Reverse T3 and T3 Only Therapy

My husband has been taking Naturethroid (so called 'natural') thyroid supplement for about a year. He increased his dose but still has symptoms (extreme afternoon fatigue and brain fog). He resumed using caffeine pills (he hates the taste of coffee) to get through the day. I know his thyroid supplement isn't working for him. However, I also know he had a rather high blood test result for reverse T3.

So I did some research on reverse T3. I learned that disproportionate amounts of reverse T3 can block T3 receptors so that T3 supplements can't treat hypothyroid symptoms. Normally T4 converts into 40% T3 and 60% reverse T3. However, if the proportion of Reverse T3 (RT3) is higher than normal, all that RT3 can block T3 receptors and prevent normal metabolism (energy, body temperature, regularity). So I asked my husband to get another set of thyroid blood tests including his RT3.

He hasn't yet received his RT3 test result. However, my research on RT3 made me wonder if I might have that problem. I learned that treatment for RT3 involved stopping all therapy involving T4 and just using T3. During the past 15 months of my hypothyroid treatment, I initially took T4 only supplements, which did nothing to relieve my hypothyroid symptoms. So I asked for a T3 test, which showed my free T3 was below normal, and then requested a T3 supplement in addition to my T4 supplement.

My initial dose of T3 relieved my hypothyroid symptoms. I was warmer, more energetic and more regular. Then my hypo symptoms returned ... fatigue, feeling cold more often and constipation. So my increased my T3 dose and decreased my T4. That helped to resolved my hypo symptoms. However my next blood test showed my T4 levels were low, which concerned my doc. I asked why worry, because I obviously didn't convert T4 to T3 very easily, which was why I didn't do well on T4 only therapy. My doc explained that I had some T3, although it was very low, which suggested I converted some T4 to T3. (However I've since learned that the thryoid gland does produce a small amount of T3, outside of T4 conversion.)

So I increased my T4 again, while keeping the same T3 dose. Then all my hypothyroid symptoms returned. So I increased my T3 and decreased my T4 (but just took a half dose). Again that combo decreased my hypo symptoms ... for awhile. Then after a few weeks on that dose (25 mcg total daily T3, 50 mcg total T4), I again experienced constant fatigue, chills and constipation. So I slowly increased my T4 to 30 daily and kept my T4 at 25 daily. I had taken divided doses of T3 (early morning and mid afternoon) for almost a year, but was still experiencing afternoon energy crash. When my symptoms returned on 25 T3 and 50 T4, I raised my T3 to 30mcg daily and later to 35mcg daily. I never had any overdose (hyperthyroid) symptoms, but I feared getting those when I was using 30+mcg of T3. So I lowered my T4 to 25mcg. I really doubted it helped much anyway. Again my hypo symptoms disappeared for awhile, but I still had the afternoon energy crash. My doc had told me that T4 would carry me through the day so that I wouldn't get that afternoon slump. So I increased my T4 back to 50mcg and continued the T3 at 35mcg. Again my hypo symptoms returned. I kept thinking I just didn't have a high enough T3 dose, even though lower doses had worked for awhile.

After I read that the treatment for excessive RT3 was taking T3 only, because T4 produced both T3 and reverse T3, I wondered whether I also had an RT3 problem. My doc never tested my RT3. However, my initial free T4 test was normal, but my free T3 test was low even after taking T4 supplements for 3 months. I thought I didn't easily convert T4 to T3. However, my experience showed that every time I took T4 with T3 I had to keep raising the T3 dose. I didn't know whether an RT3 test would be accurate at this point (after 15 months of thyroid supplements).

So I just decided to stop taking T4. I also decided to take my T3 doses 3-4x daily rather than twice daily. The first day of 4 doses was a disaster, because I took my 4th dose too late at night and didn't sleep until 8 hours after I took that last T3 dose. Then I decided I really didn't want a nighttime dose, which could interfere with my sleep. So I started taking 3 even doses of T3 at 7am, 11am and 3pm (4 hours apart). That has worked well for the past 3 days. My energy level is even all day until bedtime when I start feeling sleepy. Then I sleep very soundly all night. Also I've been very regular while taking less magnesium than I previously took. I'm still getting cold sometimes. However the weather did turn really cold and I haven't dress differently for that colder weather. Nevertheless I'll keep using this triple T3 dose approach with no T4.

According to the RT3 literature, after 8-12 weeks I may even need less T3 to prevent hypo symptoms. Whatever ... I'm happy to finally prevent my afternoon energy crash, keep warm and stay regular on the same dose for awhile.