Could elevated reverse T3 be the answer to my unusual thyroid issue?

This was me on 125mcg of T4 :


Free T3: 5.90 pmol/l
Range: 3.08 - 6.78

Free T4: 12.87 pmol/l
Range: 11.60 - 21.90

TSH: 0.51 mU/l
Range: 0.40 - 4.0

hi Rainy

no need for apology - a very high proportion ( around 25-30% of chronic lyme patients from what i read) have thyroid issues - and recovery from lyme is also impacted by thyroid status - so i think its perfectly valid here

i have Hashimoto's and have done a bit of research into this - will share what i recall as a summary and try to direct you to some useful links

firstly, actually those numbers look pretty good to me
most integrative MD's and LLMD's like Horowitz say to:

-target Free T3 in the upper 3rd of the normal range - which you have
-free T4 in the upper half or upper third
-TSH - under 1 or ideally 0.5

so on the face of it your numbers are good - well done - its not easy to get to even this point.

now the reverse T3 issue - i have read many accounts - often from integrative or functional thyroid specialists that basically say the same thing as the source you quote - and i believe there is some truth to it.
its been known for many many years that some people with hypothyroidism simply do not do well even when their TSH, T3 and T4 are all in normal range - this is particularly common when there are undiagnosed underlying conditions that are driving the health status - eg like a chronic infection.

the reverse T3 story has emerged more recently as a way of understanding that.
i am not sure if it is the full story - as the topic is a complex one and still quite a bit we do not understand - but i do think it has merit as another avenue to investigate to help improve the situation.
thyroid status significantly affects immune function and as such is an important lever in overall health status when fighting chronic infections.

most conventional endocrinologists do not measure it or care about rT3 - they are stuck in the past.

integrative Thyroid docs do - and they have ratios of rT3 to Free T3 that they feel are normal and optimal - these tests are available from most big testing labs - often as part of a thyroid test panel.

this guy has quite a lot of free resources on thyroid testing, function and treatments that i think are a fair representation of a kind of middle of the road view of the state of the art in a integrative approach to treating thyroid disorders. ( not so fringe or bleeding edge that its high risk - but not so conservative that you may as well stick with a conventional doc)
just be aware that he seems to make his living selling thyroid supplements - that are pretty pricey - and you don't necessarily need - but the info is free.

here he describes the full panel of tests to ideally asses thyroid function - including some non obvious ones - like sex hormones
see the link " complete list of thyroid lab tests" under free resources
https://www.restartmed.com/start-here/

as to cause - the long and short of it - as far as i was able to gather from my reading - is that chronic inflammation seems to drive the over production of rT3 / under production of T3 - and resulting poor rT3 vs T3 ratio.

this certainly fits with ongoing chronic infection - as in lyme and friends

if rT3 is in fact an issue - there seems to be quite a lot you can try to do something about it - but with the above panel perhaps further targeted interventions are possible -

hope its of some help

Yes, your thy levels look exactly like someone taking desiccated natural thyroid; the T3 will always be higher than T4 then. Odd indeed.

T3 can certainly present itself in weird ways when under stress. Illness is stress. But...maybe you covert 4 to 3 super well....hmm...

Ive taken the reverse T3 test quite a few times, but not in my early years of thyroid issues when this test prob would have been most helpful.

There was a period where I had T3 "pooling"; FT3 was over the range even though my TSH was hypo. Im guessing I prob had high reverse T3 too, the the Dr at the time was old school and refused to do it even though its a normal conventional test.

garzie and Rainy do you guys drink dairy?

Was listening to a podcast yesterday by a pretty sharp dr at a metabolic clinic in europe....on the link between dairy and thyroid issues, and how thats a common mistake some people make w/ keto (high consumption of cream/dairy as a fat source)

astroman said...
Yes, your thy levels look exactly like someone taking desiccated natural thyroid; the T3 will always be higher than T4 then. Odd indeed.

T3 can certainly present itself in weird ways when under stress. Illness is stress. But...maybe you covert 4 to 3 super well....hmm...

Ive taken the reverse T3 test quite a few times, but not in my early years of thyroid issues when this test prob would have been most helpful.

There was a period where I had T3 "pooling"; FT3 was over the range even though my TSH was hypo. Im guessing I prob had high reverse T3 too, the the Dr at the time was old school and refused to do it even though its a normal conventional test.

Thank you for sharing astroman, that helps to know, I appreciate it.
I hadn't thought of that but you're right, it looks like how it should be on NDT, that's an interesting thought.