Good T3 and Elevated Reverse T3

[mjb]

My latest labs show an elevated RT3, with a good FT3 . First time checking RT3, so not sure what it was at baseline. Taking 60mg NDT AM and 30mg in the afternoon.

Definitely less foggy and need less caffeine since starting NDT 1 yr ago, but could still nap most days if I had the opportunity. Hands are also not as cold, as often, like they used to be. Overall improvement, for sure.

Any similar experiences or suggestions on what to try, if anything? Less NDT and add some T3?

Reverse T3 34.8 H ng/dL (9.2-24.)
TSH 0.957 uIU/mL (0.450-4.500)
T3, Free 5.1 H pg/mL (2.0-4.4)

Testosterone, Serum 758 ng/dL 264-916
Free Testosterone(Direct) 21.4 pg/mL 6.8-21.5
Estradiol, Sensitive 25.0 pg/mL 8.0-35.0
Sex Horm Binding Glob, Serum 32.9 nmol/L 16.5-55.9


Also taking T. Cyp, 44mg EOD and hCG 500iu 2x/wk

 

[mjb]

After doing some more reading, it seems like adding T3 wouldn't make any sense. And that testing the Reverse T3 in the first place was probably not useful.

 

[BuzzSaw]

AFAIK, Isn't rT3 made from t4 (converts to rT3 assuming there's issues)? And that considering rT3 is effectivly useless, adding T3 should help things out?

I think you mean adding T4 is useless, as it is converted to rT3.

 

[Vince]

AFAIK, Isn't rT3 made from t4 (converts to rT3 assuming there's issues)? And that considering rT3 is effectivly useless, adding T3 should help things out?

I think you mean adding T4 is useless, as it is converted to rT3.

It would be interesting to see your T4 levels. Did you do thyroid labs, before or after taking your meds? If after, how long after.

 

[mjb]

It would be interesting to see your T4 levels. Did you do thyroid labs, before or after taking your meds? If after, how long after.

I know, should've checked a free T4. Just did the labs my doc ordered and didn't think about it until the results came back.

Lab draw was 2 hrs after taking AM dose of 60mg Armour.

 

[mjb]

AFAIK, Isn't rT3 made from t4 (converts to rT3 assuming there's issues)? And that considering rT3 is effectivly useless, adding T3 should help things out?

I think you mean adding T4 is useless, as it is converted to rT3.

From what I've read, an elevated RT3 and FT3 can also be seen in people taking NDT, due to the higher amount of T3 in NDT.

"Reverse T3 may be slightly high (a few points above the reference range) due to high T3. This lab profile is often found in those taking desiccated thyroid, because of the high T3/T4 ratio in the pills. The body senses the high T3 levels, and converts some T4 to rT3 since additional T3 is not needed. Desiccated thyroid also contains rT3, so reverse T3 levels should rise as the desiccated dose is increased. Lowering the desiccated thyroid dose and adding T4 has lowered rT3 levels in some patients. "

- A reverse T3 ratio greater than 20 does not indicate good health any more than a normal TSH does

 

[Vince]

I know, should've checked a free T4. Just did the labs my doc ordered and didn't think about it until the results came back.

Lab draw was 2 hrs after taking AM dose of 60mg Armour.

most people that are taking NDT split their doses. E.g. 6:30 AM and 3:00 PM. they find that the most accurate BW is 8 hours after taking the first half/AM dose, before taking the other half/ PM dose

 

[mjb]

most people that are taking NDT split their doses. E.g. 6:30 AM and 3:00 PM. they find that the most accurate BW is 8 hours after taking the first half/AM dose, before taking the other half/ PM dose

Thanks, Vince. I will time my next labs accordingly. Reducing dose for now. I think I am a little hyperthyroid, since I've been having trouble keeping my weight up.

 

[wondering]

most people that are taking NDT split their doses. E.g. 6:30 AM and 3:00 PM. they find that the most accurate BW is 8 hours after taking the first half/AM dose, before taking the other half/ PM dose

All times are accurate, but just offer different insights into levels at different times. Your peak will be approx 2hrs after ingesting. This is when Crisler always wanted patients to get BW drawn. I would think knowing your peak would be most valuable. But, being consistent in timing from draw to draw is probably most important so you are comparing apples to apples.

 

[Vince]

All times are accurate, but just offer different insights into levels at different times. Your peak will be approx 2hrs after ingesting. This is when Crisler always wanted patients to get BW drawn. I would think knowing your peak would be most valuable. But, being consistent in timing from draw to draw is probably most important so you are comparing apples to apples.

I am told your TSH won't change with dosing timing. The only reason I mention dosing timing was because of his high free T3.

 

[wondering]

I am told your TSH won't change with dosing timing. The only reason I mention dosing timing was because of his high free T3.

Yeah, I dont think TSH or T4 will change. But Free T3 will.

 

[Vince]

Yeah, I dont think TSH or T4 will change. But Free T3 will.

I concur.

 

[Vtail]

Yeah, I dont think TSH or T4 will change. But Free T3 will.

Just out of curiosity, does anyone have a feel for how quickly TSH values change following a dosage change (of either T3 or T4)? My PCP gets hung-up on TSH values, and I would love to be able to have mine in the 'normal range' when I see her. My TSH is currently suppressed with the T3/T4 I'm taking (under another doc's guidance), although I feel great. Last check my TSH was almost undetectable, and my PCP would freak out.

 

[Vince]

Just out of curiosity, does anyone have a feel for how quickly TSH values change following a dosage change (of either T3 or T4)? My PCP gets hung-up on TSH values, and I would love to be able to have mine in the 'normal range' when I see her. My TSH is currently suppressed with the T3/T4 I'm taking (under another doc's guidance), although I feel great. Last check my TSH was almost undetectable, and my PCP would freak out.

My doctor freaks out to about low TSH. 6 week before my labs, I adjust my protocol. Just to keep my doctor happy. :-(

 

[wondering]

Just out of curiosity, does anyone have a feel for how quickly TSH values change following a dosage change (of either T3 or T4)? My PCP gets hung-up on TSH values, and I would love to be able to have mine in the 'normal range' when I see her. My TSH is currently suppressed with the T3/T4 I'm taking (under another doc's guidance), although I feel great. Last check my TSH was almost undetectable, and my PCP would freak out.

If you are taking thyroid pills- levothyroxine, NP Thyroid, armour, cytomel...The direct T3 portion will increase in a matter of days and come down in a matter of days due to short half life. The T4 will take up to a month or maybe longer due to longer half life. A portion of the T4 will convert to T3 so that amount will take same to respond. Your TSH will follow both of those. So any effect from T3 will be quick and any effect from T4 will take longer.

 

[wondering]

My doctor freaks out to about low TSH. 6 week before my labs, I adjust my protocol. Just to keep my doctor happy. :-(

Hate to admit it, but i have done in the past as well. I wont now that I am with Dr. Saya.

 

[Vtail]

If you are taking thyroid pills- levothyroxine, NP Thyroid, armour, cytomel...The direct T3 portion will increase in a matter of days and come down in a matter of days due to short half life. The T4 will take up to a month or maybe longer due to longer half life. A portion of the T4 will convert to T3 so that amount will take same to respond. Your TSH will follow both of those. So any effect from T3 will be quick and any effect from T4 will take longer.

So if I understand correctly, if I lower my Cytomel the TSH will increase within a few days, but if I lower Synthroid it will take weeks for TSH to increase?

 

[Vince]

It doesn't work that way for me. I have to lower both, to increase my TSH.

 

[Vtail]

It doesn't work that way for me. I have to lower both, to increase my TSH.

Thank you.
What a PITA . . .

 

[Vince]

Thank you.
What a PITA . . .

Pain in the ass. Why do you ask?