Reverse T3 hormones (RT3)

[heapsreal]

Starting a thread on this to try and get some info flowing on it.

This is what i know about RT3. t4 hormones are sort of a precursor to t3 which is the active thyroid hormone, now under stress of any king be it psychological, infectious etc etc the body produces RT3 which basically inactivates the active t3 and down grades our metabolism. Now some gurus say this is a protective mechanism of the body where others say that this slowing down of the metabolism if chronic maybe stuck in this position and fixing this can help us to function alot more efficiently.

For many all thyroid tests can comeback normal but rt3 isnt tested by alot of docs but it can be tested, also constant low body temp can be a sign as well. People on thyroid replacement which contains t4 can also have a high rt3 level. Its also mentioned that adrenal fatigue can also be caused by high rt3 but i have also read that low adrenals need to be treated before looking into thyroid treatments, but this point is controversial. But i cant see a reason not to try to slowly increase dhea etc before looking into this, some have treated adrenals and this has improved rt3 as well.

Now some other things i have read on rt3 treatment involve treatment with t3 hormone only starting with a low dose and slowly increasing this to a tolerable level. those on t4 switch over to t3 only and later on to a mix of both t3/4 thyroid. Many only need to be on t3 treatment for a few months. Now i think how this works is that it supresses our own t4 production which rt3 comes from thus stopping rt3 and t3 therapy sort of burns off the rt3 that has built up. now when this is sorted and t3 therapy is stopped our body can produce t3 again from t4 without the high level of rt3 inactivating our t3 thyroid. Our body temp should come up to a more normal level 36.5-37c, sorry i dont know american temps.

I have no personal experience with this or know much about dosing. hopefully those who have tried this and know more about this can share your experiences. Maybe this could indirectly help improve immune function??

cheers!!!

 

[nanonug]

I have no personal experience with this or know much about dosing. hopefully those who have tried this and know more about this can share your experiences. Maybe this could indirectly help improve immune function??

Hormone replacement of any kind is tricky business, probably because the dynamics are not linear. I do supplement with a glandular called TG-100 to bring my TSH close to 1.0 uIU/mL. There is some improvement in my well-being but nothing dramatic.

 

[Ema]

I am not an expert on this topic by any means but I can share what I have learned doing the T3 protocol for the past 18 months or so as well as moderating on a group for this protocol.

Full disclosure requires me to report that I was gung-ho on the idea of RT3 causing subclinical hypothyroidism but my experiences have led me to question the function of RT3 and whether or not it actually can "block" thyroid receptors from getting the needed active T3 hormone. I also believe that one CAN live on T3 only but that there may be additional benefits to having T4 present in the system. While on T3 only therapy, T4 levels are suppressed and this is how RT3 is also suppressed (because T4 can convert to either T3 or RT3 depending on which iodine atom is removed).

I also have some concerns as to the high doses of T3 recommended by those on the T3 only bandwagon. I agree with Rich that taking a mixture of T3/T4 is inherently safer as there is a built in safety mechanism when the body has to convert T4 to T3. I would not personally feel comfortable at this time suggesting to anyone that they take the high doses of T3 especially without regular (ie monthly) thyroid bloodwork to make sure that the FT3 level is not getting too high. Too high FT3 can cause heart attacks and it can be dangerous without careful monitoring. For what it is worth, I have only ever heard of this happening in people taking upwards of 100 mcg of T3 per day.

These links do a great job of explaining both sides of the story...unfortunately no one knows which is correct for sure!

www.thyroid-rt3.com/

www.tiredthyroid.com/

This is the latest addition to the mix - circadian dosing of T3:

http://recoveringwitht3.com/

It IS crucial to have properly supported adrenals prior to starting thyroid treatment of any kind. I believe many of the problems people have with feeling wired or amped on thyroid hormone come from low adrenal function. Low iron can also cause problems in tolerating and using thyroid hormone properly. If either of these are not at optimal levels (adrenals function determined by saliva test and stable daily average temperatures; see Dr Rind temperature graphing and serum iron approx 100-110 with TIBC well above the bottom of the range), there will almost definitely be issues in raising thyroid hormone to therapeutic levels without intolerance symptoms (that unfortunately cause confusion by resembling hyper symptoms but are NOT).

Correcting subclinical hypothyroidism is crucial in my opinion to becoming well. Viruses and candida love to live in the lower body temperature found in hypo so it can only help to eradicate these conditions as well. However, for some people it may not be enough and further support (AV/ABs, anti-candida diet/supps, etc) may be required to fully recover from these conditions. I also believe that the methylation protocol dovetails nicely with replacing low hormones caused by a dysfunctional endocrine system. Hopefully correcting methylation will allow most people to discontinue hormone therapy as their own glands start performing better as a result of increased methylation.

There is obviously a LOT more to this topic...please feel free to peruse the links though as they will answer many questions and I will also be happy to answer any questions that I can here about my experiences.

 

[garcia]

I am not an expert on this topic by any means but I can share what I have learned doing the T3 protocol for the past 18 months or so as well as moderating on a group for this protocol.

Hi Ema, many thanks for your post.

Full disclosure requires me to report that I was gung-ho on the idea of RT3 causing subclinical hypothyroidism but my experiences have led me to question the function of RT3 and whether or not it actually can "block" thyroid receptors from getting the needed active T3 hormone.

Can you elaborate on this? I.e. what your experiences were on the T3 protocol and why you have begun to question whether it can block thyroid receptors.
Many thanks!
garcia.

 

[Ema]

Hi Ema, many thanks for your post.



Can you elaborate on this? I.e. what your experiences were on the T3 protocol and why you have begun to question whether it can block thyroid receptors.
Many thanks!
garcia.

You're welcome!

I am not the "typical" example (though perhaps am a type) of someone with subclinical hypothyroidism. I think the RT3 protocol is fairly simple for those who have an in-range TSH, low in range FT3 and FT4 and high RT3. It is well described on the RT3 website link posted above.

However, I was at an Addison's level of hypocortisolism when I started as well as severely anemic and rife with viral and bacterial infections. I spent the first few months addressing the adrenal and iron levels prior to starting T3. When my adrenals were well supported and iron levels good, I started at 5 mcg of T3 and worked my way up to 75 mcg. My temperature improved and I was feeling better...until my aldosterone levels tanked and I ended up in the hospital with dehydration. Florinef solved that problem but in the meanwhile, I managed to develop some "other" form of thyroid resistance which never let me get up past 50 mcg of T3 again. This level was not enough to raise my FT3 up to the top of the range where it is optimal. So I started reading and asking questions (specifically about thyroid resistance but also about the role of T4) and decided that I needed to try a switch to a T4/T3 natural thyroid hormone to see if I might respond better. That trial is still ongoing as I switched to Naturethroid about 6 weeks ago (and just had my first labs on it drawn this AM).

Many of those on the T3 bandwagon will not accept that ME/CFS is anything other than untreated hypothyroidism. I cannot stress how firmly I disagree with this position (obviously or I wouldn't be here!). I was ostracized for continuing to say that hypo was a part of my ME/CFS spectrum. I know there is a difference between those of us with ME/CFS and those with say, autoimmune thyroid disease such as Hashimoto's (not that one can't have both). There are similarities but there are also crucial differences.

These differences are what led me to question T3 only treatment but I do think that many people would do well with a trial after proper testing and with appropriate monitoring. T3 has been shown to help many people with ME/CFS and treating hypothyroidism can improve SO many symptoms attributed to ME/CFS like constipation, muscle pain, headaches, migraines, dizziness, etc etc). Low thyroid affects the mitochondrial function as well.

The tiredthyroid link that I posted above does a MUCH better job than I ever could explaining why the RT3 theory may not hold much water. It is a very well referenced site as well in my opinion.

 

[sianrecovery]

thanks

This is such a usesful thread - I hope people keep adding their experience of addressing thyroid issues. I know exactly what Ema means about the slightly evangelical tone to some of the thyroid forums. I have just started trawling through them as my doc suggested I try thyroxine - my T4 is 14.6, I dont understand enough yet to know what other measurements are relevant here. I did three years working on my adrenals, but salivary cortisol still tested low a few months ago. I did a year on a low dose of cortisone and DHEA, and years on adrenal glandulars. I feel ambivalent about thyroxine, having talked to a friend who has been on it for a long time. I've had ME for some years, and was recently diagnosed with protomyzoa, and am now on a regime of abx and herbal antibacterials. I also have KPU and methylation issues - so my caution is - if I start messing with the hormone stuff, am I going to hamper any of the other processes?

All experience gratefully received.....

 

[nanonug]

I've had ME for some years, and was recently diagnosed with protomyzoa

What's that? What kind of symptoms does it cause? How do you get diagnosed? Thanks!

 

[heapsreal]

There is a male hormone forum that i visit and they are similar in that fatigue is related to low testosterone, they dont really get cfs/me. But i think many of us have these hormone abnormalities that if we can fix can help us function better.

Ema what sort of dosing is recommend and with T3 is the dosing taken several times during the day or just a morning dose. Also do u track body temp to help with dosing??

I place i read info on mentions to stay on t3 long enough to lower rt3 then come off, those who are always on thyroid meds then change back to a thyroid combo med with t4/t3 in it.

It makes sense that if we improve our metabolism that everything should function better, immune system etc??

cheers!!!

 

[Ema]

I try thyroxine - my T4 is 14.6, I dont understand enough yet to know what other measurements are relevant here.

The most important thyroid numbers in my opinion are FT3, FT4, RT3, and TSH (not as a measure of thyroid function but as a measure of pituitary function).

Most doctors do start people on thyroxine, or T4 meds, and most people with ME/CFS do not respond well because they do not convert T4 to T3 well enough to improve thyroid function. Most people seem to need a mixture of T4/T3 or T3 alone meds to raise the FT3 (measure of available active thyroid hormone) up to the top of the range where symptoms improve. I don't see any issue with starting with T4, but it is most often a waste of the six weeks it takes to see if it has raised FT3 any at all on the next labs before switching to something with T3.

I did three years working on my adrenals, but salivary cortisol still tested low a few months ago.

Low adrenals will make it difficult if not impossible to get thyroid levels up enough to improve metabolism.

If you want to post your saliva cortisol results here, that would be a great help.

am now on a regime of abx and herbal antibacterials. I also have KPU and methylation issues - so my caution is - if I start messing with the hormone stuff, am I going to hamper any of the other processes?

I think that the three facets (antibiotics/antivirals, methylation and hormones) are all vital parts of healing and supporting each of them can enhance the others function. I personally saw my greatest gains while using all three protocols simultaneously (though I did start them all one at a time and added new things in slowly over time).

It is important though to check individual meds and supplements with your doctor and Dr Google to look for interactions though as there are almost always options.

 

[Ema]

Ema what sort of dosing is recommend and with T3 is the dosing taken several times during the day or just a morning dose. Also do u track body temp to help with dosing??

T3 has a short half life and so is best dosed multiple times a day (usually every 5-6 hours to avoid "stacking" one dose on top of another). Many people dose four times a day - something like 8A, 1P, 6P, Bedtime at lights out. It's a common misconception that T3 will interfere with sleep. Many people find that it actually improves sleep by using up cortisol and lowering those levels. Further, T3 is required to do much important repair work that occurs at night. The importance of the bedtime dose of T3 cannot be overstated in my opinion. For more on this, the Recovering with T3 website discusses circadian dosing.

Dosing and how to add in doses is covered extensively on the RT3 website I linked above. Let me know if you have trouble finding the section.

I place i read info on mentions to stay on t3 long enough to lower rt3 then come off, those who are always on thyroid meds then change back to a thyroid combo med with t4/t3 in it.

For those that believe in RT3, it is thought to take about 12 weeks for the RT3 to stop being produced and degrade from the T3 receptors in the cells. Most people try at that point to switch back to a combo product of T4/T3. Some are successful but honestly most are not and find symptoms return and temperatures start to drop. Many switch back to T3 again.

The underlying issue that caused a shift to predominantly RT3 production needs to be corrected in my opinion in order for a switch to be successful. That is why I think it is important to address methylation and underlying infections concurrently along with thyroid and other hormonal imbalances. This increases the chance for success when switching.

It makes sense that if we improve our metabolism that everything should function better, immune system etc??

cheers!!!

I would agree!

 

[sianrecovery]

Hi Ema

thank you so much for another really helpful post. I dont have tests for FT3 or RT3, the latest FT4 was 14.6, and TSH was 1.8. Thats from March this year. My FT4 I notice when I first got tested was 11.1, so it clearly flutuates.

The salivary cortisol was done a year ago, four samples over a day, 4-5 hours apart.
Sample 1 (on wakening) (ref range 12-22) 7
Sample 2 (ref 5-9) 7.6
Sample 3 (ref 3-7) 4.2
Sample 4 (ref 1-3) 1 Total daily cortisol (ref range 21- 41nmol/l) 19.8

DHEA: Sample 2 (am) (ref 0.30 -1.00) 0.30
Sample 3 (Pm) (ref 1.00-.4.00) 0.23

DHEA :cortisol ration 1.34


I was using a daily dose of cortisone cream, and 10mg DHEA, but I stopped when I got the protomyxzoa diagnosis, as I would had I been diagnosed with Lyme.
~Ema - do you have a personal recommendation on what form of T3 to try with?

Nanoug - the protomyxzoa is a blood born protozoan infection that I had diagnosed via a blood draw, through Fry Labs. I am being treated by Doc Fry, who is its identifier. to read more on it, go onto Scott forsgreen's betterhealthguy website, and look at the notes he took on a round table conference with lots of the top hitters like Klinghart, Shoemaker etc. Fry is there, and talks about proto.

 

[Ema]

Also do u track body temp to help with dosing??

I missed this, sorry!

Tracking temps is vital in my opinion while titrating thyroid. Again, this is discussed in detail on the RT3 website linked above.

Some people rely on basal temps taken first thing in the morning and this may provide one useful measure of hypothyroidism. However, taking daily average temps three times a day three hours apart is vastly superior for tracking progress in my opinion.

One will find that adrenal support stabilizes temperatures and that thyroid hormone treatment raises the temperature. Once one has stable temps (allowing for women's cyclical changes due to menstrual cycle), thyroid hormone treatment can be initiated most successfully.

Here is an excellent example of what a temperature graph typically looks like for someone treating hormones:

http://www.drrind.com/therapies/metabolic-temperature-graph#interpret

 

[Ema]

I dont have tests for FT3 or RT3, the latest FT4 was 14.6, and TSH was 1.8. Thats from March this year. My FT4 I notice when I first got tested was 11.1, so it clearly flutuates.

If you are in the States, you can order lab tests yourself in most states. I would strongly consider getting FT3 and RT3 tested before embarking on a T3 only protocol. One needs to monitor FT3 while taking T3 as well, so it is best in my opinion to either sort out a doctor who will write the lab order or order them yourself. My favorite for thyroid labs is directlabs.com which offers FT3, FT4, and TSH for $89 (no affiliation). Then you can add on RT3 as well.

The salivary cortisol was done a year ago, four samples over a day, 4-5 hours apart.
Sample 1 (on wakening) (ref range 12-22) 7
Sample 2 (ref 5-9) 7.6
Sample 3 (ref 3-7) 4.2
Sample 4 (ref 1-3) 1 Total daily cortisol (ref range 21- 41nmol/l) 19.8

In my opinion, those results are on the line for whether or not I would want to try a full physiological replacement dose of HC or try to continue tweaking with adaptogens/Isocort/HC cream first. I would probably also repeat the test as a year is a pretty long time.

The AM result is VERY low when it should be highest. The rest of the results are pretty OK but the total cortisol is below range due to the horrible first AM result. So it really would depend on whether or not you have low cortisol symptoms. It would be really helpful I think for you to know your daily average temperature. If it is stable within 0.2F degrees, I would probably opt for tweaking first before trying HC.

Also, in my opinion (and also that of my LLMD), a physiological replacement dose of cortisol does not suppress the immune system or hinder healing from Lyme. I understand this is a controversial point but the best Lyme doctors all treat HPA axis dysfunction and often with low dose cortisol because they understand the importance of cortisol to healing.

How much cortisone cream are you using (in teaspoons or mL)? What form is it - ie straight hydrocortisone or cortisone acetate or something else? Is it a cream or an ointment? Where are you applying it?

Have you ever tried Isocort or another adrenal CORTEX only product (not a whole glandular?)

DHEA: Sample 2 (am) (ref 0.30 -1.00) 0.30
Sample 3 (Pm) (ref 1.00-.4.00) 0.23

DHEA :cortisol ration 1.34

I think the DHEA supplementation was a good idea with these results. Are you male or female? Depending, you may wish to consider a higher dose.

I was using a daily dose of cortisone cream, and 10mg DHEA, but I stopped when I got the protomyxzoa diagnosis, as I would had I been diagnosed with Lyme.
~Ema - do you have a personal recommendation on what form of T3 to try with?

Most people do best with brand name Cytomel or Cynomel (Mexican form that is OTC). Will your doctor work with you on this or will you be ordering it from overseas (where are you located)? I would definitely want to get adrenals and iron in order before starting any T3, but PM me if you need suggestions on sources.

 

[heapsreal]

with adrenal support can i just say i think its important for cfs/me people tp start this at very low doses and increase doses slowly as well. Best to get dhea up first and then to try and use pregnenolone for cortisol if cortisol is low, again use low doses and go slow. For both dhea and pregenolone a good starting dose is 5-10mg and increase in 5-10mg increments.

Just treating adrenals i have had increases in body temp but now that i have been stable on my adrenal supps, dhea 25mg and pregnenolone 50mg, this body temp is now low again. This morning my temp was 35.6. Sometimes during the day after i have taken my adrenal supps my body temp can go into the low 36s. So yes i am considering t3 trial.

cheers!!!

 

[nanonug]

My favorite for thyroid labs is directlabs.com which offers FT3, FT4, and TSH for $89 (no affiliation).

Just a quick note. I recently found LabsMD.com and this one generally has better prices than everybody else (maybe excluding lef.org for members). TSH, FT3 and FT4 can be had for $77.49 (also no affiliation but I have used them twice now.)

 

[Ema]

Just a quick note. I recently found LabsMD.com and this one generally has better prices than everybody else (maybe excluding lef.org for members). TSH, FT3 and FT4 can be had for $77.49 (also no affiliation but I have used them twice now.)

Great find! Thanks for sharing it with me...

 

[sianrecovery]

Hey Ema
Thats so helpful, thank you. I will get a repeat of the salivary cortisol/DHEA and try and get a doc to work with testing T3 and RT3. I read in Dr Peatfield's work that he rates the 24 urine collection thyroid test - do you have an opinion?
I was using 1mg of the 1mg/1% hydrocortisone. No one told me to stop, I just decided it might exacerbate trying to get on top of bacterial/protazoan issues. Interesing to hear your LLMD's view; maybe I will restart. I have never used isocort. I was taking DHEA 10mg, stopped at the same time.
I am female, 47, and in the perimenopause, anovulatory cycle. When I had the cortisol test done, I also tested progesterone and oestradiol via a Genova salivary test spread over a month. The results, in total,not detail, were:

Luteal Progestrone Output: 168.8 ref range: 600-1300 pg/ml
Total Oestradiol Output: 9.9 ref range 30 - 55 pg/ml
Progestrone: Oestradiol Ratio 39.4 ref range 10 - 4
Testoserone 42.2 RR 20 - 70

There were several more values, but those were the headlines - low low low. Ratio not too bad, but no peaks or surges. My doc reckons that taking female sex hormones is inherently immuno suppressive. My nutritionalist reckons having levels this low is immuno suppressive in itself. Either way, I havent done anything specific on hormones, other than the adrenal stuff. Would hypo thryoid function produce this effect on the sex hormones?

Thanks again xxxx

 

[Ema]

Thats so helpful, thank you. I will get a repeat of the salivary cortisol/DHEA and try and get a doc to work with testing T3 and RT3.

Make sure to ask for free T3/T4 and not totals...

I read in Dr Peatfield's work that he rates the 24 urine collection thyroid test - do you have an opinion?

I don't have much of an opinion. I know that FT3/FT4 can be tested in urine and some doctors may prefer this method for various reasons. I have only ever done serum tests and I like that because I can be consistent and measure frequently to compare results on different dosages.

It is very important in my opinion to be consistent about testing thyroid though. I always get my bloodwork done fasting at the same time in the morning prior to taking thyroid meds for the day. That way I eliminate as much variability as possible in my results and can compare apples to apples.

I was using 1mg of the 1mg/1% hydrocortisone. No one told me to stop, I just decided it might exacerbate trying to get on top of bacterial/protazoan issues. Interesing to hear your LLMD's view; maybe I will restart.

1/4 teaspoon of the 1% HC cream is roughly equal to 10 mg of hydrocortisone (provided the cream contained hydrocortisone). I recently learned that some hydrocortisone creams actually contain a form called cortisone acetate which is very short acting and not really suitable at all for treating adrenals.

I have never used isocort.

It's something to consider when you get your new test results back if the morning result is still so low.

I was taking DHEA 10mg, stopped at the same time.

I might consider starting this back up again if your results are still low.

I am female, 47, and in the perimenopause, anovulatory cycle. When I had the cortisol test done, I also tested progesterone and oestradiol via a Genova salivary test spread over a month. The results, in total,not detail, were:

Luteal Progestrone Output: 168.8 ref range: 600-1300 pg/ml
Total Oestradiol Output: 9.9 ref range 30 - 55 pg/ml
Progestrone: Oestradiol Ratio 39.4 ref range 10 - 4
Testoserone 42.2 RR 20 - 70

Ouch! Those are dreadful indeed! Please tell me you are supplementing these as well...

Have you tested FSH and LH on approx day 3 of your cycle recently?

My doc reckons that taking female sex hormones is inherently immuno suppressive. My nutritionalist reckons having levels this low is immuno suppressive in itself.

That makes no sense! I'd listen to your nutritionalist. If women with "normal" levels of hormones were all immunosuppressed, everyone would be ill! Estrogen and progesterone serve many important, heart and cancer protective/preventative measures in women. If anyone would like to hear my "estrogen is not evil like big pharma has made it out to be" speech, I'll be happy to start a new post...but here is a good place to start:

http://drhurlock.com/docs/The_Truth_About_Estrogen_A_Summary.pdf

Would hypo thryoid function produce this effect on the sex hormones?

Probably not directly though low adrenal function can hamper sex hormone production. Cortisol is vital to life while sex hormones are not so they will always get preferential treatment in the conversion pathways from cholesterol. And the whole endocrine system needs to be balanced together.

If it were me, I would do a bit of re-testing, work on the adrenals and supplementing sex hormones and then start adding in thyroid as those become more solid. I think there is a lot of room for improvement here that would help with symptoms dramatically.

 

[Aiming for Healthy]

I have been tested and was diagnosed with high RT3. I was (since last August) on T3 medication and had increased it 75mcg per day. A couple of months ago my T3 levels were tested and they were substantially elevated forcing my doctor to have me slowly decrease my T3. At the same time he also diagnosed me with a partially blocked methylation cycle at which time I started taking glutathione, Enadh and other supplements with the intent of me gradually working up towards Rich protocol. While on T3 I had brief glimpses of feeling better that would last a day or two after some of the medication increases. I was very concerned that decreasing the T3 was a bad idea.... worried that any possible gains I may have made would be gone.

Well in the last few weeks I have been feeling better (most of the time) than I have in years, I am not as cold anymore (I am bad and haven't taken my temperature in a long time) and my energy levels are much better (not as many naps and crashes)

My doctor thought that if we could repair the methylation cycle it would also help repair the thyroid, stating that they go hand in hand.

This journey has been very confusing

 

[sianrecovery]

It IS confusing. Thanks again Ema - I will spend some of today looking at the links you posted. I am not supplementing the sex hormones, because 1) the doc said they were immuno-suppressive 2) I dont know where to start....I'm in the UK where the curent paradigm with low females hormones is grin and bear it. I know I can relatively easily get progestrone cream - if I take that, will it make the oestrogen deficit worse? Does your LLMD have a view on sex hormones and chronic bacterial infection?