How to Treat High Reverse T3: Natural & Medical Options

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

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

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. 

This means it’s up to you as a thyroid patient to understand what this lab test is, how to interpret your results, and how to manage high levels (if present).

High reverse T3 has the potential to slow down your metabolism, reduce thyroid function at the cellular level, and result in full-blown symptoms of hypothyroidism.

It may seem like a daunting task to learn all of this information but don’t worry, it’s not as hard as you think, and learning about it now can pay dividends to your future self.

Today you are going to learn…

  • How to tell if you have too much reverse T3 in your body
  • The name of the blood tests you need to have ordered
  • How to calculate your free t3:reverse T3 ratio (and why this is important)
  • What causes elevated reverse T3
  • And how to “flush” out or lower high levels of reverse T3 and how I treat patients with Thyroid resistance and high levels of reverse T3 in my office

Let’s jump in.

What is Reverse T3 Anyway? 

What it boils down to is this:

Reverse T3 is a hormone metabolite that is created from the T4 thyroid hormone (1).

T4 thyroid hormone, of course, is the primary thyroid hormone that your body produces directly from the thyroid gland.

Your body then takes T4 thyroid hormone and eventually breaks it down into T3, T2, T1, and sometimes reverse T3 through something called thyroid conversion.

A simplified version of that conversion process can be seen below:

the conversion of t4 to T3 and reverse T3 with the primary functions of each metabolite.

This conversion process is incredibly important to the body because it allows fine-tuning of thyroid hormone function throughout all of your cells.

And this is something you definitely want to happen, at least when it’s working correctly.

When it isn’t working correctly, the conversion process can slide down the wrong path which leaves you with the wrong types of thyroid hormone metabolites, namely reverse T3.

Unlike T4, T3, T2, and T1, which all have pro-thyroid effects, reverse T3 can be thought of as an anti-thyroid metabolite.

While T4, T3, T2, and T1 promote thyroid function, reverse T3 antagonizes thyroid function at the cellular level.

For people without thyroid disease, this conversion process works perfectly.

But if you have thyroid disease, especially for those taking thyroid medications, you can inadvertently alter this conversion process and lead to the creation of anti-thyroid metabolites which can act to make your thyroid function less efficiently.

Easy so far, right?

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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 creates it.

The fact is we aren’t 100% sure why reverse T3 exists in the body but we can make some general assumptions about why it exists.

The prevailing thought, and one that I am in agreement with, is that reverse T3 is meant to act 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 its metabolism and provide energy to your muscles? 

Of course not!

It makes far more sense to conserve your energy and metabolism by slowing down energy production and providing energy to vital organs and your immune system to take care of the immediate threat. 

This is a protective mechanism designed by the body to ensure that it can weather illnesses.

What may surprise you is that it has a name and is well-documented in medicine.

It’s known as euthyroid sick syndrome.

definition of euthyroid sick syndrome from merckmanuals

Patients who are under stress develop this condition by altering thyroid hormone metabolism through the conversion process I mentioned above.

Stress results in a typical change in thyroid lab tests manifested as low free T3, high reverse T3, and normal T4 and TSH levels.

I want you to take another glance at those lab tests mentioned above and even compare them to your results.

Do you see any similarities between your lab tests and the lab pattern typically seen in euthyroid sick syndrome?

If you are like many thyroid patients reading this then there’s a good chance you do.

But how can this be? Wouldn’t your doctor notice it?

You would think so but that isn’t the case!

Even though every doctor should have learned about euthyroid sick syndrome in medical school they believe that it’s a condition that only exists in extremely sick patients seen in the hospital or ICU.

Unfortunately, we are seeing more and more patients with multiple chronic medical conditions present with the same thyroid lab tests as those who are hospitalized which leads me to one important conclusion:

Maybe doctors are missing something about our current lifestyle, the increasing rates of illness and chronic medical conditions, and the impact that these have on reverse T3 and thyroid lab tests.

There are studies like this one (3) which can shed light on this very issue.

They show that other situations aside from being hospitalized can lower free T3 levels, increase reverse T3 levels, and cause changes in thyroid function that resemble “sick euthyroid syndrome“. 

And it’s small things like this that may explain why so many thyroid patients walk around with hypothyroid symptoms despite being told they are “normal”.

Are You Pooling Reverse T3? High Reverse T3 Explained

Now that you better understand why you want reverse T3 levels to be as low as possible the next thing you need to understand is what causes them to be elevated.

Before we jump into the causes, though, let’s briefly go through some of the symptoms associated with an elevated reverse T3.

As you might suspect, the higher your reverse T3 the more hypothyroid you will feel.

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

These are the most common symptoms but realize that each person will present in a different way from the next.

For instance, I’ve seen people with high levels of reverse T3 present with a complete inability to lose weight and with severe depression without manifesting the other symptoms mentioned.

Others may experience issues primarily with their body temperature and even others still may have a mix of all of those symptoms.

There’s obviously a significant overlap between the symptoms I mentioned above and other medical conditions which is why reverse T3 testing is very important (we will discuss this topic soon).

But first:

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

  • Calorie-restricted dieting – Especially HCG-based diets or VLCD (very low-calorie diets). These diets (4) have been shown to reduce metabolism and increase reverse T3.
  • Chronic illness and infections – This includes viral infections like infectious mononucleosis (5), bacterial overgrowth syndromes like SIBO, and even chronic illnesses like cancer, cardiac/heart disease, arthritis, diabetes, and even obesity. 
  • Chronic Inflammation – Any cause of inflammation can result in decreased T4 to T3 conversion (6) and higher levels of reverse T3. 
  • Chronic untreated Gut infections – 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 that thyroid patients deal with include SIBO, dysbiosis, reflux/GERD, yeast overgrowth, history of chronic antibiotic use, and inflammatory bowel disease
  • Emotional and physiological stressors (8) – This includes social issues like the death of a loved one, family problems, divorce, etc. It also includes psychological (PTSD) and physical trauma (motor vehicle accidents, TBI, or otherwise) (8).
  • Some Prescription 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) in addition to elevated blood pressure (10). 
chart describing how immune dysregulation leads to inflammation and thyroid dysfunction.

What You Need to Know About Reverse T3 Testing

Reverse T3 testing is actually pretty straightforward.

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

What isn’t always straightforward is interpreting your results, but even that is not as difficult as it may sound.

Before we talk about interpreting your results, it’s important to understand how reverse T3 testing fits into a complete thyroid lab panel.

There are no fewer than 4 standard lab tests that need to be run to adequately assess thyroid function and each of these lab tests provides you with different information.

You never want to just order one lab test without the others because you won’t get the information you are looking for.

This applies to reverse T3 just as much as it applies to TSH testing.

This means if you are planning to really understand your thyroid, you will need to get the following thyroid lab tests: TSH, free T3, free T4, reverse T3, and thyroid antibody levels

Obtaining these other lab tests will help you put your reverse T3 level into context, especially when combined with your symptoms.

One of the most powerful use cases for reverse T3 is in catching early thyroid disease.

Take a look at this image to see what I mean:

graph describing the relationship between serum hormone concentration and disease severity with all thyroid hormones listed.

This image demonstrates the severity of the disease state on the X-axis and the concentration of thyroid hormones on the Y-axis.

Basically, it shows what happens to thyroid lab tests and when they become abnormal in relation to the severity of your disease.

What should stand out to you is the fact that reverse T3 (abbreviated as rT3) and T3 (abbreviated as T3) are the earliest markers of thyroid dysfunction.

They become abnormal much sooner than the other thyroid lab tests which makes these lab tests sensitive for diagnosing early thyroid problems.

What’s more, is that the difference between these two lab tests is more dramatic and pronounced than any other thyroid lab test. 

For this reason, these two lab tests are critical in 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.

This ratio is called the free T3:reverse T3 ratio and is something that every thyroid patient should calculate using their own thyroid lab tests.

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. 

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. 

In order for this calculation to work, your units must be the same.

The units used in the United States for free T3 are pg/mL and the units used for reverse T3 are ng/dL.

free T3 thyroid lab test result from a thyroid patient with low normal free T3.
reverse T3 thyroid lab test result in a patient with a high normal reverse T3.

Using the example above, if you divide 2.8 by 14.4 you are given a value of 0.19 which is less than that <0.20 level mentioned above.

If your free T3 and reverse T3 lab tests are not in these units, you can easily convert them and then make the calculation with some simple tools available online.

If you want a down-and-dirty way to assess your reverse T3 then you can also just look at the absolute value.

In most patients, a reverse T3 level of less than 15 ng/dL is ideal.

Values higher than this tend to start causing problems, especially if associated with a low free T3.

How to “Flush” Out Or Lower Reverse T3 Levels

So you’ve found out that your reverse T3 level is elevated, what now?

Your next step should be to try and drive that level as low as possible.

This is sometimes referred to as lowering reverse T3, treating reverse T3 pooling, or flushing reverse T3 out of your system.

These are all different names used to describe the treatment of high reverse T3.

What I want you to be aware of is that treatment should focus on

What you need to be aware of is that the treatment will focus primarily on the underlying cause (11).

Because of this, there really isn’t a one-size-fits-all treatment program that I can recommend.

I can and will give you recommendations for common causes, but you will still need to tailor that to your specific situation.

With this in mind, let’s talk about 5 different ways that you can lower reverse T3:

#1. T3 Containing Thyroid Medications

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

This would include medications like liothyronine, Cytomel, or sustained-release T3

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

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In essence, you’re starving out the ‘food’ source your body uses to make reverse T3.

Naturally what will happen with T3 medication use is that your T4 levels will decrease, your free T3 levels will increase, and your TSH will decrease.

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. 

This is definitely the fastest way to reverse T3, but it doesn’t take into account the underlying cause.

So if you use T3 to reduce your reverse T3 without making any other changes, it’s likely that your reverse T3 will just jump back up once you stop taking T3 medication.

Is NDT Helpful for Reducing Reverse T3?

It certainly can help but there are a few things to realize if you want to use this class of medications to treat reverse T3:

  • Each grain of NDT has about 38 mcg of T4 and 9 mcg of T3, which 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 some cases, you may have to drop your NDT dose in favor of pure T3 medications.
  • NDT dosing is static meaning you can’t individually alter the concentration of T4 and T3 unless you add additional thyroid medications.

You can still treat elevated reverse T3 with the use of Natural Desiccated Thyroid, but it’s generally not considered the best option.

#2. Supplements Can 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 thyroid patients are under-treated, most also have these deficiencies.

This is for 2 main reasons:

The first is that low thyroid states lead to low stomach acid which leads to decreased absorption of nutrients across the board.

The second is that low thyroid states also increase your risk of developing gastrointestinal imbalances which may further impair the absorption of minerals and nutrients.

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. 

image describing what reverse T3 is and how it impacts thyroid function.

If you are trying to support the conversion of T4 to T3 with the use of supplements then there are a few you should pay special attention to.

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.

In addition to zinc and selenium, I’ve also seen great success with guggulsterone or guggul extract.

We aren’t as concerned about supplements that promote thyroid hormone production (such as iodine and L-tyrosine), but they can still be helpful in some cases.

In addition to these supplements, you can also check out some natural therapies that have some good data behind their use as effective tools for naturally improving T3 levels and reducing reverse 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 relationship holds true for thyroid hormones and their impact on leptin and insulin levels.

The link between these 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 both cause inflammatory states which contribute to T4 to reverse T3 conversion.

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

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

In fact, I don’t think I have ever seen a patient with a reverse T3 greater than 25 with a normal insulin or leptin level.

an example of an extremely high reverse t3 level lab test result.
example of a high leptin in the setting of high reverse t3.
high insulin in the setting of high reverse t3 lab test result.

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 to check for either of them. 

Doctors will routinely check hemoglobin A1c but rarely order fasting insulin and fasting leptin levels.

This means that if you have known thyroid conversion problems, it’s probably going to be up to you to request these additional hormone tests.

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

To learn more about how to address these hormone imbalances 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 which medications, hormones, and supplements are most effective.

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 information here.

#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 address it.

Part of the reason for this is that 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 what’s causing it.

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

And this is a problem because inflammation is a known contributor to thyroid conversion problems.

We know that inflammation directly promotes the production of reverse T3 (16) by pushing your body down the T4 to reverse T3 conversion pathway.

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

You can easily test for inflammation by ordering these lab 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.

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:

  • Milk thistle + MSM: Designed to help improve liver function and promote proper phase 1 and phase 2 elimination of medications, supplements, and other products that need elimination in the liver. This combination may also help reduce AST and ALT levels (21)(if you have fatty liver). 
  • Omega 3 Fatty Acids: Omega 3 fatty acids can help reduce inflammation by reducing inflammatory cytokines. 
  • Curcumin: This well-studied herb activates PPAR-gamma levels (22) helping to reduce inflammation in the body. 
  • Quercetin & Bromelain: Particularly helpful in patients with digestive issues and those with chronic sinus/upper respiratory illness-like symptoms (post nasal drip and chronic stuffy nose). 

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

#5. Lifestyle changes to Balance Hormones and Promote Thyroid Function

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

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.

These areas are so important that many thyroid patients can see significant improvement in their thyroid symptoms by optimizing them without the need for additional treatments or medications.

The only problem is that most thyroid patients take them for granted and would prefer to take a supplement and call it a day.

Don’t fall into this trap!

Take that supplement if you want, but make sure you are also paying attention to your diet, exercise routine, sleep schedule, and stress levels.

Final Thoughts

Elevated reverse T3 is a serious issue for many thyroid patients and it’s a problem that is often ignored by many conventional doctors and endocrinologists.

The best way to evaluate your reverse T3 is by testing for it along with free T3 and free T4 levels.

To get a better idea of how reverse T3 is impacting your body, you can measure your free T3:reverse T3 ratio.

If your free T3/reverse T3 ratio is < 0.2 you have too much reverse T3 in your body.

The fastest most effective method for optimizing reverse T3 is with the use of pure T3 thyroid medication.

Now I want to hear from you:

Is this the first time you’ve heard about reverse T3?

Have you had your levels checked? If so, was it high or low?

What type of treatments have you tried to lower your reverse T3?

Have you tried medications that contain T3 like Cytomel or liothyronine? Did they work for you?

Leave your questions or comments below!

Scientific References

#1. https://www.ncbi.nlm.nih.gov/pubmed/3428867

#2. https://www.ncbi.nlm.nih.gov/pubmed/7355063

#3. http://www.ncbi.nlm.nih.gov/pubmed/12055988

#4. http://www.ncbi.nlm.nih.gov/pubmed/12055988

#5. https://www.nlm.nih.gov/medlineplus/infectiousmononucleosis.html

#6. http://www.ncbi.nlm.nih.gov/pubmed/11716958

#7. http://www.ncbi.nlm.nih.gov/pubmed/3049061

#8. http://www.ncbi.nlm.nih.gov/books/NBK28/

#9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475282/

#10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369873/

#11. http://www.ncbi.nlm.nih.gov/pubmed/16399020

#12. https://www.ncbi.nlm.nih.gov/pubmed/8157857

#13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608008/

#14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356957/

#15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492709/

#16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978663/

#17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653962/

#18. https://www.ncbi.nlm.nih.gov/pubmed/24549403

#19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/

#20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774228/

#21. https://www.ncbi.nlm.nih.gov/pubmed/17548789

#22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234255/

everything you need to know about the reverse t3 thyroid lab test

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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 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

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580 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?

    Reply
    • 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.

      Reply
      • 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?

        Reply
        • 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.

          Reply
          • 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 there Dr. Westin

            Awesome article, reading this was very knowledgeable. My thyroid has been out of wack for the last year or so. Currently im taking Levothyroxine NA 0.15MG and my tests as of late are: T4 – 21 PMOL/L, T3- 3.12 PG/ML, RT3- 24.3 Ng/DL and TSH – 6.72 mIU/L ( this was a lot higher from 13 to 20 last year with taking less T4 thyroid medication). My new doctor told me to get off t4 completely to flush out my high reverse T3.
            He recommended me to take Cytomal 25MCg for 2 months once a day. I just want your thoughts on if 25 mcg might be to much to take or just perfect. And is slow release t3 a better way to go then cytomal. Oh and both my thyroid Antibodies are High as well. Just want your input:)

            Thanks James

      • 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!

        Reply
      • 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.

        Reply
      • 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

        Reply
        • 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!!

          Reply
          • 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…

    Reply
    • 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.

      Reply
      • 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.

        Reply
    • 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.

      Reply
  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.

    Reply
    • 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.

      Reply
  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.

    Reply
    • 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.

      Reply
      • 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.

        Reply
        • Hey Gail,

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

          Reply
  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.

    Reply
    • 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.

      Reply
    • 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!

      Reply
      • 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!

        Reply
  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

    Reply
    • 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.

      Reply
  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.

    Reply
    • 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.

      Reply
    • 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.

      Reply
    • 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.

      Reply
  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?

    Reply
    • 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.

      Reply
      • 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.

        Reply
        • 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.

          Reply
  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?

    Reply
    • Hey Danielle,

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

      Reply
        • 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.

          Reply
  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.

    Reply
  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

    Reply
  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.

    Reply
    • 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.

      Reply
      • 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.

        Reply
  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. 🙂

    Reply
    • 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.

      Reply
      • 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!

        Reply
        • Hey Sheri,

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

          Reply
  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.

    Reply
    • 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.

      Reply
  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.

    Reply
    • 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.

      Reply
    • 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.

      Reply
  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. 🙂

    Reply
    • Hey Ruth,

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

      Reply
  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 .

    Reply
    • 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.

      Reply
    • 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. 

      Reply
  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!!!

    Reply
  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!!!

    Reply
    • Hey Sherrer,

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

      Reply
  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.

    Reply
    • Hey Tara,

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

      Reply
      • 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?

        Reply
        • 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.

          Reply
  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!

    Reply
    • 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.

      Reply
      • 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!

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

          Reply
          • 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.

    Reply
    • 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.

      Reply
    • 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:-)

      Reply
  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.

    Reply
    • 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”.

      Reply
  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

    Reply
    • 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.

      Reply
  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

    Thanks

    Reply
    • 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.

      Reply
  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!

    Reply
    • 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.

      Reply
      • 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!

        Reply
  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.
    Thanks

    Reply
    • 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.

      Reply
  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.

    Reply
    • 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.

      Reply
      • 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!

        Reply
  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?

    Reply
    • 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.

      Reply
  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.

    Reply
  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.

    Reply
    • 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.

      Reply
  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.

    Reply
  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

    Reply
    • Hi Karen,

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

      Reply
  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.

    Reply
  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!

    Reply
  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.

    Reply
    • 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.

      Reply
  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?

    Reply
  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!

    Reply
    • 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.

      Reply
  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.

    Reply
    • 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.

      Reply
  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?
    Thanks,
    Josie

    Reply
  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

    Reply
  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

    Reply
  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.

    Reply
    • 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.

      Reply
  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!
    Brenda

    Reply
    • Hi Brenda,

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

      Reply
  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!

    Reply
    • 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.

      Reply
  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??

    Reply
    • 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.

      Reply
  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.

    Reply
  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!

    Reply
  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?

    Reply
    • 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.

      Reply
  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

    Reply
    • 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.

      Reply
  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!

    Reply
  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?

    Reply
    • 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.

      Reply
  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?

    Reply
    • 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.

      Reply
      • 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.

        Reply
      • 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.

        Reply
  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!

    Reply
    • 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.

      Reply
  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.

    Reply
    • 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.

      Reply
  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???

    Reply
    • 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.

      Reply
  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!!!!

    Reply
    • 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.

      Reply
  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.

    Sincerely,
    Karen

    Reply
    • 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.

      Reply
  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 🙁

    Reply
    • 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.

      Reply
      • 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
        Martha

        Reply
      • 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.

        Reply
  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

    John,

    ———————————

    IE : ” hi Doctor Childs,

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

    Reply
  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

    Reply
    • 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.

      Reply
      • 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..?

        Reply
      • 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..

        Reply
        • 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.

          Reply
  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!
    Irina

    Reply
  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.

    Reply
  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.

    Reply
    • 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.

      Reply
  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.

    Reply
    • Hey Cheryl,

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

      Reply
      • 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

        Reply
  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

    Reply
          • 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: http://www.a4m.com/directory.html#directory_search_form 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.

    Reply
  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.
    Thankfully
    Catherine Burton

    Reply
    • Hey Catherine,

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

      Reply
  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!

    Jessica

    Reply
  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?

    Reply
    • 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.

      Reply
  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.

    Reply
    • 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.

      Reply
  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.

    Reply
  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. 🙁

    Tracie

    Reply
    • Hey Tracie,

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

      Reply
  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!

    Reply
    • 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).

      Reply
  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!

    Reply
  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%

    Reply
  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!

    Reply
    • 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.

      Reply
  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.

    Reply
  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.

    Reply
  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?

    Thanks,
    El

    Reply
  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?

    Reply
  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!
    Eljay

    Reply
  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,
    Jeanette

    Reply
  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.

    Jeanette

    Reply
  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?

    Reply
  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:
    Ft3-2.7
    Ft4-1.39
    RVT3-16.4
    TSH-.371

    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!

    Reply
  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 about..it’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 wine..now..nothing! 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! So..you 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.

    Reply
  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?

    Reply
  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

    Reply
  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!

    Reply
    • Hi Gypsy,

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

      Reply
  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.

    Reply
    • Hi Suzanna,

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

      Reply
        • 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.

          Reply
  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?

    Reply
  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
    Michele

    Reply
      • 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?

        Reply
        • Hi Michele,

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

          Reply
          • 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

    Reply
  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.

    Reply
  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.

    Reply
  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.

    Reply
  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

    Reply
  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

    Reply
    • 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.

      Reply
  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.

    Reply
    • 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.

      Reply
  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.

    Reply
    • 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.

      Reply
    • 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.

      Reply
  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!

    Reply
  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

    Reply
  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!

    Reply
    • 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.

      Reply
  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?

    Reply
  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?

    Reply
  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.

    Reply
  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.

    Reply
    • 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.

      Reply
  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?

    Reply
    • 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.

      Reply
      • 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.

        Reply
  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.

    Reply
  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?

    Reply
    • 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.

      Reply
  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
    TSH:0.253ulU/ml
    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

    Reply
    • Dear Dr.Childs,

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

      Woukd appreciate your reply.

      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.

    Reply
    • 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.

      Reply
    • 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.

      Reply
  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.

    Debbie

    Reply
    • 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.

      Reply
      • 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

        “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!

        Reply
        • 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.

          Reply
  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.
    I BEG YOU TO HELP

    Reply
  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?

    Reply
  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?

    Reply
    • 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.

      Reply
  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!

    Thx~Alicia

    Reply
    • 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.

      Reply
      • 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.

        Reply
  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?

    Reply
  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?

    Reply
  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?

    Reply
  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

    Reply
  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….

    Reply
  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
    Adam

    Reply
    • 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.

      Reply
      • 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
        Adm

        Reply
        • 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.

          Reply
          • 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
            Adam

  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.

    Reply
  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.

    Reply
  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?

    Reply
  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!
    Thanks.

    Reply
    • Hi Anna,

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

      Reply
  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 ~

    Reply
  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

    Reply
      • 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

        Reply
  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……

    Reply
  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?

    Reply
  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

    Reply
  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

    THANKS
    RI

    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 ?

    Reply
  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

    Reply
  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.

    Reply
  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!!

    Reply
  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.

    Reply
  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.

    Reply
  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!!

    Reply
  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.

    Reply
  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,
    Sandy

    Reply
    • 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.

      Reply
  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!

    Reply
  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

    Reply
  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

    Reply
  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! 🙂

    Reply
  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!!

    Reply
    • 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.

      Reply
  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

    Reply
    • 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.

      Reply
  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!!!!!

    Reply
  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

    Reply
  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!

    Reply
  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?

    Reply
  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?

    Reply
  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.

    Reply
  155. Thanks Dr Childs for all your information.
    I have high RT3 with a poor T3 ratio.
    If I go on a compounded T3/T4 medication to lower my RT3, can I stop the medication when I feel better and my ratios are optimal. Steve.

    Reply
  156. Hi. I read this article about the reverse T3. My PC doctor did check this and it showed high (25). My doctor said it’s only slightly high and not to worry about it. I used the calculation you have and it came to <20 (13). When I mentioned this the doctor dismissed it. I have most of the symptoms listed. A lot of that may come from having Lyme disease 11 years ago and not getting the first treatment until 9 months after the bullseye rash. Diagnosis wasn't made until 2 years later. I have had most of your listed symptoms after the Lyme infection. How do I find a knowledgeable doctor? My PC doctor does not show any interest in pursuing.
    Thanks.

    Reply
    • Hi JJ,

      I wish I had recommendations on how to find a physician but currently I don’t have a reliable solution. I know some people in the past have had success with going to a compounding pharmacy and asking for a list of physicians that treat with bio-identical hormones, however which may be worth exploring.

      Reply
  157. Hi Dr. Childs,

    If my reverse t3 levels are high due to stress over past 4 months, having never had thyroid problems before, can this be reversed and regular thyroid function return if taking T3 meds, supplements to help with conversion and addressing the underlying cause? Or is it more likely that I will always have thyroid dysfunction? Labs only became less than optimal after 3 months of chronic stress. Thank you.

    Reply
    • Hi Lucy,

      Provided the stress is minimal you can probably reverse the condition with the use of lifestyle changes, supplements, diet, etc.

      It’s difficult to say for sure, but my experience suggests that minor dysfunction is usually relatively easy to “reverse”.

      Reply
  158. Hi could you please tell me are there some people that just can’t tolerate t3 .I have tried so many times and it gives me chest pains. Even when the t3 is really low. Also low heart rate.

    Reply
  159. I have been using a throyid protect supplement which is really working for me. My weight has stabilised my hair skin and nails have improved so much and I am not feeling the cold as Bart as I used to so very happy. I have a problem with myofacial pain syndrome. Is this attributable to my throyid function as would love to get on top of this also

    Reply
  160. What does this lab work mean?
    Tsh. 0.438
    T4 1.02
    Thyroxine total t4 8.3
    T3 free 3.16
    T3 reverse 44.6
    How would you treat? Zinc..thank you

    Reply
  161. Great article!
    Im 41 and fairly fit. I am active, do weights and cardio 3-4 times a week. I axed gluten/dairy/sugar and coffee, plus alcohol but still suffer from 5 autoimmune diseases. I have a great doc who pushed my armour to 5 grain 5+ years back and relieved 99% of my symptoms but they are slowly back, including cracked heels. My lipid panel is all green (I take a ton of supplements) but I feel hypothyroid again. What gives? Can all of this autoimmune stuff really wreck my T4-T3 conversion causing my Ft3 levels to go high? Recent saliva profile shows adrenal fatigue, high cortisol/ low dhea so im guessing that doesn’t help. Just wondering how often you see autoimmune patients w/ this issue and can we rebound?

    Reply
  162. Hi Doc,
    First, thanks so much for providing sound, valuable information and resources. I’ve been dealing with rather sudden and unexplained weight gain over the past three months. I am a long distance runner, follow Dr. Sara Gottfried’s hormone reset protocol religiously (which worked tremendously for me post partum), making the weight gain even more of a mystery. I’ve seen several healthcare professionals who are quite dismissive of my thyroid tests. My reverse T3 is 17, my free T3 is low, my free T4 and TSH are also on the low end. I came across your article on reverseT3:freeT3 ratio, and it rang a bell. I’ve subsequently been dealing with mood changes, anxiety , brain fog. I really believe this might be what I’m dealing with. Flushing out Reverse T3 requires supplementation of T3, am I understanding this correctly? Are there other means in enhancing this process? I currently take your T3 conversion booster and thyroid/adrenal support.
    Additionally, I’ve come to find out my serum ferritin is at 12, yikes!!! A problem I had dealt with post part but is clearly an issue again. I’m assuming this further complicates my thyroid issues???
    Thanks again for your support and resources

    Reply
  163. I have struggled with my Hypothyroidism for about 15 years. Doctors have always had a hard time getting my levels to balance out. I recently had labs drawn and I’m actually on the hyperthyroidism side now something that has never happened in 15 years. My labs are as follows:

    TSH: 0.05

    T3: 8.3

    Reverse T3: 26

    T4: 10.7

    Thyroid Peroxidase antibodies: 1

    I was taking Natur-throid: 1 grain 3 tablets daily
    Synthroid: 25 mcg 3 times weekly
    Ecothyroid: 4 x week

    Obviously this is to much for me and I will be seeing my doctor shortly to discuss results. Any thoughts on how to proceed.
    Thank you for any advice

    Reply
  164. Very informative article. I just have my blood not sure if i can benefit from the flush
    T4 1.38
    TSH 3.80
    IGF-1 171
    Reverse T3 25.0
    Thyroid Peroxidase 11
    Tryroglobulin 1.6

    Thank you

    Reply
  165. This article needs to be proofread and edited. There are several errors, such as this one: “Not only do they cause high reverse T3 levels but they also make weight gain impossible”. Shouldn’t that say’make weight LOSS impossible?’

    Reply
    • Hi Jennifer,

      Yes, you are correct! Insulin resistance and leptin resistance make weight loss very difficult. Thanks for pointing that out 🙂

      Reply
  166. My daughter has POTS & Hashimoto’s. She’s currently on 1 mg of LDN and WP Thyroid @ 4.5 mg. Her labs are: TSH < 0.14 ulU/mL (low), Total T4 15.2 ug/dL (high), Free T4 1.85 ng/dL (high), Total T3 275 ng/dL (high), Free T3 5.6 pg/mL (high), Reverse T3 44 ng/dL (high). Both Ab's are eleveated, TgAb at 253 & TPO at 165. Her Fibrinogen is high at 589 mg/dL, NT-proBNP is mildly eleveated at 182 pg/mL, Vit D is at 44 (normal range). Dr doesn't think she needs to lower WP Thyroid dose, I do. Dr. said she needs to reduce stress to lower RT3, I'm not convinced that is the problem although she's in college and that has caused some stress. I think she needs to reduce WP Thyroid and was hoping the Dr would prescribe some sort of T3 but no luck. How fast can you reduce WP Thyroid? or what's the protocol to reduce a NDT? Prior to starting NDT most of her thyroid numbers were in range, except Free T3 was on the low side of normal range and TSH was 3.5, unfortunately her RT3 wasn't initially checked. Thanks!

    Reply
  167. Hi Dr. Childs,
    I’m at a good weight and my complete thyroid panel was in the normal functional range except rT3 was 45. I have a cancerous thyroid nodule that is going to be taken out and I did a n looong elimination diet for leaky gut treatment. Curious if you think the cancerous thyroid nodule could affect rT3 even if localized and contained?
    Thanks,
    Maymie

    Reply
  168. Hi Dr Childs
    I have
    Low FT3 1.5 pg/ml ratio 2.0 – 4.4
    Low rT3 5.2 ng/dl ratio is 9.2 – 24
    Low FT4 .33 ng/dl ratio 0.82 – 1.77
    TSH 34.444
    I am taking 15 mcg of T3 Paddock – just discontinued and switched to Sigma brand 3 days ago
    I used a compounded T4 the last 2 months and hence my results.
    I used 75 mcg of compounded T4 but I seem to react to the cellulose in the veggie cap.
    Tirosint did not work as I have a pork allergy and they use porcine.
    I now will switch back to Levoxyl using the 50 mcg tablets. I did not feel great on it either but my numbers were much better.
    Do I need more or less T3 and T4? When increasing the dose I get restless legs, urinate a lot and do not sleep well at all. A dose of 50 mcg T4 and 15mcg T3 made me feel better but my numbers are out of wack. What shall I do.

    Reply
  169. Dr. Child’s,
    I love reading your blog! You are very informative. I was able to get my primary doctor to rx cytomel for me as my T3 was very low with a normal TSH and T4. Well, I feel somewhat better, not not 100%. By far better than when I went in last. I feel I have a conversion problem. However, I had to continue taking levothyroxine with cytomel. My new labs now show a normal T3, ft3, a low T4, and a low TSH. I fear he will take me off of the cytomel as my TSH is showing hyper. I am not! My resting HR is 56, I have low body temp, and do HIIT 6x a week mixed with weight training. I am not rapidly gaining weight, however I am not losing any either. I am also not overweight therefore my doctor is not worried about weight. I have gained 20 lbs in the last year though on the same diet, if not a healthier diet now. My concern is that I need T3 Longer. I plan on taking a few of your articles to him to read. But I feel with a straight forward plan he is more willing to work with me. However because my T4 is so low now I am unsure of what I should ask for from him. Any suggestions would be much appreciated. If you were practicing I would def be back down to AZ.

    Reply
  170. Hi Westin,

    Excellent info, big fan of your research and posts.

    My Doctor said I have subclinical hypothyroidism because my TSH was 7.2. She gave me Levo 100 but most of the symptoms didn’t go away and one come up new MY BREATHING falls when I’m doing CrossFit or any exercise.
    Even my THS reduce to 2.2, she said my levo dosage was ok and I didn’t need t3 med because t4 converts to t3 naturally (no way!! for what I read in this post I have high t3 reverse)

    what worries me it the lack of air or air hunger. I just add t3 to my t4 doing a combo of t4=100 and t3=20, with no positive result, then I add more so t4=150 and t3=50.

    If my reverse t3 is high and my air hunger still there; do I need to increase the combo dosage or only t3?

    Thanks.

    Reply
  171. Hello Dr. Childs:
    Thank you so much for your article. I have a lot of the issues you talk about, but rather than high TSH, I have low TSH. I am post-menopausal, and on a natural thyroid supplement. I do have the high reverse T3 levels, so would lowering them still be the best approach? When you talked about using bio-identical supplements such as liothyronine, you also mentioned that the TSH levels would drop, which is not something I need since mine are below low normal already. Thank you!

    Reply
    • Hi Elaine,

      It depends on why your TSH is low. If it’s low due to thyroid medication like T4 then you can reduce your current dose to add T3 without having a negative impact on your TSH.

      Reply
  172. I never had conversion problems with NDT in the past but an online thyroid group suggested that T3 might be better for me because I was also put on Cortef (hydrocortisone for my low cortisol). I started getting symptoms of too high T3 and want to switch back to NDT but now it’s converting to RT3 making me extremely hypo. Is it possible that it will start converting on its own again if I give it a week or so? Even the tiniest addition of NDT has caused me to be badly hypo. It’s only been a couple days but I have tried this a few times over in the last 2 weeks and same thing. Selenium and Zinc has not helped. How long before the Selenium and Zinc will begin converting? Is it immediately?

    Reply
  173. Hi Dr Westin I have just had my reverse t3 done 431.0 (230.0-2.200) t3 ratio 0.949(1.200-2.200) I have been told thats not bad. I have trouble converting t4 to t3. Cant take synthetic t3 as I have side effects My t4 keeps going up and down . Just wanted your opinion. Thanks Desley.

    Reply
  174. Doctor, can you please recommend a specialist in my area my endocrinologist I think is throwing her hands up after trying to treat me for 3 years. She’s now put me on the same medicine I came to her on Synthroid 3 years ago accused me of taking too much of my thyroid medicine and or taking some other Thyroid supplement in addition to the medicine she has prescribed me. I would like to find a new endocrinologist or thyroid specialist in my area who do you recommend I am On the Border in between Indianapolis and Cincinnati. Dayton Indianapolis and Cincinnati would be perfect locations for me. If you know of a specialist could you please reply thank you so much.

    Reply
  175. Hi,

    When you speak of blood pressure meds being a cause of high RT3, would a diuretic fall into that category? My most recent RT3 lab was 19, and the previous one in October 2017 was 14. What about alcohol use? I also have two amalgam fillings, so I know that I’m also dealing with mercury. But I’ve had those since a child, so that wouldn’t explain the sudden increase. I’m trying to figure out why the increase. Any thoughts?

    Reply
  176. I had some kind of toxic exposure, that lead to the usual biomarkers of ‘biotoxin illness’. I’ve been detoxing, supplementing etc for almost 2 years. My main issue was sudden debilitating insomnia. I show High reverse T3. My environmental doctor attempted to treat me with a very low dose of T3…and it sent me crawling out of my skin. So, he made the assumption that my thyroid is absolutely not the primary issue. After more research, it appears I should have never tried the T3 without addressing my low adrenal function first. Do you hold the view that adrenals must be addressed before thyroid? Most docs I’ve seen think I’m ‘false’ hypo, as I don’t show multiple symptoms. Sleep meds make me feel worse and only work occasionally (likely lowering already flattened adrenal function). I am desperate to get to the bottom of what is going on.

    Reply
  177. Thank you for the very informative and much-needed information! Here are the results from last lab tests (I requested these tests.): Free T3 3.33 pg/mL, T4-Free 1.57 ng/dL, TSH 1.82 mIUL, Reverse T3 18 ng/dL, Thyroglobulin 0.2 ng/mL, Thyroid Peroxid 156 IU/mL. I currently take Levothyroxine 88 MCg and my doctor said my labs look fine and there is no need for T3 or NDT. I asked him what he thought about discontinuing Levothyroxine and he said it shouldn’t be a problem to experiment with discontinuing the medication since I’m on such a low dose. I want to discontinue this medication due to the side effects (bone density concerns). I changed my diet in the past year and lost 50 lbs by incorporating healthy fats, limiting carbs and removing sugar. In the last two months, I removed gluten from my diet. I was diagnosed with the thyroid condition 15 years ago shortly after the birth of my son. I believe that my body is totally different now and I may be needing a different approach. Your thoughts would be appreciated. Thank you!

    Reply
  178. Dear Dr. Childs: I LOVE your thorough and informative blog posts! This post seemed to cater to my exact condition, which is the “LOW Free T3 levels, HIGH Reverse T3 levels and NORMAL T4 and TSH levels.” Background: from 2004-2016 I was essentially the same weight besides pregnancy. Two years ago I started gaining weight, despite no change in diet or exercise. I only have one ovary and was tested as having essentially non-existent Progesterone levels. Last two years I’ve been on 400 mg of Progesterone daily. 2017 was a very low-energy year for me so it prompted me to have new blood work done. Beginning of March 2018, my lab results showed: My Free T3 is 2.7, Reverse T3 is 24.5, T4 is 1.34 and TSH level is 1.390. I’ve also had other lab tests done to give the bigger picture: Ferritin 31, Iron and TIBC 001321 is normal/ideal, Vitamin D low, Progesterone, and Estradiol normal. In March I began an extensive supplement regimen, which included zinc and selenium and added daily stress-relieving walks outdoors. As per my doctor’s orders: I waited until April to start the generic Cytomel. I started off slow and did experience some of a headache and jitty symptoms, but after two weeks those went away. I have graduated slowly up to 40 mcg of Cytomel, taken in three different doses throughout the day. I’m at a loss because I’m not doing too well on the liothyronine sodium. Although my energy levels are better while on the pill, I have to take it three times daily or my energy crashes after about 4 hours + I get extreme brain fog. Since starting liothyronine, I have gained three more pounds & I have procured a constant and usual amount of water weight around my stomach (so much so that it has prompted me to take two pregnancy tests–both negative–even though I have an IUD). Both for the weird energy-rollercoaster and the weight gain, I’m not feeling very happy with the liothyronine. Should I wait it out? Does it just get worse before it gets better or do you suspect there’s an additional issue? What would you recommend? Should I get my fasting insulin and fasting leptin levels checked? PLEASE HELP!

    Reply
  179. I live in Australia and there is no one here that will help me. My RT3 is 559. What can I do to naturally reduce this as no doctor will give me T3?

    Reply
  180. Hello,

    As always, your article is very interesting.

    From what value do you consider the RT3 too low and for how long?

    My RT3 was 9 ng/dL in May 2017 and 5.5 ng/dL (9 – 24 ng/dL) in May 2018 with only 90 mg of NDT (FT3 = 5.5 pmol/L and 5.7 pmol/L).

    Is it harmful to stay so long at low value of RT3?

    What condition can cause a low R3?

    Thank you
    Adam

    Reply
  181. I just finished chemotherapy treatment (for breast cancer) just over 2 weeks ago.
    As is apparently quite common, I managed to gain 10 pounds over the course of the 5 months of treatment.
    During treatment, I walked for about 40 minutes, 3 times a week (as much as I could manage with the fatigue).
    Since the treatment concluded, I’ve been walking every day as well as doing an additional hour of aerobic and body sculpting exercises every day. And yet, it seems I’m getting more and more bloated each day.
    It finally dawned on me that perhaps my body isn’t assimilating my Synthroid (T4 – 850/week) and T3 (5 mcg/day – I take the T3 only in the morning).
    I wonder if my metabolism/hormones were altered by the chemo and steroids.
    Perhaps I should be taking my T3 twice a day, rather than once.
    I forgot to mention, since finishing the chemo, I’ve switched to a very low-calorie diet, but it seems to no avail. My weight just seems to go up and up. Very distressing.
    I hate to be going into surgery (for a double mastectomy) like the enormous balloon that I am. Cancer does indeed suck, in all aspects. 🙂

    Reply
    • Hi Abby,

      Both chemotherapy and steroids can interfere with thyroid hormone conversion (and potentially production). Cancer therapy also causes extreme stress on the body which can make the situation worse.

      It’s a tough situation to be in, but the best thing you can do is try to optimize your thyroid medication.

      Reply
      • thanks for your response!!! good to know that i’m not crazy and there’s an actual issue related to the chemo/steroids/stress. Here’s hoping my body recovers sooner rather than later!! thanks again!! 🙂

        Reply
  182. Hi,

    I had my thyroid ablated in 2005 due to Grave’s disease (hyperthyroidism). It’s been a wild ride since then. I currently have “normal” thyroid labs, but I’m finding it impossible to lose weight. In fact, I started an exercise regimen and have gained 8 pounds. Fun times. I’m 38 years old and 20 pounds overweight due to thyroid fluctuations… and that’s before I gained the 8 pounds.

    I’ve been reading a LOT of your articles and I’m trying to wrap my head around everything you’re teaching, so that I can work with my naturopath on truly getting my body back to normal.

    I’ve been on T4-only (levothyroxine) for 13 years, 150 mcg for the past 9 years.

    My labs: T3 is on the lower end of normal, T4 is on the higher end of normal, TSH is suppressed, and RT3 is just over 16. I only recently discovered the need to test RT3, so I don’t know how it’s changed over time, but I can say for sure that my labs over the years are consistently lower-end T3, higher-end T4 and low TSH. Therefore, every doctor wants to reduce my levothyroxine and then I end up feeling awful.

    But now I’m seeing a naturopath and we’re trying to solve the puzzle. We are slowly reducing my T4; I recently went from 150 mcg to 137 mcg and now we’re jumping down to 112 mcg because I’ll be adding T3 (Cytomel) to the mix. We’re starting with 5 mcg daily and possibly adding a second 5 mcg dose in the afternoon, if I don’t react badly to the T3 (I have heart palpitations of unknown cause that came on suddenly (and never went away) after I tried taking NDT 2 years ago… not sure if it was an autoimmune response or if it was sensitivity to T3).

    So, getting to my question (the long way ’round): What I don’t understand is how to properly titrate this. Do I keep reducing the levothyroxine as far as possible, assuming my body responds well to the Cytomel? Is the goal to eventually take T3 only, or is it vital to have T4 there as well (keeping in mind that I don’t have a thyroid… or much of one after ablation)? What lab results am I looking for?

    Also, if I’m taking high amounts of T4, won’t I be making too much RT3 since I’ll have the T3 readily available (because of the Cytomel) and the T4 HAS to convert to something? What’s the protocol for reducing T4-only medication so you can add T3-only medication?

    Reply
    • Hi Jenny,

      In my experience, there is no substitute for a knowledgeable practitioner that can help guide you. I’ve seen patients attempt to do this on their own and, without the right knowledge or experience, it tends to not turn out well. I would put energy into finding someone to help if possible because treatment is very nuanced and individualized.

      Reply
  183. I am so glad to have found your blog and this particular post. I have been taking Armour thyroid for years but have over the past year or so started feeling just terrible and only after requesting my doctor order a reverse T3 test found out mine was quite high. She tells me this is not a problem. The more I read, the more I think differently. I had gone on a six-month low cal diet last year and managed to get off 20 pounds. I’ve gained back 10 of that, am just exhausted all the time and can fall asleep at the drop of a hat. I feel as if someone pumped me up with a tire pump. How can I find a doctor my insurance will cover who thinks like you do? I am retired and existing on Medicare and Social Security.

    Reply
    • Hi Teddee,

      As far as I know, most doctors who think this way do not accept insurance because of all the restrictions and limitations. You may be able to find one but it may require long-distance travel.

      Reply
      • Thank you for your reply. If Cytomel is taken, I saw somewhere that you recommended to titrate the dose yet take the dose once a day.

        I read that the body normally produces 4mcg of t3 every hour or so. What happens to the excess of Cytomel if taken in one dose?

        Reply
  184. Dr Childs,

    Thank you for this in-depth, easy-to-follow analysis. I know this article is a few years old, but I’ve been desperately trying to understand something that has been going on with my own health and just came across it. A year and a half ago, I had a complete mental/physical collapse after a prolonged period of chronic stress and poor health management. Since that time, I have gotten on a path of healthy living–through diet, exercise, and sleep–but fatigue, depression, and serious brain fog have persisted. The depression itself has been abnormal, and I’ve been convinced there is a deeper physical issue. In particular, I’ve wondered if it’s thyroid related. All tests have come back in the normal range (though perhaps on the lower side) except for Reverse T3–an integrative doctor included it in my labs, and I got a result of 30 (just out of the normal range). My iron is also low (though not my ferritin) which I know plays a role in the t3 production. Anyway, I’m wondering, based on all this, is it worth pursuing a more in-depth look at thyroid imbalances? Is there something possibly here that can be a piece of the puzzle? I have some ideas of some more investigative, integrative doctors I can talk with, but I just wanted your thoughts on if this could be thyroid related. Thank you for your time and attention.

    Reply
    • Hi Wes,

      It sounds like your thyroid may be involved but you need to figure out if the thyroid is primarily responsible or if it’s secondary to some other issue, once you figure this out you can determine if you need to use thyroid medication or not.

      Reply
  185. Hi.

    I’m a little late to this site, but someone for the love of God help me figure this out. I am a believer that we are all each different and have different numbers to our own “normals”. I am 43. At the age of 23 had Graves disease and the ended up doing RAI therapy due to the pills not working. I was extremely ill, so much so they thought it would take 1 year to go hypo. It took less than 6 weeks and came in the form of what appeared to be a heart attack and 26 pounds gained in one week eating lettuce and yogurt. It was not a HA, but my body quickly going the other way. So began the years, and i mean years of med altering. Synthroid is what i was given. After years of dosing, 300mcg is what I am on. I do not convert t4 to t3 well, I diagnosed this myself, and demanded a blood test to confirm. I am also on Cytomel 25mg. No doctor will listen to me. I feel awful. I am so tired. All. The. Time. Muscle and joint pain. I can not see well out of my right eye. depressed. Anxiety with OCD behavior with safety things. My bones hurt. Weight gain and I do not eat much at all. Every doctor I see says oh my, your on way to much medicine. They send me to U of M specialist. The professor himself went through my list of symptoms at me and said he goes by numbers and that I am on an obscene amount of meds and says he believes I have thyrotoxicosis. He’ll call with my blood work. oh and that i clearly ate way to much as 40 pounds in three months is too much. He didn’t call. I had to track him down. My results. “completely normal” and hung up. tears. I have periods where I am so exhausted I can not move. can not get out of bed. requested a neurologist. Do I have MS? runs in family. Nope. I don’t. But she, whose wonderful, ran a glucose test, as well as a tolerance test. fasting normal. 86. GTT. 53. Some kind of reactive hypoglycemia or diabetes or something. She referred to yet another endo. No apt til November 2018; went to my PCP, who’s a PA, and she ordered blood work I requested as I seem to be the only one, other than the neuro, who can’t stand me living life this way. My TSH <0.05. My T3 131 t4, It was normal. Last time I made her order Cytomel my t3 was 83 and I felt awful. I still have and feel extremely Hypo. I exist in life. Not live it. I also have low vit d, and b/12 was low normal, so i got scripts for that. CRP was 5.6. elevated. What in the world do I need to do. My PCP is willing to let me switch to Armour Thyroid. Is the med, Synthroid,(generic) which I’ve been on for 20 years making me ill? Not working? No clue to Reverse values. But I'm on meds so It should be ok. Help.

    Reply
  186. I am so frustrated with my thyroid. I have always been on armour thyroid or ndt with the exception of when I was pregnant. but recently my tsh went a little too low and my t3 little high (my resting heart rate was also high at like 95-100) and t4 too low on the armour. So I switched to 137 levo /5cytomel , then I had my dr switch me to brand synthroid. I felt ok. Still little tired, but when I went to her my numbers were ok but tsh slightly low at .001. So she lowered my t4. I blew up retaining water and I look like I gained ten pounds within weeks.( In the past I have found synthroid made me retain water but when I was pregnant had no idea lol ) I had her switch me to Tirosint now. I’m hoping this helps but the bloat and water retention I have is insane. I eat the same, work out hard 5-7 days a week I am sooo frustrated !!! I don’t know what to do. And am wondering if I should ask for these additional tests or for an increase in t3, but would they give an increase in t3 if my numbers are ok?

    Reply
  187. Hi

    I have Hashi and also T4-T3 conversion issues from my ongoing blood tests. My endo has put me on 10mcg T3 but when I asked him to do a lab for Reverse T3, he qouted me this”Reverse T3 is not a test recommended by the American Thyroid Association, The Endocrine Society, or Kaiser Endocrinologists to monitor the treatment of hypothyroidism. I cannot order this test”. And this is a guy whos the Chief of Endo clinic at my hospital.

    I showed him your website and he simply said private docs will order anything and everything to grab a patients $$$$.

    Reply
  188. Hello Dr. Childs! I tried your suggestion to take thyroid at night but if I take my blood test, should I skip the night before and take the following night after the blood test? or switch to the morning and it will be 24 hrs when I take a blood test?

    Reply
  189. Hello Dr. Childs – I’m confused about after reading your information here. My recent lab results for Free T3 &
    Reverse T3 are:

    Free T3 = 3.2pg/mL (0.32ng/dL), “Standard Range” stated as 2.0-4.4pg/mL

    RT3 = 22.0ng/dL (220pg/mL), “Standard Range” stated as 9.2-24.1ng/dL

    The labs give results using different measurements which isn’t helpful, but after doing the math conversion and using your formulas, I get the following:

    Free T3/Reverse T3 = 0.32 ng/dL / 22.0 ng/dL = 0.0145 (You state the ratio should be > 0.20 which I’m FAR below.)

    The BEST ratio that’s possible using numbers within the “Standard Range” as I currently understand this is:

    0.44ng/dL / 9.2ng/dL = .05 (still far below your ratio recommendation).

    Please clarify what I may be doing wrong. I’ve been dealing with extreme fatigue for several years (despite being on a PAP machine for the last 9 months as well), and this is currently my target for understanding what may be wrong as all my other blood work (which is considerable) is “normal.”

    Thanks!

    Reply
  190. Data similar to Bob’s above:
    On NDT (NP Thyroid) 225MG
    Suppressed TSH
    RT3 = 33 ng/dl (8 – 25)
    FT3 = 3.7 pg/ml (2.3 – 4.2)
    FT4 = 1.2 ng/dl (0.8 – 1.8)
    FT3/RT3 = 0.011
    Selenium = 144 mcg/l (63 – 160)
    MAG RBC = 4.7 g/dl (4.0 – 6.4)
    FERRITIN = 45 ng/dl
    % SAT = 35
    IBC = 379 mcg/dl
    T.IRON = 131 mcg/dl
    Leptin 7.9 ng/ml
    Uric Acid 6.9 mg/dl (4.0 – 8.0)
    SHBG 55 nmol/l (22 – 77)
    Thoughts and comments?
    Thanks,
    omi

    Reply
  191. Dr. Childs, The D.O. I go to told me she was going to start me on 15 mg NP Thyroid and 5 mg of Cytomel. I have a history of hypothyroid symptoms and was diagnosed as Hashimotos but never had antibodies out of range, so doctors said I do not have it. The DO now said she is going to just give me the cytomel because I am so detailed when I talk to her, and I don’t know what that has to do with prescribing for me, either you need it or you don’t. Listening to this video, and my symptoms being that I have the fat I can’t lose, tired all the time, many hypo symptoms, should I go on the Cytomel first, my RT3 is 19.5 Reference range: 9.0 to 27.0 ng/dL. I also wonder how much of a difference in the optimal range and how important is it to follow that rather than the reference range? I took 60 mg NP thyroid for 2 days once and then went off because it was making me not sleep and my facial collagen decreased giving me hollows under my eyes. I don’t want that to happen again. I’m using a hyaluronic acid serum and it is helping from that and then I took dhea with adrenal herbs and it made deep hollows on both sides of my nose like women weightlifters get. Everything I have tried to help myself hasn’t improved anything. I’m afraid to go on the 5 mg T3 now, is that the lowest dose you recommend and could it also cause collagen collapse if I go off or decrease the dose?

    Reply
  192. After a TT 7 years ago, and being hypo, and constantly tired, this has been the best thing I’ve ever read! I can now begin to understand what is happening.

    Reply
  193. Hi Dr Childs:

    I left a message on Aug 1 but haven’t received a reply, so here’s the info again in case you missed it.

    I’m confused about after reading your information here. My recent lab results for Free T3 &
    Reverse T3 are:

    Free T3 = 3.2pg/mL (0.32ng/dL), “Standard Range” stated as 2.0-4.4pg/mL

    RT3 = 22.0ng/dL (220pg/mL), “Standard Range” stated as 9.2-24.1ng/dL

    The labs give results using different measurements which isn’t helpful, but after doing the math conversion and using your formulas, I get the following:

    Free T3/Reverse T3 = 0.32 ng/dL / 22.0 ng/dL = 0.0145 (You state the ratio should be > 0.20 which I’m FAR below.)

    The BEST ratio that’s possible using numbers within the “Standard Range” as I currently understand this is:

    0.44ng/dL / 9.2ng/dL = .05 (still far below your ratio recommendation).

    Please clarify what I may be doing wrong. I’ve been dealing with extreme fatigue for several years (despite being on a PAP machine for the last 9 months as well), and this is currently my target for understanding what may be wrong as all my other blood work (which is considerable) is “normal.”

    Thanks!

    Reply
  194. Dr Child’s:

    Thanks for your reply and links.

    Can you please address what you’d compute my T3/RT3 ratio is using my lab results.

    Thanks!

    Reply
  195. Dr. Childs,
    Bob and myself must be brothers:)
    Same issue.
    I am on NDT
    RT3 was at 33.
    Cut NDT back to clear the RT3.
    RT3 = 16 ng/dl
    FT3 = 2.2 pg/ml
    About the same ratio of 0.013.
    So only impact was to lowering all values with no impact at all on the ratio.
    So am I looking at conversion issues and should I talk to my PCP about adding in T3 on top of the NDT?

    Reply
    • Hi Omi,

      That would be a reasonable approach. You may also benefit from looking at factors which would be limiting conversion in the peripheral tissues including genetic defects.

      Reply
  196. Dr. Childs,
    Thanks for the response.
    I have done 23andme so I have the genetic data. Can you identify what specific items I might check on (type of genetic defects?)
    Thanks,
    omi

    Reply
  197. Dear Dr. Childs, I’d like to ask if I have excess reverse T3 from using Levothyroxine wrongly because of really having an autoimmune problem, not a real hypothyroidism, would the reverse T3 leave my body if I stop using the Levothyroxine? And under what time frame? And how quickly would the reverse T3 leave my body if I also take Chromium Zinc and Selenium?
    Looking forward to your answer.

    Reply
    • Hi Emily,

      It might help reduce your reverse T3 but it will almost certainly make you feel worse as your body reduces the total number of free thyroid hormone.

      Reply
  198. Hi Dr. Childs,
    Thanks for all your wisdom and the sharing of it.
    I will see my endo tomorrow and I’m wondering what I should ask for.
    Here are my labs from Sonora Quest
    TSH HS-1.03 (.045-4.50)
    T4-Free-1.3 (0.8-1.7)
    T3 Free-3.5 (2.0-4.8)
    TPO Anti-<10 (<34)
    Thyroglobulin Anti-<20 (<40)
    Rt3-24 (8-25)

    Any Advice? Thanks in advance

    Reply
  199. Hi Dr Childs,
    You mention about balancing your hormones and was wondering if menopause has an affect?
    I’m currently on 2mg of oestrogen and was wondering if that helps or hinders my TSH, FT4, FT3 & RT3.
    I had my thyroiod removed due to cancer.
    Thanks in advance

    Reply
  200. Hi, once starting on T3 while on Synthroid for high reverse T3, how long are you supposed to stay on it? Is it lifelong if you do not have a thyroid gland and are on Synthroid?

    Reply
    • Hi Aimee,

      It really depends. Some people only need it for a short period, some for others, and some do better on it for an extended period of time (for life). There is no one-size-fits-all approach.

      Reply
  201. Thank you for this protocol. I’m a healthcare provider and I’ve been struggling with my own thyroid stuff for years. Although I’m considered an expert with thyroid issues, I’ve not found the magic individualized combo of tricks for myself yet. I need a bit more guidance. I followed your protocol and got my reversed T3 down and my hair finally stopped falling out. It’s been falling out for years. Lately I had been going through a huge hair loss experience. Looking terrible, and I’m on big stages, so I’m more self-conscious now. So it stopped for a bit. Exciting! Then I retested my thyroid panel (all 10 markers) and my TSH was 180, and everything else was way low, below lab low. Did I just not do enough srT3? I stopped the tirosint (T4) per your instructions for the process. I began the Tirosint again (TSH at 180 plus antibodies were way up again- I had them down to 0 and 50) and continued on the srT3 and my hair is falling out again, a lot. I’m heading to the lab tmw to see what is going on, but I’m frustrated and would deeply appreciate a bit more guidance. How much srT3 do you suggest while you go off the T4 and clear the reverse T3? How do I stop it from accumulating again? I’m doing all the “right” things. My diet and life are cleaner than anyone I’ve ever met or worked with. Are you open to a phone conversation to help me solve this mystery? Deep Gratitude, Kristin Grayce McGary

    Reply
    • Hi Kristin,

      Great questions! Unfortunately, I would have to sit down and really dig into your labs to give you any definitive information regarding your situation. I normally spend over an hour with each person to try and piece together the puzzle and comments on the internet don’t quite allow for the same intimacy!

      Reply
  202. I found your article very interesting. I have had thyroid problems since I was a young teen. Recently, I had a full thyroid panel done with reverse T3 and free T3. My reverse T3 was 27. I was put on cytomel in addition to my levothyroxine. After two months my reverse T3 remained normal. My fasting insulin is low and well within normal range at a 9. My nonfasting insulin is also very good. I saw in your article that you said that all of your patients have high insulin levels with reverse T3. I happen to be an anomaly I guess. Cytomel is causing my TSH to get pretty low – .04. Therefore, my doctor is cutting me back on my levothyroxine so I can stay on cytomel. I am confused why my reverse T3 is not reducing with the cytomel.

    Reply
  203. Hello Dr. Childs,
    I’m a holistic healthcare provider as well. I love your work and how you’re guiding people. Although I’ve helped hundreds of patients with thyroid issues I’m having challenges dialing my own in. I had high reverse T3. I followed your guidelines and sure enough they came down and my one painful symptom (major hair loss) stopped!Yippee. And then I tested a full panel (all 10 markers) and my TSH was 180. My T4, and T3 were all below lab norms, not to mention way below functional ranges. I was beginning to feel some fatigue, but just the slightest bit. I’m an energizer bunny, in a good and balanced way so when I feel “crashy” my word for thyroid fatigue, I can tell something is off. So I increased Tirosint and srT3 meds. And my hair began falling out again. I just ran another panel 6 weeks after increasing my meds. TSH is down to 4.9 now, T4 is slightly low, T3 slightly low. antibodies are still elevated. I had gotten down to 0 and 50, now they are 170 and 1.0. When I stopped the T4 (Tirosint) to clear the RT3, I wasn’t sure just how much T3 should I take? I was up to 9mcg am and pm, but was getting symptoms of speediness, so would cut back to as little as 7. Now it didn’t help my TSH at all. YIkes it was so high. I had a goiter before from having high TSH and it disappeared with treatment. I don’t want that again. I’d love the hair to stop falling out. I’ve done everything you can think of. Many things help a little, but nothing really has solved the mystery. I have a strong reaction to iodine, it can cause a hoshi flare and put me in bed. I can do a drop or two no my skin and follow my intuition on when and how often to do this. Some weeks 3x, other weeks not at all. I’ve done neural therapy, homeopuncture, biological medicine, EAV testing, mercury detoxing for years (worked with Klinghardt), acupuncture, herbs, homeopathy, api therapy (yes bee venom, bee stings- amazing and then it stopped working) and even stem cells. I have EBV in my system but no other symptoms. Gut has always been an issue and one of my specialties so I believe I do a great deal to repair it. I’ve been diagnosed with Celiac Hoshimoto’s and worked with my friend and colleague Dr. Tom O’Bryan. I even have a book coming out on gut health so I dare to believe I understand the topic a bit. 😉 And I’m open to any new tools or advice? I have megaloblastic anemia and do B12 shots almost weekly or every other week. It hasn’t shown as pernicious anemia on tests. My predictive antibody test from Cyrex was a negative for that. I do biotin and basic things for hair. Any other ideas on how to stop the hair loss. My current RT3 level was 15, although considered normal, perhaps it’s still too high for my system? Insulin looks good 5.4. Leptin at 6.5. Cortisol 10.3 AM. Hormones- I’m perimenopause, so up and down. Blood hormones seemed ok. Estradial was up, but seemed right for where I was in my cycle. Hair Loss?? Help? Please and sincere gratitude for your time and expertise. I hope this can help others as well.

    Reply
  204. I had thyroidectomy due to thyroid cancer back in ’08. Ive been on synthroid 175mcg ever since. Ive never felt right since. All my labs come back as “normal” according to the Drs, and not one of them ever ordered a RT3 test.
    My resting heart rate has been very low for me (47-60bpm) typically my normal resting heart rate is in upper 70s low 80s.
    My current labs:
    TSH 3.8
    T4 8.1
    T4 Free 1.47
    T3 120
    FT3 3.5
    RT3 17

    I want to try taking T3. I am constantly feeling hypo. tired, cold hands and feet, low heart rate.
    What would be a good dose to start?
    I have a bunch of 5mcg T3 from the past that I never took.
    What would be a good dose to try?
    I think 5mcg pills are way too low dose for me. I know people that take 25mcg T3 a couple times a day

    Reply
  205. I recently turned 60 and I have been having constant hot flashes, lack of sleep, weight gain for 10 years. I’m always cold for the exception of when I am flashing. I recently had a scan of my thyroid which reveals a 2.0 cm nodule, a solid heterogenous nodule which is 2.0×1.3×1.8 and a solid nodule that measures 0.8×0.3×0.6 cm. I’ve seen many doctors and they only ordered CBC blood work. After, so much frustration, I ordered my own Thyroid Panel test through an online company. Test results showed my Reverse T3 Serum at 30.5 High.
    Thyroxine (T4) Free, Direct, S 1.12
    TSH 1.920
    Reverse T3 Serum at 30.5
    Thyroxine (T4) 5.7
    Thyroid Peroxidase (TPO) Ab 16
    Triiodothyronine 2.3
    I submitted this test to my physician and his response was we would just watch the nodules. Personally, I am concerned.
    Your thoughts/recommendations?
    Thank you

    Reply
    • Hi Diane,

      It sounds like you have 3 separate problems: thyroid nodules, hot flashes, and thyroid disease. Each will need to be treated separately. The nodules are most likely NOT causing the thyroid issues (it’s very rare if this happens). And hypothyroidism usually does not cause hot flashes so these are likely related to some other cause.

      Reply
  206. Hi
    I was great on NDT 2 grain and 20 mcg Liothyronine for over a year. That was after I didn’t take any medication for 2 full weeks. After that, when I slowly started NDT again, my excess weight fell off pretty quickly, the hypo symptoms disappeared and I felt great. Then starting this year I started gaining weight again and got hypo symptoms back. I just learned my rT3 is in the upper part of the reference (201 ref 90-215).

    My thought: Is it possible that I got rid of the rT3 without NDT for 2 weeks and that it then would have taken a whole year for rT3 to build up again with the low dose NDT+Liothyronine because I didn’t fix the underlying problem?

    Reply
  207. My wife had a Thyroidectomy 3 months ago due to a large mass that was borderline cancer. Since then her blood sugar skyrocketed. We waited in hopes it would go down it hasn’t. She is 130 pounds normal weight. TSH 1.48, Free T3 Normal, Total T3 .8 which is a hair low, FT4 Normal. Insulin is low at 2.6 and CPeptide normal range but low normal. She takes 75mcg of Levothyroxine and feels good otherwise. Not symptomatic with high blood sugar, but the Dr did a HGBAIC and it was 10% or 240. She started insulin this week and told she is now Type 1 Diabetic. This is shocking and hard to believe. I told the Dr we want Cortisol levels checked and Reverse T3. Should she try a T3 medication in combo with T4. Could this then lower her blood sugar if the Reverse T3 comes back high along with cortisol levels. Thank you for your website and any help offered!

    Reply
  208. Hello,

    I stumbled upon this info in one of my Thyroid groups. I have been battling Hashi’s, adrenal fatigue and Leptin resistance for years. I now live in Spain and finding doctors and medications is a nightmare. My Rt3 is 22 and my Leptin is 88. Free T4 is low at 0.59 (0.78-1.80) and my Free T3 is also low at 2.35 (2.3-4.2) I’m on 2 1/2 grains of NDT and 25mcg of T3. Should I lower my NDT and raise my T3 meds? I tried intermittent fasting and that isn’t working due to AF. Plus, to add insult to injury, I am now going thru menopause. I need a good direction and a lot of help. Thanks I appreciate it.

    Reply
  209. Hello Dr. Childs,

    New to the comment section of your great site. My husband is struggling with low T-3, high Reverse T-3. After 3 failed back surgeries he had a pain pump installed April of 2018. It unfortunately has not reach an optimal level of pain relief so he is still on some narcotics. He also had Radical Prostatectomy Aug 2017. From a short prescription of Bicalutamide prior to surgery he is still struggling with low testosterone. His PA who is practicing Functional Medicine has given him a low dose of testosterone with the Urologist’s approval. The PA how ever says he cannot give any Thyroid medication because it might cause Arrhythmia. His solution to most things is stay away from gluten which my husband does pretty well and VEGETABLES! Eat more, juice more. He hasn’t really seen improvement since going this route for 1 1/2 years.

    Now for the question, you mention that you have never seen a patient with high Reverse T-3 that doesn’t also have high Insulin. Tests results we received in the appointment yesterday were Reverse T3 32.4 ng/dL; T3 Free 2.8 pg/mL; Insulin 1.6 uIU/ml. How would you classify this out of the norm reading.

    Thank you!

    Reply
    • Hi Anna,

      You would need to also look at the hgb A1c and fasting blood glucose in order to figure out what is happening. The insulin result by itself doesn’t give much information.

      Reply
      • Thank you. His A1c was 5.5; fasting glucose 77. TSH 1.77. Free T4 1.58. Thyroglobulin Antibody <1.0. TPO 22. Cortisol 15.8. This PA doesn't test for leptin. Not sure if that is specific for overweight patients. My husband is thin and fights to keep weight on.

        Sincere thanks!

        Reply
  210. My ft3 to rt3 ratio is 0.14. I have been experiencing anxiety for the last 2 years, including panicky symptoms, which all kind of come out of nowhere. TSH 0.85 and ft4 1.4. Could this mean pooling or too much rt3 and can zinc and selenium supplements possibly help alleviate anxiety?

    Thanks,
    Jon

    Reply
    • Hi Jon,

      It’s certainly a possibility, but there are many factors which can cause high reverse T3 and anxiety outside of your thyroid.

      Reply
  211. Hello Dr. Childs,

    I find your website reply procedure very cumbersome to use. Paging down numerous times to find the end can make a person weary. Perhaps it is my browser but I do not have the problem on other sites. I keep thinking there should be numbers to take one from the beginning to the end of the replies. Just wondering.

    Reply
    • Hi Anna,

      Unfortunately, this particular post has over 400 comments which all take time to load so they must be loaded slowly to improve performance. If they all loaded at the same time then the page would take over 40 seconds to load and I can’t imagine many people would be happy about that! Most other websites get around this by either not allowing comments or allowing them to slowly load. I prefer to have conversation on the blog so I let the comments load (just slowly). You can always post questions on various blog posts as well which have fewer comments (this one just happens to be very popular).

      Reply
  212. I had high RT3 (27.6) and low FT3 (2.3). Symptoms included severe fatigue, insomnia, high anxiety, headaches, dizziness, brain fog, constant muscle pain and poor memory to name the big ones. I was experiencing high exposure to toxic black mold and diagnosed with CIRS (Chronic Inflammatory Response Syndrome) related to water-damaged buildings. hsCRP also high (4.10). Removed myself from exposure, treated with Cytomel 5mg and all labs returned to normal within 3 months. A year later still recovering but nearly back to my normal. 🙂 Sooo yes get to the root cause for sure! I see many of my chronically ill patients with high RT3. It is the body’s self defense mechanism but the root cause must be found. Great article I will share with my patients. Easy to read and understand. I am a Functional Medicine NP.

    Reply
  213. Thank you for this information, Dr. Childs, very interesting. I have high RT3/Low Free T3 after a long period of intense stress – a year of very high-stress levels followed by a year of exhaustion with low cortisol levels. I am not on any thyroid medication and have only recently realized that thyroid is part of my problem (extreme fatigue, muscle pain and stiffness, air hunger and inability to exercise are my main symptoms). My question is if I treat my RT3 with T3 medication, will I be able to off thyroid medication and function normally again after treatment? Or do I risk damaging my thyroid and becoming dependent on medication? And how long will a person typically need to be on T3 (provided I follow a good diet and reduce my stress levels etc.)? Many thanks, Maia.

    Reply
    • Hi Maia,

      It’s not always advisable to go on T3 for a high rT3 which is due to some reversible cause like stress as it may cause HPA suppression and further issues down the line. The decision on whether or not to treat depends largely on your situation and a number of other factors.

      Reply
  214. Thank you for this interesting article. I have low free T3 and high reverse T3 after a long period of intense stress. I am practically debilitated from this with severe exhaustion and muscle pain/stiffness. If I were to treat my condition with T3, how long should I expect to be on it and would it normally be possible to wean off it at some point? Or should I expect to be on medication forever? Thank you.

    Reply
    • Hi Maia,

      Everyone is different. Some people can get on a low dose for a few weeks to months while others may need it for much much longer. The dose and length of treatment time vary from person to person.

      Reply
  215. Hi. Thank you for your well-written, clear article! I appreciate you! I had a RT3 test result of 35 with a ratio of 8 to my Free T3 which was 2.8. The blood work was done after a liquid diet the day before the blood draw and a COLONOSCOPY PREP done the day before the blood was drawn. In addition to that, the 4 weeks prior to the blood work, I had been on the Keto diet with very minimal carbs, <50 per day, and I'm wondering if these factors could have made the RT3 abnormally high. I am a 55 year old woman with normal iron, cortisol, zinc, pregnenolone, copper, T4 and homocysteine levels. My dr also ordered thyroid peroxidase and thyroglobulin antibody tests which were 1 and 2 respectively. Any advice would be appreciate. Thanks.

    Reply
  216. Hi Westin,

    I fit with most of what you described in this article. I forget the number but my integrative doctor says my Reverse T3 is the highest she’s ever seen.
    Histamine and free copper (and copper/zinc ratio) all super high too, so she suspects infection if some kind. I have hashimotos and we suspect lots of gut issues, as a stool test from a year ago by the previous doctor suggests. Also, check things like Lyme etc.

    My question is this though. Besides crippling extreme fatigue, a lot of my symptoms don’t fit with what you describe. A lot of anxiety and adrenaline-related symptoms such as difficulty falling asleep and waking 4-5 am with racing heart, shakiness, anxiety (now controlled with anxiety meds propranolol, diazepam, olanzapine, and valdoxan). I also am having palpitations.

    Initially, in September my old doctor took me off T3 (10mcg SR) because I had had increasing palpitations, I energy crashed several weeks later as I forgot I stopped taking it. Fast forward to now, I have taken several months to climb back onto T3 (whilst still on 50 mcg Thyroxine). Energy improved immediately even on 2.5mcg T3 but on 5 and 7.5 palpitations started again.

    In all these medications for anxiety, the palpitations settled, and I was on 10 mcg T3, 50 T4. But after two weeks on 10 palpitations came back despite propranolol. I decreased asked back to 7.5 and stopped T4 completely. Palpitations got better. But now two weeks or so off T4 palpitations are getting increasingly worse again. Notice them especially come on if I try to take deeper breaths eg while meditating, or if hungry, or tired.

    I’m also skinny and losing weight, not gaining. But am eating mostly Paleo so could be I’m just not eating enough. Can’t eat grains or I break out with pus-filled pimples (currently the case as I’ve been having gluten-free sweet potato wraps).

    I’m. Mostly concerned about what’s causing the palpitations since I fit with everything else, and I honestly can’t be hyperthyroid. Any thoughts on the palpitations? And also should I be trying to increase T3 (only on 7.5 SR) despite them?

    PS I know propranolol isn’t helping the RT3 but it stops me from waking at 4 am and helps with anxiety symptoms.

    Reply
    • Hi Olivia,

      It’s certainly a fact that T3 medication can cause heart palpitations even if you aren’t taking a high dose. It depends on how sensitive you are to the T3.

      Reply
  217. Good evening Dr. Childs. I have taken quercetin with bromelain in the past for inflammation and allergies and it seemed to be quite effective. However, I recently read some articles stating quercetin is a thyroid inhibitor and is contraindicated in persons with hypothyroidism. In your opinion, is there any validity to that?
    I don’t know that this is relevant to my question, but I have taken cytomel only (50 mcg) for a couple years now. My doctor recently added 25 mcg synthroid because the T4 level is always so low. My labs typically are TSH and T4 both almost zero, with T3 being in normal range due to the cytomel.
    Thank you so much for the time and effort you put into providing this information. It is extremely helpful!

    Reply
    • Hi Angela,

      I’ve never seen quercetin be a problem for thyroid patients, but there are probably some individuals who can’t tolerate it out there.

      Reply
  218. Hi Dr. Childs,
    Quick question. You recommended Essenial Oils Oregano, Thyme and Barberine but didn’t state how much of each, how to take, how often, or how long you recommend to use.
    Thanks you for all the great information.

    Reply
    • Hi Charlotte,

      Most of the specifics are dependent on the person and their situation, so it’s hard to give basic recommendations like that.

      Reply
  219. Hi
    I have Hashimotos and hypothyroidism for around 10 years.
    I was on levothyroxine about 6 years ago and gained 15kg so I changed to Armour. My weight stayed the same.
    I have recently come off Armour because my body needed a break from all the medications. I started CBD oil just before I came off and became hyper. I haven’t been in any medication including CBD oil for 3 months to get a baseline.
    I got my results and my TSH is 7.55 range is 0.4-4.4
    Free t4 9 range 9-19
    He didn’t do my t3 but before I came off medications it was 6.6 range 3.1-6.0
    Tpo Ab 474.3 range <6
    Tg Ab 5.0 range <4
    Reverse t3 385 range 140-540
    Can you tell me what all this means? I cannot lose weight! I am seeing a naturopath now that has got me on magnesium and vitamin b12 and a gut repair mixture. I have cut out wheat/gluten and have cut back on dairy and sugars. I’m also a vegetarian and I’m gaining weight!!
    HELP!!

    Reply
  220. I began suffering from hypothyroid symptoms about 1.5 years ago following a period of oversupplementation with iodine. My labs are within normal ranges but I feel that some of them may still be rather high for a previously very healthy 36-year-old male (TSH is 1.98, reverse T3 is 17). I’m having trouble finding a doctor sympathetic to my concerns. I wonder whether you have any knowledge of similar cases involving iodine toxicity?

    Reply
    • Hi Ben,

      Yes, I’ve seen many people who present with hypothyroidism after using very high doses of iodine. There are also comments of others who have done the exact same thing on my blog and on my youtube channel.

      Reply
  221. Hi Dr. Childs,

    If it’s impossible for me to have RT3 tested (I’m in France and I tried everything I could…). Would it be bad to give it a try by removing my T-caps 100 and go on with my Cynomel 0,25 for 12 weeks?
    I’m 90% sure I have RT3 problems and I think it’s because of an emotional shock I had 2 years ago (+ stress, depression, anxiety, panic as a result…).

    What do you think?
    Plus, T3 only will drop T4. Isn’t it dangerous? And how do you explain people feel better with T3 only when their T4 is therefore very low?
    By the way, some people are on T3 only for years and feel great. Why isn’t it more common?

    Thank you!

    Catherine from France and THANK you for that amazing blog full of resources and ANSWERS we’ve been looking for years.

    Reply
    • Hi Catherine,

      You’re welcome!

      In regards to your question, I would caution against using T3 medication without the ability to follow at least free T3 and TSH levels. You might be able to make it work if you can’t check reverse T3 but it wouldn’t be an ideal situation.

      Each person needs a different amount of T4 and T3, some can do fine on all T4 and some can do fine on all T3 and others fit somewhere in the middle.

      Reply
      • Thank you!

        Yes I can still follow Free T3, Free T4 & TSH (hopefully my doctor prescribe these labs) but how could it be relevant to make sure it’s worth being on T3 only?
        I won’t be able to have RT3 tested, I’ve met lots of doctors they say it’s inactive and don’t care about the studies “Miss, you’re not a doctor”
        and that’s the last thing I can try to get my life back…

        Thank you for your help.

        Reply
  222. Dr. Childs, thank you for your very informative articles. After reading one on the switch from levothyroxine to tirosint for weight loss (due to the possibility of sensitivity to fillers) I requested my Dr switch me. I had spent 9 years on levo at which point I began gaining weight and spend those 9 years 30 pounds overweight in spite of my whole food diet and working out. After making the switch the weight fell off. I was elated. WOrth every penny! However, after seeing a new naturopath about some bio-identical hormones after menopause he thought my t3 looked a little low (it was lower end of “normal) and put me first on DT. I immediately started seeing fat back on my tummy in addition to feeling anxious. I went back on my tiosint which he added liothyronine to. The fat loss has continued in my tummy and thighs just like it started initially with the levo. I keep cutting back my t3 to where Im hardly taking any. I am wondering if it is possible I may be sensitive to the fillers in this as well? I am beside myself that I am putting on the weight that I finally lost after so many years due to s stupid drug. In this article you mention t3 only…should I not be taking any t4 with t3? I wish I’d never gone to the dr at this point. I’m also using only about 1/4 pump of the progesterone and 1/4 pump of the estrogen creams as I’m just wanting to be back where I was a few months ago! Please help! My email is deniseedenfield@gmail.com

    Reply
  223. Hi Dr Childs:

    I’ve been experiencing significant daily fatigue (generally worst in the late afternoon & evening) for several years following two major surgeries. My most recent attempt to be diagnosed by an endocrinologist are presented below, along with the “optimal” ranges you’ve suggested.

    * FREE T4, THYROXINE 1.24 ng/dL (Optimal 1.4 – 1.77) (Normal 0.82 – 1.77)

    * FREE T3 3.2 pg/mL (Optimal 3.8 – 4.4) (Normal 2.0 – 4.4)

    * REVERSE T3, SERUM 22.0 ng/dL (Optimal <15.0) (Normal 9.2 – 24.1)

    * TSH …. 2.140 uIU/mL (Optimal 0.5 – 1.0) (Normal 0.450 – 4.500)

    I was not tested for Thyroglobulin Antibody or Thyroid Peroxidase Antibody which you mentioned in a video. Numerous other blood tests were well within “normal” range, with one or two that were very slightly outside “normal” range.

    I asked the doctor the following question:
    Can you please provide me with more information on what hormone replacement therapy you might try to address my reverse T3 levels which is possibly causing my fatigue. Pros and cons, process, etc. Thank you.

    Doctor’s reply:
    I would initially use T4 and then some combination of T4 and T3 to suppressed TSH and low range normal, elevate T3, and potentially suppress reverse T3. Your own production thyroid would fall with of additional supplementation requiring probably 100% supplementation to achieve this end. The main side effect is possible thyrotoxicosis as we suppress endogenous thyroid function with superphysiologic levels of thyroid hormone.

    I’d appreciate your thoughts on my lab results and the endocrinologist’s proposed treatment.

    Reply
    • Dr. Child’s,

      Thank you for this article. I have long term chronic inflammation from multiple causes – mold toxicity, tick-borne infections, gut dysfunction, etc. Those with these illnesses get whole body dysfunction and often end up hypothyroid and have other hormone imbalance as well.

      I just had labs done, and everything is in range except Reverse T3. I saw you mentioned insulin and leptin resistance. I don’t believe I have either. My fasting insulin is usually around 80. I have not had leptin tested, but I am not overweight. I’m 4’11” and 91 lbs.

      Correcting chronic inflammation is a long term process. I have been sick for years now have not made much progress, most likely due to the difficulty of not being able to sufficiently avoid mold exposure. In light of this reality, what would you suggest as far as trying to help the thyroid?

      These are my lab results:
      Free T3 – 2.62 (1.81 – 4.06)
      Free T4 – 1.32 (.82 – 1.77)
      TSH – 2.440 (.450 – 4.500)
      Reverse T3 – 26.3 (high) (9.2 – 24.1)
      Thyroxine (T4) – 7.6 (4.5 – 12.0)
      Thyroid Peroxidase (TPO) – 7 (0 – 34)
      Thyroglobulin Antibody – negative

      Reply
  224. I had blood test recently and found some of my results peculiar.
    Hemoglobin A1C: 4.4% (Range: 4.-5.6)
    Insulin: 3.3 uiu/ml (Range: 2.6-24.9)
    Leptin, Serum: <0.5 ng/ml (Range: 3.2-28.9)

    Primarily the Leptin result confuses me. Could you help explain this?

    Reply
  225. I have a goiter. Endo DR wl not run the Rt3 I ordered it with my dr. it’s 16.8. it’s not super high but I am told high.
    I am doing well with a better diet ( was too low), stress reduction and sleep and you are right it’s difficult 6 months. I am on Kelp and 2 brazil nuts a day for selenium at this time my hypo symptoms — goiter tested not cancerous. Endo says ok wait but not willing to help. I see Naturalpath but I am doing all my own homework and joined a FB thyroid group of patients with lots of knowledge and stop the thyroid madness info.
    Do you think 16.8 rt3 is too high?
    My numbers are seemingly normal they want to take out my thyroid and I said no – I want to fix it — almost unheard of it seems for a patient to do this
    TSH .83/ free t3 3.1 pg/ml / free t4 1.1 ng/dl / throid peroxidase antibody 11.0 (ulU/ml) / thyroxine-binding globin 18.9 UG/Ml.

    Reply
  226. Hello Doctor Childs,
    I am a 76 y/o w/m. I have been taking 2 grains of Thyroid NP and I have weight gain that doesn’t respond to diet. I also have lack of energy and generally don’t feel well.

    My RT3 is 20.9
    TSH-.122
    T4-5.1
    T3-96
    Do I need to take Reverse T3 only or RT3 plus Thyroid NP? Is it safe to take RT3 alone or do you have to also take T4?

    Thank You,
    Jack Mitchell

    Reply
    • Hi Jack,

      By RT3 only I am thinking you meant T3 only? There is no such thing as RT3 medication but there is T3 medication. And the answer to that question (if I understood it correctly) is that you don’t always or necessarily have to use T3 to drop your rT3.

      Reply
  227. My ratio is .16 so obviously, my RT3 is too high (23.4 in march). However, in the past, I did take Cytomel and it increased my alkaline phosphatase levels to very high levels. When I stopped the levels went down. Also, I understand that T3 causes a lot of hair loss, this is a major issue for me.
    So what do I do? I currently take 1 grain NDT in the morning and I just stopped T4 (25mcg) at night, should I replace that with NDT?
    Also, I read that zinc also causes high alkaline phosphatase levels. Should I just take selenium and not zinc for better conversion? I am very confused. What helps one thing harms another.

    Reply
  228. Dr. Childs,

    Your theories about rT3 and its role as a metabolic brake make sense to me. However, many websites and forums claim the opposite; that is, that rT3 is completely inactive and won’t affect a hypothyroid patient’s wellbeing once on thyroid hormone replacement. Some say the role of rT3 is “not very well understood”. I was wondering if you have any links to reliable sources proving that rT3 does indeed play a metabolic role? Many thanks in advance!

    Reply
    • Hi Anna,

      There is a list of clinical studies at the end of this article which supports the claims that I make in it. To suggest that rT3 is not well understood would be correct in the clinical setting but to state that we do not understand how it works physiologically is simply inaccurate. We know that rT3 increases during times of stress, calorie restriction, illness, and during these times we also know that metabolism and thyroid function decline. We also know that rT3 competes at the cellular level for thyroid binding. If you put these two things together you arrive at my conclusion. Other people state that we need more information and make no claims about its function and yet it seems fairly simple to me when you look at it.

      I should also point out that you are seeing the conventional mindset when you look on the internet (except sites like mine) which has failed thyroid patients up to this date and one which is augmented by google search results. If you care to dive deeper into that rabbit hole you can find more information here:

      https://www.restartmed.com/breaking-down-the-verywell-health-thyroid-survey/
      https://www.restartmed.com/is-google-suppressing-alternative-thyroid-information/

      Reply
  229. Hello
    I have reduced my NDT from 1 grain to 1/2 and then introduced 3 mg Cytomel to reduce my very high rt3.
    Unfortunately, since doing that I can’t sleep. It’s been 5 days now on zero sleep.
    Why would cytomel cause this?
    Any thoughts would be greatly appreciated.

    Reply
  230. Hello, I am very confused. My TSH is very low .011 My Free T4 is high 4.3 (range 1.4-3.8) and my Free T3 is solid mid range 3.1 (2.3-4.2) My T3R is high, 28 (8-25). My dr says my thyroid is overproducing T4 and wants to nuke it. I am not comfortable with that. I don’t know what to make of it as I feel completely fine. No symptoms other than shedding which is most annoying. I also have a large benign nodule 4cm. Thank you for your thoughts.

    Reply
  231. I am looking for feedback on my results, please. I had a TT on Jan 19.

    Current dose:
    1 x NDT
    T3 50mcg

    No meds for 15hrs prior to testing
    Iron supplement discontinued since the last test.
    No joy with saliva testing here in Thailand preferred ranges. I have researched extensively. I will need to wait until I next have overseas travel. Any feedback on available data is much appreciated.

    Ft3 2.4 (1.71-3.71)
    Ft4 0.50 (0.70-1.48)
    TSH 0.009 (0.350-4.940)
    Rt3 3.2 (10-24) Very low

    Iron 119.90 (50.00-170.00)
    Total Iron Binding Capacity 288.90 (250.00-400.00)
    Trans Sat 41.50% (14.00-50.00)
    Ferritin 60.0 (10.0-250.0)

    Blood Cortisol am
    13.1 (3.7-19.4)

    Is it time to raise the T3? Or is it possible to raise NDT? (NDT is easier to source)

    Reply
  232. Great article and very informative. Recently I had completed 10 water lemon master cleanse (extreme low-calorie fasting). Upon restarting the food I experienced a MAJOR adrenal crash. Now I am still feeling very bad, low energy, etc. Something was really really bad. My doctor ordered all lab thyroid tests and adrenal saliva test. Adrenal saliva seems to be in the range. But reverse T3 is very very high 28, while free T3 is 3.7, &4 free 1.5.
    Since I stopped fasting and returned to normal dieting is it possible for reverse T3 to regulate itself?

    Reply
  233. Hello,

    I am on Cytomel to flush RT3 as you’re recommended in your post. it is going well. I just wonder how to stop the medication once my RT3 are back to “normal levels”.

    Thanks

    Reply
  234. So how can I flush it out if I can’t tolerate even 2.5 mcg of T3..?

    I’ve tried but it spikes my cortisol, pools in my blood and raises my A1C…

    Just lower my T4 dose?

    Reply
    • Hi Keeley,

      Focus on the other factors which are CAUSING the reverse T3 to be in, to begin with, things like inflammation and so on.

      Reply
  235. Dr. Childs,
    I am feeling sad for so many people, like myself, who desperate want energy; yet, find themselves searching for answers with too many doctors who seemingly don’t care about helping a patient figure out the root cause. Too many doctors don’t know the word doctor deeply means “teacher.” You are, Doctor, AKA Teacher! Thank you.
    However, I have noticed a pattern of you not responding when lab numbers are present. So, let me avoid those specifics and just say:
    I took levothyroxine for more than 20 years without having any thyroid symptoms.
    Then in my early 40’s, I had so many symptoms but I contributed it to: hormones changing and high stress (with little sleep).
    After learning from you (and battling for every test), I now know:
    I have high reverse T3, high serum leptin…
    sensitivities to cow dairy and gluten,
    last test showed post menopausal, yet I have a light cycle every 60 or so.
    I don’t look overweight but I have about 15 or 20 pounds of extra fat, all around my stomach; 15 of those pounds were gained in the last year.
    Just over a year ago, started liothyronine… within a week, I felt my energy come back. Yet, that wasn’t the end of the battle.
    Two weeks ago, I started taking berberine and omega 3 with each meal. I already feel more satisfied, more balanced between meals. I try hard NOT to snack, only 2 or 3 meals per day. To be continued… I plan to continue this for 6 months.

    My question do you know of any research showing MOLD having an impact on the body taking T4 and converting it to Reverse T3, instead of the needed T3?
    When all of my symptoms started, we lived in a mold house.
    I am just finishing up on a mold detox, but I just have a feeling that this moldy house was the start of why my body started having high Reverse T3. I hope if I can address the leptin issue (probably insulin too), that my body will normalize.

    Reply
  236. Maybe I should add that my mother passed away at 67 with Non-alcoholic Fatty Liver Disease. Growing up, I always remember her eating on a small plate and drinking diet drinks, yet she was very obese. I drink mostly water (never diet drinks) and eat big salads.
    I also remember my mom’s daily words, “Oh, I have to get up and get something done.”
    Like my mom, I struggle with not having enough energy.

    I suspect my mom had the MTHFR gene (I did Smart DNA testing that showed I do with 70% reduced detoxification… so I work on that!).

    Reply
  237. My daughter has a mTBI for almost 4 years. She has a headache 24/7 for almost 4 years. Out of the blue about 8 months ago she lost a lot of weight- close to 25 pounds over a 2-3 month period. Her hair is also getting thin. She has had a lot of bloodwork run and nothing conclusive. She followed up with a rheumatologist and endocrinologist. We are getting blood work done. I don’t think either of them are ordering a revers t3. I am having her cortisol levels tested. Just looking for answers. The only other thing she changed was she stopped eating meat and chicken.

    Reply
  238. I have a reverse t3 of 17. I feel very fatigued and want to stop ndt and start t3. My question is i have heard that i need to start at 5mcg and raise 5 every week. If i was on 150mg of ndt how much t3 do i want to titrate up too? When i take ndt again my reverse t3 always rises. I think i have low morning cortisol and higher afternoon evenings.

    Reply
  239. I am on 100 mcg Synthyroid a day and 25 mcg cytomel once a day. My T3 levels have been around 9 and every doctor I see immediately once to cut the dosing down saying it is too high but I feel fine. When that happens within weeks I develop spasms, muscle stiffness & weakness, joint pain and am unable to sleep. I also get bouts of being overwhelmed, am unable to think clearly, little to no energy and weight gain. I go back on the 25 mcg of cytomel and once my levels go up then the symptoms eventually go away except the weight. The new doctor I am seeing asked me why am I even on this med. In July of 2019 I cut my synthroid to 50 and was taking the 25 mcg of the cytomel as well. I was working outside and doing other activities and by October I had already lost 10 lbs. My doctor then cut my dose to 15 mcg and the symptoms came back and I gained back the weight I lose over the summer. My doctor thought it was a good idea for me to see an endo. After reading about the RT3 I am thinking I should stop the synthroid for a while and just take the cytomel, what are your thoughts? The only thing I can think of that might of caused the imbalance is 5 yrs ago I lost my daughter to cancer, my three dogs to cancer and then her dog to a brain tumor within months of her passing. There was so much I had to deal with to get her estate settled and last April we lost my mother in law and that is still ongoing. I would appreciate any advice you could give me, I am tired of living this way.

    Reply
  240. Greetings, I am wondering if you can provide any guidance. I suffer from either chronic fatigue or fibromyalgia and have had symptoms for at least 3-5 years. I have worked with a functional medicine doctor and have done lots of testing to look for stealth infections. Several have been found, including scrub typhus. However, none of the treatments or antibiotics I’ve tried have cured my daily fatigue and generally poor health and various symptoms.

    In addition, I have gained about 40 pounds over the last several years. My thyroid is sluggish (I take thyroid medicine) and my reverse t3 is elevated. (I also have a very high Cortisol Awakening Response).

    Do you have any suggestions for me? I have gone back and forth to the doctors again and again and had many tests but so far no one has the answers.

    Reply
  241. Hi,
    I have been on Synthyroid for 6 months. My TSH level is lowered now(was 6.73 in September now 1.48), I do feel some what better but brain fog does not want to leave me and of course putting weight on constantly continues. My RT3 is high now (was 23.8 and now 24.3) I had DVT last April. I wonder if blood cloth has anything to do with my TSH lelel or TSH level has anything to do with blood cloth? I stopped using blood thinner med 3 months ago. I just do not feel good as I used to 2 years ago. Brain fog is really a big deal for me.
    What shall I do as a next step?

    Reply
  242. Hello, I was doing good, but I quite smoking Dec 3rd, and now everything when hay wire, I gained weight, constipated, moody, and hot flashes night sweats I just switch to levothyroxin 88mcg, but was on 75mcg and liothyronine, 10mcg per day, but since i quite smoking, i really felt bad, now i have no idea whats going on a year ago my
    my rev. t3 was 23.3 labs this month are
    tsh – 1.9
    free t3 – 2.6
    free t4 – 1.8
    my antibody are 637.4 they went up since last year. i have seen 4 funtional med. docs, and they just dont seem to get this right, i have been eating the best for the last year and a half. please help,, i just want to feel good again, and not go back to smoking.

    Reply
  243. Dr. Childs,
    Wow, this article is sooo informative! I was just recently tested for hypothyroidism and Hashimotos, and I couldn’t make sense out of the reverse T3 results. You mentioned about people having high reverse T3, really low free T3, low T4, and high TSH. But my results are high reverse T3 at 30, semi-low in range free T3, high upper range T4, and really low in range TSH. Yet, I have every symptom of hypothyroidism. So do I have hypothyroidism, or hyperthyroidism? Can a person have both at the same time?

    Reply
    • Hi Rachel,

      No, it’s impossible for the same tissue to be both hyperthyroid and hypothyroid at the same time. It’s either one or the other.

      Reply
  244. Hi could you please tell me is there a difference in amounts of T4 in levothyroxine and compounded T4 capsules. I feel the compounded without fillers may be stronger .

    Reply
  245. Dr Childs,

    Thank you so much . I find this fascinating.
    I had a TT 20 years ago and have major weight gain and weight loss resistance. I also have a very bloated stomach .
    My Rt3 is 29
    I also have High Ft3 and very Hight Ft4. What is the best way to deal with these high levels. I think I take too much T4
    .175 sytnroid and 1 grain of armour

    Reply
  246. Dr. Childs,

    I’m at least one of the exceptions to your clinical observation:

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

    My RT3 in my most recent labs was 25.6, while my fasting insulin was only 9.2. I’m working with my doctor and trying Armour Thyroid, but my expectation is that sustained release T3-only therapy will be needed due to a genetic anomaly I have (a “deiodinaase polymorphism”) that somehow interrupts T4-T3 conversion. A lot of people have these polymorphisms, and its common enough that people should be alerted to this possibility as a cause, in addition to those you highlight so comprehensively.

    Thanks, Jim

    Reply
  247. I found Dr Childs’ Reverse T3 Blog to be true for me. I have high reverse T3 from inadvertent calorie restriction since childhood and repeat physical injuries. The only advantage to long term calorie restriction is looking young without having to work at it. Luckily, my hypothyroidism didn’t cause weight gain. My hair did start graying after I tried to reduce my thyroid medication and replaced that reduced dose with thyroid support supplements.

    My integrative medicine physician ordered a full thyroid lab panel in 2012 when I wasn’t on thyroid medication. My internal medicine physician ordered it on my request in 2019 and 2020 a couple of years after I started natural dessicated thyroid. Both lab tests showed increased D3 activity per Dr Child’s Thyroid Deiodinase blog (reverse T3 25 – 33 and the other results low-normal to normal).

    My integrative medicine physician convinced me to take supplements and change my diet from veganism until that my nutrient panels showed normal to good results. I had just suffered from a physical injury.

    My joint pain improved after increasing my thyroid medication dose. Manual massage and myofascial release worked to temporarily relieve symptoms but the pain came back ,through much improved after the treatments. I greatly appreciate Dr Child’s blog about The Connection Between Chronic Pain and Fibromyalgia & How to Treat it. I just found it and hope that the recommendation to add T3 only medication works out.

    I started having symptoms of a painful eye disease that intermittently affected my vision and disrupted my sleep from night eye pain. Another reader commented on having euthyroid eye disease, so I now know that I’m not the only one. The ophthamology field doesn’t show much interest in it and most of their research is in retinas. I was already taking the supplements in Dr Child’s T3 Conversion Booster and Dr Axe’s Thyroid Support System and increased my thyroid medication to a full grain of NDT. My eye condition significantly improved – enough to stop my prescription steroid eye drops.

    I wish Dr Childs would write a blog about the connection between thyroid and eye disease and what to do about it.

    Reply
  248. Hi Dr Childs.
    I have had my t3, RT3 tested after almost four years of CFS.
    My ratio between the two was 0.009 (5.3t3-545rt3)
    I have been using iodine, vit C, selenium, b complex and EPA/DHA, adaptogens with acupuncture and pyschotherapy to improve thyroid function and also cortisol levels.
    I am looking to start t3 medication later this month after seeing an endocrinologist, how long do you think these levels will take to recover? and do you believe the CFS is solely caused due to these levels?

    Reply
  249. I have been feeling unwell (fatigue, gaining weight, hair loss, sudden constipation) after switching to liothyronine (5mcg) and 13 mcg TIROSINT after stopping NP Thyroid 1/2 gr. about 6 months ago. I’m 5’8″ and 122 lbs., age 61. Today I got my lab results:
    TSH dropped to 0.87; FT3 2.6; FT4 1.01 and… RT3 22.1! All very much worse than my usual, but not optimal, thyroid labs. So Naturopath increased liothyronine to 10mcg, while maintaining TIROSINT for now. I’m going to check adrenals with cortisol test + DHEA-S to see if there are issues there. What do you think? Do I need to be off TIROSINT?

    Reply
  250. First of all, i found this very helpful for I have been suffering from hypo thyrod for 8 years now. I have been taking Armour thyroid 180 mg for the past 3 years daily. My test just recently changed and my symptoms are worse. Fatigue continuously, skin tone changed, constantly itching, hair is shedding bad, depression, anxiety, ……. I have every symptom. Got the test results back and they have changed. My T3 levels were always low now:
    TSH =.07
    Rt3= 69
    T3= 6.3
    T4=.8

    Work out daily, healthy eating and I am going out of my mind until I realized this was not my imagination.

    Will any of your plans work for me and which one?

    Reply
  251. So thankful for this article. I’m from Belgium, so my English is not that good. I was searching for a cause of my high rT3 and bumped into this article. My story: I am a 47 year old woman. I was on Erfa for the past 5 years, I took 90 to 120 mg. In 2020 I was starting to getting bad hypersymptoms and was hospitalized. The endrocrinologist in the hospital forced me to stop with the NDT and I had to do a reset. After a few months she put me on T4 meds (levothyroxine). After begging she put in T3 for me. But after one month I was starting to feel worse, I lost 5kg in 4 weeks, had severe stomach problems, could barely eat. I had a total check up, gastro-intestinal, pancreas, liver (MRI, colonscopy, endoscopy). Everything turned out normal, the only thing they could see was that my T3 was too high. So again stopped with the thyroid meds. Now I don’t take anything. My TSH is ok, free T4 within range but low, free T3 slightly lower then minimum, but rT3 is 41. My ratio T3/rT3 is 0,14. I’ve tried taking T3 only but the same symptoms of stomache ache and not been able to eat returned after a few days. It seems like I can’t tolerate the T3 meds. I don’t have a lot of stress in my life at the moment. My symptoms are fatigue, pain in muscles and bones, can’t lose any weight (I eat very healthy), always cold (especially hand and feet), a sadness that is always on the background for the past six months. But my hairloss is better now than I was on thyroid-medication. I don’t have any at the moment. It is very confusing. What can I do if I don’t tolerate T3? How can I find the real cause of the high rt3? Thank you very much for your help.

    Reply
    • Hi Anne,

      You can take advantage of natural therapies to help increase T3 levels 🙂 You do NOT have to use T3 medications necessarily.

      Reply
  252. Without getting too far into my medical condition(s) I have Hashimotos, a nearly total thyroidectomy, and was just recently diagnosed with CKD (interstial nephritis). My ferritin and CRP levels are at or above the testing limits. I am on NDT as well as berberine, ALA, milk thistle, and a food based vitamin that provides selenium, iodine and zinc at the levels my doctor prescribed. My T4, fT4, T3 T3up and TPO are all in the “normal” range after reducing my NDT. My TSH is basically non-existent (<0.005). My thyroglobulin antibodies (10.1 down from 17.4) and rT3 (33.8 down from 61.4) are still well above the lab ranges. My question is, how much of the high rT3 is due to CKD? My nephrologist is following my T4 and T3, but not my rT3. My thyroid dr. (whose specialty is sports medicine) is happy with my numbers dropping after lowering my NDT and is recommending standard follow up. I do not feel the doctors are working “against” each other, but after reading this article, I am wondering if their apparent “unconcern” with my rT3 is due to the CKD. Thank you in advance

    Reply
  253. This was the best, most-comprehensive article on thyroid issues that I’ve ever read. Thank you for that and for also writing the other articles that you referenced in this particular one. Please keep up the great work!

    Reply
  254. Hello I had my thyroid removed at 23 in 2019. I am now 26 and it’s 2021 I used to weigh 130 before thyroidectomy now I weigh 180 and it seems like I gain like 5 pounds a month. They have me on 125 mcg of synthroid and say my levels are normal. Idk what to do. I can’t stand the way I look and feel. I wish they would have told me all these side effects after the removal because I would have never chose that option to have it removed. I have Graves disease that’s why they removed it.

    Reply
    • Hi Anna,

      There’s always a way to feel better, even with RAI! It will take a lot of energy and effort but it’s definitely possible. I have loads of resources to help do just that on my website and youtube channel.

      Reply
  255. Hello, I’ve been struggling with Thyroid symptoms for over 10 years now and have been diagnosed with Hashimoto’s. I keep alternating between hyper and hypo symptoms. I’m currently taking 50 mcg of levothyroxine a day. My last lab results showed a THS level of 1.27, T3 is 2.5, rT3 is 20 and free T4 is 1.3. I’m currently experiencing hypo and hyper thyroid symptoms. Muscle pain, bone pain, bone loss in my mouth even though my dental hygiene is very good. My doctor wants to start me on 5mcg Liothyronine. It seems to be the right thing to do but the last time I tried it my hyper thyroid symptoms went through the roof after 4 weeks: Heart palpitations, insomnia, weight loss, joint pain, bone pain and rapid bone loss in my mouth. I don’t want to loose my teeth over this and I suspect my bone density is suffering as well. Should I take the Liothyronine and continue the Levothyroxine as well?

    Reply
  256. Hey Dr.
    I’ve been hypothyroid for 38 years. Complete autoimmune loss of thyroid gland. Ive been on thy merry go round for far too long and only in recent years using Synthroid after the NDT DISASTER lost my Naturthroid. I’ve had every bad thing reslt from low thyroid and beat dying several times. I’ve got my back to wall now with stage 3 CKD (39 gfr) , Diabetes (6.4 a1c) HTN that’s just not responding well to meds. (Clonidine, Verapimil, etc..) my t3 is low and t4 is very suboptimal on 300mcg. Ive started having mineral issues with very low magnesium.
    Andc I’m on my third crappy Endo that like thy previous only wants to prescribe Insulin and not dig into my thyroid and hormone problems. I need a new doctor in Lake County Illinois and I’m sure you already suspect I running out of time seriously bad. I need to supplement but that CKD and Diabetes complicates things. I’m using D, B complex, SLOW MAG, 2K mg Fish oil, zinc, Insulin, BP meds, Carbamazepine, opiates, and oral diabetes meds. Any advice? Craig

    Reply
    • Hi Craig
      So sorry to hear what you are going through. I had thyroid surgery as a teen that was not followed up and have suffered for decades because of the medical profession’s lack of knowledge when it comes to thyroid disorders. I was doing poorly for years on Levothyroxine, which is the same as Synthroid. I finally found a doctor that treats with T3. He put me on a form of liothyronine and it made a huge difference. I felt normal again, although I still have my ups and downs because in Australia there is only one dose available that is hard to adjust. When I was on Levothyroxine my reverse T3 was the highest my doctor had seen in his entire career (he is around 60). He put me on a lot of supplements too. My advice is, keep searching for the right doctor/practitioner that has the necessary knowledge. Have you tried the American Thyroid Association for support? A bit far from you but I find Thyroid Patients Canada a great resource too. I hope you have people that can support you and help you do so.

      Reply
  257. Hola Dr. Westin,
    So I hope question is relatively easy. My T4 and T3 are within range and my RT3 is high. I take 100 mcg’s of Tirosint, 30 mcg’s of liothyronine and 4.5 LDN. Any suggestions for bringing down RT3?
    I also take supplements (vit D, berberine, tudca, probiotic, NAC, vit C)

    Reply
  258. Hello Dr. Childs, I already asked this question but didn’t see my comment or a reply so hoping you see it this time. I had Graves disease and in 2017 had RAI much to my regret as it’s been awful since then. My PCP has listened and kept my TSH at .02, but I’m still having “hypo” symptoms with a lot of weight gain and inability to lose. I’m on Tirosint, take selenium and zinc every day. My FT4 is at 1.4, FT3 at 3.3 (I stopped zinc and selenium 2 days before my test since Dr wanted to lower my Tirosint as FT3 was too high last time), My RT3 however is at 26. My PCP didn’t and doesn’t interpret RT3 and what to do so I asked my Naturopath Dr and she said to reduce my T4 since that is driving my RT3 so high. From your articles, this does not make sense to me! Sounds like I need to increase my T3 correct? Please help if you can. I’m on Ashwaghanda as well for stress as I feel that is what’s increased my RT3. I’m lost and I don’t think any Dr’s around Burlington, VT have enough knowledge of the thyroid and validate any symptoms. Thanks and I hope to hear. Also, is there an easy way to check for responses? Seems like dates on this blog are all mixed so tons of scrolling. Thanks.

    Reply
    • Hi Erika,

      Unfortunately, I am not able to provide medical advice regarding what kind of changes you should or shouldn’t make to your thyroid medication. I believe you should get an email notification when someone responds to your comment.

      Reply
  259. Such an informative article!! Thank you Dr. Child’s! What’s the marker and number that warrants T3 only treatment to fix a reverse t3 issue? Mine is at 16 and have all the symptoms of reverse t3 conversion issue. Is it safe to say anything above a 15 + symptoms of hypo would benefit from t3 only? Essentially, I’m wanting to understand the specific labs that tell me I need t3 only to flush the reverse issue out.
    Thanks

    Reply
    • Hi Shelley,

      I don’t really use a marker or number when determining if someone needs pure T3. I usually go based on a number of factors such as the severity of thyroid disease, presence of other comorbidities, their response to other thyroid medications, and an overall feel of the patient and their health.

      Reply
  260. Dr. Is it possible to have TSH, free T3, free T4 in normal range but R t3 688pmol/l High. Why it is so? M having 50mcg levothyroxine with thyroid support supplement. Can u please answer?

    Reply
  261. Hi Dr. Childs,

    I have a question that I will generalize instead of pointing it towards myself.

    Hypothetically speaking, if a person has really high RT3 but borderline hypo FT3 and FT4, and that person is taking NDT, could that person lower his NDT and take cytomel instead to flush the RT3 out but simultaneously risking going into hypo range with his FT4. Would that hypothetically speaking be ok to do temporarily to flush the RT3 out?

    Hope you can answer my question. This is no way me seeking medical advice.

    Reply
  262. Hi, lm so very grateful to have found you, thanks for doing what you do.
    Okay i’m your odd person out, my unsulin fasting is 3.3
    SHBG 199
    Ferritin 38
    TSH 0.01
    T4 16
    T3 3.6
    RT3 very high, will be retested at the end of Aug.
    I take eltroxin 200mg a day
    20 mg x2 times a day tertroxin
    I truely believe inflammation is in the gut. i’ve spent a lifetime trying to control it and not there yet. very inflammed right now. ive had a hysterectomy and BRCA1 positive so been thru many preventative surgeries. DO you think adding the Quercetin and Bromelain will help?
    Also do you think it’s worth trying the Tirosint?
    I’m very very sensitive to change. The last time i changed medication it left me in a very bad hypo for 10 weeks on the couch unable to function…….. I feel like your are my last resort and will understand my unique situation. I very much look forward to hearing back from you. I’m a very fit active mother of 2 from australia who desires to live my best and most healthiest life. Lisa

    Reply
  263. Hi,
    Thank you for this article, it isn’t easy getting information and advise on this subject. I wanted to check if rT3 is what is causing thyroid symptoms. I have a Multi nodule Goitre which the endocrinologist told me is not a problem (no more further information) will check again in a year. I had my labs done separately which I have listed below, from what I can work out I do believe that my rT3 is high and also the ratio to fT3. I would be grateful if you could confirm this for me.
    TSH 1,725 uIU/ml
    FT4 0.87 ng/dl
    FT3 3.31 pg/ml
    rT3 0.30 ng/ml

    Any information will be greatly appreciated

    Reply
      • Thank you Dr. Childs,
        I can now see from reference range that rT3 is defiantly high. I have been struggling with the math and conversions for the last few hours for the ratio
        fT3 3.31 pg/ml
        rT3 0.30 ng/ml
        I converted the ng/ml ~ pg/ml = 300 pg/ml
        This gave me a ratio of 1.1, your article says Your ratio should be > 0.20. Is this correct as i don’t know what unit you are referencing.
        I’m just getting confused, as very time i covert the values into a different units and do the sum i’m getting different results.

        Lisa

        Reply
  264. Great information. My doctor and I are trying to figure out why after 130 pound weight loss in 2017-2018 and 4.5 years strict keto (not one cheat at all), I gain 40 pounds without change in nutrition or exercise. I have exercised every day since 2017 and many days over 1 hour exercise, my reverse T3 is high (28)and leptin is below low at 3.7. I am fatigued and body fat percentage has increased. I asked her to put me on T3 along with Synthroid that I have been on since 1990. I have been on T3 for 3 month now. Sleep could be huge factor as I sleep, however, only about 6 hours a night as I wake up at 330 am each day to exercise. Going to ask her to reduce Synthroid from 200 mg to 175 mg and T3 is 75mg- 3 times per week and increase that to daily. I also need to get 8 hours of sleep-even if it means going to bed at 730 each night. I know leptin could be low due to carb restriction for 4.5 years. Appreciate any words of wisdom you may have!

    Reply
  265. Morning,

    This information is so useful. I was born without a thyroid and have been on levothyroxine since I was born.

    I have been feeling lethargic and tired for a long time and after meeting my doctor my results were coming back fine but I still felt the same way, no periods, tired, dry hair.

    I knew it was normal as when I was young I was full of energy almost the opposite high metabolism hyper but after uni I was slow sluggish putting on weight. I was referred to a encroligist to carry out further tests on my hormones he noticed my testosterone was marked high he explained I had PCOS and I needed to take metformin him now on 2000mg my periods have come back. I think he was so focused on fertility that everything else went away but I still feel the same and I’ve dropped of his Radar and list since covid.

    I think I need a full panel of bloods and I think my body is so out of whack. After reading this I’m not getting enough T3 causing insulin resistance causing high testosterone not the other way around.

    I definitely need to check my reverse T3 and Free T3 as I’m on 200mg of levothyroxine a day and my symptoms don’t change.

    I also suffer with gut problems and have gone dairy free but I’m pretty sure there is inflammation there to what tests would be good to get to check gut health? Is it worth getting a panel on intolerances?

    It’s a bit all over the place but this page has really highlighted areas which match exactly how I’m feeling and given me direction on what to ask for. What’s hard is taking metformin for insulin resistance but then this is causing gut issues and inflammation? It makes sense how they all knock into each other though.

    Thank you
    April

    Reply
    • Hi April,

      There are loads of tests that exist to help determine gut health but they are not all equally accurate or helpful. The same is true for food intolerances as well. Unless you know what you are specifically looking for, testing your gut health randomly is not always helpful and it can be very expensive. In the hands of a knowledgeable practitioner, your symptoms can guide you to the correct tests.

      Reply
  266. i was diagnosed with high reverse T3 this summer and put on liothryonine, which in week 3 stopped my hair loss in it’s track, YEAH!!! but sadly week 4 i started developing serious side effects to where week 5 they became dangerous/life threatening and i had to stop taking it. i’m now almost 2 months post taking it and my hair is falling out by the handfulls… HELP!!! i’ve only taken prescription medications a couple times in my life and each and every time i’ve had to stop as i have very serious side effects.

    Reply
  267. Hi, I have had free T4 in low end of range for years and free T3 in high end of range or over, and low TSH .07. I’m on desiccated thyroid. 30 mg isn’t enough so tried 60 and too much, then 45 and T3 dropped low and tsh so have been on 60 one day and 45 the next. Am in low end of range for free t4 and high end for free t3 and 0.7 tsh. I feel cold all the time and tired on the days I take 45 and when I take 60 feel reved and can’t sleep with either. Had 50 mg compounded but seriously do I have reverse t3? How come t4 is so low and t3 so high?

    Reply
  268. You mentioned that 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. What does it mean if you are supplementing with T3 and my T4 drops but my TSH is increasing instead of decreasing?

    Reply
    • Hi Melissa,

      Every change that I mention is dose-dependent. If you take a very small dose of T3 then you won’t see these changes occur until your dose reaches some threshold. That threshold is different for each person but generally starts to occur around 25mcg/day. If your TSH is increasing while taking T3 then it means your dose is very small or you aren’t absorbing it.

      Reply
  269. For the first time ever my TSH is actually low at 0.474. Reverse t3 high at 27.2, my ratio to free T3 is 0.12 which I know after reading this is definitely not good. Pero abs at 29 and thyroglobulin abs at 19 both say normal. I feel good knowing I wasn’t crazy about all the symptoms I’ve been having for so long. However, I wonder what could have caused the TSH to drop below normal and does this matter with whatever treatment plan I opt to do?

    Reply
  270. Hello,

    I’m taking compound T4/T3 28.5:6.75MCG. I would like to know if I can stop and do a natural approach instead?

    Blow is my lab test:

    THYROID STUDIES
    TSH, 3rd Gen. 0.971 uIU/mL 0.270-4.200
    T3, Free 2.3 pg/mL 2.0-4.4
    T4, Free 0.93 ng/dL 0.93-1.70
    T3, Total 0.70 L ng/mL 0.80-2.00
    T4, Total 5.42 ug/dL 0.41 24.86
    T3, Uptake 1.1 TBI 0.8-1.3
    Free Thyr. Index 6.0 H Index 1.1-4.2

    Thank you,
    Laurence

    Reply
  271. Well you have now ‘met’ your first thyroid patient with LOW fasting insulin (2) and high reverse T3 (26). Not enough is known about the diodinases which are responsible for which hormone T4 is converted to. I have read that the thyroid gland itself produces some of these diodinases so those who have no working thyroid gland are at a complete disadvantage. It would be phenomenal if you figured out a supplement to help the diodinase enzyme conversion process and the transport carrier proteins needed to take thyroid hormones in and out of the cells. Thanks

    Reply
    • Hi Deb,

      I’ve definitely seen situations in which fasting insulin levels do not correspond directly with other metrics including thyroid lab studies and glucose levels. My assumption in these cases is that it was genetics playing a role.

      I’ve written about deiodinase enzymes in this blog post and you can learn more about the genetics involved here: https://www.restartmed.com/thyroid-deiodinase/

      Fat-soluble vitamins like A, D, K, E as well as zinc can sometimes help thyroid hormone receptor problems. Those can be found in my Thyro ADK supplement blend here: https://www.restartmed.com/product/thyro-adk/

      Reply
  272. I have never heard of any of these:
    reverse T3?
    Have you had your levels checked? If so, was it high or low?
    Have you tried medications that contain T3 like Cytomel or liothyronine?

    Reply
  273. I do not seem to respond to synthetic T4. I have been on NatureThroid for about 8-10 yrs. Recently my doctor added Levothyroxine despite my feelings about it and my recent rT3 was 24. Am I correct in thinking that the added T4 is the cause?

    Reply
    • Hi Jeanne,

      Additional T4 likely didn’t help the situation but it’s hard to say if the T4 is the actual cause or if there are underlying conditions like inflammation present as well.

      Reply
  274. For 30 years I was subclinical with slightly elevated TSH At 76 iTSh started rising into 6 range periodically never over 10. I started T4 and dropped TSH and other markers in normal range but O wasn’t feeling great. My doc worked with me and we started T3. I feel
    Much better, weight loss slowly coming down 220 now 209. Goal 198. RT3 = 19. Free T3 =4 Ratio 0.21 I am taking most of the supplements you recommend in this article. Fasting glucose always 100-109. I feel i am a bit insulin resistant.
    Diet is more on Keto side.
    T4 – Levo 50mcg 2 times
    T3 – Lio 5 mcg 2 times

    So I take 1 of each am and 1 of each pm.
    No other meds
    Your thoughts

    Reply
  275. As always, brilliant info here! As someone 10 yrs post thyroidectomy, who’s suffered all the things since then, I can also attest from personal experience that everything mentioned is so true! If only I’d learned it back then…but better late than never!

    My question is how to note inflammation from ferritin levels or where to find more info about that. I’m chronically anemic and get lots of iron labs regularly.

    Also wondering if there’s recommendations somewhere on dosing the anti inflammatory supplements or just starting with whatever the supplements themselves indicate?

    Thank you for your tireless work & dedication to the troubled thyroid community!!

    Reply
  276. Hi Dr Childs, thank you so much for the information you provide.
    In 2017, at the age of 50, I had a total thyroidectomy and RAI as a result of thyroid cancer. After that I was put on Eltroxin (T4) but after two years of that I was in the grip of depression and despair as I had no energy, no memory and all the hypothyroid symptoms. When my endo increased thedose I felt worse because then I had hyper and hypo effects. The bad memory was the worst for me because at school I could memorize textbooks so I have always had a great memory.
    Anyway weighing by now 134 kgs, I’m 172 centimeters tall, I came across one of your reverse T3 articles. I went for the lab tests and my ratio of reverse T3 was 0.11. Even the reverse T3 test alone showed that my reverse T3 was outside the normal range of the high side of the range. I acted on the information and switched gradually over a period of about 5 weeks from Eltroxin(T4) to Tertroxin(T3). This was in May 2019. Since then I’ve been on Tertroxin exclusively. I take one 20 microgram Tertroxin tablet every 8 hours. That’s three a day (60 micrograms).
    The result is that I feel again like I did as a child and a teenager. You know when your body is just there and it works. You just take it for granted. I no longer feel like I’m dragging myself around. My memory is excellent. When I play brain games and I get compared to my own age group world wide, I score in the top 98 %. Life is good. Through intermittent fasting, which I started doing about 15 months ago, I’ve dropped my weight from 134 kgs to 110kgs, and it was easy. And I’m not finished yet. I plan to reduce my weight to at least 75 kgs, which was what I weighed in my 20’s. But I’ve got time, so I’m not pushing hard. Mostly I’m enjoying life now. Thank you for the advice you provide. It has given me back my life.

    Reply
  277. Hi Dr. Child’s
    I Always enjoy reading your posts and explanations. I shared your article on high cholesterol and thyroid to 2 of my doctors! But as expected no response.
    Anyway my question is these articles are centered on high RT3,
    What are your thoughts on very low borderline abnormally low RT3?

    Thank you
    Patricia K.

    Reply
  278. I was aware of reverse T3 but not the ratio between T3 and reverse T3. I knew that TSH was not a reliable marker for thyroid function. I just didn’t know how to tell if my thyroid was not functioning properly. I believed that T3 alone would help me, but my doctor disagreed, and I am taking Liothyronine and levothyroxine. I read about Zinc and Selenium and take both. I get about 8 hours of sleep each day. I eat plant-based foods but also meat. I am always stressed over something.
    I actually followed Dr. Wilson’s protocol of T3 only for over 6 months but saw no improvement. That is when I gave up on just taking T3. Your article caught my attention because you emphasize the ratio between T3 and reverse T3. I don’t know what the ratio was while I was taking T3. I would like to learn more about your methods of improving thyroid function. Maybe I will stop Levothyroxine for a day each week and see what happens. I take two of your products now. Thyrosol and Andreset. Don’t know if they are making a difference.

    Reply
    • Hi Ralph,

      I don’t have a product called Thyrosol or Andreset, perhaps you are confusing my supplements with someone else’s?

      Reply
  279. I had 28 problems caused by Covid (I’m a former Covid long hauler). One problem was high Reverse T3. I’m not sure what all the Functional Medical group did to lower it because it was an overall plan for all 28 problems but I’ve lost 18 lbs. in 3 months after the symptoms of long Covid were pretty much remediated. I found this article fascinating. Thankfully I didn’t gain any weight during the 18 months I suffered but I sure couldn’t lose any weight even when I tried. I’ve heard that hibernating bears have high Reverse T3. That’s a perfect description of what my body was doing that 18 months. Even though this article mentions fighting infections as one of the purposes of high Reverse T3, i wonder if you have written anything current on high Reverse T3 related to dealing with long Covid?

    Reply
  280. Hello Dr. Childs,
    I feel like I’m starting over now that I have a new primary care physician, and it’s exhausting work and my energy is sapped. My previous pcp retired and it took me a long time to provide her with current information. Could you please help me?

    In my search for a good explanation to give to my new primary care physician for lab test rT3, I came across an article from Dr. Christianson who states that he never orders a rT3. Here is the link
    https://www.drchristianson.com/blog/how-to-interpret-your-thyroid-labs/
    This is exactly what my new primary care physician said to me last week. Since there are at least 2 sides to a story I’m wondering what you would say to Dr. Christianson.

    Also, my new pcp told me it does not make any difference when I take my medication prior to lab tests. Another confusion for me. I’ve been on Armour for more than 2 years and Nature-Throid prior to that. TT in 2010. I think every article I’ve read states, labs early a.m. then take meds. Of course, there are exceptions that I don’t think I fit into. What do you say and why? I have read your information on this issue.
    Thank you for any guidance to pass along to the new guy on the block.
    Rhonda

    Reply
  281. Hey, Dr. Childs
    I would be ever so grateful if you would respond to my question sent to you on May 4, 2023.
    After 13 years of having a TT due to papillary cancer I am beginning to gain weight, 10 pounds in a months period of time. I take Armour Thyroid 90mg per day.
    Mostly, I am concerned about my new primary care physician and how to help him understand the importance of a rT3.

    Thank you,
    Rhonda

    Reply
  282. Hi, Dr Childs

    I have Hashimoto’s. Currently on Levothyroxin 100mcg.

    After watching one of your videos I had my doctor include rT3 in my test. He said everything is fine….?

    T4 = 15.2 pmol/L
    T3 = 5.4 pmol/L
    rT3 = 542 pmol/L (high)
    TSH = 0.14 mIU/L (low)
    Peroxidase Ab = 61.4 IU/ml (high)
    Thyroglobulin Ab = 1.6

    Although the Peroxidase is high, a number of years ago (10?) it was around 950! It has gradually been decreasing.

    As I gained weight when I started on Levo about 3-4 years ago, and have been unable to lose it since, I am wonder if you have a solution available to an Australian 🙂

    I am also on Effexor 37.5mg following panic attacks brought on by an overdose of thyroid medication when it wasn’t needed about 5 years ago. This was when the Hashimoto’s was actively sending me over active, stable, under active, rinse and repeat, LOL. I told the doctor at the time that the specialist advised me not to go on medication. He said I needed to this time. Wrong. A month later, I collapsed. Haven’t been to him again!

    Thank you

    Reply
  283. Hi Dr. Childs.

    Currently don’t have an official diagnosis.
    TSH- 0.02mIU/L
    Free T4- 16.2pmol/L
    Free T3- 8.5pmol/L

    Numbers of a hyperthyroid but the symptoms of a hypothyroid. Very easy to gain weight but seemingly impossible to loose it. They won’t test for rT3 where I’m at. Any thoughts on the possible causes to investigate. My initial thoughts are possible autoimmune? Feel normal other than the occasional swelling/ tight sensation in my neck. I did go through a few years of very frequent use of antibiotics. Any insight would be much appreciated.

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  284. My T-3 is off the chart on my last test , my T-4 is perfect . I take Armour Thyroid 180mg , how can I get my T-3 lower ? My Dr is at a loss when it comes to thyroid issues !

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    • Hi Debb,

      Some people are just more sensitive to T3 than others and because dosing in Armour is static, you’ll never obtain optimal T3 and T4 levels simultaneously by increasing the dose. The more NDT you take, the higher your T3 will go and the more it will drive down your T4. Chasing these optimal levels is a fool’s errand anyway, but if you wanted to get there, you’d need to use individual T4 and T3 doses.

      It’s always better to pay attention to other markers, though, such as those found here: https://www.restartmed.com/thyroid-related-health-metrics/

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