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Tired? Have You Heard of Reverse T3?

Recently, I went to my doctor for a prenatal check up. I had been having bouts of crying, no, weeping, for no real reason. This is my first pregnancy, so I attributed this to all the hormones raging through my body.

However, when I mentioned this to my midwife, she asked me a few other questions.

"Are you constantly cold in your hands and feet?"
"Are your skin and hair more dry?"
"Are you tired often?"

Yes, yes and yes!

She sent me to the lab to get some blood work done on my thyroid. I have had these issues my whole life, I have also been underweight almost my whole life. I can easily feel when my blood sugar is too low, I become quiet and hangry. My mom jokes with my husband that we need snacks for me, no matter where we go. It is very true, because if I get hungry and there is no food in sight the situation gets dicey, fast. 

I have had my thyroid tested many times by doctors, but everytime the tests come back "normal."

This time was different.

Little did I know, most western medicine practicing doctors only look at your T3, T4 and thyroid stimulating hormone. These numbers can be normal, but if your reverse T3 (a huge component of thyroid function) is high, it can cause you to have the symptoms of an underactive thyroid.

Functional medicine doctors more commonly also test for reverse T3. In addition to testing for reverse T3, they have a more rigid standard for what the "normal range" is.

For western medicine a normal range for reverse T3 is between 8-25, where as many functional medicine doctors believe anything higher than 15 is cause for questions and further investigation.




If you are suffering from the symptoms of hypothyroidism, but your T3 and T4 look normal, reverse T3 should not be ignored when getting blood work done.

Our body is meticulous. Our pituitary glands and hypothalamus send a signal for our body to make the thyroid stimulating hormone (TSH). This hormone creates T4 which is converted into one of two things: T3 or reverse T3.

On button: T3 works to regulate our metabolism through the conversion of oxygen and calories into energy, they are known as the "speed up" mechanism.

Off button: Reverse T3 is the mirror image of T3. It is so similar to T3 that is it able to bind to the receptor sites T3 uses, blocking the "speed up" process reducing the amount of T3 the body can uptake.


If your T3 and T4 look normal, but you are still struggling with the symptoms of hypothyroidism, you want to ask your doctor to check your reverse T3.

When the ratio of reverse T3 to active T3 is imbalanced, you may have enough T3 floating through your body, but you are unable to uptake the necessary amount to keep your body functioning properly because reverse T3 has blocked the receptor sites. This results in the symptoms of hypothyroidism, even though your labs may come back "normal".


There are plenty of factors that can disrupt the conversion of T4 to T3 in the body.

Low iron, zinc or iodine
Selenium deficiency
Consistent low protein
Fluctuating blood sugar levels
Chronic illness
Chronic inflammation
Poor liver function
Metals and toxicity

We also live now in a world that is constantly disrupting our natural hormone balance. You may do your best to be a healthy individual, but depending on where you live you may have a harder time keeping your hormones in check.

High reverse T3 (anything greater than 15) is a indicator of a few ailments that you can actively treat without thyroid medication. 

Chronic infection
Gut inflammation (try a paleo diet and reduce all gluten intake)


If you are extremely sluggish, constantly cold, dry, have post nasal drip and your doctor recommends checking your thyroid levels, ask them to check for reverse T3.

Look at your labs. Western medicine has different standards than functional medicine in regards to what are acceptable levels.

High reverse T3 is an indicator of underlying problems. Try cutting out gluten and changing your diet to a low sugar, high fat, moderate protein diet. Eat healthy snacks throughout the day to keep your blood sugar levels stable.

No yo-yo dieting. This puts unnecessary stress on your body. One month you are eating 1500 calories a day, then you are up to 2500 calories because that diet was too restrictive and you couldn't eat anything you like. Start with small compounded changes rather than a huge change that you can't stick to for long. The goal here is long term health.

Minimize your multitasking. Stress is a huge factor in relation to thyroid health. Society encourages a high-stress lifestyle. Practice yoga or meditation to bring balance back to your mind and body. Take a good look at your life and ask yourself what is causing you stress and see if you can change your lifestyle to reduce it.