Reverse T3, or rT3 - Understanding The Role This Thyroid Hormone Plays In Hypothyroidism

So, what is reverse T3, and what causes it? There's no quick, simple answer to this question, but let's explore the various layers to this important issue, and how it plays a critical role in hypothyroidism.

Firstly, some degree of rT3 production within our bodies is normal. However, as with every biological system... it’s all about things remaining in balance – or what science calls 'homeostasis'.

Hypothyroidism Is So Much More Than Just A 'Weak Thyroid Gland'

As has already been touched on earlier, one issue that can occur in those presenting with hypothyroidism symptoms is a problem with converting free T4 to free T3.

A range of factors, such as:

• chronic stress (due to severe burns, surgery, prolonged hypothermia, etc.)
• increased free radical exposure
• lack of adequate amounts of dietary antioxidants
• chronic alcohol or other drug abuse
• undue mental or emotional challenges
• excessively low calorie diets or fasts
• liver and kidney disease
• toxic heavy metal exposures
• insulin dependent diabetes
• and even aging itself...

...these can all result in a decreased amount of T4 production from the thyroid gland. This means there is less to convert to the active T3 format of this thyroid hormone.

The Role Of Stress In Creating rT3

Simultaneously, sources of stress - as mentioned above - can create higher levels of cortisol within our bodies, which tends to further inhibit the conversion of T4 to T3.

In fact, aside from inhibiting T4 to T3 conversion, these higher levels of cortisol also have a distorting effect on such conversion, causing the T4 to go into reverse T3 instead... which alas, then competes with normal T3 (triiodothyronine) at the receptor sites.

All these factors add up to there being less of the active form of thyroid hormone, T3, with which to drive out metabolic functions

Again, keep in mind that as a 'mirror molecule' of normal T3, reverse T3 is intrinsically inactive, because it docks onto receptor sites in an upside-down fashion. This in turn prevents proper activation of that receptor site, and only serves to block such sites; it does not activate them.

The more that we are bombarded by a range of constant stressors, so too do we generate ever more amounts of reverse T3, which ends up sabotaging normal metabolic function on a cellular level, causing a drop in basal metabolic rate.

The Role Of Dieting In Creating rT3

Another common factor, especially in the obese populations of the West, is doing too many diets, or being on too restrictive a diet. When the body goes into a fasting mode, it's response is to slow down the metabolic rate in order to conserve whatever little energy intake the body has access to.

Want To Skip Ahead In This 'Reverse T3' Discussion?

The following discourse will obviously flow more logically if you read it as it unfolds below, however, if you're in a hurry and wish to focus on one specific point initially, then simply click on any of the links in the blue box below in order to jump ahead.

Putting It Altogether In Regard To Diagnosing A rT3 Problem
The Basal Body Temperature Test
Ferritin (Iron) Levels, rT3 & Hypothyroidism
How Lack Of Stomach Acid Can Affect Thyroid Function
Additional Tests To Diagnose Thyroid Disorders
The Value Of Using rT3 As A More Viable Alternative Test
TSH/T4 Tests Lack Credibility For Measuring Effectiveness Of Thyroid Drug Therapy
So, What Is This 'rT3 Ratio'?
'Connecting The Dots' Between Adrenal Function & Thyroid Function
Just Because Medicine Doesn't Recognize A Syndrome Doesn't Mean it Isn't Real
Adrenal Depletion Goes Through Several Phases
The 3 a.m. 'Wide Awake' Phenomenon Explained
Chronic Stress Can Also Have Serious Repercussions On Your Nervous System
The Need To Equally Treat Thyroid, Liver & Adrenals Simultaneously
Drugs Can Also Deviate T4 to rT3 Conversion
How rT3 Can Act As Metabolic 'Brakes'
rT3 Can Get Entangled In A T3 Blood Test Result, Skewing Results
The Impish Role of rT3
rT3 Also Affects The Further Conversion Of T3 To T2
Why Then Does The Body Produce rT3?
How To Treat rT3
Detoxing In Modern Times Can Be Dangerous
Treating Excess Reverse T3 With Synthetic T3 Supplementation Is Tricky
Deal With Core Issues Driving rT3 Problems Before Using T3 Therapy


Putting It Altogether In Regard To Diagnosing A Reverse T3 Problem

One important factor which should alert a therapist to the possibility of their patient having a high reverse T3 problem is that they are not responding as well as they should to 'normal hypothyroidism treatment'. This is termed 'thyroid resistance', and a high reverse T3 level is a common cause of such resistance, yet mostly goes unrecognized by medicine.

Patients may have been put onto some sort of synthetic T4 supplementation (e.g. Oroxine, Thyroxine, Synthroid, Levoxyl, etc.), and despite their blood tests looking relatively 'normal', nevertheless, that person just isn't picking up. In fact, they may even be feeling worse on the treatment.

The Basal Body Temperature Test

If this is the case, then ensure that a Basal Body Temperature Test is done. If this is low, it strongly suggests that overall, systemic thyroid function is not working.

Remember, one major role of the thyroid gland is to regulate body temperature, so it is a really good end-point from which to judge how functional the thyroid is; not just relying on how much hormone is floating around the body.

Ferritin (Iron) Levels, rT3 & Hypothyroidism

Relatively low Ferritin, or low B12 levels are another 'red light' – along with a strong list of hypothyroidism symptoms - suggesting the possibility that abnormally high reverse T3 levels are the source of the problem.

Ferritin is a protein, which the body uses to store iron for future usage. It's a useful test to do, as ferritin levels correlate to how much iron is in your body.

However, such storage can be affected by conditions such as anemia due to poor iron intake from the diet; lack of iron absorption from the intestines (despite adequate dietary intake), or due to health issues such as liver disease.

Various studies have also shown a correlation between hypothyroidism and a reduced level of ferritin. One such study was published in the 2002, 'International Journal for Vitamin and Nutritional Research', which showed a connection between iron deficiency and goiter (goitre) in Iranian children.

Goiter is also strongly associated with hypothyroidism and thyroid disease. Therefore, iodine is by no means the only critical mineral needed for healthy thyroid function.


How Lack Of Stomach Acid Can Affect Thyroid Function

It's important to understand the connection between healthy hydrochloric acid production in the stomach, and the impact this has on nutrient absorption from our food. Many people with hypothyroidism don't produce enough hydrochloric acid in the stomach, which in turn can cause a wide range of nutrient deficiencies – including iron.

The problem is that a lack of iron hampers the primary production of T4 and T3 by reducing the activity of the enzyme 'thyroid peroxidase', or TPO. This enzyme is involved in the addition of iodine to tyrosine, and thus the manufacture of these two fundamental thyroid hormones.

Further, iron - like selenium, zinc, iodine, copper, B6, B12, tyrosine and vitamin D – is an essential co-factor for allowing the 5-deiodinase enzyme to do its job of converting T4 to T3 – the inactive to the active form of thyroid hormone.

Perhaps it's becoming clear why, in the diagnosis of hypothyroidism, especially in regard to the role that reverse T3 may be playing, it's important to not just go by one parameter, but instead use a range of yard-sticks by which to deduct a reverse T3 problem.

As an aside, it's worth noting that anyone who has treatment-resistant anemia should be investigated for hypothyroidism; not just given higher and higher levels of iron supplementation.

Additional Tests To Diagnose Thyroid Disorders

We've already looked at some of the limitations associated with the routine blood tests presently used by most doctors and endocrinologists in order to diagnose thyroid disorders.

It's now time to look at an extra way in which such routine thyroid labs can be complemented, and thus allow for a more accurate and comprehensive diagnosis of hypothyroidism – an important health condition which is too often missed because of the way present lab blood tests are carried out, and interpreted.

Hypothyroidism, also called hypothyroidism type 2, or subclinical hypothyroidism can be quite invisible if the routine blood tests are all that's used, or such tests are interpreted in too narrow a fashion.


The Value Of Using rT3 As A More Viable Alternative Test

However, there is a way to dispel that seeming invisibility by doing an important additional blood lab test, which is to measuring reverse T3 levels (rT3). This thyroid test already exists, and is normally available from most pathology laboratories.

Unfortunately, despite this being the best thyroid test for better understanding what's driving a person's hypothyroidism symptoms, at present this is also one of the blood tests that most doctors haven't even heard of, nor does the Australian Medicare system rebate on this test, which can therefore costs the consumer an average of $60 or so.

Why then would you consider doing this specific thyroid blood test for reverse T3? How and why would this test provide any greater relevance for better diagnosing hypothyroidism?

One good reason is that from the many types of blood tests used for gauging thyroid function, the value of using the T3 and the reverse T3 results – especially when presented as a ratio - is in fact confirmed by studies.

This is acknowledged by the 'Journal of Clinical Endocrinology & Metabolism' as: (ref.1) 'the T3/rT3 Ratio is the most useful marker for tissue hypothyroidism and as a marker of diminished cellular functioning'. (emphasis added). That statement says it all, and couldn't be more clear!

It highlights the reality that solely using TSH and T4 as markers for hypothyroidism is seriously ineffective, because they are incapable of picking up on how effective - metabolically - those hormones are on a tissue or cellular level.

Therefore, solely using the TSH/T4 tests causes many people with definite hypothyroidism to remain undetected - if these blood tests are the only diagnostic parameters used.

TSH/T4 Tests Lack Credibility For Measuring Effectiveness Of Thyroid Drug Therapy

Equally, using serum TSH and T4 levels as a way of gauging whether a patient is on enough thyroid hormone replacement medications, such as Oroxine, Thyroxine, Synthroid or Levoxyl, is also a seriously defective way of determining treatment efficacy.

Again, these above points are vindicated by other sources too; for example, as stated by the Holtorf Medical Group, Inc. (ref.2) : 'This study (mentioned above) demonstrates that TSH and T4 levels are poor measures of tissue thyroid levels. TSH and T4 levels should not be relied upon to determine the tissue thyroid levels, and that the best estimate of the tissue thyroid effect is rT3 and the T3/rT3 ratio.' (emphasis added)


So, What Is This 'Reverse T3 Ratio'?

Because reverse T3 and normal T3 amounts can vary from test to test and from lab to lab, a more accurate method of determining whether reverse T3 is a problem is to work out the ratio between these two readings, called the 'Reverse T3 Ratio'.

This is done by dividing the FT3 (free T3) result obtained from one's blood test, by the reverse T3 amount, which should give a figure of greater than 20. If that ratio is lower than 20, this can indicate that rT3 is a major component to one's hypothyroidism, or why 'normal' hypothyroidism treatment is not working as it should, due to thyroid resistance.

One final point to keep in mind is that when working out this ratio, the figures used need to be from blood tests that were both done on the same day. They also need to be in the same units of measurement.

If you'd like to give yourself an instant headache, or feel like you're going bonkers... then try and find a standardized reference range for thyroid blood tests!

Unfortunately, despite constant assertions by medicine that it is so scientific and standardized... it's anything but! Alas, pathology labs all seem to have their own 'normal ranges', or provide figures that don't match with how other labs present their findings.

Hence, to untangle this mess of supposed 'standardization', one needs to do a few mathematical tricks in order to work out the correct ratio result, using the figures your particular lab may have presented you with.

But even then, be forewarned that it may still not be possible to use your particular lab blood tests effectively. The formulas for trying to obtain a rT3 Ratio are discussed in another section on this site: ''. If you'd like to work out your rT3 Ratio, please click here.

'Connecting The Dots' Between Adrenal Function & Thyroid Function

Let's now look at another important layer to the overall phenomenon of hypothyroidism, and how reverse T3 can play an integral role in its manifestation.

When we are stressed – mentally, emotionally or physically – the adrenals are called upon to produce more stress hormones – cortisol and adrenalin being the two major ones of concern here. Noradrenalin, growth hormone and glucagon are the other stress hormones.

Having high levels of cortisol and adrenalin within your system, over short spans of time, with adequate rest periods in between is O.K.

However, when the stress is more relentless, the excessive demands on the adrenals can result in them becoming depleted, causing a condition termed 'adrenal fatigue', or subclinical hypoadrenalism. Unfortunately, although this is a genuine condition, it's nevertheless not yet fully accepted by medicine.


Just Because Medicine Doesn't Recognize A Syndrome Doesn't Mean it Isn't Real

However, keep in mind that for many years medicine equally denied that PMS (PMT), or chronic fatigue syndrome were real health issues. In those days, anyone presenting with symptoms of these conditions was either ignored by doctors or classified as a hypochondriac.

However, once science finally decided to research these health phenomenon, it became clear that what patients had been saying all along was real, and not some fabrication from a fevered imagination, or due to a case of hypochondria!

Eventually, medicine will recognize this 'grey zone' of underfunctioning (versus malfunctioning) adrenals as a real cause to a wide range of very real symptoms too.

Adrenal Depletion Goes Through Several Phases

As the adrenals go into the first stage of having to cope with excessive stress demands, you can initially experience a phase of too much cortisol in the body, which causes its own range of problems, such as:

• decreased immune function
• syndrome-X or insulin resistance (a precursor to diabetes type II)
• poor mental functioning – 'foggy-headedness', poor recall/memory
• anxiety, paranoia or depression
• fatigue and weakness, to the point of 'chronic fatigue syndrome'
• hypoglycemia – or poor blood sugar control, in turn causing irritability, tiredness, weakness, poor mental functioning; fainting; ravenous hunger
• irregular menstrual cycles or infertility
• low libido in men
• excessive hair growth in women – hirsuitism
• muscle pains (often people with fibromyalgia have hypothyroidism as a major component to their syndrome)

Eventually, as the chronic stress continues, the adrenals become increasingly fatigued or depleted, causing people to go into a rather 'wobbly phase' - from a symptom perspective. Here, you can experience bouts of either too high or too low cortisol, further adding to a confusing range of symptoms.

Then comes a stage, once the adrenals have truly been constantly stressed for a long time, where a chronically lower than normal level of cortisol occurs, causing such symptoms as:

• chronic exhaustion
• weight gain
• persistent anxiety or a tendency to panic attacks
• difficulty handling lots of noise or bright lights
• problems coping with life situations
• experiencing nausea for no apparent reason
• sweet and/or salt cravings
• paranoia, depression, and more
• low libido
• immune function problems, such as frequent infections, colds & flu, etc.


The 3 a.m. 'Wide Awake' Phenomenon Explained

Insomnia can become a persistent, yet little understood component of adrenal exhaustion. In healthy people, around 3 a.m. in the morning is that time of night when the body normally experiences its lowest level of blood glucose and cortisol levels.

However, for those suffering from adrenal depletion, or exhaustion, this 3 a.m. low point in glucose and cortisol levels is accentuated, often dropping the amounts of these necessary substances to far below normal.

This can result in you waking up ravenously hungry, due to your system having gone into a hypoglycemic nose-dive – low blood sugar crisis. This in turn is registered by your various 'on-board control systems' (homeostatic mechanisms) as somewhat of an emergency, causing your body to respond via a huge squirt of adrenalin into the bloodstream in an effort to raise glucose levels - necessary for brain and every other bodily function.

However, that squirt of extra adrenalin can also cause a case of 'the jitters', and a racing mind. So much for any further sleep! Think back to an example of where you may have been involved in a narrow escape from a car accident.

Do you remember how shaky and sweaty you probably felt within a few moments of having – hopefully! - avoided that accident? Those body symptoms were precisely created by the huge surge of adrenalin your adrenals dumped into your bloodstream, in order to get you physiologically ready to deal with an emergency.

A similar situation occurs when your blood sugars drop far too low, as this is also seen as an emergency by your body.

The best thing to do at this point is to get up and make yourself a snack; preferably some complex carbohydrate with protein. For example, a piece of wholemeal toast with cheese, peanut or other 'nut butters', or some cold meat.

Very often, within 10 – 30 minutes of such a snack, your jitteriness and racing mind will settle, and usually you'll find you can get back to a few more hours of sleep before the day begins.

By the way, this tendency to awaken at about 3 a.m. - if you do have adrenal exhaustion - can be worsened by having a too-early evening meal, especially if it was high in carbs, or you had a lot of sugary dessert afterwards.

Chronic Stress Can Also Have Serious Repercussions On Your Nervous System

Another phenomenon that can occur under conditions of chronic stress is that the sympathetic nervous system - SNS - (the 'fight of flight' response) gets 'stuck', as it were, in a state of over-drive, in turn causing it to become chronically over-stimulated.

This causes its own swathe of symptoms, including:

• worsening of anxiety, nervousness, racing mind and insomnia
• breathlessness
• tremors
• palpitations
• poor digestion capacity due to decreased production of hydrochloric acid in the stomach
• subsequently, this can cause a range of gut-related symptoms, such as bloating, gas, reflux (the latter is often not due to excess stomach acid at all!), burping, colic, 'irritable bowel', poor gut ecology, lack of nutrient absorption, etc.
• allergies – due to a skewing of the immune system towards an excessive TH2 (antibody production) format
• hypoglycemia – low blood sugar
• menstrual problems, including exacerbated menopausal symptoms

The sad reality is that once again, at present (July 2012) most doctors, including endocrine specialists, don't recognize this very real, interim adrenal-exhaustion phase, as the adrenals slide further and further towards full-blown adrenal failure, or Addison's disease. Only the latter is presently recognized and treated.

Eventually, if the stress remains a constant feature of your life, the adrenals go into this final 'Addison's Disease' phase. Here, the adrenals are well and truly depleted, and become incapable of producing adequate amounts of cortisol when stressful situations arise. This end stage can become a life-threatening situation if not picked up diagnostically and subsequently treated.

Unfortunately, stress is still a much underestimated factor within many health issues of our modern era; especially the effects of stress as they relate to earlier stages of health decline, but before they reach that more visible end-stage of malfunction. Presently, medicine tends to only validate stress when it is associated with these far more advanced, end-stages of disease.


The Need To Equally Treat Thyroid, Liver & Adrenals Simultaneously

When wanting to successfully deal with hypothyroidism, it's important to simultaneously look for, as well as effectively treat adrenal depletion too. If this is not done, then a person can feel a lot worse upon instigating thyroid treatment.

In fact, there is a third component to successful hypothyroid management, which involves an equally crucial need to also ensure that liver function is at an optimal level.

And don't go by the supposed LFT or 'liver function test' results; they will invariably be 'normal'. This test is a misnomer, as it does not measure function at all, but only indicates how damaged a liver may be – a completely different issue!

In regard to thyroid function, remember that the liver plays an important role in converting the relatively inactive T4 into the far more active T3 thyroid hormone.

Think of a rocket with 3 powerful engines. If only one of those engines is fired up on launching, there is no way that rocket will take off in a straight trajectory. All three engines need to be firing equally for that rocket to have a successful launch, and get into space.

So too with when treating hypothyroidism. It's just as crucial to ensure that the three 'engines' of thyroid, adrenals and liver are all working optimally, and in a coordinated manner.

If this is not achieved, the person can feel quite 'wonky' upon instigating any thyroid treatment, which, despite being completely indicated and correct, is nevertheless being given without due consideration to also making sure the adrenals and liver are equally considered in the treatment equation – and treated concurrently!

Drugs Can Also Deviate T4 to Reverse T3 Conversion

Certain drugs can also augment an abnormal deviation towards increased reverse T3 formation, or decreased levels of free T3, with examples including:

• Betablockers
• Certain radiographic dyes
• Dexamethasone (it's one of the steroids and can block the conversion of T4 to T3, as well as decreasing how much TSH – (thyroid stimulating hormone) - the pituitary can produce)
• Amiodarone ('Aratac', 'Cardinorm', 'Cordorone')
• Lithium (blocks the thyroid from using iodine, as well as being able to secrete thyroid hormone – ever wonder why so many people on lithium become overweight?)
• Aspirin – one study (ref.3) showed that it can cause low levels of TSH, T4 and T3. This alone, (aside from the very real potential for intestinal bleeding!) should sound alarm bells for the many people who have been put onto chronic, low dose aspirin for cardiovascular reasons.


How rT3 Can Act As Metabolic 'Brakes'

Remember, normally the body converts T4 (mostly inactive) to the more active T3, but one way in which the body maintains a balanced level of T4, without ending up making too much T3 is by having the liver convert excess T4 to rT3 – which is inactive.

By having extra reverse T3 in the system, this blocks many of the receptor sites on cell membranes, preventing the active T3 from docking and triggering biochemical processes.

In this way, various feed-back loops cause the reverse T3 to act like a brake within the 'metabolic machine', with this process being invoked whenever the system generally senses that there is a need to conserve energy. Remember, energy is one of the major byproducts of thyroid function.

For instance, the body may feel it needs to do this if we are starving (or dieting!!), with not enough 'fuel' coming into the body to meet the system's energy demands.

rT3 Can Get Entangled In A T3 Blood Test Result, Skewing Results

Another problem associated with reverse T3 is that when a regular Free T3 test is done, this test automatically measures and includes levels of its mirror-opposite molecule, reverse T3!

This reality is generally not known by many doctors. In other words, any regular Free T3 test is a measure of both Free T3 and reverse T3 - but without differentiating how much of each contributes to that final result.

Yet again, the point needs to be strongly made that reverse T3 is not physiologically active, and hence its inclusion in the overall Free T3 findings can lead to doctors making quite an exaggerated over-estimation of expected biological activity from such FT3 blood results.

In other words, the doctor will look at that T3 test result and conclude that there is sufficient of this hormone floating around in that patient's system... so a genuine, systemically underactive thyroid won't be suspected – let alone treated.

Hence, reverse T3 presents us with at least two serious consequences:

• Firstly, any rT3 unintentionally – and usually unknowingly! - included in a Free T3 blood results, does skew this result.
• Secondly, rT3 also blocks regular and hormonally active T3 molecules from docking – and activating – their respective receptor sites on cell and nuclear membranes. When this occurs to an excessive degree, it can have the sort of serious health repercussions discussed on this webpage.


The Impish Role of Reverse T3

Bottom line? In a person with an underactive thyroid, or hypothyroidism type 2, there may well be a normal T4 level, along with an inevitable reverse T3 excess - which will only be picked up by a doctor if they know about its role in hypothyroidism, plus if they order this specific rT3 lab blood test.

This means that according to the present interpretation of any regular thyroid blood test done (i.e. TSH and FT4/FT3), it will appear as if there is 'enough', or possibly even too high a level of Free T4.

Ironically, we need to bear in mind that this will inevitably also cause a 'normal' to possibly low TSH test result (remember, the loop between the pituitary and the thyroid?)... with the equally inevitable diagnosis of 'normality' for that person being tested!

At the same time, the high levels of reverse T3 cause a sabotage effect, via competition with whatever levels of biologically active Free T3 does exist within the system. But unless the rT3 levels are tested for, the extent of this anomaly won't be differentiated.

rT3 Also Affects The Further Conversion Of T3 To T2

Yet another layer exists in this reverse T3 story. The enzyme 5'-deiodinase is needed to not only convert T4 to T3, but is also involved in the conversion of rT3 to T2 – another thyroid hormone. Now, the problem is that if rT3 levels are up – for the reasons discussed earlier – then there is extra competition for whatever levels of 5'-deiodinase enzyme exist within the body.

In other words: more rT3 in the system = more of this enzyme being siphoned off from routinely converting T4 to T3, with a shift towards converting rT3 to T2 instead.

End result of the above loops? A vicious cycle where there is less capacity by the system to produce enough T3 – which, remember, is the far more active form of the thyroid hormone; in fact 4 times more active than T4 alone.

Another biochemical factor to consider is the reality that although T4 is so much weaker in its biological effects on cells, it also lasts much longer within the body. This has the unfortunate effect - if blood levels of T4 are normally-high - that cell receptor sites may be occupied far too long by the much weaker stimulus provided by such T4, while preventing the more active T3 from docking onto those same receptor sites. Again, this causes less biological activity to occur with which to drive our metabolism.


Why Then Does The Body Produce rT3?

Just one final point on rT3, before we go on to explore other diagnostic means for uncovering a hypothyroidism type 2 situation. After reading how rT3 seems to be such a complicating factor in our overall thyroidal system, you may be wondering why our body even manufactures something like rT3?

Well, the answer is rather simple. It's used as a way through which the body can slow down the metabolism, when the various feed-back systems perceive it has to conserve a wide range of 'body reconstruction material', such a vitamins, minerals, proteins and more, all normally used up by our metabolism.

Remember, one major factor causing an increase in rT3 production is… stress or starvation (read: dieting - within a Western setting!). In our increasingly obese population, dieting can therefore be a major contributor to switching on this excessive conversion to reverse T3, thereby effectively setting off a vicious spiral into functional hypothyroidism.

Hence, having the body divert its T4 conversion into rT3 makes sense when seen within the setting of modern life. Who in today's culture is not suffering from either chronic stress, or bouts of acute-on-chronic stress episodes? Also, within society's current lifestyle, who hasn't gone onto a diet?

Furthermore, in today's 'normal' life situations the often excessive use of a range of medical drugs – as partially outlined earlier – also contributes to this phenomenon of excessive reverse T3 production. So why then are we surprised that in present times this subclinical form of hypothyroidism does exist – and indeed is increasing in prevalence?

How To Treat Reverse T3

If a person presents with hypothyroid symptoms, and a rT3 issue is suspected, then from a naturopathic perspective it's important to firstly try to bring any excess rT3 under control. This can be done by looking at what it was in that particular person's situation which caused their levels to go so high.

Was it primarily stress? Have they had a lot of dental work done lately, thereby possibly exposing them to an acute dose of fluoride – on top of what they may already be getting on a daily level via their water or other dental products?

Or did they either have amalgam (mercury 'silver' fillings) implanted or removed? This would have exposed them to a sudden influx of mercury into the system, a known toxin to enzyme systems. Or are they on certain drugs – mentioned earlier – which could be the culprit? If so, could those be changed?

In other words, rather than initially start to think of treating excess reverse T3 from the angle of now prescribing synthetic T3 (discussed shortly), first look at the above type of factors, which may have instigated their health situation. And then focus on removing or modifying those factors as the primary treatment approach.

Perhaps that person really needs to address the stress in their lives, via a range of techniques – meditation, counseling, changing factors in their home or work environment, etc.

Perhaps they need to look at their alcohol or drug use – often engaged in as a way of dealing with stress – although in turn generating its own additional problems!

Perhaps someone with high reverse T3 needs to take specific supplements such as selenium, known to help bring down elevated rT3 levels.

Perhaps they are smoking, and this is a good time to use their hypothyroidism symptoms as a motivator for finally giving up this very addictive and damaging habit.

Perhaps they have had a lot of environmental exposure to certain toxins – like weedicides, pesticides, home renovation chemicals, working in a dry-cleaning shop, living near a chemical factory spewing out lots of smoke and other noxious fumes… and the list goes on.

If this is the case, someone with a high reverse T3 situation, and a lot of hypothyroidism symptoms, may need to do a carefully planned detox, which allows their system to eliminate those toxins in a safe and gentle way.


Detoxing In Modern Times Can Be Dangerous

Although it's an entire topic of its own, nowadays detoxing always needs to be done in a careful and gentle manner, simply because people's toxic burdens are so high, and the toxins themselves so incredibly poisonous and damaging.

Detox too rapidly, without the proper co-factors the liver and kidneys need to properly break down those poisons, and you can actually cause even more harm to your system. When all those toxins are suddenly mobilized out from storage areas (like fat and cell membranes) to now flood into the blood, this can over-burden your eliminatory organs.

Treating Excess Reverse T3 With Synthetic T3 Supplementation Is Tricky

One method, often touted by various experts, is to treat a high reverse T3 situation by taking medically prescribed synthetic T3, and although clinical experience does show this approach can be effective, it is not without its own hazards.

T3 does not last long in our bodies, so if taken as a medicine it requires frequent doses throughout the day, let alone the need to take numerous temperature readings, through which to determine the next, 'correct' synthetic T3 dosage. One major problem, however, is that it's the most potent of all the thyroid hormones, and therefore there is a high likelihood for things to go wrong.

Hence, using too much of this form of thyroid hormone could have drastic, and possibly dangerous effects within the system. Some of the potential side-effects include:

• Nervousness
• Headache
• Vomiting
• Irritability
• Tremor
• Diarrhea
• Fever
• Excessive sweating
• Weight loss
• Insomnia
• Ravenous appetite

Normally, keeping T3 levels within our bodies at just the right amount requires a finely coordinated juggling act between various regulatory systems in the body. For us to try and do this ourselves, by popping synthetic T3, is not only fiddly, but also requires a lot of skill.

Hence, this all makes for a potentially bumpy ride when it comes to stabilizing symptoms, because if the incorrect amount of T3 is administered, this in itself can cause even more symptoms, or an exacerbation of existing symptoms.


Deal With Core Issues Driving rT3 Problems Before Using T3 Therapy

That's why it is so important to initially manage a high reverse T3 situation from a more holistic and natural approach, before starting to use a synthetic hormone protocol.

Additionally, once the body has been on such synthetic T3 for a while, this in itself can shut down the thyroidal system's overall capacity to ensure adequate T3 amounts in the body.

In other words, the body can become dependent on now having to have that T3 administered on a regular basis, and any sudden withdrawal could cause serious health complications. It's a bit like suddenly withdrawing cortisone therapy in someone who has been on it for some time – quite a dangerous thing to do!

Hence, anyone thinking of using this treatment approach by means of synthetic T3, as a way of treating high reverse T3 levels, absolutely needs to be under the management of a real expert in hypothyroidism; a therapist who truly understands all the subtle levels involved in this health syndrome.

For those of you solely depending on what you've read on the Internet or in a book... please do not try to treat yourself with synthetic T3, such as Cytomel or Tertroxin – two popular brands of this form of hormone - (also known as Liothyronine or Triiodothyronine).

Above are just some broad outlines of how to approach a reverse T3 problem from a treatment perspective. A more detailed discussion of thyroid disorders, with specific focus on hypothyroidism is available by clicking on this link. [page soon to be built]


Indeed, reverse T3 plays a pivotal role within hypothyroidism. Hopefully, this discussion has been able to clarify for you why so many people, who do have clear symptoms of an underactive thyroid, nevertheless fall between the 'diagnostic cracks' still so prevalent in the practice of medicine today.

Especially, if the only tests done in trying to diagnose hypothyroidism are the TSH, FT3 or FT4 – plus they are also only interpreted in what is in fact an outmoded fashion.

'Knowledge is Power', and now, with an enhanced understanding of the many subtle layers driving hypothyroidism – especially the role of reverse T3 – hopefully, you're better placed to manage any thyroid problem you may be living with.



1) The Journal of Clinical Endocrinology & Metabolism 2005; 90(12):6403–6409. Thyroid Hormone Concentrations, Disease, Physical Function and Mortality in Elderly Men; Annewieke W. van den Beld, Theo J. Visser, Richard A. Feelders, Diederick E. Grobbee, and Steven W. J. Lamberts Department of Internal
2) ( )
3) Samuels MH; Pilote, K; Asher D, Nelson JC, Variable effects of non-steroidal anti-inflammatory agents on thyroid test results, The J.Clin.Endocrin & Metabolism; 88.(12).5710-16.

"Knowledge empowers; intuition guides – both are needed to succeed in Life's Journey"

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