My reverse T3 is 'normal' so why I am still hypothyroid?


Feb 9, 2013
I had a reverse T3 test done and my doctor's office called me this morning to say the results were normal and "not high" (they wouldn't give me the exact numbers yet).

I am so surprised as I was sure that was my problem.

Background: I was taking T4 for a long time before I switched to NDT at the beginning of this year, gradually increasing to the point where I am now at double the T4 I was taking before.

Previously: 85mcg T4 + 8mcg T3 (11:1 ratio)
Now: 158mcg T4 and 36mcg T3 (4:1 ratio)

I felt really good as I increased the dose (4.5 grains now) but in the last few months it seems I have hit a wall where I still have hypothyroid symptoms that are not getting any better such as low temperatures (never above 36.4 on waking), peeling nails, etc... and then NEW hypo symptoms such as allergies that weren't a problem before. In the meantime I have "hyper" numbers:
TSH 0.01
T4 26
T3 9.5

My theory was that the T3 made me feel good initially but that the doubling of the T4 gradually built up to the point where it's blocking T3 receptors and I'm getting more hypo again. But, this isn't showing up in the bloodwork.

Does anyone have any ideas for what might be going on? Is it just a matter of self-experimentation and lowering the ratio to 3:1 or 2:1? I'm totally on my own now as my doctor said to go see an ND and refuses to prescribe me T3.


This is guessing on my end on things you could do:

Use some T3-only pill in addition to ERFA.
Supplement pregnenolone to see if there is a problem in conversion from cholesterol to steroids.


Dec 31, 2012
Paul Robinson discusses the effect of low/suppressed TSH on T4 to T3 conversion. This may apply to you. I got the same feeling increasing my doses. Felt good for a while, then got hypo symptoms again.


Feb 20, 2013
Do you know your cholesterol level? RP thinks one has to have normal
level of cholesterol before starting thyroid supplement.
Body makes protective hormones from cholesterol with the help
of vitamin A and thyroid. Have you talked to RP about your abnormal
T3, T4 and reverse T3 level? Your numbers are quite unusual.
It is more useful to measure all the thyroid test at the same time.
T3 and reverse T3 level changes quickly. How is your temp and pulse?


Sep 19, 2013
I wouldn't put too much stock into the labs if I were you. Did you also by chance take any thyroid the day of the tests (before)? My labs have looked great a few times, and RP said it doesn't matter. Temps and pulse over-ride it all pretty much. If you feel better on more T3, I would follow that.


Thread starter
Feb 9, 2013
Thanks everyone. It does appear that more T3 and less T4 is the next step, as suspected.

J., is there any dosage guideline on pregnenolone? I take around 90mg daily but never noticed anything from it either way.

ttramone, I believe you shared that link with me before - I'm a bit slow, on a second read it seems to make more sense to me now - haha :) Did you show that to your doctor and does he/she agree with the theory? I'm having a very hard time with mine since my labs just say I'm hyper in all 3 measurements... she wants to reduce dose full stop, no discussion. She told me on Friday to go see an ND, ugh.

Mittir I don't know my cholesterol. I think I will email Ray Peat with my numbers once I get the rT3 result tomorrow (they wouldn't give it over the phone). I know ideally the complete thyroid panel should have been done all at once, but the rT3 was a paid test I had to go back for... I did them at the same time of day (3pm). My MD said it didn't matter if I took meds beforehand or not so I believe the T3/T4/TSH was without having any meds that day, whereas the rT3 was with meds. Hopefully that doesn't skew the results completely. I know I definitely feel more stressed when I don't take any thyroid until that time.

My pulse is usually 70s. My temperature on the 1st few days of menstruation (when Broda Barnes says to measure) has been quite low, 36.2. Rest of the month around 36.4.

iLoveSugar, yes I know the labs can't be right as I would be losing weight and sweating all the time if I really were hyperthyroid. And my numbers were perfect when I was very hypo before. The main problem is my MD controls the prescriptions and I don't live in the US where it's legal to order your own meds.
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