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Old 05-17-2012, 06:54 AM   #1
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The big T3/RT3 question

Hi all -- (thyroid question below )

Newbie here. I'm 29, and have struggled with fast-worsening fibromyalgia (muscle knots, fatigue/exhaustion, parasthesia, headache, etc) for 2 years. I've gone from being an extremely active professional to a non-working, hardly functioning human being.

My doctor at the Cleveland Clinic Center for Integrative Medicine is trying to help me get to the bottom of some of my symptoms. She recently did a total thyroid panel on me. I can't get in for a while to discuss with her, but I've done some reading that leads me to believe I could have a problem with RT3.

FT4 = 1.2 (range 0.7-1.9)
FT3 = 2.8 (range 2-4.4)
RT3 = 220 (range 90-350)

Any insight/advice for me about what these numbers might indicate? Thanks so much for your input.

 
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Old 05-17-2012, 07:52 AM   #2
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Re: The big T3/RT3 question

Forget the RT3 problem. I chased this for far to long. You will find people on some websites telling you that this is a problem and you need to take T3 only and drop the T4. Then, you will find others (like on here) that will tell you that YOU (and I mean you!) need to increase your T4 and T3 together. Your numbers are low. My RT3 was MUCH higher than yours. Mine came down on it's own once I removed the stressors from my life. You don't have a RT3 problem, you have a thyroid problem. Sammy and others will be able to help you out further than this, but please... PLEASE... don't waste your time with RT3.
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Old 05-17-2012, 12:08 PM   #3
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Re: The big T3/RT3 question

If those are the only tests you had for thyroid, it wasn't a "total" thyroid panel. Where are the TSH and two thyroid antibodies (TPO and Tg) tests?

"Fibromyalgia" isn't a disease; it's a syndrome. Plenty of experts on the subject agree that it's a manifestation of thyroid dysfunction, somewhat different from basic hypothyroidism, but treatable with thyroid hormone all the same. Read the work of Dr. John Lowe to find more on that angle.

I agree that RT3 isn't your problem. You're hypothyroid and would very likely benefit from treatment for it.
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Old 05-17-2012, 12:09 PM   #4
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Re: The big T3/RT3 question

Thanks, AlwaysTired. I'm surprised to hear you say you think my levels are low and that I have a thyroid problem--not an RT3 problem. Looking at my numbers in the ranges, I thought they looked pretty solid. I guess this is why I am not a doctor . In any case, I'm miserable--and looking for any clues to what might be going on in this body of mine.

 
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Old 05-17-2012, 12:11 PM   #5
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Re: The big T3/RT3 question

Thanks, Midwest1. I did have a TSH done at a prior blood draw; it came in normal at 1.49 (range .045-4.50). During that same prior blood draw, Total T3 came in at 104 (range 71-180).

 
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Old 05-17-2012, 12:39 PM   #6
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Re: The big T3/RT3 question

The rT3 test predated the invention of the FreeT3 test. The rT3 was the best-guess estimate of FreeT3.

Now that labs can test FreeT3, there's really no need for rT3.

Simply put, an "rT3 problem" usually means the patient has an inadequate FreeT3 level....and you do.

You also have an inadequate FreeT4 level.

In fact, your FreeT4 is identical to the FreeT4 level I had when I was started on meds - my FreeT3 level was actually "better" (higher in the range).

Most healthy people have FreeT4/T3 levels in the upper half/upper third of the range - neither of your levels is even at mid-range. You are hypothyroid, without a doubt.
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Last edited by sammy64; 05-17-2012 at 12:46 PM.

 
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Old 05-17-2012, 12:40 PM   #7
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Re: The big T3/RT3 question

Hi Pirtastic,

I don't have an answer for you but I just received my RT3 results too, so I can show you my labs for comparison.

I think that typically, when in the same units, T3 and RT3 should be about equal. There are some T3 (FT3)/ RT3 calculators online that I cannot post here due to forum rules.

In a healthy person, the body converts T4 to T3 and RT3 in more or less equal proportions. When the body is under stress, more of the T4 gets converted to RT3 in order to conserve energy and slow metabolism (anorexics typically have very high RT3 levels because the body goes into starvation mode). I think that ignoring high levels of RT3 is failing to address the root of your thyroid problem. Personally, I don't think merely adding more T4 and T3 to overcome high RT3 levels is the solution. In my case, I would need my FT3 to be between 6 and 7 to have a good ratio with my RT3 levels.

My latest labs are as follows

Feb 2012
TSH 2.88
FT4 1.2 (0.9-1.8)
FT3 2 (1.8-4.2)
TT3 90 (60-180)

April 2012 (after 6 weeks T4 25 mcg)
TSH 3.31
FT4 1.2 (0.9-1.8)
FT3 not measured
TT3 70 ng/dL (60-180)
rT3 288 pg/mL (90-350)

I don't know what my RT3 from the first test was, as it wasn't measured but assuming the same RT3 value for both tests, my ratio for FT3/RT3 is 6.9 (should be over 20) and for T3/RT3 is 2.5 (should be over 10). So, it appears as though my body is making 4 times as much RT3 as it is T3.

There is a lot of speculation about RT3 and its effect on "tissue hypothyroidism." I think mainly because the Dr who first posed the theory was a discredited quack. However, I don't think one should just ignore the fact that your liver is converting T4 into RT3 at much higher percentages than T3. I have not discussed my results with my doctor yet, as I will not meet with her for another two weeks. Since my last results, I have been taking 30 mcg of desiccated thyroid, so I am hoping that my T3 levels have improved. I did start taking milk thistle, which improves glutathione levels (as a liver cleanse), in the hopes that it will help make more T3.
Have you had your selenium levels checked? I suggest checking zinc and magnesium too.

 
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Old 05-17-2012, 12:42 PM   #8
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Re: The big T3/RT3 question

Oh, I forgot to add, low ferritin levels are also associated with diminished conversion of T4 to T3, with increases in RT3. So, if your levels are low, start supplementing with iron. It's also not a bad idea to have your Vit A retinol levels checked. I have similar thyroid levels to you and my Vit A & D were very low, despite supplementing with both.

 
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Old 05-17-2012, 03:06 PM   #9
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Re: The big T3/RT3 question

Sammy -- Thank you. That is helpful. What kind of doc did you see that looked at your lab results that fell within range but still recognized a problem? Based on my doc's nurse's comments, I don't get the feeling she's seeing a clear problem with my numbers. My doc is an integrative med doc at Cleveland Clinic and, in fact, I sought her out because I'd read and heard she was pretty open with "can't-always-go-by-the-numbers" approach to care.

Bee -- Thank you for sharing your story. I'm very interested to know what you end up learning from your doc appointment. Your RT3/FT3 ratio seems quite a bit more severe than mine (yours at 6-ish mine at 12-ish). What do you mean by "the root problem" of the thyroid issue? I was tested with a comp metabolic panel, but I don't think that test included selenium, zinc, magnesium, or ferritin.

 
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Old 05-17-2012, 03:16 PM   #10
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Re: The big T3/RT3 question

Quote:
Originally Posted by Pirtastic View Post
What do you mean by "the root problem" of the thyroid issue? .
I just mean that there may be an obvious solution to your conversion issue- chronic stress, vitamin/ mineral deficiencies, liver/biliary dysfunction etc. My doctor ordered a liver function test that she said was more accurate and specific than ALT/ AST called GGT (Gamma glutamyl transpeptidase). This enzyme will be high in cases of liver damage and low in hypothyroidism and magnesium deficiency. I'm trying to understand the implications of this, since my number was on the low side of the range at 9 (5-55) but not below range.

 
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Old 05-17-2012, 03:18 PM   #11
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Re: The big T3/RT3 question

That's not to suggest that there isn't a thyroid issue- your FT4 is still low in the range and that would be unrelated to conversion issues.

 
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Old 05-17-2012, 03:20 PM   #12
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Re: The big T3/RT3 question

Pirtastic

I suspect my situation is a bit different. My current thyroid doctor (#5) started caring for me one month after I went off anti-thyroid drugs for Graves'. My levels at that time were almost identical to the levels I had when I started thyroid hormone replacement so, yes, I was hypo.

During my first appointment with her, I shared my history and told her I thought I hadn't been medicated properly (I hadn't). She agreed to monitor me and we agreed on what she would do if I started to go hyper again.

Well, I never went hyper....my levels actually improved a bit but, then returned to the levels I had when I went off anti-thyroid drugs.

Before I even know what those levels were, I was sharing with my doctor all the symptoms I'd developed since my last appointment. She recognized them as symptoms of hypothyroidism and I asked her to start me on thyroid hormone replacement which she did.

My doctor does realize that each of us has his/her own "normal" FreeT4/T3 levels within the ranges of normal. Since I maintained a journal of symptoms as they pertained to my labs, I was able to identify my optimal levels.

My doctor accepted that determination and has adjusted my doses to maintain those optimal levels.

You might want to try getting contact info from local pharmacists for doctors that Rx Armour or Cytomel. Doctors that prescribe either of these meds tend to be more thyroid-savvy. Please don't get discouraged if the first pharmacist you call doesn't help...keep calling until you find one that will.
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Last edited by sammy64; 05-17-2012 at 03:23 PM.

 
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Old 05-17-2012, 04:44 PM   #13
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Re: The big T3/RT3 question

Quote:
Originally Posted by bee01 View Post
I just mean that there may be an obvious solution to your conversion issue- chronic stress, vitamin/ mineral deficiencies, liver/biliary dysfunction etc. My doctor ordered a liver function test that she said was more accurate and specific than ALT/ AST called GGT (Gamma glutamyl transpeptidase). This enzyme will be high in cases of liver damage and low in hypothyroidism and magnesium deficiency. I'm trying to understand the implications of this, since my number was on the low side of the range at 9 (5-55) but not below range.
I have written down the liver test and the vitamin/minerals you mentioned to talk about with my doctor. Will you please let me know what you find out during your appointment? I hope it brings you answers!

 
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Old 05-17-2012, 05:00 PM   #14
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Re: The big T3/RT3 question

Quote:
Originally Posted by sammy64 View Post
Pirtastic

I suspect my situation is a bit different. My current thyroid doctor (#5) started caring for me one month after I went off anti-thyroid drugs for Graves'. My levels at that time were almost identical to the levels I had when I started thyroid hormone replacement so, yes, I was hypo.

During my first appointment with her, I shared my history and told her I thought I hadn't been medicated properly (I hadn't). She agreed to monitor me and we agreed on what she would do if I started to go hyper again.

Well, I never went hyper....my levels actually improved a bit but, then returned to the levels I had when I went off anti-thyroid drugs.

Before I even know what those levels were, I was sharing with my doctor all the symptoms I'd developed since my last appointment. She recognized them as symptoms of hypothyroidism and I asked her to start me on thyroid hormone replacement which she did.

My doctor does realize that each of us has his/her own "normal" FreeT4/T3 levels within the ranges of normal. Since I maintained a journal of symptoms as they pertained to my labs, I was able to identify my optimal levels.

My doctor accepted that determination and has adjusted my doses to maintain those optimal levels.

You might want to try getting contact info from local pharmacists for doctors that Rx Armour or Cytomel. Doctors that prescribe either of these meds tend to be more thyroid-savvy. Please don't get discouraged if the first pharmacist you call doesn't help...keep calling until you find one that will.
Bear with me -- so you were treated for hyper even though you were really hypo? I do know my doc prescribes those meds; just not sure she'll agree I need them. (More than anything, I'm anxious that this is not the answer and I will continue to be in pain/exhaustion.)

 
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Old 05-17-2012, 05:30 PM   #15
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Re: The big T3/RT3 question

Quote:
Originally Posted by Pirtastic View Post
Bear with me -- so you were treated for hyper even though you were really hypo? I do know my doc prescribes those meds; just not sure she'll agree I need them. (More than anything, I'm anxious that this is not the answer and I will continue to be in pain/exhaustion.)
Sorry for any confusion.

I started my thyroid disease journey with Graves' induced hyperthyroidism. I was often hypo when taking anti-thyroid drugs because my former endos overmedicated me.

I went into remission and then joined the 20% of Graves' patients that go hypo after remission.

Your labs are clearly hyPOthyroid.....the biggest challenge will be finding a doctor that recognizes this since many don't (including my former endos).
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