I started taking less T4 and I tanked my Reverse T3 (RT3) below detectable levels

[tastyfood]

I've always had pretty "good" RT3 results despite taking north of 100 mcg of T4 per day. The range is 9.2-24.1 ng/dL. I've had results as low a 7.4 while taking this much T4 (about 125mcg per day), and it typically coincided with lower cortisol results.

So, this time, I had been experimenting with a 1:1 T4 to T3 ratio. I lowed my T4 consumption per day to 50 mcg of T4 per day. Well, my reverse T3 results were not only below the range, but below what the lab can show a result for. The result was <5. I also got the lowest cortisol AM result I've ever gotten, and some pituitary hormones were also lower than before.

I am starting to wonder if the high T4 supplementation was causing stress on my body and especially on my liver.

I am still not sure if reverse T3 has any beneficial function, or if it's "better" to have it suppressed.

 

[Hans]

I've always had pretty "good" RT3 results despite taking north of 100 mcg of T4 per day. The range is 9.2-24.1 ng/dL. I've had results as low a 7.4 while taking this much T4 (about 125mcg per day), and it typically coincided with lower cortisol results.

So, this time, I had been experimenting with a 1:1 T4 to T3 ratio. I lowed my T4 consumption per day to 50 mcg of T4 per day. Well, my reverse T3 results were not only below the range, but below what the lab can show a result for. The result was <5. I also got the lowest cortisol AM result I've ever gotten, and some pituitary hormones were also lower than before.

I am starting to wonder if the high T4 supplementation was causing stress on my body and especially on my liver.

I am still not sure if reverse T3 has any beneficial function, or if it's "better" to have it suppressed.

Makes sense since rT3 is created from T4. Less T4 can lead to less rT3. Plus, now you're taking T3 as well, which gives you more of the "benefits" of T4.

Are you experiencing hyperthyroid symptoms? If not, I wouldn't worry about the rT3. And if you were, I'd just lower the T3 dose.

 

[JudiBlueHen]

I've always had pretty "good" RT3 results despite taking north of 100 mcg of T4 per day. The range is 9.2-24.1 ng/dL. I've had results as low a 7.4 while taking this much T4 (about 125mcg per day), and it typically coincided with lower cortisol results.

So, this time, I had been experimenting with a 1:1 T4 to T3 ratio. I lowed my T4 consumption per day to 50 mcg of T4 per day. Well, my reverse T3 results were not only below the range, but below what the lab can show a result for. The result was <5. I also got the lowest cortisol AM result I've ever gotten, and some pituitary hormones were also lower than before.

I am starting to wonder if the high T4 supplementation was causing stress on my body and especially on my liver.

I am still not sure if reverse T3 has any beneficial function, or if it's "better" to have it suppressed.

Just curious - if you are willing to answer - why were you taking so much T4? Reason I ask, is that my sister had a thyroidectomy and only took 87-112mg depending on labs. I went with her to her endocrinologist and he was testing her regularly.

 

[tastyfood]

Just curious - if you are willing to answer - why were you taking so much T4? Reason I ask, is that my sister had a thyroidectomy and only took 87-112mg depending on labs. I went with her to her endocrinologist and he was testing her regularly.

Good question. Your comment is really on point. I have to question why I have been taking so much because I never had a doctor recommend more than than 125 mcg of T4 for my situation.

This is more of my story:

I have been tritating the dose for the last 8 years. Hospital endocrinologists put me on T4 only the moment they saw my high TSH at the time, and they kept increasing my dose. This is an experience many men (like me) and women have with endocrinologists. At the time I was recommended to take 75mcg at the start, and the recommendation went up to 125mcg when I expressed that I wasn't improving. Of course, things only got worse with more T4 like many of us know.

I then learned about the T4/T3 combination, which I have been on for about 7 years, but it took me another few years to understand that a lower ratio could be beneficial. I think that, like many, I was stuck with the concept that I need that much extra T4 otherwise I'll have hypothyroid symptoms. Recently, I started to suspect that much T4 was putting a strain on my liver, which has to convert it all to something.

In the podcast with Danny Roddy and Keith Littlewood, they mentioned that idea of supplemental T4 being tough on the liver.

Now that I take less T4, my labs are starting to show "low" total T4 and free T4, although my TSH and T3 are good, so it looks like it's something I shouldn't worry about. Like I said in the title of this post, my RT3 is also tanked.

 

[JudiBlueHen]

Another question - not trying to be nosy! But wondering how high your TSH was.
I took 25-50mcg T4 for many years, and although I am likely hypothyroid, I have only been treated by PCP. I stopped the T4 for a while and my TSH peaked at 12.x. So the PCP put me back on 50mcg T4. That took TSH back to 2.5-4.0 range, but I really wasn't feeling any better.
Due to more knowledge about the potential harms of too much T4 supplementation, I have cut back to 25mcg, and I still don't feel any different. I don't really know if it is necessary at all.

 

[tastyfood]

My TSH was about 8 when I was first diagnosed in my mid twenties. It's been suppressed for years thanks to a combination of T4 and T3.

 

[Nebula]

Good question. Your comment is really on point. I have to question why I have been taking so much because I never had a doctor recommend more than than 125 mcg of T4 for my situation.

This is more of my story:

I have been tritating the dose for the last 8 years. Hospital endocrinologists put me on T4 only the moment they saw my high TSH at the time, and they kept increasing my dose. This is an experience many men (like me) and women have with endocrinologists. At the time I was recommended to take 75mcg at the start, and the recommendation went up to 125mcg when I expressed that I wasn't improving. Of course, things only got worse with more T4 like many of us know.

I then learned about the T4/T3 combination, which I have been on for about 7 years, but it took me another few years to understand that a lower ratio could be beneficial. I think that, like many, I was stuck with the concept that I need that much extra T4 otherwise I'll have hypothyroid symptoms. Recently, I started to suspect that much T4 was putting a strain on my liver, which has to convert it all to something.

In the podcast with Danny Roddy and Keith Littlewood, they mentioned that idea of supplemental T4 being tough on the liver.

Now that I take less T4, my labs are starting to show "low" total T4 and free T4, although my TSH and T3 are good, so it looks like it's something I shouldn't worry about. Like I said in the title of this post, my RT3 is also tanked.

What kind of dosing schedule have you found best for T4 and T3? Both at the same time, T3 spread throughout the day or some other way?

 

[tastyfood]

What kind of dosing schedule have you found best for T4 and T3? Both at the same time, T3 spread throughout the day or some other way?

Nothing different than what's discussed in the forum often. No more than 10mcg of t3 each time, always with food, spaced out a few hours. T4 at night, and also in the morning depending on dose.

 

[Jkbp]

Nothing different than what's discussed in the forum often. No more than 10mcg of t3 each time, always with food, spaced out a few hours. T4 at night, and also in the morning depending on dose.

Interesting that you take your T4 at night. I would think it would keep you awake?
Based on your current dose, what amount are you taking at night and what amount are you taking in the morning? Also, how long were you on this new lower amount of T4 before your blood results showed a higher tsh? Asking because I have also been suppressing my thyroid over the last decade, taking a very high amount of T4, and also T3. I have been titrating down over the last year and a half and I’m now at 150 MCG of T4 and 5 of T3. My blood tests still show my TSH <1. Are you taking supplements for your liver? If so, which supplements? Thanks!

 

[tastyfood]

Are you taking supplements for your liver? If so, which supplements? Thanks!

Everything is changing all the time in terms of what I'm doing. I am not taking anything at the moment. Trying to stay off supplements. I'd recommend you go through my posts for previous history.

what amount are you taking at night and what amount are you taking in the morning?

I'm at 50 mcg per day, split in two morning and night.

 

[JudiBlueHen]

There were some studies from years ago that I can't locate at the moment (Pubmed) that showed that taking T4 at night was equally effective as taken in the morning 20 minutes before eating. I started taking it at night years ago. Also I recall Ray Peat in an article suggested it was better to suppress TSH at night. If I find the reference I will edit this comment.

 

[sunny]

"“The metabolic rhythm should correspond to the light-dark rhythm, because darkness is a basic biological stress, and sleep is protective against the stress of darkness. Since TSH has many maladaptive effects, and rises along with prolactin and cortisol during the night, some thyroid taken at bedtime helps to reduce the stress, moderating the TSH rise while keeping the blood sugar from falling too fast. Ice cream (i.e., sugar and fat with a little protein) at bedtime has a similar effect, reducing the rise of adrenaline, cortisol, etc., with the result that the morning cortisol peak will be lower, preferably below the middle of the common range, and then it should decline in the afternoon.”

Inflammatory TSH – Functional Performance Systems (FPS)

Thyroid: Therapies, Confusion, and Fraud

Ray Peat

raypeat.com

View: https://m.youtube.com/watch?v=v9GqRNO0loc

 

[JudiBlueHen]

"“The metabolic rhythm should correspond to the light-dark rhythm, because darkness is a basic biological stress, and sleep is protective against the stress of darkness. Since TSH has many maladaptive effects, and rises along with prolactin and cortisol during the night, some thyroid taken at bedtime helps to reduce the stress, moderating the TSH rise while keeping the blood sugar from falling too fast. Ice cream (i.e., sugar and fat with a little protein) at bedtime has a similar effect, reducing the rise of adrenaline, cortisol, etc., with the result that the morning cortisol peak will be lower, preferably below the middle of the common range, and then it should decline in the afternoon.”

Inflammatory TSH – Functional Performance Systems (FPS)

Thyroid: Therapies, Confusion, and Fraud

Ray Peat

raypeat.com

View: https://m.youtube.com/watch?v=v9GqRNO0loc

Yes that is the Ray Peat quote I was thinking of - thanks!
It also reminds me why a little ice cream at bedtime is so comforting for me. I don't even have to feel guilty.

 

[FitnessMike]

Now that I take less T4, my labs are starting to show "low" total T4 and free T4, although my TSH and T3 are good, so it looks like it's something I shouldn't worry about. Like I said in the title of this post, my RT3 is also tanked.

Porcine NDT which is meant to be roughly 1:4 t3:t4, drove my ft3 high but ft4/total t4 became low as in your case, the only problem is that it made me feel symptomatic again, so it feels that you need optimal t3 as well as t4/ft4.

Adding t4 as very tricky if you have a history of high rt3 as i do, i think i need to start very slow with t4.