your energy and metabolism by SLOWING down energy production and providing energy to vital organs

This is a protective mechanism built by your body and it may surprise you that it has a name and is well documented in the scientific literature. 

It's knwon as euthyroid sick syndrome.

Euthyroid sick syndrome definition

Patients that are under stress develop this condition which results in LOW Free T3 levels, HIGH Reverse T3 levels and NORMAL T4 and TSH levels

Hmm... Does this sound like your lab results???

You see: 

Despite the fact that EVERY Doctor has learned about euthyroid sick syndrome most believe that it's a phenomenon only seen in hospitalized patients. 

But, we are seeing more and more, that patients with multiple chronic medical conditions present with the same lab tests as those who are hospitalized. 

Studies like this one (3), shed light on the fact that other conditions, such as calorie-restricted diets, can lower free T3 levels and INCREASE Reverse T3 levels and cause changes in thyroid function that resemble "sick euthyroid syndrome". 

Are you Pooling Reverse T3 in your body?

Now that you know you want Reverse T3 levels to be as LOW as possible the next thing you need to know is what CAUSES the high levels, to begin with. 

Before we jump into the causes it's important to know how high reverse T3 tends to present from a symptom perspective (This can help you understand if it's even something you need to worry about). 

As you might suspect, the higher Reverse T3 is in your body the lower your metabolism will be and the more weight you may gain. 

Patients with high levels of Reverse T3 tend to have one or more of the following symptoms:

  • Lower than normal metabolism
  • Constant weight gain without changing eating habits
  • Crushing fatigue
  • Symptoms of hypothyroidism
  • Chronic pain
  • Depression, anxiety and/or bipolar disorder

These are the most common symptoms, but realize that each person presents in a different way. 

For instance, I've seen people with high levels of reverse T3 present with the complete inability to lose weight and with severe depression.

If you have one or more of the following symptoms it's going to be VERY important for you to get your Reverse T3 levels checked and consider the treatment options below...

But first:

What causes elevated Reverse T3 levels, and what should you look out for? 

In my experience these are the most common reasons that people have high levels of Reverse T3:

  • Calorie-restricted dieting - Especially HCG diets or VLCD (very low-calorie diets). These diets (4) have been shown to reduce metabolism, increase reverse T3 and make permanent weight loss almost IMPOSSIBLE. 
  • Chronic illness and infections - This includes viral infections like infectious mononucleosis (5), bacterial overgrowth syndromes like SIBO and even chronic illness like cancer, cardiac/heart disease, arthritis, diabetes and even obesity itself. 
  • Chronic Inflammation - ANY cause of inflammation can result in decreased T4 to T3 conversion (6) and higher levels of Reverse T3. Inflammatory states include any untreated autoimmune disease, leptin resistance, insulin resistance, intestinal dysbiosis, cancer, etc. 
  • Chronic untreated Gut infections/Imbalances - Up to 20% of T4 (7) is converted to T3 in the gut, which means if you have gut issues you may be missing out on up to 1/5th of your conversion power. Gut imbalances include SIBO, dysbiosis, reflux/GERD, yeast overgrowth, history of chronic antibiotic use and inflammatory bowel disease. 
  • Emotional and physiological stressors - This includes social issues like the death of a loved one, family problems, divorce, etc. And it also includes trauma: psychological (PTSD) and physical (motor vehicle accidents, TBI or otherwise). Read more here. (8)
  • Certain Medications - The most common medications causing elevated Reverse T3 include Blood pressure medications, diabetic medications, anti-seizure medications, narcotics, and antidepressants. A common example is the use of beta blockers which can be used to treat the symptoms of Hyperthyroidism (9) and they are commonly used to treat blood pressure (10). 
Inflammation and T4 to T3 conversion

I know, I know... 

I said I wasn't going to get technical and I did anyway.

I apologize but it's important to know why many people are suffering from this issue. Chances are very high that you fit into one or more of the categories above and it's highly unlikely that anyone has ever looked at your Reverse T3 level.

Everything you need to know about Testing for Reverse T3

Luckily it's pretty straightforward to test for Reverse T3.

There is a serum marker for Reverse T3 that most standard lab companies can run.

The tricky part can be understanding and interpreting your results. 

Before we talk about ranges you need to understand how these lab tests all fit together with one another:

One of the main reasons Doctors fail to recognize the importance of certain thyroid lab tests is that they look for thyroid studies in the "normal range" as opposed to the "optimal range". 

If you haven't already please read this post which outlines the difference between being "normal" and being "optimal" as it relates to your hormones.  

To start you will want to get a full thyroid lab panel which includes: TSH, Free T3, Free T4, Reverse T3, TSH and antibody levels

Euthyroid sick syndrome lab values

As you can see from the image above, you can have high levels of Reverse T3 and most of your lab tests will likely not be outside of the "normal" reference range provided by the lab testing guidelines.

But this doesn't mean that your thyroid is necessarily working properly. 

To determine if that is the case you will need to look at all of the tests and look at how they fit into the 'big picture'. 

One of the most obvious changes to notice, in the image above, is the difference and spread between Reverse T3 levels and the Free T3 levels. 

You can see that as Reverse T3 levels rise, free T3 levels will fall and this difference is the most dramatic when compared to the other thyroid lab tests. 

For this reason, these two lab tests are critical evaluating thyroid function. 

You can determine the "spread" between these two values with a simple calculation which will give you the ratio of reverse T3 to free T3.

In an ideal world, you want your Free T3 levels to be as high as possible (generally upper 1/2 to 1/3 of the "normal" reference range) and you want your Reverse T3 levels to be as low as possible. 

This lab pattern allows for less competition at the cellular level and will allow for T3 to do its job. 

In most patients, I find that a reverse T3 less than 15 to be ideal

But remember that it's possible to have a "normal" Free T3 and VERY abnormal "reverse T3" which is why the ratio is so important.

To calculate your Free T3: Reverse T3 ratio simply divide the numbers.

Your ratio should be > 0.20. 

Any ratio < 0.20 indicates TOO much reverse T3 to Free T3 and means that you should focus on either increasing your free T3 or reducing your reverse T3. 

How to "Flush" Reverse T3 out of your body

You need to realize that treating your Reverse T3 problem is only effective if you treat the UNDERLYING cause. (11)

If your high levels of reverse T3 is secondary to insulin resistance and diabetes and you don't change your diet, then even with treatment your high levels will come right back. 

For this reason, it's very important to find the underlying cause before you initiate treatment - because part of your treatment needs to be focused on that particular issue.  

Having said that, there are definite ways to lower Reverse T3 levels quickly...

I've split treatment into 3 main categories: 

1. Thyroid Medications to Reduce Reverse T3

The fastest and easiest way to get rid of excess Reverse T3 is with bioidentical hormone formulations that contain pure T3. 

This would include medications like liothyronine, Cytomel or sustained release T3 (available from compounding pharmacies). 

The reason this approach works so well is that when you give your body T3 hormone directly it suppresses T4 automatically which reduces the substrate that your body uses to create reverse T3. 

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Naturally what will happen with T3 supplementation is that your T4 levels will decrease, your Free T3 levels will increase and your TSH will drop.

While on T3 thyroid medication it's important to monitor Reverse T3 closely, at least once every 6 to 8 weeks. 

Typically within 2 months (and assuming your dose of T3 is high enough) your reverse T3 should drop to less than 10.0. 

As I mentioned above, this is by far the fastest way to reduce Reverse T3 - but it's important to still seek out and eliminate the CAUSE of your high reverse T3 levels otherwise they will just come back once you stop taking T3 medication. 

You can find more information about T3 dosing in my weight loss and mastery guide where I have videos that walk you through the process (including how to titrate your dose, how to evaluate your labs and more).

NDT & Reverse T3 Levels

Can NDT be used to help flush out reverse T3 levels in the body? 

It certainly can help but there are a few things to realize when trying to flush out reverse T3 levels while using NDT:

  • Each grain of NDT has about 38mcg of T4 and 9 mcg of T3 - that means that NDT still primarily consists of T4. 
  • In order to flush out the reverse T3, you must lower the substrate of T4 which generally means lowering your total dose of T4, in most cases that means dropping your total dose of NDT
  • NDT dosing is static meaning you can't individually alter the concentration of T4 and T3 unless you add medication to the NDT

With these considerations, and if you are on NDT but still experiencing high reverse t3, it's usually best to decrease your total dose of NDT and add T3 in addition to the NDT. 

For most patients, dropping NDT down to 1-1.5 grains is usually sufficient.

But, remember this:

Simply manipulating the reverse T3 number by changing medications does NOT treat the cause of the elevated reverse T3, to begin with, and if you don't treat the underlying cause your levels will increase once you go back to your full dose of NDT.

2. Supplements to Enhance T4 to T3 conversion

In addition to medications, every thyroid patient should also consider utilizing nutritional supplements.

The reason is simple:

The hypothyroid state sets the body up for certain nutrient deficiencies and since most people are under-treated, most people also have these deficiencies.

Low thyroid = low stomach acid = decreased absorption of nutrients and puts you at increased risk for developing GI imbalances which further impairs absorption

You can check out this post here for more info about which supplements you should consider using and how to check to see what your body needs. 

When it comes to thyroid conversion we only want to focus on a few certain nutrients:

The two primary supplements that you should focus on are Zinc and Selenium. Both of these supplements have been shown in some clinical studies (12) to increase T4 to T3 conversion, thereby potentially decreasing reverse T3.

We aren't as concerned about supplements to promote thyroid production (such as Iodine and L-Tyrosine) because that isn't the problem with conversion issues (it may be for some but not for the majority). 

If your Doctor isn't willing to change your medication you can check out this post for more info on how to naturally increase your Free T3 levels. 

3. Reversing Hormones that promote T4 to Reverse T3 Conversion

As you are probably aware your hormones all work in tandem with one another. 

This means that as one system slows down it may drag down other systems or cause an increase in other hormones to make up for the deficit.

This holds true with thyroid hormone and leptin/insulin levels.

The link between these three hormones is clear:

This is VERY important because hypothyroidism leads to a state where developing both insulin and leptin resistance becomes much easier. 

Why do we care?

Because insulin and leptin resistance cause inflammatory states which contribute to T4 to reverse T3 conversion.

Not only do they cause high reverse T3 levels but they also make weight loss very difficult.

Is this sounding familiar now?

Patients with high reverse T3 levels almost always have high fasting insulin and high fasting leptin levels.

In fact, I have never seen a patient with a reverse T3 > 25 with a normal insulin/leptin level.

Leptin resistance labs
Fasting insulin and hypothyroidism

You can see examples from several patients above showing abnormal reverse T3 levels, high fasting leptin and high fasting insulin levels. 

These values may fall within the "normal" range but they are far from normal and will lead to symptoms of hypothyroidism, weight gain and weight loss resistance

Another big reason I want to talk about these hormone imbalances is that Doctors don't frequently run tests on either of these hormone imbalances. 

Providers will check a Hgb A1c but rarely do they order fasting insulin and fasting leptin levels.

This means that if you have known high levels of reverse T3 (by the way, they don't always order this test either), it's probably going to be up to you to request these specific hormones.

Treating and reversing both insulin and leptin resistance is very important for not only lowering reverse T3 but maintaining low levels of reverse T3 over time. 

To learn more about how I address these hormone imbalances (including treatment options) please see the following case studies below:

These case studies provide a step-by-step walkthrough of how to approach leptin and insulin resistance including medications, hormones, and supplements designed to help both conditions. 

If you know you have insulin resistance then you can consider using these supplements to help lower your levels: 

  • Berberine: Helps reduce cholesterol, improve fasting glucose and may help with weight loss.
  • Alpha Lipoic acid: Helps sensitize the body to insulin and may help to reduce nerve damage in certain patients
  • Chromium: Helps improve insulin sensitivity to cells and may help reduce cardiovascular disease in certain patients. 

If you prefer the natural approach to treating leptin levels you can find more info here on how to target supplements towards OTHER imbalances for the most benefit

Most leptin supplements don't work unless they are used correctly.

4. Addressing Inflammatory Levels and "Cooling Off" Your Body

Everyone knows inflammation is bad for the body (15), but very few people understand how it makes things worse and more importantly how to treat it if present.

Part of the reason for this is because the markers we use for inflammation are non-specific.

That means most of the time we know inflammation is present, we just don't necessarily know where it is coming from.

Sure, in the presence of other abnormalities we might be able to take a guess, but we will rarely ever know with 100% certainty.

 But how does inflammation relate to thyroid function and reverse T3 levels? 

Thyroid conversion with leptin resistance

It turns out that inflammation directly promotes the production of Reverse T3 (16) from the substrate T4 resulting in high levels of Reverse T3 over time. 

So if you have high reverse T3 levels you need to be actively searching for sources of inflammation and treating the cause directly. 


How do you test for inflammation? Check the following blood tests...

  • CRP: You want this to be as low as possible but definitely < 1.0 for optimal thyroid function
  • ESR: Another non-specific marker of inflammation (17), for optimal thyroid function this should be < 10
  • Ferritin: Both a marker for iron stores and an acute phase reactant (18) this marker can be used in certain instances to help isolate non-specific inflammation in the body

These are non-specific serum markers and may indicate that inflammation is present somewhere in the body. 

If you know that you have both high levels of inflammation AND high levels of reverse T3 then you can safely assume that the inflammation is likely worsening your thyroid function.

The next step is to find where it's coming from.

In hypothyroid patients it's usually in these three places:

  • Hormone imbalances (especially insulin and leptin resistance): Please refer to the section above to understand how to both diagnose and treat these conditions. 
  • Undiagnosed gut imbalances like SIBO and SIFO: Both of these gut issues promote inflammation (19) in the GI tract and lead to increased intestinal permeability. You can find more about both here
  • Undiagnosed food sensitivities: These sensitivities promote inflammation (20) and further food sensitivities unless treated. 

Bottom line?

If you have both high reverse T3 and elevated serum markers for inflammation you should be looking at the 3 main causes above and treating those if applicable.

If you don't know where the inflammation is coming from you can still do some good by taking supplements designed to help reduce inflammatory levels and promote the "clean up" of breakdown products in the liver:

This approach isn't ideal but it's better than simply ignoring it.  

Remember to work with your Doctor if you suspect you have an inflammatory process contributing to your high reverse T3 levels.

5. Lifestyle changes to Balance Hormones and Promote Thyroid Function

Never underestimate the power of these 4 major areas when it comes to your health:

  • Getting 7-8 hours of quality sleep per night
  • Reducing and managing your stress
  • Daily low-intensity exercise and episodes of high-intensity exercise 1-3x per week
  • And a balanced diet full of real, whole foods

If you don't practice these 4 basic things it doesn't matter what you do - you WON'T get better. 

These are particularly important for those with high Reverse T3 levels. 

Remember that your body is a NETWORK of systems and hormones that all interact with one another. 

When one system isn't working properly, it will bring other systems down as well.

Often times boosting thyroid function with steps 1 and 2 above while improving these 4 areas is enough to bring balance back to other hormone systems. 

That means you may find your menstrual cycle become more regular (as estrogen and progesterone balance), your belly fat to shrink (as cortisol level regulate) and your lean muscle mass increase (while testosterone levels out and insulin levels drop).  

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 these questions, we need to consider the function of reverse T3 and how it operates in the body. 

If you have a state of low reverse T3 that means that there will be less competition for thyroid receptors at the cellular level. 

This state will allow free T3 to bind to nuclear receptors and turn on genetic transcription which is exactly what you want to happen. 

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, there may be reason to believe it's 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 for an indefinite amount of time. 

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.

Final Thoughts

High levels of Reverse T3 can be a very serious issue for many thyroid patients and may help explain why you've been consistently symptomatic and resistant to weight loss despite taking thyroid medication. 

In order to diagnose high levels of Reverse T3 and thyroid resistance, you need to look at both serum levels of Reverse T3 and Free T3.

Measure your ratio of these hormones (as this is the most sensitive marker for tissue levels of thyroid hormone). If your Free T3/Reverse T3 ratio is < 0.2 you have TOO much Reverse T3 in your body.

The best treatment for reducing these levels is by taking pure T3 thyroid medication, taking supplements to increase T4 to T3 conversion and by making the appropriate lifestyle changes to balance other hormones in your body.

Doing these things will finally help your body get back into balance and get RID of your hypothyroid symptoms.

Now I want to hear from you:

Do you have too much Reverse T3 in your body? 

Have you tried pure T3 medications like Liothyronine or Cytomel?

Did they work for you?

Leave your comments below!

References (Click to Expand)

how to flush reverse T3 out of your body

About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 70,000+ people have used them over the last 6 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

P.S. Need more help? Check out my free thyroid downloads and resources.

537 thoughts on “Reverse T3 Treatment Guide + How to “Flush” it out of Your Body & Start Feeling Better”

  1. Hi

    I have no thyroid but have Hashimoto’s Hypothyroid. Recent blood tests were TSH=.08 , T4=7.61 and t3=4.9….no reverse T3 run. Have to wait til July when I see new endocrinologist. These numbers seem good to me. Thoughts?

    • Hey Patty,

      People get too obsessed with lab numbers when trying to treat the thyroid, they are not 100% accurate and therefore only represent a small part of a larger picture. I don’t recommend basing treatment off of lab tests alone.

      • Hi there, awesome article. I have high reverse t3 and boarder line low thyroid levels and I have never been on any thyroid medication so I’m just wondering if when you say “clearing out reverse t3” you mean it as it can be a temporary treatment that you use to clear the build up and then stop and have your thyroid revert back to normal and healthy.. Or would you have to be on it permanently?

        • Hey Madison,

          I’m glad you liked the article. Obviously each patient is different, but some patients can flush out the system and have a return to normal (assuming they also treat the cause of the high reverse T3 in the process), while others may need therapy long term – it just depends.

          • Awesome thanks so much for getting back to me you are awesome! What if people have low/normal T4 as well as low/normal T3 and high/normal Reverse T3… In this situation is it usually better to use the NDT + T3 option so you are still getting the T4?

            I have sent and email through your site I really hope it gets to you 🙂

      • Hi. I need advice. My reverse t3 is 44. Also my free T3 is 2.4. Been to two doctors. One prescription was for T3 , 5mg 2x per day. The second opinion was a functional approach because my pregnenolone is low, 59. Please help me decide which course to take. Thank you!

      • Hello, thanks so much for the article. I’ve had hypo symptoms for years, started after the birth of my 2nd child when I just couldn’t lose weight and had hair loss(all the hypo symptoms) but my results are always in the normal range although low on the range when not medicated, normal when medicated. There are 4 of my family members with hypothyroidism. I am just not classed as being hypo as my T4, T3 and TSH comes back normal. I have the classic moon face, swollen neck and also often swell up. I got so poorly that I chose to self medicate eventually with NDT. I was cutting out physically. I had gestational diabetes in my last two pregnancies and was pretty insulin resistant. Starting a low carb diet now. Was told by an endo I saw during pregnancy that my reverse T3 was high but I’ve had no treatment here in regards to my hormone/thyroid issues or investigations. I think doctors think I am making it up. I also often have inflammation markers in my bloods. I am in the normal rage for rheumatoid factor but it’s really near the threshold. Had elevated C-reactive protein in the past but not at present. Had lots of back, joint pain issues over the years. Low vit D, prone to low iron but not had that checked in ages. My stomach is also swollen a lot, so much so I got asked if I were pregnant the other day and I am not. No chance of getting any type of sustained release t3 as uk based. Can you advise the best supplements to take to increase my immune system please?. It’s impossible to lose weight. Or I do for a bit and then put more on. I’ve gone through stages where I have exercised loads and actually put on weight! Done diets where I have put on weight.

      • I have been on t4 for a long time and had all the symptoms of hypothyroid, infact it was horrible as the doctor initially gave a very high dose t4 and it affected my whole body. I started having fluid retention and it was causing nerve numbness when i was asleep
        they developed hyper tension and started BP tablets.
        Later I found a funtional doctor in India and started on t3 t4 medication. Did feel better, but not able to loose weight so far, my eneryg level has improved. but my hscrp was 3.7 .
        My doctor put me on progesterone as i had cramps right side.
        the dose was 200ml cream and had so much energy i gave my thryoid medication for 2 weeks, but started getting numbness and water retention my weight increased. BUtmy hscrp went to 0.9. Again i have started my thryoid meciation, i want to understand why my hscrp went down after i stopped thryoid medicaiotn and started progesterone

        • I’m no doctor but when I went on NDT my TPO antibodies shot up, My A1C went pre-diabetic. Once I went back to T4 only all of the resolved. Also on NDT my pregnenolone was -10. I don’t think all of us can absorb T3 properly and some of us have sensitivities to the pig hormone. I had some great benefits from NDT but the negatives outweighed the positives for me. So I had to go back to Synthroid after trying NDT, t4/t3 combo, Tirosint/ cytomel. Couldn’t function on any of those. Now I’m back on Synthroid only. I have stiffness and swelling with it but I can at least function mentally and emotionally. Praying one day to be completely off hormones. Had Covid in November and it the stress of trauma of the infection threw off my progesterone, became estrogen dominant, lots of brain swelling, blurred vision and POTS symptoms for a while. I’m finally starting to turn the corner but have felt hypo off and on and also had a very high RT3 after and during covid. ANNOYING!!

          • Hi Keeley,

            It is rare but some people do react with an elevation of thyroid antibodies when using medications like Armour thyroid.

  2. Dr. Child’s,

    Thank you for these very informative articles. I’ve been on the Hashimoto’s ride for quite and have done a TON of research trying to help myself get better. I have also seen MANY doctors who have been useless in helping me. In Georgia Naturopathic type doctors are hard to come by. I have cleared high Reverse T3 levels several times during the course of my illness. I have addressed adrenal health and iron levels. Even still Reverse T3 always returns when I go back to adding NDT.

    My questions to you are:
    In your opinion can one simply stay on T3 only for life or is T4 medically necessary to the body. I’ve read conflicting opinions on this.

    Secondly, could Reverse T3 levels rise due to taking too much T3 along with the NDT?

    Thank you…

    • Hey Laura,

      Most people do fine on T3 only medications. If you are a post thyroidectomy patient I would proceed cautiously, but in my experience they are still able to function quite well with T3 formulations only. I say proceed cautiously because theoretically some individuals may have a hard time transporting T3 into the brain.

      You also have to consider that you are more than just your labs. Your reverse T3 levels will elevate as a natural safety mechanism if your free T3 levels get too high. If you are not symptomatic, then don’t worry about your reverse t3 levels.

      And yes, I’ve seen reverse T3 levels rise as free T3 levels rise for the reason I stated above.

      • Hi Doc!

        Could you elaborate on your statement “theoretically some individuals may have a hard time transporting T3 into the brain” — why would this be the case for just some? Are there any links/references you could provide to explain further? Thanks so much for all the great info on your site! Lee M.

    • Laura, not sure what part of GA you’re in, but I highly recommend Vine Medical for doctors who are willing to take a natural approach to thyroid issues. They are in Alpharetta, but do telegraphy as well.

  3. I am reading your very interesting information and seek to find some answers. I do know that my hashimoto antibodies rose after prolonged period of high stress. I did take 10mg of cytomel and within a month gained 25lbs on top of the 20lbs I previously gained within a year. Does this explain further any direction of uncovering the Sx and cause? Please advise.

    • Hey Ana,

      Unfortunately that isn’t a lot of information to go on. Weight gain around the time of taking cytomel doesn’t necessarily mean that it was due to this medication (though it is possible). It’s also possible that you would have gained 40 pounds instead of 20 because you were on the cytomel. You need someone to dig into the problem and figure it out.

  4. Hi there,
    I have about 10-15 extra pounds of body fat around my mid section and my BMI is off. I eat really well, exercise and otherwise do everything ‘right’. I had my thyroid removed 15 years ago and ever since I crossed over to menopause (I’m 56) I have not been able to get back to ‘normal’. It’s not far off – I just know I could be feeling better. I SO appreciate this article as I never knew what reverse T3 was and no one (of many docs)bothers to check it. Are there natural forms of Zinc and Selenium – or supplements the only way to go? In appreciation.

    • Hey Debbie,

      Yes, you can get zinc and selenium from natural sources – but I almost always have my patients add these supplements even if they try to consume enough via food sources. I just feel that the results are better that way.

      • What amounts of selenium and zinc would you recommend for an 11 yr old and do you want patients to take selenium along with Vit E? Thank you.

        • Hey Gail,

          I wouldn’t make recommendations for a child unless I knew their health history and medical problems.

  5. I love reading stuff about this. I’ve been dealing with my thyroid issues for 5 years and I’m only 22. They haven’t been able to level my thyroid my t4 levels are high my t3 is fine, but I still have all the symptoms. What should I ask my doctor next time I see him? I want to get to the bottom of this but evrytime I read about something and bring it to my doctor he tests me for it and I end up being normal. Just want to know the right words or terminology to ask him.

    • Hey Leah,

      You will never get help the way you are going about it. If your doctor isn’t ordering the right tests it’s because they don’t understand how to interpret them. So, even if you get them to order the tests – they won’t know what to do with the results, which means you won’t get the right treatment anyway. You will need to find a new doctor to help.

    • If you visit a compounding pharmacy,there are usually business cards posted for practitioners in your area who specialize in this. Or you can ask the people at the compounding pharmacy. Our local compounding pharmacy is amazing!

      • Hi Just thought I would sail into this one for Kelly and anyone else. I went to my closest compounding pharmacy to where I work in the middle of sydney ‘Newtons Pharmacy’ in York Street and I asked them for a specialist GP or Naturopath for hormones and thyroid issues, they sent me to Dr Edward Butterworth in O’Connell Street. I had been seeing him for thyroid issues 2013 but then went to a Functional Medicine Practitioner / DR in the area where I live. But after mentioning a number of times to her that I was in a lot of discomfort and ongoing pain and lots of stuff turning on in the body and the brain, and not happy in this Catch 22 situation, she ordered other bowel tests etc all expensive. So I went back to my original hormone specialist Dr Edward Butterworth (whom it turns out I should have stayed with) for a second opinion who then asked me if the other Dr had taken my Reverse T3 levels and I said ‘No’, she had said at my appts that research had come in and said that RT3 testing and protocols had not been found to be a good idea. So all my blood tests do not show any results for the Reverse T3. So Dr Butterworth ( worth his butter! ) got my tests done and now I am on Lio-thyronine and progesterone creme made specially for my hormones (I am 55) . I bought all this yesterday for the next 2 months. Yes I agree ! always ask your compounding pharmacy for a recommendation and/or a second opinion. Sometimes here in Australia in Sydney not even the Functional Medicine Dr’s know how to treat thyroid issues and this Dr has thyroid issues herself. So I should have stayed with Dr Worth his Butter ! I would not have gone through 4 years of discomfort, crazy ville-ness and empty pockets!

  6. i taking armour and t3 25 mg in the afternoon
    seems to be helping with anxiety

    2 endo have told me to stop – it could ruin my heart and cause bone loss

    any thoughts

    • Hey Maria,

      It can definitely cause those issues if the dose is too high, the trick is getting on a dose that works well for the patient but doesn’t cause those side effects.

  7. Hi Dr. Childs,
    I’ve been hypo for about 17 years. Sometimes I test positive for Hashis and sometimes not. I take10 mcgs of Liothyronine three times a day (total 30 mcgs per day). I read in someone else’s post that this dose can cause heart and bone issues. Can you elaborate? Also, how would I know if this is happening? I do have occasional palpitations and would have more if I didn’t take Magnesium every night.

    I cannot take any brand of T4, including Synthyroid, Levoxyl, Tyrosint, Armour, Naturethyroid and Westhyroid. When I do, even at very low doses, I experience widespread debilitating muscle pain. I have re-tried taking T4 more times than I can count and always have the same result. Not a single Dr. I’ve talked to has ever heard of this side effect or can explain it. Have you ever heard of this reaction? Seems strange given that I seem to need it. My T4 is always low, and Drs. always want me to take it.

    • Hey Lori,

      It’s not about the dose so much as it is about your body and how you tolerate the dose. I’ve had people on much higher doses that do great, and people on much lower doses that are symptomatic. If 30mcgs is elevating your resting pulse > 90 and you are having palpitations then it may be too high a dose for your body. And it’s easy to follow bone density with dexa scans, so it would be worth looking into that as well.

    • Hi Lori,
      I saw your comment and wanted to ask how are you doing now? Do you still take Cytomel? Magnesium? How are your symptoms? Your comment sounded just like what I’m going through now (I even take reacted mg every night to help with the shortness of breathe…)

      I hope this note finds you well. I really empathize with your comment and wish your wellness.

    • Hi Lori, I am having the same problem when I take synthroid,. It sends me into some type of flare that makes me hurt all over. I will be starting t3 here shortly … sure hope it helps. I tried it about years ago and after about 2 weeks… started making me have severe panic attacks. I have never broken up the dose thru out the day. I will have to try that.

  8. Can you just add Cytomel T3 to Naturthyroid 1.5grams to clear out Rev T3?
    Or do you take T3 by itself?
    How much T3 do you add?

    • Hey Pam,

      Usually you need to remove the NDT as well, but it just depends. Dose depends on the person, there isn’t a specific dose to start with. I usually gauge the dose of T3 based on the reverse T3 levels. But remember to search out the cause of high reverse T3 to begin with, otherwise it will come back again.

      • So if you Rt3 was 20 (10-24), what would you consider a clearing dose of T3? I have been under poor care for 3 years resulting in fibro and nearly quit work. I think I have found a good dr who has checked Rt3. I want to understand if she is being conservative or not when we discuss stopping NDT and starting T3. Thank you.

        • Hi Bella,

          Doses vary from individual to individual and depend on many different factors. A dose as low as 5mcg can work for some while others need much higher.

  9. So much conflicting information out there.

    I recently found my adrenals are mostly low. I feel better in higher doses of ndt, but end up with symptoms of hypo and hyper at same time. Prednisone was prescribed, and it’s horrible too.

    Can these issues of muscle pain, cramps, low temps, sleepless nights, swelling, be caused by reverse t3 levels being off?

    • Hey Danielle,

      It’s possible. You could still have tissue level hypothyroidism despite being on NDT.

        • Hi Roslyn,

          Tissue level hypothyroidism is the idea that each tissue has a certain “demand” or “need” for thyroid hormone and this demand is different for all tissues in the body. Furthermore it may be possible to have sufficient thyroid hormone for some tissues but not for others.

  10. My problem with the Liothyronine or Cytomel they are made with a wheat-gluten filler. I am wheat-gluten sensitive, therefor I cannot take either of these medicines. What else can be recommended.

  11. I had a partial thyroidectomy for a goiter in 1982 and put on synthyroid. My doctor six months ago added 10 mg of generic cytomel, I am on 112. Of synthyroid. Is this a effective combo? Thanks

  12. Hi.. I was on Synthroid only for last 10 yrs. felt horrible gained weight constantly cold all the time. Took my records went to see a new dr. Last reverse T3 was almost 30. Dr put me on T3 only. I’ve never felt better. Been on it now for 5 weeks. Best decision I made. I was diagnosed with Intracellular Hypothyrodism Diease.

    • Hey Pamela,

      I’m glad you found a doctor willing to work with you! It’s unusual for doctors to prescribe T3 only medication nowadays even though your experience reflects what most of my patients feel as well.

      • I took cytomel for a yr, after taking it for 6 mos and quitting at least 6 mos- due to no effect. It didnt work the full yr I took it either.
        Fat, freezing and fried (from exhaustion)
        Would love to have something that works. I was at 10mcg maybe and she wouldnt give me anymore ever as my T3 was fine and my TSH was kind of low actually. I bet Im a person who needs a TSH of 1 before my dose is enough!
        My rT3 is high also. Ratio Over 20, I think it was 21 or 22.

  13. Hi! Thank you for all the information. I wish other doctors were better educated on thyroid issues. You mentioned that taking T3 will make TSH go down, but what if I have a lower TSH and high Reverse T3? Do I want TSH to go down any further? I suffer from hyper & hypo symptoms. My lab values are as follows: TSH .49 (.3-5.0), T3 Reverse 21 (8-25), FT3 3.3 (2.2-3.9), T4 1.6 (.6-1.6), TPO antibodies 28 (0-8.9). I clearly have something going on, but doctors just say I’m fine because TSH is great. I’m currently on the hunt for a new doctor. 🙂

    • Hey Sheri,

      You are welcome!

      I was just stating it as a fact, not that it necessarily matters. Suppressed TSH levels are fine provided you don’t exceed the limit of what the body requires. If you exceed that limit then it can cause damage, but that’s why I recommend following resting pulse + basal body temp while on T3.

      And yes, you definitely have a problem with T4 to T3 conversion with a reverse T3 that high. I would also suspect a severely reduced metabolism.

      • Thank you for your response! It sounds like the next step would be finding a local functional medicine practitioner who can help me search for my root cause as to why I’m not properly converting T4 to T3. What exactly do you mean by a”severely reduced metabolism?” My BMI is in the low/normal range, however my energy levels are much lower than they should be. Thanks again!

        • Hey Sheri,

          Your metabolism and thyroid function are linked, I was just implying that your thyroid function is still suboptimal.

  14. Hi – just got back labs – let me say, I WAS on 300mcg Synthroid, and 7.5 mcg Cytomel. I didn’t feel like they were doing anything for me, still had issues with weight, and fatigue. We started all over again. No thyroid meds for a while, got labs done…
    TSH 18.5, T4 Free – 0.2, T3 Free – 0.8, T4 Free (direct dialysis) – <0.2, then T4 Total – <0.8, no reverse T3 done. Put me on 175mcg Synthroid and no Cytomel this time. I'm still exhausted, and weight keeps coming on. My naps are HEAVY. But in my thyroid's defense, I only get around 5 hours of sleep a night until Friday night. Then I catch up on my sleep. I'm swollen and constipated too, and all the rest of the horrid s/s of hypothyroid disorders. I'm going to add zinc to the supplements I'm already taking. Good article.

    • Hey Kathi,

      I wouldn’t put much weight on your lab tests at this point, it’s clear that you need more T3. Your sleep needs to be addressed ASAP as well.

  15. Hello
    I have the symptoms of hypothyroid with normal levels but a low free t3/Rt3 ratio. I do have lyme disease but I was extremely well for 10 yrs after the tick bite, only becoming unwell 5yrs ago during a period of prolonged overwhelming stress. I have eliminated all the stress now and as most of my symptoms can be explained by hypothyroidism is it worth me trying T3 for a period of time to see if i can clear the RT3 and get my body back to managing the lyme as it was for all those years. Thank you.

    • Hey Karen,

      It’s worth a shot, I’ve done it successfully with other lyme patients. Just make sure to use higher doses of T3, preferably sustained release.

    • I was wondering if you have tried getting treatment for your Lyme by repeated, mostly whole-body, hyperthermia ( H20 temp 109 degrees,to raise body temp to at least 105 degrees, sustained for 20-60 min) treatments? Repeated treatments are needed to repeatedly catch the spirochete out of its cyst form it was explained on one site.

  16. Hi! First, thank you for all the great info you are putting on this website! So helpful and informative! I’ve been misdiagnosed for years and I have some of the lab tests to prove it. But I’ve now been on a combination T4/T3 50/12.5 for 9 months. Had to insist on my labs being re done because I went from feeling a little better to horrible once again. My FT3 (253pg/dl range 202-443) and my FT4 (1.5ng/dl range .7 -1.9) both stayed the same. The TSH dropped from 4.87 to .88. RT3 went from 20.8 to 27. Oh and my TPO increased to 387. TgAB went up to a 4. So obviously I’m not getting what I need into the cells and the autoimmune component is getting worse. Your article talks about T3 only, but I was wondering if I should be staying on the compounded T4/T3 and just add more T3 as a second med and increase as you have written about in the article? Side note, I’ve gone gluten free and reduced sugar so I’ve lost weight, but energy is non existent. 🙂

    • Hey Ruth,

      Hard to say, no two patients are alike. You will have to use the combo of lab work + trial and error + symptoms.

  17. Hi Dr. Childs , would like to know what could cause high Rt3 when not on any thyroid medications ?

    My son is 21 has type 1 diabetes (diagnosed at 10 ) , could that itself cause the high Rt3 it’s at top of range?

    His FT3 is 3.1 (2-4.0 ) and Ft4 1.27

    What can be done to make it lower without thyroid meds .

    • Everyone with insulin resistance will have higher levels of reverse T3, the only way to reverse it is to reduce hgb A1c and insulin levels.

    • I had two relapses on Rebif, none so far on Copaxone. I do notice my balance was getting worse, and my memory, as well as erectile dysfunction and spasms’ had no choice to sick for other solution and I was introduce to totalcureherbalfoundation gmailcom which I purchase the MS herbal formula from the foundation, the herbal supplement has effectively get rid of my multiple sclerosis and reversed all symptoms. 

  18. Hi Dr Child’s!
    Firstly thank you so much for your amazing blog!
    I had a thyroidectomy almost five years ago. I’ve felt terrible ever since! After reading your blog, I searched for an integrated GP who ran the test for negative t3. My levels are 693! That same doctor unfortunately also prescribed 200mg a day of dedicated thyroid hormone and after 6 tablets I was in the ER needing medication to lower my heart rate, the doctors said I had thyroid poisoning.
    Now my body is struggling to calm so my new GP is waiting a few weeks before we introduce t3, 10mg a day to lower my negative t3 (after reading this article), what happens if you can’t tolerate t3? Should we be lowering t4 so the my per day is the same?
    I’ve had chronic iron problems for five years with my iron at 16, I’m booked to get an iron transfusion next week. Finally I have hope and I can’t thank you enough!!!

  19. I really need some advice and help bc I am at my wit’s end with trying to my a solution to feeling normal again. 5 yrs ago when pregnant with my 2 child I happen to feel a lump in my neck. End up having a total thyroidectomy due to it being cancer. So I went from feeling totally normal never having any thyroid issues what so ever to Bam…Feeling like death ever since my surgery. Not one single Dr that I went to remotely prepare me for what life was going to be like post thyroid. They made it seem like you just have it remove and then take a pill everyday for the rest of your life and you will be fine. NO big deal….I went from being on 0 meds before my thyroid surgery to now I am on 5 different meds trying to get back to my old normal, Which none are working. I am constantly fatigue no matter how much sleep I get. Never want to do anything bc after I work and see about the house and kids I am totally worn out. I am very short fuse,irritable, and brain fog etc..These are just a few of my horrible symptoms my list goes on and on. I can’t even stand being around my own self. So I can only image what it is like for other people who have to be around me. My Endo Dr only believes in T4 and tells me as long as my TSH is were he wants it then that is all he cares about. He said my symptoms are related to post surgery and my season of life of having 2 small kids. I ask about adding a T3 along with my Synthroid and he said No bc that wouldn’t make any difference. After feeling very discouraged I was starting to just accept this was as good as it was going to get and this is now my new normal. I did do my own research and follow the Dennis Wilson Protocol bc once I started taking and recording my Temps they were always around 96 degrees. So I started on his T3 protocol and was able to capture my temp at 98 and maintain it but I still did not see any positive benefits from it. Actually they only thing that change was now I am constantly hot always sweeting and having real bad night sweets where my house stays on 64 and the rest of the family are complaining on how cold it always is in the house. Now I am very discourage bc I truly thought that the T3 was may answer. Here are my Labs that I got done on my own just to see If these symptoms were all in my head are was there truly something wrong with me and that I wasn’t crazy. TSH 0.009, total T4 10.7, total T3 118.3.
    Free T4 1.83, Free T3 4.1 and Reverse T3 27. Can you please give me some advice from where to go from here. I am wondering if it might be Adrenal Fatigue. What test or medication would you recommend base on this brief hx. I would greatly appreciate any advice that you give that might help in any way….. Thanks in advance for your help!!!

    • Hey Sherrer,

      It sounds like you are over treating yourself with T3 medication which may be making some of your symptoms worse.

  20. I am on 1/2 grain naturthroid my recent labs last month were tsh was 1.97 t4 1.19 t3 2.7pg/ml and i got my reverse t 3 tested for the first time and its 24.4 ng/dl. I have been severly fatigued and losing insane amounts of hair and anxiety.

    • Hey Tara,

      Your reverse T3 is quite high, I would consider implementing some of the steps in the article to help lower it.

      • I am afraid of t3 causing more hair loss… I. Mean it’s not just a little hair loss. I have lost their half of my hair (no joke). I read online of some peoples hair loss getting worse by adding t3. I worked with a functional med dr 2 years ago. I am an extremely clean eater. No dairy, no gluten, hardly any soy or corn. Also stay away from foods I tested an IgG reaction to. I eat organic and plenty of veggies. I also only do filtered water not tap to not get added junk. I do liver supporting supplements and and adrenal support. I do t know other than possible heavy metals I have compound heterozygous mthfr or extreme stress or inflammation that’s causing this. Would I still add in some t3 and would I cut down my naturethroid?

        • T3 can definitely accelerate hair loss, what I’ve found in some people is the hair cycle appears to just be more rapid in general. Meaning more hair is falling out, but more hair is also growing. Then there are some other people who actually do just lose hair on T3.

  21. Hi, I just started armour thyroid 4 weeks ago for low free T3 levels (2.2) and lower than optimal T4 levels (0.9). My tsh was already .3. I started on 60mg and was fine for a week…then anxiety, racing thoughts and jitters came out of nowhere. I immediately went to 30mg and the symptoms disappeared within 24 hrs. I felt great at 30mg for 2 weeks, but then the achy joints came back so I decided to try 45mg. After two days of that dose the anxiety, along with depression and racing thoughts, came back with a vengance. Now I just decided to go completely off. I’m newly pregnant and I’m worried about the levels fluctuating so much. Does this sound like my reverse T3 skyrocketed with upping the dose, or does it sound like free T3 is pooling? How long would you expect it to take for the levels to drop and for the anxiety to go away? It only took 24 hrs last time but now it’s been 3 days. 🙁 Thanks so much!

    • Hey Jennifer,

      Some patients don’t tolerate T3 or NDT. In these cases it doesn’t mean they don’t need thyroid hormone, but instead they need to try various types of medications to find out what works best for them.

      • Thanks. Do you have a list of functional medicine Drs that would be able to help me? I’m in the Twin Cities, MN. I’m having a hard time finding names. Thanks so much!

        • Unfortunately I do not. Nowadays many people claim to practice functional medicine but really just practice conventional medicine with some supplements.

          • Dr. Westin, the symptoms of panic, racing heart, and inability to sleep for more than a few hours at a time are getting worse. I’m trying to make an appt to see someone that’s not my general MD (she just told me I turned hyperthyroid with the NDT and to wait 4 weeks to see her again) but most are booked out a bit. Do you have any insight in the meantime as to why symptoms are getting worse, not better, after removing the higher dose? The first time I removed the high dose 3 weeks ago the anxiety went away right away. Now I lower the dose to the pt of going off and symptoms aren’t going away. I am pregnant and I know cortisol and thyroid hormones change in pregnancy. The first time I lowered the dose I had just conceived. Now I’m 6 weeks pregnant. Could this have something to do with it not getting better as quickly?

          • I would recommend you find someone local to see you and get checked out ASAP. While pregnant you don’t want to mess around with symptoms like these.

          • I know this post is more than a year old, but I’m pretty sure that it was the elevated progesterone levels due to pregnancy that kept your anxiety, panic and racing heart going. Progesterone stimulates thyroid. I learnt this the hard way myself. This is why post-partum thyroiditis is a terrible phenomenon.

  22. This article really opens my eyes, I have had Hashimoto going on 20 years, I have kept all my lab results since 2009. During that time period my RT3 has only been checked twice!!! Both times it’s been in the 9.5 range. My FT3 is way too low in the range (never going higher than 3) it’s only 13% of its range. and my FT4 is actually below range, last tested .76. Rule of thumb for me is for my FT4 to be about mid range and FT3 to be in the upper half to upper third of its range.
    I find that I have insulin resistance, PCOS ( surgery induced menopause – complete hystertectomy with BSO), I have depressed progesterone. I know my hormones are all wacked. I gained 20 lbs in a year and holding steady at 179.

    I am just started taking Selenium, but only 200mg so,I will up that. Berberine 3x 500mg ,Vitamin D, Biotin, Armour 90mg,Ashwaganda 800mg. Eating high protein, mid fat, low carb, 1600 calories a day, strength train full body 3x wk. not sure how that will all play out on my journey to healing or how long it will take. I get my probiotics in my Raw Meal protein shake, do you think that’s sufficient or should would Prescription-Assist be another needed layer? Can a person take too much probiotics?

    No one is wanting to put the pieces together for a treatment plan.
    I am hoping to find a functional dr to assist with my treatment, I plan on firing my Endo.

    Thanks for the information.

    • Hey Kat,

      No problem and good luck!

      In general it’s not necessarily about the amount of probiotics, but which probiotic your body needs. Most with hypothyroidism do better on soil based organisms.

    • Hi Kat,
      I’m just finding this information! It is awesome, just wish we could clone Dr. Child’s since I’ve been on a search for 3 years. I, too, have PCOS (lean)with a total hysterectomy in 2012 and haven’t been right since 2014! Hormones all off, terrible IBS-D, but I have trouble maintaining weight! I take Synthroid and cytomel but my reverse T3 is 21.7 (ratio of FT3/RVT3 is 14.28…eye twitching for three years and palps and exercise intolerance…how do you address inflammation and high cholesterol and get RVT3 to clear? Have you had any luck? Diane:-)

  23. I was diagnosed 10years ago with Hypothalamic Hypothyroidism (of unknown reason, all other Pituary levels were normal but my 24hr cortisol level was high normal) and I was started on synthroid and cytomel. I felt better with the hormones, I continue on them but feel that I may have induced the diagnosis due to the extreme stress in my life at the time. Do you think I will ever be able to stop the synthroid and cytomel.

    • Hey Greer,

      Hard to say, some people are able to do it, others are not. Only time will tell.

      As an aside you should probably be checked for adrenal cushings with a dexamethasone suppression test. In some cases the cortisol can impact thyroid function and the tests appear relatively “normal”.

  24. Hello Dr.Westin,i really do need your help in reading my thyroid report.My doctor says i’m normal but i have all the symptoms of Thyroid disorder.Can you please give me your reading on my lab report.Thank-you.

    Anti-thyroglobulin(Anti-TG)13 IU/ml
    Anti-thyroid peroxidase(Anti-TPO) 6 IU/ml
    Thyroid Stimulating Hormone 1.86 mIU/L
    Free T3 4.0 pmol/L
    Free T4 13.3 pmol/L
    Reverse T3 406 (140-540)pmol/L

    • Hey Isabel,

      I never recommend looking at thyroid lab tests in isolation, they aren’t normal by my standards but that doesn’t necessarily mean anything without the context of symptoms and other medical conditions.

  25. Hi,

    Great article, very explanatory.

    I would like to know your opinion regarding iodine supplements for thyroid problems, like iodoral.

    I have been dealing with tingling and burning all over plus pain in upper back, arms and gluteus. After visiting a lot of different specialist, and without any clear diagnosis and help, I found a doctor who just ordered for me the complete thyroid panel that you describe plus several other hormonal tests.

    In the mean time he wanted me to take iodoral every day, because he suspects problems with my thyroid.

    I have my tests back, but won’t have the appointment until the 24th this month when my doctor will let me know his opinion regarding the results..

    I took iodoral just for one day and I am still dealing with a weird sensation in my throat. As I have read is a side effect of iodoral.

    I have researched about iodoral and lugo’s solution over internet, and there is so much controversy with iodine supplements. I am confuse wether to take it or not.

    My T4 free is 1.18
    TSH is 1.020
    TPO is 8
    T3 FREE is 2.9
    T3 Reverse is 16.8


    • Hey Ana,

      I don’t base my iodine recommendations off of thyroid lab tests alone. I would wait until you touch base with your physician and go with his recommendations.

  26. My son, age 13, was diagnosed with SIBO (Small Intestine Bacterial Overgrowth) and Fructose Malabsorption in the fall of 2014. He missed over half of the school year and slept 18-20 hours for several months. We now have the SIBO under control, but he still suffers from crushing fatigue, a very low body temperature (usually around 96-97 degrees), a weak voice, depression, constipation, weakness, and weight gain- just about everything that would point to hypothyroidism. (I am hypothyroid myself.)

    We saw an endocrinologist at the hospital twice and she thought that his symptoms were not due to a hypothyroid. His GI doctor ran a reverse t3 test and it came back at 23. So far, we have just had him on thyroid supplements (that include zinc and selenium), which seemed to help him wake his body up a bit early on, but now over this summer he has been back to very low energy and the above symptoms.

    Do you have any advice on what to do next or what to try? I am broken-hearted that my son is so lethargic and is not participating in life normally.
    Thanks for your help!

    • Hey Amy,

      I can’t give you any advice because he isn’t my patient but it sounds as if he might benefit from thyroid hormone with all of the symptoms you suggest he has.

      • He is 16 now. He had a rough sophomore year last year. He missed all of October and most of November from school. This time, the doctors in the emergency room diagnosed him with mono and also swollen lymph nodes in his abdomen (which had originally seemed like appendicitis). He recovered, but all of the doctors were not sure it was really mono and he never really got back to even “his normal” level of energy. (His GI doctor did a colonoscopy and endoscopy to see if he could figure it out, but found nothing.) This past March, he went through another bout of fatigue, as he had in 2014. After about a month of sleep, he slowly came out of it again. In June, after a fever and sudden and unexplained onset of pain in his knee, he was admitted to the hospital for 4 nights with a bad bone infection (osteomyelitis) in his leg. He was on heavy-duty antibiotics for 6 weeks, which I thought would mess with his stomach, but he actually seems a little better since then. * He has been on thyroid support supplements for several years now. His doctors all think his thyroid is fine and won’t give him thyroid hormones. Even though he was diagnosed with SIBO and fructose malabsorption (and originally tested way off the charts for both), his stomach doesn’t seem to bother him. It is his low energy which has seemed to set off his other symptoms. I am still confused on how to help my son. He is such a sweet kid and it breaks my heart to see him go through all of this! Thanks for asking!

  27. Hi,
    I’ve been to multiple pcp’s and endos and basically it of options with my insurance. They are all only concerned with TSH. Finally got one of the pcp’s to order reverseT3. He admitted he’d never heard of that. When the results came it was 60, which according to the lab was high. He hadn’t ordered freeT3 so not very helpful. I had already researched and concluded that I need T3, pretty much begged him to prescribe and he wouldn’t (because TSH was normal range). My main question to you is this, how can I get T3 without a prescription? Or is there some alternative supplement that would work? Any suggestions would be helpful. Changing doctors is not an option, been there done that.

    • Hey Catherine,

      T3 is the active thyroid hormone and therefore the most potent of all thyroid medication which is why the only way you can get it is through a prescription. I don’t recommend attempting to self dose with T3 because it can very quickly lead to thyrotoxicosis if you aren’t experienced.

      I would also point out that T3 is likely only a small part of your problem here because low T3 and high reverse T3 potentiate multiple hormone imbalances in the body and fixing one generally doesn’t lead to significant improvement.

      At this point your best option is likely seeking further care outside of the insurance model.

  28. Hi am 42 year old female. I have been on ERFA f(125) or over two years and it hasn’t done much for me, other than I can get by with 7 hours sleep rather than 9. In fact when I started the ERFA I was not hypothyroid. My TSH level was something like 2.65. I had my T3 and T4 tested but can’t remember the levels, just that the doc was happy with the levels after the treatment.

    Before taking ERFA I took a product called Thyroid Energy by NOW Foods and felt ok, just not good enough. I stopped that when I started the ERFA.

    I became sick this May and had my thyroid tested then. The doctor said my T4 was dropping and put me on Thyroxine 30 mpg in the evenings which made me feel better initially and then much worse after a few weeks. I was tested again and told I was not responding to the Thyroxine. I had my Reverse T3 tested and was told that it was high, to stop the Thyroxine and to continue with the ERFA. I still feel awful.

    I am off to see an endocrinologist on Friday, but I have seen an article saying I will need to come off the ERFA and take another medication for life. I am so scared about this! I just want to get off all meds. It’s costing me a fortune and not doing anything for me.

    Has putting me on the ERFA when I didn’t really need this done this to me or would the reverse T3 problem have always been there?

    Any advice much appreciated!

    Oh and also I have a heterozygous MTHFR mutation and am taking 1000mcg of folate and 1000mcg of B12. I think this may be making the problem worse. My son has had the full gene testing and found other mutations that mean he cannot tolerate the methyl donors and I am concerned that I may also be carrying those mutations.

    • Hey Daniela,

      It’s impossible to say unless you have reverse T3 checked before and after. Many thing scan cause an elevation in reverse T3 levels including T4 only medication but it’s certainly not limited to just that.

      • Hi Dr Childs,

        Wow thanks for getting back to me so quickly!

        FYI doc stopped the Thyroxine when my T3 went to 3.5 pg/mL and Reverse T3 was at 30 ng/dL (T4 was 1.6 ng/dL and TSH was 0.01 uiU/mL). In May (before thyroxine) it was Free T3 1.0, Free T4 0.69 and TSH 1.04 (that’s when I had the M Pneumonia – I was told the changes in results from six months prior were a big deal but not linked to the infection – six months prior it was Free T3 2.9, Free T4 0.94 and TSH 0.06.

        Have you ever had patients come off the ERFA completely and be fine? I would like to stop it as the only difference has been 7 hours sleep vs 9 hours before and a slight change in energy. The ERFA costs a fortune here in Hong Kong and I really can’t afford it anymore!

        Thank you!

  29. Hello. My Dr did order a rt3 and regular thyroid tests. The rt3 was very high. He wanted to put me on SNYTHROID. Reading about rt3 doctors seem like they don’t agree at all on this and seems I also have a heart issue. I declined the medicine as my Mother passed away having a massive heart attack was on Synthroid. So reading about the synthroid medicine and effects it can have on ones heart I felt I don’t want to touch that. So I have a few issues. I have hormones all over the board from female related surgery. Change of life from that. Weight gain and I suffer from tachycardia high blood pressure. I ask. What’s safe???? Can this ever get outbid my system? I did have a Dr say recent illness and stress can all raise this. Can it all of a sudden go away? The fatigue not as bad as it was but weight gain and not eating real different stinks. I don’t want to add problems to my problems. I don’t like to take medicines unless I have to. I am super sensitive to many. My Doctor knowing my situation knowing about my family’s heart iissues understood my decline for treatment with valid reasons. Left it up to me on research and what to do next. Reading all the controversy about rt3 is hard to choose the right thing to do. What would you suggest?

    • Hey Ane,

      I feel that the use of T3 is quite safe if used correctly but that requires knowledge about how to use it and not everyone has that. I can’t provide specific medical advice to your situation so instead I would recommend you seek someone out who is knowledgable and who can help you further.

  30. Very informative article with great insight!

    My Dr. says I am borderline for T3 meds and it is up to me.

    I feel tired in the afternoon, have some anxiety, and have low body temperature at all times (96.6-97.4). I am currently taking .088 mcg of Synthroid.

    Free T3: 2.6
    Reverse T3: 14.5
    T3/Reverse T3 ratio: .179
    Free T4: 1.39
    TSH: 3.05

    Any thoughts on whether I should start T3? Thanks so much! Really appreciate all the articles and insight.

  31. My 19 year old daughter has benefited significantly from Liothyronine. Her reverse T3 came out very high when she went in to be tested for fatigue, depression and extremely low bloodpressure 75/44 and positional hypotension which caused her to blackout even when sitting. The liothyronine 5mg twice a day has brought her temperature up to normal but she needed to take it with real licorice root extract (not DGL) (3x day at 400mg to bring up her blood pressure and reduce the blackouts. With both of these taken together, her low thyroid symptoms have resolved. What was the source of her reverse T3? Undiagnosed Celiacs. She is now on a gluten free, dairy free diet and will soon be starting the GAPS diet.

    • Hey Anne,

      Great story and thanks for sharing! I would also point out that many patients nowadays have what’s known as non celiac gluten sensitivity which can also cause issues but antibody tests for celiacs disease may come up negative.

  32. Hi, just thought I’d share my quick little story and ask for a bit of advice. I have been “moving through thick mud” for the last 6 months, finding it hard to move my legs, get out of bed, always feeling “like I’ve been hit by a mini moke” and still exercising like crazy, and eating like a sparrow because I was putting on weight…(10 kilo in 6 months!!) I went to my regular GP where he gave me a standard Thyroid test which all came back at normal levels, and he sent me on my way and told me to exercise MORE and cut down on carbs, after all Beck….your symptoms are telling you that you are 45 years old…. But I barely eat carbs!! I told him. “Come back in a month” he says “and I’ll weigh you again”. Buggar that! I thought….So I asked another GP from a different clinic what could be happening to me. She did a full blood test…requesting everything from Iron to folic acid. She found that my thyroid function test, like the other doctor, came back in normal ranges, however my serum Reverse T3 test came back at 628 pmol/L (normal range is (170-450). Now I know you said don’t get too hung up on numbers, but my second opinion did say that the result is very high…and has put me on a concoction of vitamins and iron tablets to see if my reverse T3 improves before putting me on anything else. She has put me on Vita D (results came back low), Folic Acid (as it also came back very low), Iron (normal range but a bit low), Selenium, and an Adrenal support. Is she treating me correctly for Reverse T3 issues or should I go and get a third opinion? I am running out of doctors in the area lol. I don’t want to appear like a hypochondriac but I want my old body back and I want to jump out of bed again without the stiffness and aches and pains, I also want my voice back!!! I sound like stevie nicks on a big night of smokes!!
    Any advice would be greatly appreciated. By the way…I am in Australia, Melbourne.

  33. Great Article! I am a Graves patient treated with Radioactive Iodine 24 years ago. Have only recently found a doc that will treat me with NDT and look at other thyroid levels. I have been treated with Levothyroxine for all those years and just last month started on NDT. I had Rt3 at 20 before(on levo) and now it is at 24, with a ratio of 5.125 I am feeling awful. My doc wants to add Cytomel only. Don’t I need to decrease my dose of WP Thyroid when I add the Cytomel to get my levels to drop? Although he is willing, I don’t think he has the experience. Do you normally decrease the NDT when treating with Cytomel to lower Rt3? Not asking for medical advice just wondering what you usually do.

    Thank you!!! Karen

    • Hi Karen,

      Approaching your thyroid levels is different for each person and may require some degree of trial and error.

  34. I have had Hasimotos for 9 years and have been treated successfully by an endocrinologist with T4 thyroxine treatment. Recently I moved and found a intergrative GP to help manage my thyroid condition. He did a reverse T3 test as he suspected my t4 dose was high and maybe not entirely effective, the result was the highest he has seen, 1000! He suggested t3 and t4 treatment. I am feeling nervous about changing my treatment when I have been feeling fine with no major symptoms. So I found a new endo and they said to not pay attention to this test and go back to t4 just slightly reduced as I was hyper-thyroid. I’m so confused with the differing opinions and don’t know what to do! I don’t want tondosregRd a test that was the out of range but I am feeling normal….your insights would be most appreciated.

  35. I found this article while searching for Low RT3 numbers – just rec’d labs back and mine is 5.5 on a scale of 9-27.
    My Free t3 was 2.6 on scale of 2.3-4.2
    what does a low reverse t-3 mean? thanks!

  36. Hi Dr. Childs,
    I want to express my gratitude for the impressive information you provide. It’s broken down into the basics for us “lay people” to really grasp. I didn’t think I could find a more knowledgeable thyroid specialist than my current doc, but am considering going to you on my next labs for a new perspective.
    A couple others have also asked this question: My reverse T3 is less than <5. Is that good, or can reverse T3 ever be too low?
    Thank you in advance.

    • Hi Lisa,

      I don’t get worried when reverse T3 is low, though I don’t typically keep patients on regimens that maintain low reverse T3 levels long term.

  37. Hi
    Im just understanding this finally…thankyou for such great explanation. So I just was diagnosed w Lymes and I did lab work and had low t3 and Im thinking thats do to Lymes. Im on antimicrobials killing off the bugs and feeling great but today i saw a thing Klinghart(kinda a lyme expert) said to do Wilson protocol with t3 . Just a little nervous as to what Im doing …I bought IAS t3 pro and have been taking 5mcg every hour going to try to get to 75mcg or 98.6 whatever feels best..What do you think?

  38. Thank you for the information. I exercise daily and I am VERY careful with my diet – no processed foods, no sugar, no alcohol, etc. About a year ago I gained 12 pounds. I have talked with several doctors to no avail and started research on my own.

    T3 = 2.67
    RT3 = 20.1
    Thyroidglobulin antibody = 445
    TPO = 319

    I’m taking 125 mcg Levo and a few months ago my dr started me at 5mcg every other day of T3 (wondering if this is enough).

    Based on my bloodwork, what suggestions would you offer? Would you consider the RT3 to high and T3 low? Should I be asking my dr. to take another look?

    Appreciate your help!

    • Hey Maureen,

      I can’t offer advice on your labs because I’m not your doctor but I would recommend you seek out someone who will actually look at them correctly.

  39. Hi Dr. Childs,
    Thank you for your article. I learned a lot of about RT3. The following are my test result from the past.

    8-Jun-2007 24-Oct-2013
    TSH 5.99 ulU/mL (0.40 – 4.70) 5.28 ulU/mL (0.40 – 4.70)
    Free T4 15.6 pmol/L (9.0 – 25.0) 15.6 pmol/L (9.0 – 25.0)

    4-Nov-2014 15-Jun-2015
    TSH 5.22 mlU/L (0.270 – 4.200) 6.100 ulU/ml (0.270 – 4.200)
    Free T4 14.4 pmol/L (12.0 – 22.0) 1.20 ng/dl (0.93 – 1.71)

    In 2013/2014, I get tired very easily and have very little energy left to do work. Even though my TSH was high, my doctor said I am normal based on my Free T4. Only in Jun-2015, when my TSH was much elevated that my doctor decided to put me on Thyroxine (Euthyrox) initially for 50ug and 1 month later 75ug. And I didn’t feel tired or sleepy after that.

    20-Jul-2015 12-Oct-2015
    TSH 2.620 ulU/ml (0.270 – 4.200) 0.961 ulU/ml (0.270 – 4.200)
    Free T4 1.42 ng/dl (0.93 – 1.71) 1.63 ng/dl (0.93 – 1.71)
    Total T3 1.84 nmol/l (0.90 – 2.60)
    TRGAb <10 U/ML (0.0 – 60.0)
    TPOAb <10 U/ML (0.0 – 60.0)

    19-Feb-2016 27-Jun-2016
    TSH 2.770 ulU/ml (0.270 – 4.200) 4.280 ulU/ml (0.270 – 4.200)
    Free T4 1.48 ng/dl (0.93 – 1.71) 1.28 ng/dl (0.93 – 1.71)

    My TSH continue to drop and Free T4 increase. In May-2016, I decided to cut to Euthyrox 50ug.

    Date: 1-Nov-2016
    TSH 4.63 ulU/ml (0.270- 4.200)
    Free T4 1.37 ng/dl (0.93 – 1.71)
    Free T3 4.5 pmol/l (2.8 – 7.1)
    Reverse T3 26 ng/dL (10 – 24)
    TPOAb 29.3 U/ML (0.0 – 60.0)
    Sex Hormone Binding Globulin 17 nmol/L (11 – 52)

    I have been slowly gaining weight, despite my diet control & exercise. Almost everyday, I have moments of floating sensation and bouts of giddiness. I constantly have headache. My skin will itch every 4 days, and it will go off after taking Cetirizine HCl 10mg. So, on 1-Nov-16, I went for a full thyroid test above. The Reverse T3 is high. TPOAb has gone up.

    Is my Reverse T3 and TPOAb a concern? Is my overall thyroid function a concern? Do I need to reduce the Reverse T3, and what's the best method given my situation.

    Thank you.

    • Hey Meng,

      You will have to take these questions to a physician, I can’t comment on your case because you aren’t my patient. The best thing you can do is find someone willing to help you further.

  40. Hi Dr Childs,
    Curious if you could speak to the difference of using Sustained Release verses Regular T3 medication for clearing out RT3? I’m assuming the daily dosage is the same. Do you have any preference and if so, can you explain why?

  41. I take cytomel and t3 and I keep gaining weight even though I am trying to diet. I was fine before my tyroid problem I could eat and not gain any weight. Do you have any suggestions. Thanks

  42. Hi Dr. Childs, I have been on NDT and Liothyronine for several years (Hypothyroid) and can’t seem to get a good balance. Eventually because my Free T4 levels are low, my doctor raises the NDT and I end up with too much RT3. One of my symptoms is a prickly kind of feeling in my arms. I haven’t found that symptom anywhere. Have you seen this before? I had the same thing happen when one doctor tried to switch me back to synthroid. It is frustrating because I already feel terrible and then I have to deal with this too. I do appreciate your article very much and hopefully I can show this to my new doctor. Thanks

  43. So, I finally have an appt this week with a holistic functional MD, I finally have an opportunity for someone to listen and hopefully connect the dots. Dr. Child’s, I am nervous that I may talk to much but then worried that I may not tell her all my struggles, in your opinion what and how much should I reveal without sounding like a novel?
    Also what would you say would be some of the most important questions for me to ask during this appointment- the first consulatation is an hour long. Any help would be appreciated, thanks in advance.

    • Hey Kat,

      It’s more in the hands of your provider than it is yours. What I mean is that your provider should direct the questions so he/she can find out what is actually important. Unfortunately the skill level of holistic providers is all over the map, so they will either get it or not.

  44. Hi Dr. Childs,
    Thank you so much for all the information. Great website. Thyroid test results: PA said the Reverse T3 is high and ratio of FT3 and Reverse T3 is off, but said nothing else. Results: Reverse T3=19, FT3=3.5
    FT4=1.31, TSH=1.450, TPO=15 Is the Reverse T3 then collecting and not being used appropriately? Pre-diabetic.. A1C, 5.8… Have low body temperature and can’t lose weight. Also have had 2 ANA tests come back high. Any suggestions how to proceed to get the numbers in a better range?
    Thank you so much!

    • Hi Brenda,

      You will need a comprehensive treatment plan that includes lifestyle changes, medications and supplements.

  45. Hello Dr. Childs,
    My daughter was diagnosed almost 3 years ago at the age of 7 with Hypothyroid. Like most, she started on Synthroid, and has had good lab results since then. She is always complaining about being tired, having occasional headaches, and frequent mood swings. Recently I have been concerned about her weight gain. That’s when I started doing my own research and see that these can all be side effects from the Synthroid. Her last lab work results were all good in June ’16 – TSH=1.160 and T4 = 1.71. I just contacted her Pediatric Endocrinologist and asked if we could have T3 added to her lab work. She just dismissed it and said TSH and T4 are sufficient for her. I was taken aback by that… I thought she would be happy to add it to humor me. My daughter is due to go next week for lab work, for an appointment the first week in January. The Dr. just said she would like to see her sooner due to our concerns. I have brought up the fatigue for the last 3 years, and mentioned the weight gain at the last appointment, and she wasn’t concerned at all because her lab work was good. I don’t want to “waste” another appt with nothing to back up my suspicions. I am in the Tampa Bay area, where there aren’t a lot of other Pediatric Endocrinologists available. This Dr. was my 2nd opinion 4 years ago, for follow up on my daughters short stature. Do you have any suggestions? Should I maybe ask her primary Pediatrician if they will do the lab work? Do you think it’s necessary for a 9 (almost 10) year old? Thanks so much!

    • Hey Renee,

      Most providers aren’t comfortable with the addition of T3 and most don’t understand the nuances to the advanced tests you are referring to. Your best bet is to find someone willing to work with you who understands these nuances.

  46. Hey Dr. Childs,
    I have been very passionate about functional medicine for the last 3 years and have altered my life to this lifestyle and never will change. However, despite eating gluten/dairy/soy/nightshade/egg free, taking targeted supplements, reading countless blogs and following medical functional docs (Hyman, Mercola, Axe, etc) seeing a “hormone specialist ND” , FDNs, DOs, etc, taking NDT, doing body weight training etc….I am only getting worse.
    I recently was pushed too high on my Wp Thyroid with cytomel, and became hyperthyroid. Doc took me off and said my RT3 was too high and removed everything for 14 days to clear it out to start on a Wilsons type approach with ST3 medication. My temps are all over the place, sometimes 96.9, sometimes 99.0, etc. I haven’t been able to lose a SINGLE lb in 2 FULL years despite all my efforts. I have bad edema, acne, bloating, low progesterone etc. I have supplemented with progesterone bioidentically before and blew up in weight so immediately stopped. Everything has been all over the map and I just need help. I did a GI screen and showed no overgrowth as well as doing a lactose breath test and showed no SIBO. I also did a 4 point saliva cortisol and it showered normal/normal/moderately high/normal. So just a little elevation in the evening. I am so depressed on where I am at and don’t recognize myself in the mirror. I believe in eastern medicine and all of this lifestyle but it has yet to work at all for me.
    I am hopeful that this T3 titration will work somewhat, however it’s day 3 and I just feel terrible and even more swollen/bloated and like I’m gaining more weight.
    I am 145 at 5’4″ and just a swollen mess.
    I have been told my testosterone isn’t high enough for PCOS , and I eat so clean that insulin doesn’t seem to be an issue (a1c was a 5.5). I just don’t know where to turn.
    Iodine made me break out rapidly, progesterone made me gain so much weight, naturthroid and WP did nothing for the 2 years I was on NDT. I AM LOST and need help. Any advice for someone who has tried everything??

    • HI Tina… we must be twins. I am 53 years old, 5’4″, went from being 125 10 years ago to 143lbs and increasing. I work out doing interval weight training and cardio 3-5 week for an hour, eat clean, have seen holistic/alternative med docs for 15 years. My first one diagnosed me correctly with hypothyroid despite my conventional doc saying my symptoms were “normal” and as were my test results.

      I was on Armour Thyroid for past 8 years with improvement in fatique but not weight gain. Slowly added a few pounds per year. Past two years I gained 10-15 lbs without change in clean diet or exercise. I too need help and a functioning doc who specializes in thyroid. I heard Armour reformulated in 2009 and 2015. Curious if that has anything to do with my rapid increase in weight.

      After spending days reading and listening to every word in this blog, things are starting to come together.
      WIll do testing for Leptin Resistin, retest my thyroid T3 and T4 all levels as well as other areas suggested. Thinking at first glance, the more Armour thyroid my doc prescribes, the worse I get leading me to believe I am not converting to T3 but rather reverse T3.

      I too am lost and need help. Need to find a doc to help me.

  47. Wonderful article! Lots of good information! I found your article when trying to find out if turmeric can help lower rt3. I recently found I have excess rt3. I’ve been following the STTM (stop the thyroid madness) and it has been extremely helpful in my hypo journey. From the information in the books, on the site, and their groups, I requested to lower my NDT and add in T3 to help get my rt3 go down. My labs showed inflammation from my 4 iron labs. But I also suspect adrenals issues, also very common among us hypo patients. According to STTM, adrenal issues like low cortisol or mix of high and low cortisol can cause inflammation but also includes things like gut, autoimmune, hypothyroidism itself, heavy metal toxicity, lyme, just to name a few. Like you, they suggest using selenium (if labs show low), milk thistle but advise that milk thistle can lower iron in some, treating inflammation, and adding using T3. They also suggest treating adrenals and low iron issues. I wish more docs had your knowledge in treating hypothyroidism. But thankful for information in your article and from STTM sites, books, and FB groups.

  48. Thank you so much for taking the time to explain everything in so much detail! I’ve read through many of your articles, and am now at the edge of deciding whether I should take WP thyroid or just Liothyronine.
    My TSH level has been on the higher side ranging from 3.5-4.3 on different days.
    T4 Thyroxine is normal at around 7.9 ug/dl and Free Thyroxine at 1.2 ng/dl.
    Free T3= 3 and Reverse T3= 16.7 so the ratio is 0.179 (less than your cut off at >2.0).
    Since my T4 is normal, I’m wondering if taking NDT might contribute more to the problem to because my body may convert the extra T4 from NDT to reverse T3 instead of free T3.

    Also, I remember you mentioned the SHBG level is an indicator of hypothyroidism at a cellular level. Is 61.0 nmlk/L normal.?

    Lastly, is there any link between hypothyroidism and PCOS? Will thyroid medication affect testosterone/estrogen levels? Can NDT help lower testosterone? I’m looking for a good solution to hit 2 birds with one stone targeting hypothyroidism & PCOS high testosterone levels. Any good advice? You are the best! I wish every doctor was like you!

  49. I have been on synthorid and cytomel for a while. In January of 2016 I started to gain weight and feel awful. I tried many different things increased cytomel, added supplements. In July, I stopped everything but synthroid. Then in September changed to natureroid. I have changed my diet and have had no success in how I feel and my symptoms are getting worse, especially with the weight gain. Any suggestions?

    • Hey Cicilia,

      The best thing you can do is find someone willing to help you figure things out. I find that most patients who try to deal with their symptoms on their own end up frustrated and either over/under treated. These type of symptoms are quite common and fixing them usually isn’t too difficult if you understand what you are doing.

  50. Dear Dr. Childs
    I am a 56 year old women. I have had hypothyroid about 7 years. I have been taking NP Thyroid 90 every morning. My TSH Sens is 0.02, my Free T4 is .69 and my Free T3 is 3.0. My leptin is 9. My thyroid Ab group is thyroperoxidase Ab, S- 1.4 and thyroglobulan antibody s – <1.8.I keep gaining weight and feel tired all the time. Any suggestions on what I should do? Thank you Linda

    • Hey Linda,

      I would start with the suggestions in this article but realize they are only a starting point. Treating metabolic damage like you have is difficult and requires help from someone who understands what they are doing.

  51. Scratching my head over my higher reverse t3 numbers! My t3 is 2.2 pg/mL and my reverse t3 is 23 ng/dL. Well that puts my ratio at 9.6, ack! I also have awesome insulin and leptin levels, and follow the AIP diet. My fasting insulin was 1.7 and my leptin was 5.9. I started taking zinc and selenium and hoping that helps my body convert t4 to the right pathway! And will be pouring over your website to try and gain more understanding, thanks for all you do!

  52. I am currently on 150mcg cytomel a day split into 3 doses around 5hrs apart. I have had no reliefe from my hypothyroid symptoms. Main thing is about 15-18lbs of water retention and weight gain,dry skin, acne and no libido ect. I am more temp tolerant, and my hair breaks less. That is it. I have been on this dose for about 1 week. I also want to know if you accept distance patients?

    • Hey Bonnie,

      That’s a good dose of cytomel so I would be surprised if you didn’t have any improvement with it. Also, water retention could be from many causes including other hormone imbalances. And I’m not currently accepting patients right now.

  53. I’ve been advised that a low T3:Reverse-T3 ratio contributes to coronary artery calcification, which I have been trying to control for the past five years. I’m advise to get T3 between 4-6 and T3:RT3 above 20. As briefly as possible, my T3 was in this range a few years ago before I learned its importance. I was taking 25 mg of iodine and my doctor thought that inadvisable, so I cut back and forgot about it. When I found out about the heart disease connection, I started trying to increase my now low T3 (2.4) by taking iodine. This time there was no improvement in about six months. So I found a doctor who would prescribe thyroid medication. I started with 15 mcg Liothyroinine and still saw no improvement. In fact my reverse T3 increased dramatically from 15.4 ng/dl to 26.4 ng/dL. My T3:RT3 went from 15 to 9. Three weeks ago the doctor increased my dosage to 25 mcg per day. I will re-test in a couple of weeks. My TSH has been between 5-7 with the iodine supplementation. Any thoughts about what is going on? Why did the iodine work so well two years ago but have no effect in the past six months? What might be causing the dramatic increase in reverse T3?

    • Hey Mike,

      While yes that ratio does contribute to coronary artery disease and calcifications there are other conditions which seem to contribute more (such as insulin resistance and abnormal blood glucose homeostasis). I would also caution against focusing solely on lab values as a marker of success without changes in imaging (are the calcifications worsening?) or without changes in your clinical symptoms.

      Also, taking T3 thyroid hormone by itself should lead to a drop in T4 due to a lack of substrate, so if your reverse T3 levels are increasing then your T3 dose is not likely high enough to cause pituitary suppression which means your body is still producing T4. You can simply drop the T4 by increasing the dose of T3, but more important than that would be to focus on the cause of reverse T3 in the first place. You will want to look at inflammatory markers, insulin, leptin and other hormones to find out what is causing the high reverse T3 levels.

      • Thanks, Dr. Childs, and happy new year.
        As I mentioned, I’ve been working on the coronary calcium for five years. The past year I made some progress, an increase of only 26 points, against what had been yearly increase of 100 points or more. I think the major change was getting a root canal tooth removed after reading Dr. Thomas Levy on that issue. My most recent score was 695, still high risk.

        I do a lot of reading, and I’m taking a raft of supplements, including vitamins C, K2, E, D3, CoQ10, zinc, selenium, niacin to reduce Lp(a). You get the idea. My CRP has always been fine. PL-PLA2 sometimes a bit high.

        I have not tested for thyroid antibodies, but my wife and I eat low carb, non-gluten diet. I exercise vigorously and have no serious hypothyroid symptoms, only cold hands and low pulse rate, which could be because I’ve exercised strenuously for fifty years. I don’t have heart disease symptoms either, but I gather when the symptoms appear, things are well advanced.

      • One addendum: I have had one symptom of heart disease: atrial fibrillation, which was an issue before I started taking about a gram of magnesium per day.

  54. I was hoping maybe you could steer me in the right direction! I’m 32 and have been to multiple doctors (some Holistic) and no one has been able to help me! My guess is that I’m having both adrenal and thyroid issues. I have had most of these symptoms for over 5 years but I got a lot worse after I went through a very stressful event a few months ago (Didn’t sleep or eat much for over a mth)
    Test results show:
    No hashimotos
    ANA direct = negative
    Thyroid peroxidase TPO = 10 (0-34)
    THyroglobulin antibody <1.0
    Aldosterone 19.3 (0-30)
    ACTH 49.6 (7.2-63)

    TSH 2.60
    T3 2.9 (2.3-4.2)
    T4 1.0 (0.8-1.8)
    Reverse T3 = 15
    All lipids are within good range
    Glucose serum 94 (65-99)
    Sex Hormone Binding Glob is always high and has been for years 215 (24.6-122)
    Free testosterone 0.5 0.0-4.2
    Prolactin stays on the high side 23.4 4.8-23.3
    Estradiol 193.39
    Ferritin and iron is low
    Iodine 40.9 (40-92)
    Dhea has been low the past couple of years.
    DHEA sulfate 47.4 (84.8-378)
    Dehydoepiandrosterone = 475

    Saliva test for adrenals shows normal levels throughout the day but high during the evening hours around 5 pm

    Symptoms: Hair loss (has got a lot worse over the past few months), fatigue, Brain fog, Joint pain that comes and goes in hands, I wake up with a locked jaw that gets better as I wake up, Melasma over entire face, Gains wt easily but has kept my weight down due to diet and exercise. My body can’t handle any kind of stress or even excitement ( My body over reacts to everything that seems to get my adrenaline pumping and it takes a while for my body to calm down such as a rapid heart beat ). I have been dairy and gluten free for years. I try not to eat any soy and try to only eat sweets once or twice a week at the most.

    I am extremely sensitive to most vitamins, caffeine, and all medications. I am also sensitive to chemicals (Clorox and other cleaning agents cause me to have headaches and I get very dizzy).

    I currently take vitamin C, B complex, Vitamin D, and probiotics. I try to take magnesium but it tends to make me feel jittery. I drink 1/2 teaspoon of sea salt in water every morning for adrenal support.

    I tried armour thyroid for only 3 days but it made me extremely fatigued to where I didn’t’ want to get out of bed . After trying armour my TSH shot up to 7 (was 2) but I can’t recall what my Reverse T3 was at the time. I am scared of trying any other thyroid meds due to that it took my body over a month to recover from the armour. My recent doctor prescribed me Slow release T3 compounded. Do you believe this would help or be a good idea to try? I also recently started taking kelp to increase my iodine levels. What are your thoughts on ways to increase iodine or if this sounds like a good idea considering my labs? Any help would be greatly appreciated! I’m scared to try any medications in fear of losing more hair (very thin now) and worsening my symptoms so I would love to hear what you think!

    • Hey Len,

      Not everyone does well on NDT, and most people that transfer over do so at low dosages or never get to the therapeutic dosage range for their body. This leads to people wrongly believing they don’t do well on certain medications.

      You will need a full evaluation including other hormones to determine what your body would do best on. The best thing you can do is try to find someone local to help you out.

  55. First, thank you for your website. It has been so valuable since having a total thyroidectomy in April. I have had trouble getting regulated on NDT. I have been systematically getting all the various labs done that you have recommended. I am addressing all of my “low” values (iron, ferritin, testosterone, adrenals), but my question revolves around Leptin. Within the last six weeks my FBS was flagged as high, as well as my A1C as compared to six weeks earlier. My fasting insulin has doubled and my Leptin is 30. I purchased a meter and having been checking myself several times a day. I feel like I need to address the leptin/insulin issue. What would you recommend, or how can I communicate this to my doctor. Though I follow a Paleo/AIP protocol and exercise with weight training 3x week, weight will not budge. I was also told in April that I have Hashimotos.

    • Hey Karla,

      The sudden rise in your leptin/insulin is likely secondary to a reduction in your thyroid hormone post thyroidectomy. This happens to patients with just plain hypothyroidism but usually takes years to develop. The good news is that you know what is wrong, the difficult part will be obtaining treatment. General physicians aren’t taught to test or look for leptin resistance and there are few treatments available. On the other hand, general physicians don’t really know how to address fasting insulin levels that are elevated unless they are accompanied with an elevated Hgb A1c at which point they will recommend metformin or other diabetic medications. You are probably sitting in a position where you have high fasting insulin/leptin levels but relatively normaly hgb A1c levels which means most providers won’t be likely to treat you. The best thing you can do is find someone who evaluates hormones in a similar manner you see on this site.

  56. I am about three months postpartum and was being treated for subclinical hypothyroidism during pregnancy with T4 only medication. My levels were great…FT4 about mid-range and FT3 upper range during pregnancy. However, during the postpartum period, my numbers have gone crazy. My FT4 is slightly below mid-range, my FT3 is waaaay ABOVE range, and my RT3 is at 16. I have been told I could be pooling. But my numbers don’t fit any scenarios you discussed above. We ran my labs multiple times to rule out lab error. I decreased my T4 meds and rechecked after a month. My FT4 had dropped, probably too low, my FT3 was still high, and RT3 still at 16. Ferritin levels and iron levels were good. Vitamin D was at 60. My doctor has no clue what to do and wants me to find another doctor that can help me figure this out.

    I was feeling perfectly good at first, but now I’m starting to have more hypo symptoms once again…mostly just foggy, depression, tiredness, and not losing weight. I do have a three month old baby that still wakes in the night. What do you think could be going on???

    • Hey Jessica,

      Unfortunately, I can’t give you specific medical advice because you aren’t my patient but a couple things to consider:

      – Your lab tests don’t really matter if you are feeling well, meaning there is no need to change your dose based on your numbers below
      – If you dropped your dose then became symptomatic, then I think you have your answer
      – Postpartum hormones are always in flux, which is why I generally don’t recommend checking thyroid hormone (or other hormones) immediately after pregnancy

      Hopefully this helps give you some guidance.

  57. Hey there 🙂 Found you by accident surfing on the web about reverse T3 etc. I have had Hashimotos since I was 23. I have always been on T4 meds like Levoxyl and Levothyroxine and did okay with them. I started on Armour and then Nature Thyroid because of my TSH level. Found out through a board on Facebook that I should be checking TSH, T3Free, Reverse T3, Free T4. Thankfully my doctor is amazing and willing to help and listen. At the moment I am on 2.25 grains of Nature Thyroid and I have NEVER FELT MORE HORRIBLE. The worst muscle aches and pains and weakness that I have ever had even being on the T4 meds only. I am so discouraged because there is so much info and so many opinions.
    My T3 Free numbers were a 2.7pg/ml (Out of the range of 2.0 – 4.4 pg/mL)
    TSH 1.850 uIU/ml (Out of the range of 0.450 – 4.500 uIU/mL)
    REVERSE T3 was 23.1 ng/dL (Out of the range of 9.2 – 24.1 ng/dL)
    T4 Free was 0.86 ng/dL (Out of a range of 0.82 – 1.77 ng/dL)
    I have had gallbladder surgery last year and it seems like a reactivated Epstein Barr numbers in my blood work.
    My doctor wants to put me on Cytomel? Will this help me? I am so scared to add or take away anything to my body since I have had so much the past two years. My doctor is so willing to help but don’t know how well versed she is in thyroid issues…..HELP!!!!

    • Hey Cathy,

      I can’t provide personalized medical advice via this forum since you are not a patient of mine. Your situation is not as complex as you might think, but you do need someone who understands thyroid function to help you further.

  58. Dear Dr. Childs,

    I see that you do prescribe bio-identical hormones. Do you find that compounded bio-identical progesterone has an effect on compounded Tri-iodo-L-Thyronine. I know that progesterone supports the thyroid, so when supplementing both, have you found that one affects the other in any significant way.


    • Hey Karen,

      I haven’t found progesterone to clinically impact thyroid levels, but I have found that thyroid hormone supplementation can impact progesterone/estrogen levels significantly.

  59. Hi Doctor, Thank you very much for all the information you provide.

    Do you know any fellow practitioner in Australia who follows a similar protocol as yours? My Free T3 is 2.7 (3.1 – 6.0) and Reverse T3 is 0.624 (1.200 – 2.200). I feel crushed. Also, I am Vitamin D and Iodine deficiency 🙁 …I am also a good doctor deficiency as well 🙁

    • Hey Martha,

      Unfortunately I don’t know any other providers who practice like me, this is something that was self taught – so the only way that doctors may practice like this is if they spent the time researching on their own.

      • Thanks, Dr. Childs, for your reply.

        If there is any chance that you can treat me, despite of the (very) long distance, please I kindly ask you to let me know. I feel horrible and I think that what makes me feel worse is being unsupported by a good physician.
        Thank you very much

      • Hi Dr. Childs,

        If you don’t know of any other providers who have a practice such as yours, and you are not accepting new patients, have you considered teaching and training seminars to educate doctors so we all may benefit from your knowledge? Thank you.

  60. Hello,

    I can’t find the erase button on this board. Please erase my previous post.
    My wife wants me to return to a previous doctor. And for legal reasons,
    she wants this post removed.

    thank you



    IE : ” hi Doctor Childs,

    This is all quite interesting. I say this after being treated on T3 – for 30 years —…………………. etc “”

  61. Hi Doc
    I am a doctor myself and I must say your site is great. I have been having some symptoms my self for a few yrs. Persistently low DEHA-S levels, hair loss on my legs back pains etc..
    Did my Thyroid panel: TSH 1.59mIU/l (normal for lab 0.4-4.5)
    Free T4 1.0 ng/dl (Normal 0.8-1.8)
    Free T3 2.2 ( low) (normal 2.3-4.2)
    Reverse T3 22 ( normal 8-25)

    Between 2011-2013 I was under tremendous stress with a legal issue, It took a toll on my system. I weigh 187 lbs age 48. Is a good idea to start on T3 alone..?? possibly cytomel/ liothyronine or 1 grain of westhroid ..

    Regards Dr Uche

    • Hey Chris,

      In this case it’s probably better for T3 only titration. I would also check both free and total testosterone and coritsol levels then treat both.

      • Hi there..
        Thanks for the quick response… When you say treat both I assume you mean Supplement the DHEA or do you mean the T levels if indeed they are abnormal.. Do you have a contact number ? or practice number..?

      • Hi Dr Westin
        I weigh 190lbs.. I started off on lowering mt Reverse T3 ( level was 22) with Cytomel 10mcg.. It there an optimal dose..? IS it best to titrate up to 15mcg or titrate depending on symptoms..? and what a good duration.? 6wks or just depending on levels and symptoms..

        • Hey Chris,

          There is no optimal dose based on weight/age/sex/etc. instead it’s based on a combination of other factors including lab tests, symptoms, body temp, resting heart rate, etc.

  62. I love your website – tons of great info. Thank you for the education! I am a Chernobyl survivor battling Hashimoto for the past 30 years after partial thyroidectomy. I am on 112 mcg T4, and 7.5 mcg T3. My latest numbers are TSH 0.045, FT3 2.7, Ft4 1.1, rT3 15.6. Antibodies 37-42.
    I calculated my T3/rT3=0.173
    B12 573, Vit D 75, Zn 80, Se 145, CRP 0.31, low cortisol, low testosterone, low DHEA, Ferritin 20, HGB 13.9
    I think my T3 should be increased, but my Doc is afraid due to low TSH. I am a classic hypo with low energy, weight gain despite clean diet, hair loss, brain fog, irritability, cold intolerance, constipation, low libido, and so on. I am a full time medical professional, wife and a mother. I am so exhausted of being exhausted. Any advise would be greatly appreciated!!!
    Do you think its safe for me to be on T3 only?
    What can I do to increase Ferritin?
    Thank you for your expertise!

  63. Hi. My mom is 6 months post thyroidectomy with 5% remaining thyroid. She is taking 75 mcg of Levothyroxine but still has depression, anxiety, severe leg cramps, hair loss, weight gain and started having epigastric pain that is the same kind of pain when she had a duodenal ulcer. Physcian ordered omeprazole. She was goiing to the gym 4-5 days/week but now does not have the energy.

    I am an RN, nutritionist and currently in ND school. I ordered a lab panel and results are as follows: Electolytes normal – checked due to leg cramps. TSH=1.120, RT3=24.6 (9.2-24.1), FT3=2.8 (2.0-4.4), FT4=1.83 (.82-1.77), T4=11.5 (4.5-12). I am coming up with 0.11 ratio and think she would benefit from an RT3 flush with a bioidentical T3. Would this been reasonable to you? It is very difficult to find physicians that know the information that you are sharing. Her endocrinologist says she is “normal” because her TSH is normal and does not do any other testing. Her suffering is leading me to websites such as yours, trying to find an answer. Any information that you can provide is appreciated.

  64. Yes hi I have high rt3 at 134. My Dino test came back positive and an being treated with antibiotic. I am t3 meds 3mcg x2 daily repeating blood word in two weeks. Was put on tons of supplements, and on cortef. After being on cordef for two week was haveinv horrible side effects so had to stop. Also on ldn. Still not feeling well, it’s a day to day right now. Any recommendations? I suck at handling stress, am a recovering bulimia-purge.
    Low vit b, was anemic, low mag, nutrient deficiencies. Currently gained 8 lbs, eating greens, and superfoods, implemented exercise three times per week. Been treeatdd by current doctor since Jan.

    • Hey Charlene,

      Patients who have had bulemia and/or anorexia like behavior in their life tend to react much slower to medication changes and tend to take a lot longer to feel better.

  65. Roughly 5 years ago, (age 47) during an extremely stressful period of my life, I was prescribed levothyroxine for an elevated TSH of 4.7 (0.40-4). At the time, the only other level read was my FT4 = 1.22 (.80-1.8). I had felt many symptoms of hypothyroidism so was kind of excited for the treatment.

    Two years later, with little change in my symptoms, and after my doctor quit his practice, I stopped taking the levothyroxine. The next year I found an endocrinologist who (for the next two years) ordered many tests and a whole lot of lab work, resulting in lots of head scratching and being told we will just monitor you for a while.

    I am now 52, I still feel like crap and my weight of 185 at 5,8 makes me feel like a slug. Since stopping levothyroxine my FT4 levels have ranged between 2.98 – 4.48 (0.80 – 1.80) my FT3 readings have ranged between 9.2 down to my latest reading of 5.7 (2.30 – 4.20) and my DHEA, has ranged from 200 to 457 (15 – 170). No rT3 has EVER been ordered or suggested. I am currently in search of a new endocrinologist but was wondering if those numbers mean anything to you. So far none of my doctors can figure me out. Just looking for some direction.

    • Hey Cheryl,

      Lab values by themselves mean very little if they aren’t paired with symptoms, body temp, resting heart rate, etc.

      • Oh yes, I get that! It’s just that, even with my doctors having all that vital info before them, they still can’t make heads or tails of my numbers. They would explain “if this number were high while this number was low, then it could be this or that, but your numbers aren’t like that”. They literally have nothing to offer (besides, wait and see) to help me understand my combinations. So I was only wondering if you have run across numbers like mine or if am I just the ‘lucky one’.
        Thank you

  66. Hello Dr. Childs. I posted on Feb 22nd. I realize you are bombarded with questions, but am I on the right “thinking” track in regards to needing a RT3 flush with bioidentical T3 for my mom? Thanks for letting me pick your brain. Shar

          • I know that you have mentioned before you no longer take patients and you don’t have recommendations on doctors in other areas, but like many, I am desperate. I have been to so many docs, gone completely broke, begged and pleaded and am suffering miserably. I live in Seattle. I need someone who can help. I have tried all kinds of natural thyroid meds, T3, Wilson’s protocol, diet changes, supplements and I have gotten worse. I need help. I truly can’t live like this anymore.
            If there is anything you can provide as far as recommendations I would be so incredibly grateful. Thank you!

          • Hey Tina,

            I plan to email my mailing list when and if slots open up for new patients, but I don’t expect this to happen for a while (if it happens at all and I wouldn’t recommend you wait for that to happen if you are suffering). If possible you might be able to seek out someone local, but I don’t have any resources I can guide you towards.

          • Tina. I hope that I am not overstepping any bounds (including Dr. Childs :)) but I “hear” the desperation in your e-mail. My mom has expessed some of your same symptoms.

            I have been to many A4M conferences and those who go through their training/internship programs seem to look for root causes of imbalances and incorporate additional complimentary treatment protocols. Although I do not know any of these practitioners nor do I know Dr. Childs or his professional opinion, you can check out this website: for those who are A4M boarded and practice in Seattle.

          • Hi Tina
            I feel your pain.. I am a physician and have Thyroid issues too.. what are your lab results.?? I may be able to give you some pointers

  67. Hi – I just got back my lab results. I was on 3 grains of Armour Thyroid and my Dr said i should increase by half a grain, every time i went he asked me to increase, so i asked why he was doing this and he said he was just testing cos really i was normal. I told him i was not, it was 5 degrees outside and i was wearing a T shirt, i had serious heat intolerance and swelling, he then said, OMG since when, and i told him i had been saying this for the past 8 months, he then told me that if i had heat intolerance and swelling, then i had Thyrotoxicosis and that i should reduce the meds by half a grain. i didn’t do that, maybe i did wrong, but what i did was stop all my medication at once, i just continued to take my supplements. This was 2 months ago and now i’ve got my results as follows, l still have issues with weight, and fatigue and brain fog. I also have Hashimotos.

    TSH 6.79 T4 Free – 6.5 T3 Free – 1.3 Reverse T3 <0,009
    Thyroglobulin antibodies 103.00
    Thyroperoxidase antibodies 345.5

    I'm exhausted, and weight keeps coming on. My power naps are about 3 a day of minimum 30 minutes.

  68. Hi, I am awaiting results for reverse T3, I was amazed to see your point about beta blockers, I have been taking propranalol for years for essential tremor.
    I have been to the Dr so many times about issues of sleep disturbance, fatigue in the daytime, joint pain and muscle weakness.
    All I ever hear is it’s your age, I am 55 years, and had a full hysterectomy at 37 years of age. I just want to know if it’s a result of beta blockers or no HRT, or something else. How long would it take to determine the true cause of my issues, if they are related to reverse T3. If I stop the beta blockers I wont be able to do my job, If proven to be raised levels of Reverse T3 is there a medication I could take that wouldn’t contradict the propranalol.
    Catherine Burton

    • Hey Catherine,

      Usually there are other factors that contribute more to reverse T3 levels than beta blockers.

  69. Hi Dr. Childs,

    What a great article. I really appreciate your straight forward approach and easy to understand writing style. I believe I’ve been suffering from T4 to T3 conversion issues for some time. I’ve had hypothyroid-like symptoms for over 5 years, but my labs have always been in normal range. I’ve been to 5 different doctors both in the conventional world and the alternative world – none of them have been overly concerned about my thyroid. After reading your article I pulled out all my old labs and did the math – in 2014 my T4:T3 ratio was 0.11, in Dec 2016 it’s 0.13. My hair is falling out, my skin is so dry it hurts, my eyebrows are practically nonexistent… the list goes on. However, I am underweight, not over – for now.

    I have a pretty good understanding of what my underlying factors are – chronic stress, EBV and definitely some gut issues. I am also homozygous MTHFR which as I understand it, makes detoxing more difficult. I’d like to bring this to the attention of my primary care doctor and work collaboratively with him to create a plan. He’s open minded and is usually interested in my input. However, I feel like we have yet to really get to the root of the problem. Any advice on how to have that conversation or suggested starting points for a treatment plan would be appreciated.

    Thanks for all you do and for making information like this accessible and understandable for people like me! You’re really making a difference!


  70. How would you treat a patient if their reverse t3 was exactly 15 and ratio above .20? Would you want this lower or is 15 the absolute cut-off?

    • Hey Denise,

      Reverse T3 by itself is not very helpful, you need a more complete panel. Sometimes high reverse T3 is a normal compensatory reaction from high doses of T3.

  71. I had to switch doctors. The new endocrinologist convinced me to switch to Levothyroxine from Armour Thryroid. I had been on Armour for 10 yrs. The doctor insisted it was a more stable medication, and that my blood tests were always fluctuating. It’s been a year on the Levothyroxine and I feel terrible. I have developed all kinds of muscle and tendon tenderness, tendonitis and muscle cramping. As well as weight gain. I am having a hard time convincing the Dr. to switch me back. Any thoughts on what I can say to convince them to switch me back?
    It’s really terrible that as a patient I have to beg them to listen to me.

    • Hey Lise,

      It’s generally not worth it to try and convince a doctor to treat you a certain way, your time is much better spent looking for someone who is more willing to listen to you.

  72. Ahhh, gotcha and thank you Dr. Westin for the response. My ft3 was a tad above range, 4.4 with range limit of 4.2. Ft4 is still rather low at about 10% of range. I am on 150mg NP and 25 mcg cytomel. I am perplexed on which to cut, nurse practitioner said play around and find what makes me feel good. I feel if I cut 30mg of the NP, that should do the trick of getting that ft3 back down some.

  73. I have had low thyroid for over 20 yrs. I took T4 meds for over 20 yrs. No one cared about constipation, dry skin, memory problems, intolerant to cold, very low body temp, ect. Two years ago I tried T3 meds and loved it. About one year ago I thought I needed new hormones, (E2 and Test) pellets under the skin. By the last round in November, I couldn’t lose the weight that these things put on me, I started producing Tsh again. No one knows why. Is it important? Who Knows. The doctor suggested Nature Thyroid meds, so I tried it. I had allergic reactions 3x. So then I thought I needed an endocrine’s advice. This doctor told me taking T3 was cheating, like taking steroids. It would also hurt my heart. He put me on low dose of T4 med. Two days later, tummy aches, eyes puffy and swollen, ect. Finally, after one month I went back to T3 meds. Mood improved in less than 24hrs.

    I also started producing thyroid antibodies that are going up, not sky rocketing, just climbing up. Yep, I’m taking my health back into my hands.

    I work in laboratory medicine, and understand the numbers game. I just wish I didn’t have to play it. 🙁


    • Hey Tracie,

      Thanks for sharing your story and I think this is a great starting point to help you get back on track.

  74. I found your article very helpful!! My doc tested tsh and t4 which came back normal. I asked her to check t3, which is on low end (2.4). She left it up to me if I want to proceed and treat, but didn’t say with what. After finding your website, I now know about rt3 and asked if she would check it, which she will. I plan to go in soon. She’s willing to check whatever I ask, which is great, I just wish conventional doctors were more in tune with this instead of the patient having to do so much research! So thank you for the very helpful info!
    My d3 also tested low, (26.5) and my cholesterol high (ldl 129 hdl 147). In your experience, can either of these two be related to slow thyroid? I already was taking 2000 d3 (liquid form with k2) which I’m increasing to 10,000 then retest in 8 wks. I get confused what to focus on. If my rt3 comes back high, would you recommend treatment, or wait to see if increasing d3 helps my symptoms ( fatigue, stubborn weight, eczema, depression)? My doctor is willing to try what I suggest, depending on how I feel. Thanks in advance!

    • Hey Kristen,

      As a rule of thumb if you have to ask for testing you will most likely never get the right kind of treatment necessary to feel better. Testing is only about 5% of the problem, the other 95% is dependent upon how and what you are treated with (including other hormone imbalances).

  75. Wow thanks for the speedy reply, I appreciate it! Yes, I feel I need to find a functional medicine doctor in my area to address my symptoms. I do believe in conventional doctors to a point, but I think they focus too much on prescriptions before exploring further. Thanks for what you do!

  76. Dr Childs, I have managed most of my symptoms by switching from Levothyroxine to NathureThroid. I still have fatigue and brain fog…. but The one major issue I have is weight loss. No matter what diet I try, I cannot even lost 1 pound. Sometimes I even gain weight. Ive tried KEto, low cal, high cal. Paleo, you name it!

    I could really use some guidance on that. PLEASE help!

    Here are my labs:
    Reverse T3: 17.4
    T3 Total: 2.6
    T4 Total: 7.9
    T4 Free 1.29
    TSH 1.55
    Vitamin D 35 ng/ml
    Ferritin 20 ng/ml
    Average Glucose/ A1C 105 mg/dl 5.3%

  77. Hello Dr. Childs,

    Love your website and the breakdown of information provided. I have had hypothyroidism for the past 15 years and was being treated with synthroid. Unfortunately, my symptoms have become much more severe over time and thanks to you website, i had my physician test my reverse T3 in addition to the others standard readings. My T3 just cam back today at a level of 30 with my TSH, T4 and T3 at normal levels. I was so relieved to now have the data to be able to better understand my thyroid condition and actually start taking an appropriate medication (doctor put me 5 mg of liothyronine) to help me during the next couple of months. In the meantime, since my symptoms and acid reflux has become so severe and debilitating over the past two months, I I am now committed to a total change in diet to help my body heal. I just downloaded your 4 week food plan and I noticed that in the list of basic guidelines, there is no mention of dairy products needing to be removed, however in reviewing all your recipes, I noticed that there are no dairy products. Should dairy products be avoided? Thank you for helping to educate and support those of us who have been living in a chronic state of illness not understanding why we just could not get better!

    • Hey Isabel,

      Dairy is highly individualized, but the best way to approach it is to remove it for at least 4 weeks before a trial introduction back into your diet. If you find you can tolerate dairy products then using raw/organic/full fat dairy products may be fine for your body.

  78. Hi Dr. Childs,
    Thanks for another great article. I’ve printed several and put them in a binder I now call my ‘thyroid bible’ along with my labs, food and symptom journals and find the info very useful.

    If I understand this article, if a person (me) has a conversion/reverse T3 issue and is given a higher dose of T4 (Synthroid), this could actually prevent balance of the thyroid hormones because being a poor converter, I now have more opportunity to create RT3, which might further block the absorption of liothyronine at the cellular level. If correct I get the sense my current provider is taking me down this path. A recent increase of T4 shows optimal TSH and T4, meanwhile doubling liothyonine saw no effect on consistently decreasing FT3 values. I was told that a sub-reference value (20ng/dl) was ok because things fluctuate. There has been no fluctuation in 7 months, only decreased values. Hoping this provider is willing to work within these constructs but if not I’ve scheduled with a local integrative/functional MD to pursue root cause and optimal treatment options.

  79. Is it possible that Reverse T3 rises within quite a short time. I have adrenal fatigue, which was already getting better before we started treating my SIBO. I took first Biocidin for 3 weeks, but this got my SIBO so bad that I was spending most of my time in bed. So I went on Rifaximin for 4 weeks, which has helped and now I’m absorbing nutrients and things are better. But as a result I now get very tired in the evening as well whereas before I was kind of waking up towards the evening as you often do if you have a bit low cortisol. I have a functional doctor and a functional nutritional therapist helping me out. We checked my TSH, Free T4, Free T3, TPOAg and TyglAg and they had got better during the last 7 months. Yet, I got more thyroid symptoms like the tiredness in the evening. Cortisol is still the same a little bit below normal. So I’ve just taken a test for Reverse T3 and am hoping that this would be the answer to why I’m not getting better now. So I was wondering that as my symptoms got noticeably worse during the SIBO getting worse, I was wondering if the reverse T3 could have increased during a short time of feeling really bad.

  80. Dr. Childs,

    Thank you for this information – extremely helpful. Do you have any recommendations for colleagues in the NY/NJ area that understand thyroid issues particularly reverse T3? My T3 to RT3 ratio is low and I believe I may have subclinical hypothyroidism. I don’t want to go to someone that will misunderstand or put me on the wrong course of treatment.

    Alternatively, would you be willing to consult with someone by phone or visiting from out of town even if they don’t live in your area?


  81. Dr. Childs is the following possible? A person is taking both Synthroid and Cytomel or NDT. This would cause RT3 to be
    elevated in order to prevent T4 from converting and increasing T3 too much with T3 meds on board?

  82. Hi Dr Childs,

    Great reading! Several endocrinologists haven’t been able to offer any treatment protocol for exactly what you have described. I have normal T4 and TSH, low to normal T3, but highly elevated RT3 out of the reference range. Being out of options, I have obtained T3 myself and my only question top you is, what is the process following the recommended 2 months of T3 titration? I was under the impression you can’t abruptly stop taking T3 or is the dosage at the end of the 2 months not significant enough to damage/stop natural production if you suddenly stop taking it?

    I will be getting bloods done at 4 and 8 weeks to monitor it.

    Thanks in advance!

  83. My Dr wants me to start cytomel and drop my synthroid way down. I am so nervous as I am a “sensitive” patient. What if I can’t tolerate this protocol? What should someone like myself do?

    Appreciate any suggestions. Struggle with everything.

    Thank you,

  84. I had left another post but failed to mention that I also am dealing with adrenal exhaustion. I am so afraid to start this protocol as I already feel terrible.

    Suggestions appreciated.


  85. Hi,
    I have the following blood tests as of 3/17/17:
    Got my DHEAS & 4 times saliva test results back today. These were done by ZRT.
    DHEAS (saliva) 8.8mgmL 2-23ng/mL (Age Dependent) in the picture this shows it as high
    Cortisol 6:30 am 7.2 ng/mL Low 3.7-9.5 ng/mL (morning)
    Cortisol 11:55 am 1.9 ng/mL Low 1.2-3.0 ng/mL (noon)
    Cortisol 4:46 pm 1.8 ng/mL High 0.6-1.9 ng/mL (evening)
    Cortisol 9:43 pm 0.5 ng/mL High? 0.4-1.0 ng/mL (night)
    Iron total 85 45-160 mcg/dl
    Iron binding capacity 299 250-450 mcg/dl
    (calc) % Saturation 28 11-50 %
    (Calc) & Ferritin 29 10-232 ng/ml
    Vitamin B12 328 200-1100 pg/mL.
    Magnesium, RBC 6.2 4.0-6.4 mg/dL.
    TSH 1.03 .40-6.20
    FT4 1.16 .54-1.24
    FT3 2.7 2.5-4.4
    RT3 24.8 9.0-27.0
    TPA 1.5 <=9.00
    AB <0.9 <=4.0
    Selenium 197.1 60.0-230.0
    Zinc 14.6 9.0-14.7
    Iodine (urine) 57 34-523
    I haven't slept in over 3 weeks for more than just an hour or 2 and then dose the rest of the night. Any suggestions?

  86. Hi Dr. Child’s,
    9 weeks ago I switched from Armor to Synthroid and recently added cytomel.
    After 2 weeks of 10 mcg of cytomel, my numbers are as follows:

    I have Mitral Valve Prolapse and am VERY sensitive to all meds…haven been on a beta blocker for 30 years and I have started having a lot of palpitations and anxiety…any suggestions since my ratio is 16? Not fatigued at all, just more loose bowels than usual. Also working on getting magnesium levels up but very difficult!

  87. Dr. Child’s,
    After reading many of your articles on Thyroid issues I noticed in one you had listed an Arizona address & contact info to see patients.
    I moved from Queen Creek AZ to Washington state but had my former husband go to the address listed for you online. Long story short he was told you were no longer practicing there. I called the phone number listed and left several messages but didn’t receive any call backs. I’m fairly new to Hypothyroid as diagnosed just last Spring right after diagnosed with Fibroids and then undergoing Hysterectomy leaving healthy Ovaries. I was also diagnosed with OSTEOARTHRITIS just this past year by my Pain specialist. Its in my cervical’s and entire spine. Its just been one thing after another!
    I’m having a horrible time finding a good doctor to help me. I dealt with terrible and long-term stress for many years which is I think reason for thyroid issues plus chronic pain after a freak accident slip & fall 1994 led to back & knee surgery. Due to over 1 year misdiagnosed issues damage to nerve root led to chronic pain in low back reason for pain meds & then accident car accident few years later 2005. Then another car accident just this Feb. 2017!!
    I know this Email is quite long but please bear with me.
    I decided to try & wean myself off one of my chronic pain medication since Feb of this year & it’s been horrible but I had actually thought I was going to make it after the worst part seemed to be behind me or so I thought was over..that is until this past week! My muscles & joints all over down to the soles of my feet are in excruciating pain! I just saw my new pain doc today & broke down. I explained I’d been trying to get my Endo to see me & get my last lab results from 2 months ago! I truly feel my levels have been off & may be contributing to severe pain.
    She agreed & suggested I be checked every 6 weeks until feel better.
    My usual weight of 115-120 has rocketed to 136 with majority of fat around my midsection. I look 6 months pregnant & feel so disgusting! I saw my GPA day b4 & she obtained my lab results of 2 months. She told me my Thyoid levels were pretty high. I explained I’d just been able to finally get an Appt with my Endo for next week. She said I’d need new labs taken.
    My concern is when they finally called the girl on phone..some office person told me labs normal..when asked her about TSH..she paused & only said I’d need to cut back my thyroid meds’s & wait 6 months to be seen! I refused to wait that long & she clearly knew nothing about labs let alone what TSH even meant!
    So Dr. Child’s I am pleading with you for your help.
    I honestly feel the T3 and debilitating pain throughout my entire body for these last 2 weeks now truly has to do with the issues you wrote’s as if they each are describing me and my body & symptoms!! I did see a Naturopath in Arizona last November after unable to see or reach you.
    He prescribed changing from Armour to Naturethroid plus a number of supplements some of which I’d taken for years. He also put me back on a natural Progesterone cream & low dose Testosterone pill. I’ve been menopausal since 2009 (actually still had menses monthly but lab panel showed full menopausal with all symptoms) on bio-identical hormones right after being diagnosed. My new Gynecologist didn’t think it was necessary regardless of how bad I felt.
    Naturopath also ordered battery of tests plus saliva and Adrenal Fatigue with numerous others. Yet..with being here & my continued issues especially zero sleep and weight gain plus fatigue I truly feel I NEED another doctor! He also feels it has to do with the fact that I’m exposed daily to Wi-Fi signals from computer system in house & told me to do away with & revert to dial up instead.
    So, Dr. Childs are you available to see patients?
    I am in a desperate need of a physician who actually knows and can treat this horrible illness! Helping people online is absolutely wonderful but also still
    treating them personally and helping them to have a normal or semblance of normal life is a very generous gift!
    One more thing…before my first freak accident in 1994 a slip & fall which led to both knee & back 1995 & 1996 surgery…I was extremely healthy and active & looked beautiful and had a great healthy body & never took any drugs or had any illnesses!
    Just wanted to give u a bit of my former health HX.
    I also slept like a baby & have eaten a very healthy diet with supplements & never a smoker & social drinker
    OR was social drinker..mostly white! Now I am Always exhausted due to
    Lack of sleep & no meds have helped. Sleep studies first Dx Sleep apnea after contracted a severe staph infection in both lungs while trip to Mexico 1999.
    Almost died. Took docs almost year to correctly diagnose! see this is yet another reason I am begging you for your help! I’m afraid I will end up in same situation again…please..can YOU help me?
    I relocated to a small town..Kennewick WA. NOT MANY Thyroid docs especially of your caliber!!!
    Dr. CHILD’S, I will anxiously await your reply…please know I wouldn’t be so desperate if I had either experienced any change in my Thyroid issues but everything is only getting worse!
    THANK YOU Dr. Child’s for all the information in these 2 articles. In case I don’t hear from you I plan to print out this info & take to my Endo Appt next week to both reason & run the T3 tests needed.
    I truly feel this may be the issue…
    Again Thank you Dr. Child’s.

  88. Curious… I have hypothyroidism but continue to gain weight despite healthy clean eating and interval training. Looking into Leptin Resistance. I check all the boxes.

    My Reverse T3 to Free T3 ration is .3 It is not below the .2 you mentioned I will get more uptodate blood work per your suggested areas to test. But, is this an indication that my body is not converting T4 to T3 but rather to reverse T3?

    My doctor’s answer to increased weight and hypothyroid symptoms is to add an afternoon dosage of armour. I am concerned about taking any T4/T3 if I am converting to Reverse T3. Counter productive.

    How do we find a doctor in Cleveland area?

  89. Dr Childs,
    Thank you for your articles, they are a lot of help!
    Let me ask you what shall i start with? T3 only or T3 plus Ndt?
    I have low FT4 ….11.3 ( 10.3 – 24.5)
    Low/mid FT3 …..4.27 ( 2.3 – 7.00 )
    High TSH……8.28
    High Reverse T3 …..27 ( Insulin 7,8, SIBO)
    I take all the reccommended supplements for several months.
    I’m going to start with T3 only but i have read that T4 levels will be lowered after introducing T3.
    Should i add some T4 or it is not necessary?
    Thank you

  90. Hi! I’m currently struggling with high RT3, but am also pregnant. I’m reading that I need to drop the NDT and Cytomel that I’m currently taking in order to flush the RT3 out, but I’m scared of doing this while pregnant. I’m reading conflicting information about the baby’s needs for thyroid hormones (most commonly said is baby takes T4 and converts it to T3, which makes me scared to take away the little T4 I currently have. There’s very little information about treating pooling while pregnant – can you point me to someone or a resource to guide me? Currently my functional doctor doesn’t recommend flushing the RT3 and says the elevated number is likely just bc of pregnancy. Obviously, my reproductive endocrinologist isn’t knowledgeable in this area. Any wisdom? Thank you!

    • Hi Gypsy,

      I wouldn’t recommend changing up your thyroid medication while pregnant without physician supervision.

  91. Hi Dr. Childs, thank you so much for information very useful but hard to implement without a right doctor. How can I become your patient? Who do you recommend if I can’t see you? Please help, what you are explaining makes so much sence. I am looking forward to your response. Please help.

    • Hi Suzanna,

      Unfortunately Dr. Childs is no longer accepting patients and we currently don’t have anyone to refer you to.

        • Hi Suzanna,

          Dr. Childs only prescribes medications and hormones for his patients and he is currently not accepting patients. If you are referring to one of the other programs we offer, those do not include medications.

  92. Hi dr child’s!

    What a great article thank you!

    I asked my dr to check rt3 last year as weight loss was extremely difficult. Rt3 was 585!!!
    I started t3 I’m on 15mcg daily. 6 months later my rt3 is 274.

    I am diabetic on insulin. I eat under 30g carbs daily. My leptin levels last time I checked were very high (can’t remember exactly but very high!). I weight 80kg – 12kg over my happy weight. I’m down as type 1 dm but no antibodies. Metformin doesn’t work for me but I do think I have insulin resistance as my insulin requirements are increasing even on low carb diet.

    I take 200mcg selenium & 60mg zinc citrate daily.

    I was thinking I might need more iodine? Last iodine spot test was 80 & I take 5 drops 3 x weekly.

    I have been recovering from very severe cfs following EBV. Before then I was very active & fit. I do think my thyroid is the main cause of my weight issues.

    I’d love any input you may have I’m 100% compliant!

    Many thanks
    Stefi x

    Perhaps I should be increasing the t3?

  93. Hi Dr. Childs in your post you wrote “For reverse T3 I use > 15 as my cutoff for abnormal”. Couldi you tell me please what is the considered unit of measure for reverse T3?

      • Thanks Dr.Childs. I tried to calculate my ratio Ft3/Rt3 and I don’t realize your indication about.
        I have a good Ft3, upper 1/2 of the normal reference range (0,33 ng/dL), and I have also a good Rt3 by your indication (14 ng/dL). I expect to have a good ratio but if I calculate FT3/RT3: 0,33/14 = 0,023, that is very far from >0,20 you consider in your post. What’s happened?

        • Hi Michele,

          The ratio is only important if you symptomatic. If you are just fine then don’t worry about the numbers.

          • Dr. Childs I would talk with my doctor about your interesting post without any doubt. So, if you consider 15 ng/dL as the limit between normal and abnormal RT3, and 0.20 the limit between normal and abnormal ratio FT3/RT3, I realize that the limit between normal and abnormal FT3 is 3 ng/dL. This is impossible: the usual range for FT3 is 0,15-0,45 ng/dL. It could be that the limit ratio FT3/RT3 is 0,020 instead 0,20?

  94. Hello,
    I’ve been treated for hypothyroidism for about 11 years now. It was only recently discovered in my labs that I have low progesterone, testosterone, and cortisone along with my thyroid issues. I have been on a very high dose of thyroid medications for a long time. 10 grains of NDT and 75mcg of Cytomel daily. My free T3 and T4 are above range. My other low hormones are now being treated with more bio identical medications. Yet I still have hypo symptoms. I am wondering if it is from pooling RT3. I will try to have the lab done for it soon. Maybe you can help me with one major question I have until then…I have seen where some information online suggests dropping NDT down to 1-1.5 grains a day to clear the RT3 out, other sites suggest dropping NDT by half the person’s total does to accomplish this. What I don’t understand is are you supposed to drop your medication levels suddenly or taper them down to get rid of the RT3? Like would I need to drop to 5grains or 1.5 if RT3 pooling is confirmed or taper down over a couple months?
    Thanks, Marie

  95. Dr. Childs,
    What if the patient has a free T3 of 4.9 and a Reverse T3 of 43… TSH is elevated at 5.8. Free T4 is 1.4. Antibodies are not elevated. Patient is symptomatic. Would you recommend starting lower with T3 supplementation for this patient? Patient also has symptoms of testosterone deficiency & adrenal fatigue… working on getting those labs.

  96. Dr Childs
    My Dr & I have found your videos & information very valuable. I am very sensitive to meds & a lot work paradoxyl on me.
    I was on T4 88mcg for 4 years & felt great @115lbs. Then out of no where it was causing issues of fatigue, weight gain & etc. My levels on or off the T4 were much the same so I decided to stop it & felt much better. My Rt3 levels started to drop from 28. I am gluten, sugar & dairy free, I eat very little processed foods. My leptin was 17.7, RT3 serum 15.8 T3 Serum 2.54. T4 1.07,Uric acid 7.0, SHBG 50. So she put me on a compounded T3SR 2mcg. All as it has done is to make me exhausted & the pharmacist says I should get energy. So I started taking it before bed making sure I had not eaten for a few hours, then night sweats. I have not lost 1 ounce. When I was first put on T4 I lost 9lbs in the first 48 hours?
    We are at a loss now. As she said if the T3 doesn’t work she doesn’t know what else to do? I have tried for a wile to get in with Andrea.

  97. Another wrinkle in the RT3 picture:

    I have very high Reverse T3, so far none of my docs have been able to treat it.

    One complicating factor is that most of the manufacturers of T3 meds use microcrystalline cellulose as a filler, and that binds with all the thyroid hormones, and my system doesn’t seem able to unbind it.

    So I became even more hypo-thyroid, and felt terrible.(Not good ever, but especially if you don’t have a thyroid gland!) There was one maker (Mylan) I could identify that used other fillers, but my pharmacy wasn’t able to specify any source when they order meds. So we stopped trying the usual method to reduce RT3.

  98. YOU SAID ABOVE SERUM URIC ACID LEVEL AT <5 TO MUCH FRUCTOSE, BUT A COUPLE OF SENTENCES DOWN YOU SAY YOU LIKE TO SEE SAL AT <5 ??? I am going to get this and my leptin test on line so I would like to know what you really like to see. PS. Your awesome! Ava

  99. Hi Dr. Childs!

    I was diagnosed with Graves Disease in 2008 and after 3 months of acupuncture and Chinese herbals my levels were all in normal/optimal range. A few years ago I started to feel hypothyroid and my doctor said my TSH, fT4 and fT3 all were normal and the symptoms were probably due to menopause. I continued to feel hypo. The past several months I felt really crummy. Had my labs done again, this time adding rT3

    TSH 0.97 (0.35-4.94)
    fT4 1.1 ng/dL (0.7-1.5)
    fT3 2.0 pg/mL ( 1.7-3.7)
    rT3. 26 (10-24)

    Doctor recommended I increase vitamin D, take a trace mineral complex that has selenium and Zinc and also take Rhodiola. She is also willing to prescribe T3 5mg twice a day. What are your thoughts on how I should proceed? Also my fasting glucose is 100, non fasting is 116 and my cholesterol is 224 non HDL is 130

    • Hi Amy,

      Unfortunately I can’t give you specific medical advice, my best recommendation is to find a physician who you can trust and is willing to work with you.

  100. Thank you for this podcast and overview. I am currently weaning off liothyronine and have been on it for 18 months. I was on 40 mcg for most of the time and was pushed up to 60mcg. I was 54 kg at this dose and since starting to waen i have put on 5kgs in 3 weeks with less calories and it is continuing to rise. Im an active person and i measure my food. I am very scared and any advice would be greatly appreciated. The t3 only treatment did not lower my reverse t3 but imsorry i cant give you the number as my doctor wouldn’t give me my pathology results.

    • Hi AF,

      Calorie restriction will cause long term metabolic damage resulting in high reverse T3 levels and leptin resistance. You should find someone who can help fix your metabolism or the weight gain will likely continue.

  101. Hello Dr Childs

    My problems started with extreme anxiety over a very long and sustained time and was given Seroxat antidepressant. in the first few weeks i found i was constantly tired and sleeping throughout the day ,so much so i realise now that at one point i was probably going in and out of conciousness. I stopped taking Seroxat.
    I then was given a blood test told my TSH was low and have been on thyroxine for about 16 years but the symptoms i originally went to the GP with were hypoglycemic symptoms.

    That was 16 years ago and yet it was only 6 years ago i finally saw a Endocrinologist who did a fasting test. I was then told that i was a reactive hypoglycemic. My blood sugar was 1.8 causing the symptoms that had been happening many times over the past 16 years.

    Can you tell me if this is a symptom of hypothyroid or a separate complication.
    as i am now taking 150 mg thyroxine and taking 150 mg of a different antidepressant. Also eating a normal healthy diet as i have always done.
    I have never gone back to my normal metabolism and still get hypoglycemic episodes if i get anxious or exert myself too much.

    • Hi Brenda,

      Reactive hypoglycemia is usually an indication of an imbalance between glucagon and insulin levels, but I’m unaware of a direct relationship between that condition and hypothyroidism.

    • I had a SIBO that was causing for me to have a lot of hypoglycemia, because I wasn’t absorbing nutrients. I only absorbed carbohydrates and only high ones any time quickly. If I took something like nuts or fruit when I was hypoglycemic, I would continue to get worse until I had something like juice or bread. After treating the SIBO my hypoglycemia has been gone.

  102. Dr. Childs –

    Do you have any suggestions for physicians in the Mid-MO area? I feel like my endo thinks I’m crazy. I have Hashimoto’s but my TSH, T4 and T3 are all normal. I have all these thyroid symptoms but they tell me nothing’s wrong. I also have fibromyalgia so I’m dealing with chronic pain and inflammation issues as well. I just feel like they’re not listening to what I’m telling them. Thanks!

  103. Hi…

    Been on t4 only for ten years post TT. Been on metformin 1000 Sr for 7 years for pcos. Switched to ndt 2 grains with t3 due to conversion issues. Gained a lot of weight. Now on t3 only. Does t3 only increase blood sugar levels and chances of diabetes?

    Thank you

  104. Hi,
    Thank you for this article it is so informative. My daughter whose is 20 has Hashimoto. Just recently had labs done. She started the AIP diet in January, To be perfectly honest, I know she isn’t eating enough and is basically starving herself. Her biggest complaint is that she is unable to lose weight no matter what she does. Here are her labs.

    T4F 1.2. .7-1.5
    TSH .006. .400-5.0
    T3. 99 86-192
    T3F. 2.5. 1.8-4.2
    RT3. 30. 8-25

    Iron. 26. 35-135
    Saturation. 8. 20-55

    She is currently taking 125mcg Levothyroxin and 25 mcg cytomel. She did not take any medication 12 hours prior to labs. She just started taking an extra 25 mcg cytomel. I think she needs to stop the Levothyroxin. Her reverse T3 is too high. Please any suggestions or advice would be welcome. So sad that most of these DRs do not know how to treat. Her functional med DR hasn’t seen the RT3 labs as of yet, but he is unable to prescribe any meds. At our wits end :((( Thank you!

    • Hi Debbie,

      Calorie restriction in the way you are describing will only make her reverse T3 worse and make weight loss efforts more difficult down the line, unfortunately.

  105. My doc recently prescribed Cytomel 25 for three months due to high RT3 levels. It’s too soon to say if it is helping, but my question is – why only 3 months? I am afraid to go off it if it makes me feel better. Do you know why a Dr would only want me on it a short time?

  106. Dr. Childs,
    What if the Free T3 level is high-normal, but Reverse T3 is still so high that the ratio is poor? What would you recommend in this case? Would you just start with a slightly lower dose of T3?

  107. I’m so grateful to have found this website and will share articles with my dr. He sent me to an endocrinologist because my TSH, T4 and T3 were all almost zero, so he was concerned about a pituitary problem, and didn’t know why the TSH and T4 were not inversely proportional as is typical in hypothyroidism. The endo said I didn’t need the cytomel that I was taking in addition to the synthroid and took me off of it, after which I felt AWFUL! Thankfully, my GP put me back on it, but I have noticed that when I don’t have the synthroid refilled in a timely manner and only take the cytomel, I feel much better. (I know I should not let the prescription lapse.) I’ve never asked about reverse T3 levels, but I certainly will at the next appointment. Thank you for the information, Dr. Childs.

  108. Hi Dr. Child’s, I realize this article is from 2016 so I’m hoping you still will see my question. I have hashimotos with total destruction of the thyroid gland. I eat a very clean diet and take supplements religiously. I’ve suffered from severely low D levels in the past as well as low potassium and iron. I supplement with those as well as magnesium, selenium, zinc, vitamin C and probiotics. My current labs are TSH 1.02 (0.4-4.5uIU/ml) Free t3 3.7 (1.8-4.2pg/ml) Free t4 1.1 (0.89-4.2ng/dl) with no reverse t3 labs even though I have requested reverse be run many times I just can’t seem to get it run. I have been on .100mg synthroid for years and I suffer extreme widespread chronic pain. Is it possible to see a reverse t3 issue when chronic pain is involved? I have had inflammatory markers run with normal results so I am perplexed at what could be causing my severe pain? I have tried adding small doses of 5mcg cytomel twice a day with my synthroid dose at .88mcg. with bad results of anxiety and heart Palps. Would t3 only be an option for me with my problems even on lower doses of t3? I have suspected tissue level hypothyroidism as my problem for years but can’t get any doctors to listen and the ones who do don’t know how to dose t3 only. Any advice would be so helpful to me.

    • Hi Alicia,

      Unfortunately the single best thing you can do is find someone who understands what I’m talking about here and can help you further. Each person is unique and different and so there is no generic answer I can give without a complete evaluation.

  109. I was diagnosed with Hashimoto’s almost 3 years ago, I’m 24. Doctor is saying my Synthroid dose is too high because TSH is 0.04. My Free T3 is 3.5 and Reverse T3 is 27. My Free T4 is 1.4 and my TPO antibodies are 782. My doctor wants to lower my dose. Would you tend to agree or disagree?

    • Hi Ashley,

      Unfortunately I can’t give you specific medical advice, but it doesn’t appear that you are heading in the right direction based on this limited information.

      • So in your opinion, would you agree with my doctor, or should I try to see someone else? I am just getting to where I “feel” better. Don’t get me wrong, I still have “flare-ups” and feel awful some days, but recently I’ve finally been able to function and I feel more like myself than I have in years.

  110. Hi Dr. Childs.

    My FT3 is at the very top of range at 4.2 (2.3-4.2) and my RT3 is 23 (8-25) which gives me a ratio around 18. My TSH is less than .01. I currently take 150 mcg Synthroid and 30mcg Cytomel per day. Based on your article, I believe that I should eliminate or reduce the Synthroid, but I’m not sure what to do about the dosage of Cytomel. I believe I read that FT3 levels can rise as RT3 falls, and I don’t want to become hyper.

    Thanks so much. I love the article.

  111. I had my Thyroid removed 12 years ago. I’m a 42 year old female and I’ve been busting butt in the gym, 6 days a week for the last 8 weeks, and I’m not seeing as great if results as most. I had my blood work done, and my TSH is 0.337
    T4 is 11.3
    T3 uptake is 30
    T3 is 125
    Reverse T3 is 24.6
    What can I do to lower my Reverse T3? And is this hindering my weight loss? What kind of doctor should I search for to aide in my problem?

    • Hi Stephanie,

      High reverse T3 levels are usually caused by some issue that needs to be identified and addressed if you want to lose weight. I would look into leptin and insulin levels first and go from there.

  112. Hi,

    It was really difficult for me to get my test done as in my country no option of getting test of Reverse T3 and leptin. Got lab test done in Dubai. Really confuse. Would appreciate if you can tell me which way to head. Currently Iam on levothyroxine 150mcg and liothyronine: 25mcg

    Reverse T3:0.21ng/ml,
    Free T3: 2.60pg/ml
    Total T3:1.42nmol/l
    Free T4:0.90ng/l
    Total T4:6.0ug/dl
    Leptin(EIA) fasting:10.95ng/ml
    B12: 316pg/ml
    Insulin fasting: 20.10ulU/ml
    Uric Acid:5.3mg/dl
    Iron: 210ug/dl
    Hb1ac: 5.30%
    SHBGH: 38.58nmol/l
    Estradiol: 54.62pg/ml
    TIBC: 349ug/dl

    Best regards

    • Dear Dr.Childs,

      Its so strange that you have replied to most of the people but me…..

      Woukd appreciate your reply.

  113. GP’s are the first line in treatment. And most GP’s dismiss anything but lab results and disregard the symptoms. My GP actually said NDT was garbage after me being on Synthroid for 20 years of misery. I ignored him and have lost 45lbs on it. Feel great. He was furious I took NDT. He said armor and NDT was garbage despite my loss and energy. Synthroid sellers has pretty much been responsible for having banned Armor from Canada, and Canadians have to sneak to get NDT. Very sad.

    • Hi Missy,

      GP’s are the first line of treatment in conventional medicine, but you can bypass them directly by going to an integrative/functional/etc. physician.

    • My experience is that conventional doctors don’t know a thing about treating the thyroid or adrenals. I had hypothyroidism and conventional doctors didn’t check anything else but TSH. I had hypothyroidism, low T3 and a bit of hashimotos. With the help of a functional doctor I have no more problems with my thyroid. Still working on my adrenals though as I burnt myself out real bad. No medications though. Lots of supplements and I’m improving little by little. No more staying in bed or sofa. I can do a bit of walking already and normal daily things, just need to make sure I don’t stress myself too much.

  114. Hi

    So if I am following your protocol to reduce RT3 by only taking T3, my question is What if I am taking more T3 then is needed? Will that extra T3 then turn into RT3? What happens to extra T3 in your body? People with Graves have extra T3 does that move into RT3? I am hypothyroid, I’m just curious. Thank you.


    • Hi Debbie,

      I don’t have a protocol for treating RT3 (at least not made public), and I certainly wouldn’t advocate taking more T3 than you need because then you truly would be in a hyperthyroid state. The confusion exists surrounding what is “enough” T3 or “enough” thyroid hormone and I have my own opinion on that.

      But to answer your question, T3 cannot be converted to RT3, at least not with our current understanding, but excess T3 can still cause harm in the body.

      • In your comment on April 30th 2016 you said:
        “Your reverse T3 levels will elevate as a natural safety mechanism if your free T3 levels get too high.”


        “And yes, I’ve seen reverse T3 levels rise as free T3 levels rise for the reason I stated above.”

        So, just to check understanding: although excess T3 itself isn’t “converted” into a Reverse T3, it does “drive up” Reverse T3?

        (I suspect that’s what Debbie actually meant, even though the words came out a bit different…)

        P.s. Thank you got the level of detail and patient experience you’ve been willing to share here. Not many practitioners would give this amount if information freely!

        • Hi Ami,

          Generally not unless the T3 is also accompanied by T4, either because the person is taking T4 thyroid medication or because the TSH isn’t completely suppressed.

  115. Dear Dr Childs,
    I beg you to help and advise me. My level of ft3 was always low (which caused a myriad of problems and debiliating symptoms) – usually under the range so my Dr recommended taking Cytomel- altogether with Levo.
    The first month was amazing and the level rose to 2,7 (range 2-4.4)
    but after another month without changing anything- nor the dose of cytomel nor the diet or lifestyle
    ft3 decreased to 0,59 (range 2-4,4)
    I feel like Iam dying… no energy AT ALL depressed pain all over
    WHY? WHAT SHOULD I DO? My Dr doesn’t know …. has no answers

    I have been on antibiotics for Lyme for 8 months, very slim, take all the mentioned supplements, probiotics, sleep a lot, do gentle excercise- literally everything you wrote.

  116. Hello! Thank you for the great article. I only found out this past week that my reverse T3 was extremely elevated. While all other labs were very normal. I am pregnant but my doctor seems to think the reverse T3 is very high. I have had two children born with hypothyroidism. No thyroid antibodies detected in any of us. I am very symptomatic and it only seems to get worse with each pregnancy. Extreme weight gain, fatigue, headaches, etc.. have you seen this in any of your patients?

  117. You said early on in your comments “I usually gauge the dose of T3 based on the reverse T3 levels.”
    In the example you gave in your article (where RT3 level was 41.1; leptin 19.6 etc) what dose of T3 did/ would you recommend?

    • Hi Ami,

      I don’t talk about dosing specifics in my blog posts, but I have some videos in my weight loss guide that go over dosing, etc.

  118. Hi Dr Childs,

    Have you seen patients successfully lower reverse T3 naturally, without prescription thyroid meds like T3? I’m going to start doing the natural treatment things you suggest, but am curious of outcomes you’ve observed.

    Great article, thanks!


    • Hi Alicia,

      If it’s possible then it probably takes years to happen and it’s a very slow process. I’ve never seen it, but that’s because by the time patients come to me they’ve usually exhausted most treatments and need stronger therapies.

      I think the problem comes in that many people are sold on the idea that everything can be treated naturally, and that’s probably true to some degree, but realistically some of these things will take years and years to reverse.

      • Thanks for the response. I just purchased your 60 day program. You talk about fasting in the main guide. Is the every other day fasting safe for people with high reverse T3 assuming we eat per your program on the non fasting days? My fasting insulin is 7.5; A1c is 5.3; leptin is 26.9. So I think fasting would be beneficial for me, after reading you guide. I only worry that my reverse T3 will go even higher than 33 if I fast, but maybe this concern is unfounded?

        Also, I was on a half grain of Naturethroid which is what Dr prescribed for the high rT3 and my reverse T3 increased from 27 to 29 to 33. Dr said I should increase Naturethroid to a full grain, but seems like my body may just continue to convert T3 to rT3 if dose increases. Do you have any insight you can share/suggest? I have one of those new age expensive boutique doctors but I don’t think even he knows how to deal with reverse T3.

        He won’t prescribe cytomel but I can always get it from Mexico, but T3 only sounds like scary stuff. I guess I’ll not take anything, and try to get my iron utilization and B12 into normal ranges first before resorting to doing a self monitored rT3 flush using cytomel. I do order my own labs and have access to the T3 protocols.

  119. I just purchased your 60 day reset and weight loss program. You talk about the hormonal and metabolic benefits of fasting. Is the option 2 fasting program safe for people with high reverse T3 assuming we eat as per your program on the non fasting days?

  120. I have been trying to figure out what is wrong with me for so many years. I had a husband commit suicide 17 years ago and can’t recover from it. I have been on so many different kinds of antidepressants and treatments but I suffer with symptoms of hypothyroidism, depression, chronic tiredness, my body temp averages about 97.2 deg, etc. I just read your article and recently had thyroid tests AGAIN. I calculated my FreeT3:revT3 ratio to be .147. SO perhaps I have too much T3? I have tried levothyroxine and Armour and neither helped with hypo symptoms. Do you think I am on the right track?

  121. I am being treated by a functional medicine Dr. currently for adrenal fatigue. In January we ran TSH, Free T3, Free T4, Reverse T3 & TPO/Thyroglobulin antibody. I have been taking adaptogens and a few supplements and still have all of the same symptoms. High heart rate, fatigue, insomnia, anxiety/panic attacks, no appetite, severe weight loss, dizziness, vision changes. She again ran all the same tests last week and there has been a few changes but in the wrong direction. I am not currently on and thyroid meds.

    Jan 2017 results:
    TSH 1.33 (range 0.47-5.01uIU/ml)
    Free T3 2.5 (1.7-3.7 pg/ml)
    Reverse T3 24.4 (9.0-27.0 ng/dl)
    Free T4 1.04 (.71-1.85 ng/dl)
    TPO 0.4 (0-9.0 IU/ml)
    Thyroglobulin antibody <0.9 (0-4.0 IU/ml)

    June 2017 results:
    TSH 2.41 (increase)
    Free T3 2.8 (increase)
    reverse T3 24.4 (no change)
    Free T4 0.97 (decrease)
    Ferritin 18 ng/ml (5-204 ng/ml) – very low have started a iron supplement. Could the low ferritin be causing all of these symptoms? Do I need to also be on T3, how do I convince my Dr of this?

  122. I have been chronically fatigued for over 15 years. I’ve tried all different avenues and have spent thousands of dollars trying to get well. I just tested and have high reverses t3 and low free t3 levels. I feel like death. I can barely type this to you today. My doctor prescribed me cytomel and I just started taking it and also doing a very clean while foods no grains diet. Once the reverse t3 is lowered.. What do I do then? Would I then need something like armor or just be done with thyroid meds? I don’t think my doctor knows what to do either. We are trying to find the source of inflammation now. So far nothing. Not hashimotos. I do tend to over eat and always hungry no matter what. Possibly leptin. Going to ask for that test next. Please help me if you can. I am so desperate. Thank you

  123. Last March my labs looked like this: TSH – 2.37; Free t3 – 133; Free t4 – 1.13; Rt3 – 15.3; ALT (SGPT) – 84 and flagged as high, meaning liver issues AND Naturopath said I have no thyroid issues.

    I went to a different healthcare provider and she found candida, hypoglycemia, low iodine, low Vit. K, and very low progesterone. (I am a fairly fit 54 yr old female – life long runner).

    I was given iodine, changed diet to no dairy, no sugar, no gluten, added probiotics and added Cytomel 5 mcg a day.

    These are my latest labs – TSH 6.34; Free t3 – 128; Free t4 – 6.7; Rt3 – 16.6; iodine is now too high and same liver test is in normal range.

    I feel sicker than ever and my healthcare provider has now added dessicated thyroid – 30mg a day. I also take 1000 mcg of B12 methylcobalamin sublingual melts a day – my heart does weird jittery stuff if I don’t take it.

    Good sleep is impossible. I feel I am in a walking coma and can’t find any healthcare provider who knows what they are doing. WASTED TIME, WASTED MONEY! This is my life….

  124. Hello,

    I have hashimoto and I would like to know if it is normal to have a very low RT3 for more than 2 years: 5.5 [9.2 – 24.1 ng/dl]? I use 1.5 grain of NDT for 2 years, my FT4 is still low 12 [12-22 pmol/L] and my FT3 still in the upper limit 5.7 [2.6 – 5.7pmol/L], with a TSH <0.01. On all forums I am told that I have pooling problems, but my RT3 is low, is it possible? Despite 4-5 times a week of cardio and a good diet (Paleo), I continue to gain weight. Would the T3 protocol only be better than the NDT in my case? I do not know if there is a link, but my SHBG is very high also 70 [12-60 nmol / L].

    Thank you

    • Hi Adam,

      High SHBG may be limiting your testosterone levels which may worsen some of your symptoms. You will want to evaluate all hormone systems in addition to your thyroid.

      • Thank you for your response, your site is very interesting, but unfortunately we do not have functional physician in Montreal and it is very difficult to pass more accurate tests. Is the T3 in the NDT can increase as much the SHBG? My SHBG was much lower with synthroid.

        Thank you

        • Yes, it is most likely the T3 in the NDT that is causing your SHBG to rise. I use SHBG and total T3 as a way to determine if patients are getting “enough” thyroid hormone. You don’t want either of these values to be elevated.

          • If I understand correctly, if the T3 is high and the SHBG is also high, my medication is correct and my doctor should not increase it, even if I am only 1.5 grains. Can T3 and SHBG be raised in the blood, but the T3 does not penetrate the cells and that’s why I continue to gain weight and be tired, even though my T3 is very high? Have you ever seen a patient have enough NDT with only 1.5 grain? Before taking NDT, I was using 137 mcg of Synthroid, I use 1.5 grain only because my doctor considers that 1 grain = 100 mcg of T4.

            Thank you

  125. After a pesticide exposure I gained and gained weight and was completely exhausted, joint pain, tendon pain. After testing high rT3 went on T3 only meds.

    After 12 weeks on T3 only I felt absolutely amazing, the chronic pain was gone and I began losing weight and feeling happy again. I also became much more flexible, energetic and productive.

    I thought my doctor was crazy when she suggested high rT3 issues and am sorry I waited too years after the diagnosis to act.

  126. Hi Dr. Childs,

    I was wondering. I have quite normal thyroid levels now. T3 is not perfect (4.1 (range 3-6.5). My functional doctor says ideal is between 5 and 6. I had a small amount of hashimotos, but this has been fixed with nutritional changes now. I still have lots of neurological symptoms like numbness, difficult mornings, tiredness, weakness, cold and heat intolerance and some other thyroid symptoms. We tried Nature Throid, which got me completely badly overstimulated and exhausted. I have also good days, but still not enough. My doctor said that the thyroid problem is on cell level, meaning the cells and metabolism are damaged, but that there is enough of thyroid hormones in the blood now. I was hypothyroid before and no medications for a few years. I have supplements like d-ribose, CoQ10, fish oil and a whole stack of vitamins and minerals. I’m on a dairy-free and gluten-free, very low sugar diet. What is the best approach to treat the cell and metabolism issues? Any tips? Are there any articles here about this kind of issues? Or is it just the matter of time and letting the body heal with the right nutrition and supplements? Thank you.

  127. Hi Dr Child’s, I have high rT3 (28) and am about to start on T3 only ( liothyronine ) bloods were:
    TSH 4.2 ( 0.27-4.2)
    T4 126.6 ( 64.5-142)
    FT4 16.44 ( 12-22)
    FT3 3.93 ( 3.1-6.8)
    RT3 28 ( 10-24)
    RT3 ratio 9.14 ( normal>15. Borderline 12-15 Low <12 )
    My Question is what would be a starting point in mcg to throw at rT3?

  128. Hi, if I’m taking T3 medication, can I test for RT3 or will the T3 medication affect the results?

    I hope you can answer this for me! I’d really appreciate your thoughts!

    • Hi Anna,

      Yes you can test for RT3 while taking T3 only medication and it will affect the results (but you want it to).

  129. Dr Childs
    I recently got diagnosed with hypothyroidism. I had to beg the Dr. to run more tests because I really felt like something was wrong. I have been losing hair over the past few years and I was becoming concerned. My Reverse T3 was really high
    37.4 ( 9.2-24.1ng/dl)
    I read your article and Thank You so much for making sense of this. I am on Cytomel and Nature Thyroid, its to early to tell how I am doing since i just started. My question, does Ferritin play a role in the thyroid and hair loss? And if so or not what supplement can i take to help hair loss? And would it be ok to take with the medication I am on?
    Thank you kindly ~

  130. Hi Dr Childs

    I am in the UK. I have FM but no diagnosis of hypothyroidism, in spite of symptoms of weight gain, cold intolerance, hyperhidrosis and fatigue.

    I recently had some private blood tests and my T3 was 4.5 (nearer the low end of the range), but my reverse T3 was 28 (though measured in ng/dl rather than pmol). I tried to work out my ratio with the adjustments but one ratio came up with 0.2 and the other 6. I see they’re both too low but one seems much lower than the other! I’ve no idea what’s causing my reverse T3. None of the other results stands out, except my C Reactive protein is just on the high side (just outside range) and I am on antidepressants and wonder could these be the cause of my results. Thanks

      • Hi Dr Westin
        I followed the link to hypothalmic obesity disorder which I read with interest – I have many of the symptoms as well as sweating when I’m cold. I have Fibromyalgia and am going through the menopause so hard to separate what is what at the moment. I’ve had no thyroid treatment because all my thyroids are within range although my reverse t3 came out high in a private test (plus ratio between that and t3 was less than 0.2). I’m in the UK though, and so a lot of your treatments aren’t available. My appetite is not particularly voracious though not having quite passed through the menopause the hormonal changes have caused hunger cravings at times – the females in my family have also tended to bloat around this time of life. I eat a lot of fish and no meat, though I do have a sweet tooth. I am also on anti-depressants anyway for other symptoms, only a small dose, but the equivalent of what you call Paxil over there, and it’s one of the a/d’s that causes the most weight gain. I know some people have had Low Dose Naltrexone prescribed with Fibro so that is available over here. I am nervous about self-medicating on t3, even if I could get it, (though it has been advised online) but I have also been told it can be dangerous. My t3 is low but within range. Thanks

  131. Great article! Should a person stop taking iodine with high reverse T3? My reverse T3 is 22.6 ng/dl , my free T3 is 2.94 pg/ml, TSH 2.5 and T4 6.9 ug/dl

    I take 5 drops of lugols 2% a day. I wonder if iodine is helping or hurting in the case of high reverse T3……

  132. Hi Dr. Childs,
    I am taking levothyroxine 25mg for a couple of months now. My TSH level slightly drop and my FT4 is slighty higher which I suggest is a good thing but my FT3 level dropped. What may be the reason about it?

  133. Thank you for your informative talk. I have TSH of .869, T4 9.5 Free T3 0.81 and Free T3 2.3. I do have Hashimoto’s T peroxidase Antib 191.10.
    I am inflammatory and trying to address that with the microbiome diet and foods for gut health and probiotic balance. But do you think I should take less T4 (I take 88 mcgs/day now) and more T3 (I take about 1.75-2.5 mcgs a day (cutting the lowest pill of 5 mcgs). These are substitutes – so I think the generics are slightly lower in strength, from my experience. Thank you so much for your time – if it’s not too late to converse with you (now 2017!) Joanne

  134. HI Westlin Childs
    firstly id like to thank you on behalf of all the people here you have gone out of your way to reply too and such a great article. You give many hope and direction here….

    I am new to all of this. Please help me understand my situation.
    I had helicobacter bacterial infection five yrs ago and my health deterioted since then and i was then diagnosed with chronic fatigue syndrome/ M.e is the other name, this diagnoses was from symptoms alone, not a definitive test ..therefore i am not satisfied with the diagnoses .
    I am dependant on probiotics now. I am ill without them.I eat healthy and dont have many bad habits that way,.My lifesyles been stressful but i have started meditating a lot more and self hypnosis ..both wonderful..and help me stay positive in all this.

    Recently symptoms of hypothyrodism (which i’ve always known i have incl cold intolerance and eyebrows vanishing at the ends amongst all the other more well known symptoms there are )have worsened, to the point its hard to do my daily chores severe mental fog too.

    Here are my results

    TSH 1.02 miu/l
    FREE thyroxine 16.7 pmol/L
    total t4 91.4 nmol/L
    free t3 4.26 pmol/L
    reverse t3 27 ng/dl
    reverse t3 ratio 10.27
    thyroid antibodies –
    thyroglobin antibody <10 iu/ml
    thyroid peroxidase antibodies 9.8 iu/ml

    VIT D 53.9nmol/L (dropping every year no matter if i take supplements or sit in the sun all day get a tan, also i have a sun allergy showing up on forearms last few yrs)
    CRP high sensitivity 0.3 mg/l
    Ferritin 13 ug/l (dropping no matter what i do again)

    the report says my results are ok..but i dont this is really true. Especially since reading your informative article.

    Please reply and advise


    i must add i took lactoferrin once and felt like complete death huge reaction …..i wonder why that was until today … is there a link at all ?

  135. Hi
    Pls may I share my results…where my reverse t3 level is 27 and ratio is 10 % .. all the other’s seem relatively normal within range but some lower end. Myvit d and ferritin keep dropping regardless of any action I take to bring them up and area quote low now. I have all the hypothyroid issues. Thanks

  136. Dr. Childs,

    First of all, thank you for this amazing article. Needing your advice. Have been hypo for a few years now. Started on synthroid and never got to feeling good. April 2017 test results of TSH 1.030
    Free T4 1.47
    T3 160
    Free T3 2.8

    Decided to go to NDT since was having continued fatigue, hair loss,and inability to lose weight on synthroid.

    Just got labs done again (Aug 2017) after being on NDT for 8 weeks. Lab results of
    Tsh 2.2 (went up)
    T3 234 (went up)
    Free T3 4.7 (went up)

    Feeling better, have energy, decreased hair loss, but have weight gain again. Could my reverse T3 be high? Should I add in cytomel? Help, at a loss since tsh went up from 1.030 to 2.2.

  137. Hello, Westin I really am thrilled to have found your blog. Two years ago I began the struggle with euthyroid eye disease and did a full thyroid panel.
    I had normal Free T4, Free T3, TSH but was borderline for high for Reverse T3(27.3 with less than or equal to 5.5 considered normal). I have seen an endocrinologist and was insulted when I brought up the reverse T3 number. She said they weren’t important and when I was tested for TPO and TG antibodies which both were high she said so what you have hashimotos and said your TSH is normal so I don’t need to see you for another year. What do you make of this!!

  138. Dr. Childs,
    I have been looking into thyroid problems for appox. 6 months, because I was diagnosed with Hashimoto’s Thyroiditis. I went to see one Dr. who told me my labs were fine, even with a TpO Anitbody # of 324.7, I was fine; the reason I couldn’t lose weight was because I was fat, lazy and crazy. Obviously I don’t see her any more, and have started going to an endo, and have found a different doctor. The Endo upped my levyothroxine to .88 which got rid of 75-80% of my problems, except for a few (hair loss, weight gain, being cold, oh and I have a few tremors due to sub-clinical hyperthyroid).
    My labs…: TpO: 369.8, TSH: .040, T4: 1.09, T3: 132.1. RT3: 20.1, Iron: 82, Ferritin: 52, Cholesterol: 182

    The Endo wants me to cut my levythroxine in half one day a week, and take normal dosage the other 6 days. I should mention he doesn’t believe in T3 or RT3 as they have nothing to do with the thyroid and they are pointless tests. As you can see I’ve done my homework.

  139. Dr. Childs,

    I literally started reading this article and began to cry. I think I have the Reverse T3 problem. I have seen general practitioners, rhuematologists, and endocrinologists. No one has an answer to really help me. My T3 is always high and I have been told that something I am taking is causing it like a supplement but that it is not a big deal and we shouldn’t treat the condition with medication. They encourage me to try to figure out what I am taking that is causing the high T3 and alter my diet. I have spent years trying to do this but nothing I do causes my blood work to change. I wouldn’t care so much except I am suffering.

    I’m experiencing:
    Extreme Joint Pain
    Intermittent Joint Inflammation
    Numbness in parts of my body that come and go (and I have had a full panel of tests for MS and I do not have that)
    Feeling like my mind is foggy and my recall is at times challenging
    Migraines with aura
    Hair loss – my hair is constantly falling out
    Weight gain – I am 30 to 40 pounds over my typical weight and have been for the past 5 years but am a healthy eater and I exercise. Plus no matter what I do I can not lose weight.

    The consensus is that I have Fibromyalgia with some atypical numbness present due to sensitive nerves. That and I am ingesting something that is causing my T3 to be elevated. All other markers are in range therefore the high T3 I’m told is not something to concern myself over. Maybe that is exactly what I have but when I came across this article I thought this might explain what has been happening to me. I don’t know if Reverse T3 has been tested for me. I have only heard he term T3.

    I know you are not taking patients (or at one time were not) but if that has changed I’d really like to come see you. I am desperate.

  140. I just calculated my free T3/reverse T3 ratio and it is 0.156. So it’s too low and my reverse T3 is high (27, normal 10-24 ng/dl). When I first started Naturethroid (NDT), my rT3 had gone down, but now it’s back up again. My TSH was 0.3 (normal 0.3-4.2 mIU/L), free T3 4.2 (normal 2.8-4.4 pg/ml), and free T4 0.9 ng/dl (normal 0.9-1.7 ng/dl). I already have insulin-dependent diabetes since 2015, and my HbA1c is now at 5.7%. What would you recommend for me to try to bring the rT3 down? I am a post-thyroidectomy patient for a history of papillary thyroid cancer in 2009. My Endo has not been keen on letting me only take T3 without any T4. My current dose of Naturethroid is 1.125 grain in AM and 1 grain in PM. Thanks!!

  141. I have no thyroid and my Reverse T3 test came back 19.7 ng/dL Is this normal? I’m not understanding the along with your numbers. Thank you.

  142. Hello,
    My T3 is low, but when I try any type of medication with T3 I get severe insomnia. I’ve tried starting with very low dose and still get insomnia. Any tips?
    Thank you,

    • Hi Sandy,

      It may be that your low T3 is due to something such as inflammation or nutrient deficiencies in which case fixing that problem should be your priority over taking T3 medication.

  143. Hi Dr Childs,
    I had a total thyroidectomy back in 2010 and since then I’ve been struggling. Synthetic meds did not work for me, then I ended up on NatureThroid. I stabilized at 4.25 grains, but it was giving me gut issues (constant clearing of my throat, GERD, etc). Now I am on 5.75 grains of WP Thyroid and my gut feels much better. However, I cannot regulate the dosage. I tried lowering to 5.5 grains but the day or two after, my hips would start hurting a lot, I’d get irritable, etc. My latest labs are Free T3 5.3, Reverse T3 36, T4 1.7 and TSH 0.01. I know these are high, but don’t know how to lower them without painful symptoms. I also seem to have water retention issues (puffy ankles), a few stubborn pounds (about 7 lbs), memory issues, and body temp variations. I have no idea what to do and what other tests to ask for. I could really use your advice – thank you very much!

  144. Hi!! Great article I found this just on the right time. I got my labs yesterday
    Rt3 34.5
    Tsh 1.19
    Free t3 2.9
    T3 uptake 30
    Free t4 1.03
    T4 11.4
    T7(FTI) 3.3
    And my endo says that Im ok. I’ve been for a 1yr now in extreme pain, fatigue, hbp inability to loose weight and gaining without making any diet changes. Im really tired and stressed loosing my hope of feeling better. Im a single mother also working fulltime and I think I wont survive another year this way

  145. I take WP Thyroid, my T4=1.16, TSH=1.79, FT3=3.2, TPOAB=11.7. RT3=20. I had been taking selenium but it raises my blood pressure

  146. Hi Dr. Childs…

    Can someone who is underweight have the RT3 problem? My ratio of T3 to RT3 is 15.7. I have cardiac sarcoidosis, an inflammatory immune illness. About a month ago I started having extreme jitteriness first thing in the morning, which dissipates through the day and is usually gone after dinner, but is worse again in the morning. I’ve been a poor eater most of my life (not bad food, just not enough food) and am wondering if it’s finally caught up to me at 55! (I am consciously eating better since my sarc diagnosis this past May.) My doc says my thyroid tests are “normal” (TSH is 3.96, T3 is 3.6, T4 is 1.36, RT3 is 23) but I have many of the symptoms you describe, except that I am underweight and can’t put weight on if I try!
    Thanks for your help! 🙂

  147. I had a goitre that has been removed along with parathyroid glands that had some cancer cells detected.
    I now use thyroid extract which has 20% T3 and 80 % T4.
    I still feel cold and achy a lot of the time and attend an osteopath once a week to deal with trigger points that cause me chronic pain. I use anti inflammatory drugs every day as a result of the pain.
    Can I start on supplements as the warning on the bottle says do not use with thyroid hormone medication?
    It was hard enough to get my Dr to change to extract let along run the tests you suggest and living with chronic pain is not a dodle!!

    • Hi Chrissy,

      The supplements can be taken in conjunction with thyroid hormone medication, they just shouldn’t be taken at the exact same time as they may interfere with absorption.

  148. Hello and thank you so much for your posts! On the road to wellness (I hope), I have suffered from chronic candida, sibo and ALL that goes with it (intermittently caring for it which has led me to a greater state of dis-ease now), MTHFR as well and now my Naturopath found my RT3 levels are high and she started me on liothyronine. My biggest fear is what to eat? I am so restricted with the candida and sibo foods and then I was just reading I shouldn’t eat cruciferous veggies?! Is there a good diet guideline that I can follow that doesn’t cost me $200 for a coach to tell me? Any whole foods that I should truly avoid? I don’t eat fruit or any grains. Thank you

    • Hi Rebecca,

      Glad you found them helpful!

      A couple of thoughts regarding diet and health:

      1. Restricting the amount of foods you eat may lead to tolerance issues long term, meaning you won’t be able to add back foods into your diet without side effects.

      2. The exact macromolecule ratios and types of food you need to eat depends on your body, hormone imbalances, autoimmune issues, etc. so it really needs to be tailored to your body. What you should be eating changes over time as well and shouldn’t be static during the healing process.

      For these reasons it’s usually helpful, and sometimes necessary, to get professional help.

  149. I have hashi’s and I have been on every brand of NDT out there , I’m currently on Np thyroid at 4 grains a day, prescribed 5 a day but it seemed to be too much. I do raise by half a grain during my ovulation time of the month or I have worsening of symptoms. I was recently put on cardizem for heart palpitations and depakote for migraines. I have gained 40 lbs in a year and I am MISERABLE! I can’t stop either one of the meds due to the medical conditions (4-5 migraines a week with a hospitalization at least once a month for them). I’m not really sure what to do at this time . No one has ever checked the reverse t3 and I had to beg the family Dr 10 years ago to even check the “free’s” . I feel like I get a little weaker and more sore every day. I just need a direction follow. I was also diagnosed with Mast Cell Activation Disorder because I have recurrent anaphylactic reactions, hives and general allergic reactions. Could this be something to do with the hashi’s? I’ve done more research than my Dr’s and I just seem to be getting more confused by the conflicting information. Anything would help. Thank You in advance. Ps I’m the mother of 5 children and the need to be healthy and well is a must!!!!!

  150. Hi Dr Childs,

    My Rt3 is 25 and I have been on Topimnax for about the last 41/2 to 5 months. I was on 25mg and and on 37.5mg for almost 3 weeks of the total time. My bad estrogen is dominant also even though I’m post menopausal and barely have any. Will the Rt3 go back down naturally since i am off the topimax? If so how long will it take? Thanks so much

  151. Read this article and switched from levo 100 (T4) to NDT 90 (Armour) and was able to lower my RT3 from a 34 to a 16 after 6 months. Super change! I have more energy, less headaches, and much less hair fall out now. My Free T3 stayed about the same (low end of normal) and my Free T4 dropped from high end of normal to low end of normal. I am now slowly increasing my NDT dose to around 105. So far, this is the best I’ve felt in years. However, my TSH is still .1 and it has always been low ever since I’ve been on thyroid replacement since total thyroidectomy 15 years ago. I just don’t care about the TSH anymore, but man, do the doctors sure place a lot of importance on it!

  152. Hi I’ve been on 6 grains naturethroid and 50 mcg levothyroxine but hypo symptoms and weight problems won’t resolve. Last time I had my reverse t3 tested it was high at 49. Free t3 was 4.4 Do I have to do a t3 only protocol? If I lower my ndt dose will it help me lose weight?

  153. I have been on NDT for three years and it basically stopped working for me, despite raising my dose higher and higher until I was on 8 grains a day at one point. I felt it was likely a reverse T3 issue, because of intense stress/pregnancy/surgery/illnesses in the past few years, so I requested that rT3 be added to my labs. It was high, as I suspected, but my endocrinologist dismissed it as the reason for my weight gain and hypothyroid symptoms because the ratio of rT3 to T3 was fine. Is it still an issue if rT3 is high (upper 20s) but the ratio is within range, and if so, should it be treated the same way as outlined here?

  154. I have a reactivated Epstein-Barr virus. My RT3 is 28, Free T3 is 3.0, TSH is .727, fasting insulin is low at 2.0 and I have trouble gaining weight. I do have hypo symptoms like fatigue and dry skin, but I am not at all depressed. I seem to confound a lot of info on your site. I am healing EBV with rest,’diet and supplements. I take Tirosint 125 and just added 5mg Liothyronine. Sounds like I need to reduce Tirosint and increase T3. My Ferritin is low at 34. I was hoping that RT3 would go down on its own as I heal from the virus.