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Thyroid Blood Panel Results - What Now?

Hello, can someone give me an opinion on the results of my thyroid bloodwork? Is everything ok? Could it be better? What can I do to improve those numbers?

I feel I have a hard time losing fat and wonder if it’s something related to thyroid. Also, about half of the time my underarm temperature is lower than should be, although mouth temperature is always normal.

I have booked a doctor to eval those results but it’s only next month. So it would be nice to know what other members of this forum think about those results.

I also have drawn blood for a reverse T3 exam but results will take a while to be available.

Here are the numbers:

Total T4: 8.44 µg/dL (range: 4.5 - 12.5)
Free T4: 1.40 µg/dL (range: 0.89 - 1.76)
Total T3: 110.10 ng/dL (range: 64 - 152)
Free T3: 2.85 pg/mL (range: 1.88 - 3.18)
TSH: 3.56 µIU/mL (range: 0.55 - 4.78)
Cortisol: 20.26 ug/dL (range: 5.27 - 22.45)

Your cortisol could be the culprit. And stop wasting time taking your temperature, it’s irrelevant to thyroid health. Stupid quack nonsense.

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This is not my opinion, this is fact, when the thyroid gland becomes inefficient in early hypothyroidism, the TSH becomes elevated even though the T4 and Free T3 may still be within the normal range. You still need to treat your thyroid because TSH has a story to tell, but I don’t expect your doctors to do anything because of the “in range” brainwashing that happens in medical school.

People can have normal body temperatures and have hypothyroidism, temperatures are irrelevant.

Reference ranges for TSH and thyroid hormones

The evidence for a narrower thyrotropin reference range

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I got my reverse T3 results: 28 ngdl, range 9-25.

I went to my endocrinologist and she’s told me everything is normal. That I would need treatment only if my TSH was greater than 10. I sense bullshit.

How would I treat it? I’ve read the stickies, researched about it, but it seems like there are many different protocols and ways to treat, different dosages, taking T3 and/or T4, etc. I have no idea of an ideal protocol to begin. How would you treat it if you were in my shoes?

With your reverse T3 that high, you would need to get free T3 to almost 6.0 to overcome it. Options include a compounded T3/T4 combo or armour thyroid. Synthroid or levothyroxine will not work for you.

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It’s almost impossible to find T3 in my country, only T4. There’s no armour thyroid here. Do you think iodine supplementation would work?

This is old and outdated, this is the way it used to be before the ranges were narrowed. Your doctor is living under a rock and can only claim ignorance. It’s been known for a long time TSH is a poor marker for thyroid status, free thyroid hormones will tell you how the thyroid is performing, not TSH.

TSH doesn’t correlate with symptoms very well, you can have TSH <3.0 and have below range Free T3, the ranges go to 4.7 so 10.0 is well beyond high normal. The problem is small countries are usually lagging behind, things change here in the US and it takes decades for things to change elsewhere because there is no evolution of medicine anywhere outside the US.

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Your rT3 is off the charts Effectively making you hypo. Go to stop the thyroid madness website and read about cortisol and high rT3. You need to start Cytomel and titrate up until you get your rT3 below 15. Do not go above 100mcg on cytomel.

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@thebigzerg27
I have similar numbers. Your RT3 is higher than mine but similar. I’m going to try @trifive 's advice taking T3 only. You can get it online very easily. 10 min of searching will get you there. It’s super cheap. @thebigzerg27 let me know what you end up doing and any results you get.

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Start out at 25mcg. Go several weeks and see how you feel. Then go to 50 for 2-3 weeks. See how you feel. Your rT3 should come down at that point. I’d do blood work and see. If it’s still above 15, then jump to 75mcg and do bloods again after a while. Do not go above 100mcg. But allow your body to adjust before bloods and titrations. Pay attention how you feel. If you get jittery, rapid heart beat etc then you’re going hyper and need to back off the ends a tad.

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Isn’t 25 mcg too much for a starting dose of T3 only? I have seen some people use only 5 or 10 mcg per day. What if I start at 5 and then increase as needed?

I have found where to get T3 in my country, only compounding pharmacies sell them. Tomorrow (Monday) I will get in touch with some compounding pharmacies to order my T3

My rT3 was at 24. I started out at 5…then 10…then 15…then 25…then 50…then to 75. My rT3 came down to 14 at 75. I didn’t start feeling anything different until 50. If you want to start out at 5 then work up no one would argue with that.

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Could the high reverse T3 be caused by excess estrogen? For some time, maybe a couple of months, my estrogen had been higher than it should have been, and I did my thyroid blood panel at that time (I found out that Aromasin doesn’t work well for me, it wasn’t effective, so I went back to Arimidex, but when I drew blood for this thyroid panel I was on Aromasin and E2 was high). My E2 started getting high around the start of June, and I did the thyroid blood exams on the beginning of July. I brought my E2 back to the sweet spot a week ago.

This page says there is a relationship: https://schoolafm.com/ws_clinical_know/low-thyroid-function-estrogen-dominance/

estrogen dominance can promote hypothyroidism via several pathways including increased levels of thyroid binding globulin due to increased estrogen levels or increased anxiety (from ED) promotes higher cortisol which impairs thyroid hormone action via increased levels of Reverse T3 which competes for receptors with Free T3

What do you guys think? Maybe getting my E2 to where it should be (the so called sweet spot) will bring my reverse T3 levels back to normal and then taking T3 pills would be unnecessary?

If Reverse T3 is blocking Free T3, well this could slow down your metabolism and affect liver function then increasing estrogen. If your metabolism is slow, every organ is slower including estrogen secretion through the liver.

Aromasin is weaker than Arimidex.

Did you notice libido gains?

I started today, just took my first T3 dose. I will take 5 mcg twice per day. What should I expect to feel? Will I feel it “kicking in”? How long to feel it? Hours, days, weeks, months?

You should feel any t3 in hours. BUT, t3 is very suppressive of tsh, so at 10 mcg/day, the effect will gradually wear off as tsh and t4 are suppressed. So you’ll have to gradually increase the dose up to a full replacement.

The average (I don’t know variance and range unfortunately) T3 production is about 30 mcg/day, with 24 coming from t4 conversion and ~6 made directly from the thyroid. T4 does have function independent of t3, meaning you’ll need more than 30 to feel normal. I’ve tried various t3 protocols, but from what I gathered, 50 mcg/day is about average replacement dose for t3 only patients.

That being said, your thyroid numbers look fine to me. I’ve had high rt3 and thought I needed t3 only but it turns out I was insulin resistant. Insulin is a strong regulator of t3 conversion. Today I take 150 mcg of T4.

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Very ilustrative post @mr.inquisitive !. Are you splitting the dose into 25 mcg morning and 25 mcg afternoon?. Edit: If you are back to t4 I understand there is no need to split dose.

@arroway It’s been a while since I took that much t3, but I think I did 2 times/day.

Today I take 100 mcg and a grain of armour. I personally won’t take less than 125 mcg of t4/day.

Personally, I don’t really believe in treating rt3. It declines w/ age w/ thyroidal output decline and is higher in hyperthyroid sufferers.