Chronic/Pain Conditions >> RT3 Problem
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In this video, Dr. Huntoon discusses the importance of understanding your symptoms and what your symptoms mean. Is it ever normal to have a symptom?
Watch this video and consider what it says before going forward with your health.
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When we talk about "resistance to thyroid hormone" we are talking about people that don't respond properly to Thyroid Hormone supplementation and appear to have hypothyroid symptoms despite being on thyroid replacement and having normal blood test results. One of the most common causes of this lack of response to the thyroid hormone is something called "Reverse T3" (RT3).
The main symptom of RT3 issues is that of hypothyroidism that won't respond to treatment. If this sounds a bit like Chronic Fatigue Syndrome then that's not unduly surprising. Unless you have a very clued up Doctor this diagnosis will probably get missed. It can be picked up by blood tests, but only if they do the right ones and then interpret the results correctly.
It’s interesting that two "modern diseases", Chronic Fatigue Syndrome, and Fibromyalgia only started being diagnosed in the 1970s. This was the time that the Thyroid Stimulating Hormone (TSH) test came to be accepted as the "gold standard" for thyroid diagnosis. This so called "Gold Standard" is really a "tarnished brass standard" as it has led to generations of people that could have been helped being written off as "normal" without treatable conditions being diagnosed and treated.
The body naturally produces some RT3 and this isn't a problem in most people. The problem arises when the ratio of FT3 to RT3 sinks too low as the RT3 then gets in the way of the T3 that we need to function causing hypothyroid symptoms.
There are several causes for this ratio getting disturbed, the principal ones that we know of are:
- Extreme dieting, the RT3 increases to slow the metabolism and make better use of the available food
- Low Iron (including Ferritin)
- High cortisol, this disturbs the balance of the thyroid hormones
- Low cortisol, this again disturbs the balance of the thyroid hormones
- Insulin dependent Diabetes
- Low Vitamin B12 levels
- Graves disease or other causes of being Hyper Thyroid (New 10/10)
- Other forms of thyroid resistance causing heavy supplementation of thyroid Meds.
In addition to these common causes there are a large list of additional causes
- Burns/thermal injury
- Caloric restriction and fasting
- Chemical exposure
- Cold exposure
- Chronic alcohol intake
- Free radical load
- Hemorrhagic shock
- Insulin-dependent diabetes mellitus
- Liver disease
- Kidney disease
- Severe or systemic illness
- Severe injury
- Toxic metal exposure
What is Tissue Resistance?
Tissue resistance to thyroid hormone is just what it says it is, there are normal amounts of Free T3 in the blood and yet the body behaves as though it's hypothyroid. This is often caused by Reverse T3 blocking the Receptors on the cells that the T3 should stimulate.
There are causes of this other than RT3 but treating resistant hypothyroid people with Natural Thyroid (Armour Etc), or synthetic T4, leads to large doses being given. This leads to excess levels of Free T4 and that in turn leads to RT3 being produced and resistance begins building up. The only successful way I have heard of to treat people with other thyroid resistance is to use T3 only.
At a very basic level thyroid hormone is made of iodine, among other things, and the numbers that are talked about (T4 and T3 etc) represent the number of iodine atoms in the molecule.
T4 is the main hormone that is produced by the thyroid gland and supplemented "Synthroid, Levoxyl, Thyroxin etc", This hormone is totally inactive biologically and it's only after an iodine atom is removed, thus making it into T3 that allows it to have an effect on the body. T4 is a storage hormone and lasts for weeks in the body, T3 is the active one that deiodinates to T2 and then further to T1 which also have metabolic activities of their own. T3 has a life of a few days in the body. T3 is a catalyst that the body needs for its chemical reactions to progress at the right speed, without enough of it people are cold, tired, and lethargic.
Reverse T3 (RT3) is what is made when the "wrong" iodine atom is removed from T4, it's a "mirror image" molecule to T3 and is not bio-active. This in itself is not a problem. The problem is when RT3 is in excess, it "fits into the T3 receptors" and gets stuck there blocking the action of T3 on the body. This means that your body doesn't respond properly to T3 leading to hypothyroid symptoms despite a normal TSH and normal T3 and T4 levels in the body. This is what we refer to as "Tissue Resistance to Thyroid Hormone". Doctors will tell you this is very rare, but that is because they don't look for it!! Fortunately there are ways of treating it and people can recover and feel well again.
Lab work has a lot of value to it but needs to be interpreted carefully, just because the results are "in range" doesn't mean you will feel well, they need to be in the right part of the reference ranges. RT3 and FT3 tests can be ordered without a Doctor and there are labs that will do this. In particular Econolabs and Life Extension are currently the cheapest sources for RT3 testing.
The prime diagnostic for RT3 issues is the ratio of Free T3 to Reverse T3. Once they are in the right units (the units used by labs differ so some have an FT3 range of 230 to 450, whereas others might have a range of 2.5 to 4.5) then the ratio of Free T3 divided by reverse T3 should be 20 or greater. If it's less than that you have a RT3 problem. If you only have a T3 reading rather than a FT3 reading then the ratio of T3 to RT3 needs to be 10 or greater. A cautionary note is that a FT4 reading that is over 1.4 is a marker for RT3 being high. If it's vastly smaller or larger you may have to move the decimal point to get the units right.
The initial diagnosis tends to be "the normal things don't work, what's happening". If someone has a low but stable temperature (stability indicating that adrenals are behaving), iron labs at a satisfactory level, and a Free T3 (FT3) near the top of the range then they may well have a RT3 issue. Their temperature should be normal with the rest of the things right.
The most reliable diagnosis of RT3 problems is by looking at the ratio of FT3 to RT3. This is made more complex by the many different units that are used for these measurements by different labs.
The first step is to make sure than both measurements are in the same basic units which fall into 2 categories, metric, and molecular weight.
Examples of metric units are:
|T3 REVERSE||552||90-350 pg/mL|
|T3 FREE||3.23||2.50-3.90 pg/mL|
Examples of molecular weight units are:
|Reverse T3||800 pmol/L (170-450)|
|FT4||22.0 pmol/L (9.0-22.0)|
You need to have measurements that are all metric or all molecular weight, mixing them stops a direct calculation The Molecular weight ones all have "mol" in them. These are mainly used in Europe.
Whatever units are used you need to make sure that the FT3 number is about 10 times the RT3 number and move the decimal point if need be to achieve this. An example would be
In this case the FT3 is a lot smaller and you need to move the decimal point 3 places to the right making it 3230. Then 3230 / 500 = 6.46 = a horrible ratio, this needs to be 20 or better.
Other ways you may see the same numbers are FT3 323, RT3 0.5, in this case you need to make the FT3 into 3.23 and that gives 3.23 / 0.5 = 6.46, the same sum with the decimal point moved on both units.
If you are finding this difficult while brain fogged then send your lab results TO Dr. Huntoon and he will calculate it for you. If you only have a T3 reading rather than a FT3 reading then the ratio of T3 to RT3 needs to be 10 or greater.
RT3 is only made from T4. If you get rid of T4, both from your own thyroid and from supplements, then no more RT3 gets made. In order to do this and stay alive an alternative source of the bio-active T3 is needed and this is readily available in the form of synthetic T3 hormone.
The basic treatment is to stop all meds containing T4 and start T3 instead, The dose is then slowly increased week by week as the T4 levels in your body diminish. After 6 weeks or so the T4 and RT3 levels in your blood will be very low. You need to keep going longer than this though as it takes around 12 weeks for the RT3 to clear the receptors as well.
During this time you may not be able to take enough T3 to fully clear hypo symptoms though some people may feel pretty well at this stage. It all depends on how hypo you were, how high the T3 and RT3 levels were, and your iron and adrenal status. We do not recommend going above 125 of T3 during this clearing process, there is no improvement in clearance achieved with a larger dose, provided there is enough to suppress TSH and stop T4 production then clearance will occur.
If the T3 you are taking does clear most hypo symptoms and you had high in range, or over range RT3 levels then be prepared to drop the amount of T3 you are taking when resistance clears. This can be dramatic and you can end up needing half what you needed the day before when the resistance clears. This is one of the reasons that you need to go by symptoms and pulse/temperature, things happen too fast to base it all on lab numbers.
You can of course keep the dose lower and put up with feeling hypo for longer, and then when it clears you simply end up feeling less hypo. Dosing at this time is a compromise between symptoms and the effect when clearing and we do not recommend going above 125mcg of T3. A lot of Doctors are worried by people doing this as things happen too quickly to be done by lab tests, patients need to adjust dose by symptoms and vital signs.
T3 Treatment Medication
T3 only medication is the main bio-active thyroid hormone. Brands include Cynomel (Mexican), Cytomel (American), or Tertroxin (UK). The Chemical names for this are Liothyronine sodium or triiodothyronine.
Changing over to T3 only, and adding enough to suppress your own thyroid's production of hormone, eliminates T4 from the body. Without T4 no more RT3 can be made and hence if you go long enough, the RT3 circulating in your body will decay or be excreted and you will greatly improve the ratio.
Fairly early on the lab tests will show a great reduction in RT3 but don't hurry to change back to Armour or T4 as it takes longer to clear the T3 receptors that are blocked up with RT3.
It typically takes 12 weeks of T3 only for this to happen and then the results are sudden, you can find overnight that you need to drop your medication almost completely for a day or two and ramp back up again to around half the level that you needed before to stop feeling hypo.
Medicines Two Choices for You
A Holistic Chiropractor who is well versed in checking for RT3 problems will always have a simple solution. Utilizing a TBM Technique, the testing and correcting takes less than a minute and involves reactivating the normal T1 to T4 to T3 mechanism and turning off the RT3 mechanism. Once this is done, making sure to support the normal physiology of the thyroid with thyroid supporting supplementation and by clearing the trapped emotion that created the RT3 problem to begin with is necessary, otherwise, the pattern can return. Understanding what is creating and feeding the RT3 problem emotionally is important if you truly want to avoid the effects of having this condition.
The treatment for too much RT3 involves stopping more being made and waiting for the body to excrete it. This is relatively easy but there are potential pitfalls along the way depending on how you go about it.
Getting your body to come back into balance is most important. Suppressing symptoms by taking medication, does not address the problem, and is both costly and ineffective, as it will lead to having other health concerns and the need to have your thyroid removed. By identifying and treating a RT3 problem early your long term prognosis is improved.
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