Latest / Health with Hashimoto’s - Thyroid or Immune Education for Autoimmune Thyroid Disease / 094 // Thyroid Labs Explained: T3, Free T3, and ReverseT3

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094 // Thyroid Labs Explained: T3, Free T3, and ReverseT3 · Health with Hashimoto’s - Thyroid or Immune Education for Autoimmune Thyroid Disease

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Thyroid labs can be super confusing. I mean, you've got T3, free T3,
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reverse T3. Those are just the T3 ones.
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What do they all mean? Which ones are important?
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What do they tell you? What are you supposed to do with the information?
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So many questions, so much confusion, and not just for you.
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I have had providers that are like, I don't really know which labs to order
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and which ones are important.
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And they're like scratching their heads because this is a confusing issue.
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You. It's not just for you.
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So today in this episode of Health with Hashimoto's, I'm going to break it down
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and I'm going to help you understand the T3 labs.
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I've talked about other labs in past episodes. I will link those down below
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in the show notes. And today is going to be all about T3.
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But first, let's review like what is your thyroid? What are the labs in general?
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And what do they mean for your health?
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My name is Esther. I am a registered nurse. I am a holistic health educator.
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I'm the mom of four boys, a homeschooler, half homeschooler.
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Two of my boys are homeschooled. Two of them go to a public charter school.
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And I'm like, I understand busy. I understand overwhelm. And I find that a lot
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of women with Hashimoto's also are going, going, going.
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They have so much on their plate, like juggling so many balls,
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doing so many things. things and we don't have time to be confused.
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We do not have time to dig into things and figure out what are all of these
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acronyms, what do they mean, and how does it actually impact my life?
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Because when you're juggling so many things that you want just the bullet points,
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you want to know what actually matters.
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So your thyroid is a little gland on the base of your neck at the front and
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it produces thyroid hormone.
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Every single cell in your body has a little receptor site for thyroid hormone,
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but it wants it in a specific form.
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So when your brain.
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Gets told by your body that it's not having enough energy, that it needs more
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thyroid hormone, and then your brain sends a signal to your pituitary gland,
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which is at the base of your brain, which then sends a signal to your thyroid.
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The signal that your pituitary gland sends is TSH, and you're probably very
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familiar with TSH because that's the first thing that Western medicine checks.
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They test this TSH, which is your thyroid stimulating hormone.
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Your TSH is your your brain saying to your thyroid gland, hey,
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I need a little bit more energy here. Can we produce more, please?
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So the more elevated that your TSH is, the more your brain is asking for more.
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It really means that your thyroid is probably not producing enough.
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So your thyroid function could be low if your TSH is high.
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So when your thyroid gland gets that signal and produces thyroid hormone,
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it comes out in the form of T4.
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T4 is thyroxine. It's basically the T is for your thyroid hormone and the 4
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is for molecules of iodine.
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So T4 is thyroxine and that's what your thyroid produces.
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But the thing is your body can't use that T4. It wants T3.
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Every cell in your body, the ignition switch is the T3.
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So the T4 mostly goes to your liver and your small intestine,
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and there it is converted to T3.
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So one molecule of the iodine is going to be taken off.
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The T3 is officially... Now, some of your T4 is converted to T3 in other tissues, but...
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20% is in your liver, converted in your liver, and 20% is converted in your small intestine.
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And it's about 40% of the T4 that's converted each day.
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So 20 plus 20, 40. The bulk of your T4 being converted to T3 is done in those
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two areas, your liver and your small intestine.
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But like I said, it's also done
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in other areas of the body. A lot of the organs and tissues can do some.
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So now you know, your brain sends a signal to your thyroid, your thyroid produces
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T4, your liver, small intestine, convert that to T3.
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The T3 goes to all the cells in your body and says, hey, let's turn on,
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let's have some energy, let's start working.
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And then when your cells are working, then your tissues and organs are working.
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And when your tissues and organs are working, then you're working and you feel like yourself again.
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That's the goal. We want to feel like ourselves. We want everything to be online.
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All systems go, right? Yes, that is what we want.
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So when you're looking at your labs, how do you know what is like not normal?
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Because there's so many different things to look at.
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I remember the first time that a provider was like, I want to check your thyroid.
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And it wasn't something that she ordered every day.
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So she ended up like even calling the lab saying, which panel do I order?
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Because different labs, they will bundle different.
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So labs as you know, the corporation, they will bundle different labs as in
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the tests together in a panel to make it technically easier for providers.
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So they just order one panel and they get everything they want.
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Well, there's so many different combinations of panels or different.
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Lab tests within panels. I think on the at-home lab that I use,
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and I can link that down below too, it's through Ulta Labs.
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I think there's like four or five, maybe more panels of thyroid tests that you
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can get. So it is confusing.
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And I remember my practitioner like, okay, I want to know this and this and this.
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So which one, you know, it's just, it's just confusing.
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I think I I was actually relieved when that happened, because for the first
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time, I thought, I'm not the only one who's confused by this.
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You know, when you're in the emergency department, we all really try very,
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very hard to have a good answer for everything.
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And so if you ask a doctor a question, I mean, if they're coming in with labs,
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they're going to know a lot of the lab work in their heads because they've studied for so long.
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And if it's something that they're not familiar with, they will have just looked
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it up before going into the room so they can answer your questions.
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And that was me too. As a nurse in the emergency department,
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I need to be able to educate my patients.
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So if I had somebody who had thyroid problems, then I would look it up.
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And if you've heard my story before, I would study thyroid stuff and I would
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get it for just a short, short amount of time and then it would be gone.
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I could not keep it straight in my head.
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So when I heard my provider call the lab and explain what she wanted and try
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to figure this out for the first time, I thought, oh, I am not alone.
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This confuses other people too.
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So let's make it a little less confusing. The first T3 that you can get on your
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labs is just the total T3. It's usually called T3.
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It's really not helpful for very much at all, unless they're checking for something
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like Graves' disease, if they think that you have too much thyroid hormone in your blood.
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So T3 is, it's not usually helpful.
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I'm going to give you a bit of a disclaimer. Like like all of this information.
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I've been studying thyroid for what, three years now, I think. I don't even remember.
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I've read so many books. I've read so many articles. I've read so many research
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papers and I cannot cite one place that I'm pulling this information from because
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it's from so many different places.
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And then I put that knowledge together.
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The labs, it's the same way. I want you to look at the reference range for the
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lab who drew your blood or who ran the tests because each lab is going to have
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their own specific reference range.
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The numbers that I give you here are based on what I found as the most common
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functional medicine ranges.
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And these came from multiple different sources. So I do not have one place to
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cite because again, I was looking for the commonality.
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There is so much disagreement among everybody in medicine, especially thyroid stuff.
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So when you're looking at just T3, the best functional reference range that
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I found is anywhere between 100 and 180.
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If it is elevated, then you might have too much T3 in your blood,
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and it might point to something like Graves, which is an autoimmune problem,
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and it's where your thyroid puts out too much hormone.
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So that was just T3.
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Now let's talk about free T3. You'll see that one in your labs as well.
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That, well, I say that you will see it. You might not see it.
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You might have to ask specifically for it.
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Free T3 is a measurement of how much T3 is actually available for your cells to use.
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It's free it's free to be used
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so that is free t3 it has a
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more narrow range and it's between three and four when
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i was looking at a whole bunch of different labs at their functional
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reference ranges so between three and four now remember i said that t3 is like
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the ignition switch it is what your cells need to be able to turn on so we want
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to have enough t3 so that our cells can work and if our cells are working then
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our tissues and organs are working and then you're working.
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So if your T3, your available or free T3 is low, then you're not going to have
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as much available to your cells.
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And then you might feel hypothyroid.
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If people feel like they have hypothyroid symptoms, you know,
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if they're gaining weight, their metabolism is slow, they're feeling cold all
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the time, they're constipated, they're feeling depressed, their hair is falling out, skin issues.
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Feeling sluggish, having brain fog, all of these things can be hypothyroid related.
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And you might feel all of those things. And your doctor or your provider says your TSH is normal.
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Well, but you're still feeling hypothyroid. It might be that you don't have
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enough available free T3.
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You don't have enough for your cells to use.
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So that is a a crucial number to look at. But then you ask like,
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why? Why don't I have enough?
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If your thyroid is producing T4,
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and 40% 40 ish percent of it is supposed to be converted to T3 on any given
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day, then why are why don't you have enough?
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Well, that's the other thing that T4 can get turned into.
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Sometimes it's turned into T3. And other times, your body is like,
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nope, we need to rest to slow down to heal.
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Because it is when you are resting and sleeping that your body is healing and
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renewing and restoring.
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So sometimes your body prioritizes those things. It increases the brake system.
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So your thyroid produces the T4 and then your body is like, nope,
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we actually don't need a lot of energy. We need to heal.
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We have too much stress, too much cortisol.
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So it makes more reverse T3. That's like the brake system.
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It is your body saying, let's halt here. Let's slow down and heal.
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Your reverse T3, everybody has some because on any given day,
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about 40% of your T4 is being converted to T3 and about 20% is converted to reverse T3.
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If that reverse T3 goes up, it means that your body is prioritizing the brake system.
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It's going to do that, like I said, if it's under stress. That can be chronic stress.
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It could be acute stress. So something happening right now. It could be inflammation.
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There are a lot of things that can increase your reverse T3.
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So increased cortisol or extra cortisol, that's the stress hormone,
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that definitely does it.
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So trauma, there is a big link between trauma and autoimmune problems because
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it's such a trigger, especially for Hashimoto's.
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When you have chronic stress and your cortisol is constantly elevated,
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your adrenals, those are the little things that put out the cortisol,
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they can get tired and then your cortisol can be too low.
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Too low of cortisol can also cause problems with your reverse T3.
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It can cause it to be elevated.
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That's because your body really likes the Goldilocks range.
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It wants it not too hot, not too cold. It wants your cortisol to be not too
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high, not too low. Everything needs to be in the Goldilocks range.
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And if your cortisol is too high, it can make your reverse T3 get elevated.
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If your cortisol is too low, it can elevate your reverse T3.
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And the specific mechanism for when your cortisol is low, and that leads to
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increased reverse T3, is because when your cortisol is low, thyroid hormones
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can actually build up in your blood.
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And then your body, it says, oh, there's too much T4 in the blood.
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It's not getting processed quickly.
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And so then it makes excess reverse T3 or more reverse T3 to take care of the excess T4.
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Does that make sense? so you have too much T4 and then your body produces extra
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reverse T3 to take care of that.
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It doesn't want to use it, it just wants to take care of it and to get rid of it.
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There's another thing that can cause reverse T3 to be elevated and that's when
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your iron levels are low and this is really the same thing as if your cortisol is low.
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It's a different way to get to the same ending, I guess, because if your iron
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is low, then typically you do not have as much blood cells.
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And if you do not have enough blood cells, then it's not carrying enough.
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And so you're going to have excess thyroid hormone that, again,
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needs to be taken care of.
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So you create increased reverse T3 to take care of the excess.
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And the final most common reason for increased reverse T3 is if you're taking
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medications that are beta blockers.
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Those are usually for your heart, for your blood pressure.
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Metoprolol is one of the most common ones. They're all going to end in an olol.
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So metoprolol, propranolol, those are beta blockers, and those can also increase your reverse T3.
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The most common thing that I see in the people that I talk to and in the Holistic
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Hashimoto's course is stress.
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It is the cortisol link when they are constantly stressed.
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And so they have increased reverse T3. And that's what we focus on is lowering
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stress levels and increasing resilience, because both of those things can help our cortisol.
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We want to help our body thrive in the environment that we have.
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Oh, I didn't give you the numbers. So the numbers that I have written down,
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again, check with the lab that is doing your blood work.
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For free T3, I have written down between three and four.
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And so that's based on the lab that did my blood work or who has done my blood
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work, it's based on looking at a whole bunch of different physicians and providers
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online and the endocrine people.
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Endocrine is just a fancy name for hormones. And of course, your thyroid hormone
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is a hormone. So that's the free T3.
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And then reverse T3, you know what?
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I don't have a number for you. The lab that I was looking at and all of the
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different ones that I researched, they said it should be less than 15.
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So what if your numbers are low? What if you don't have enough available T3
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or if you have too much reverse T3?
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Then we want to address what's causing it. But while we're addressing it,
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if your cells don't have enough,
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then it might be time to talk to your doctor about a combination medication
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therapy of doing both T4 and T3 and find something that works for you.
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Everybody is different. I've talked to people who felt amazing on T4 only.
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I have talked to people who felt amazing on a combination of T4 and T3.
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I have talked to people who felt amazing with no medications.
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If they took medications, they felt worse. You have to figure out what works for you, for your body.
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So if you don't have enough T4, then you're not going to be able to convert enough to T3.
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So you're going to need to have more T4. And that is medication.
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Synthroid, levothyroxine, those are the most common ones. And if you want a
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combination, then you can get
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natural desiccated thyroid, that's NDT or armor or something like that.
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But what you really want to do is you want to address why it's not converting.
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Are you having problems with your liver.
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Your liver does so much work every single day.
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It is so hardworking and it works hard with your hormones, especially,
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well, all of them, but estrogen.
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Estrogen, it processes, and if it doesn't have enough time to process the estrogen
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that's in your blood, it'll send it around and say, maybe I'll get to you next time you come through.
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And then we get too much estrogen in our system and that's estrogen dominance.
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And that can be really hard on the liver. And so that's why I did an entire
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podcast episode a while back on estrogen dominance.
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And we talked about things that you can do for your liver health because you
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want your liver functioning really well so that it can do its job.
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One of its jobs is to convert T4 to T3. So look up that estrogen dominance podcast episode.
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Again, I'll put the link down in the show notes and figure out what you can do for your liver.
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The thing that I do every day, super simple.
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I just swallow a tablet of five different herbs. It's called Protandim NRF2,
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and it helps so many different things in the body because it activates my body
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to do what it's supposed to do, like create antioxidants, to create your master detox
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thing, glutathione. You've heard of that, right?
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Glutathione is so powerful for taking care of the stuff in our body and we want more.
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And so this NRF2 activation, it makes my body, it activates my body to make
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300% more glutathione. That's huge.
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It also takes care of other detox pathways and supports my liver.
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We want to support our livers so that our liver can do its job.
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And then the other thing, do you remember where else I said that most of your
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T4 is converted to T3? It's in your small intestines.
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And that's why we talk about gut health. And that's why everybody needs to be
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eating some sort of probiotic every day.
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You know, you can get it from fermented foods. You can get it from a capsule.
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I do have fermented foods every day. I've started making sauerkraut and I was
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really scared about it at first.
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I really was. It just, I don't know. It made me really nervous.
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Also, I was scared of the taste. I just thought it was going to be gross. And it was gross.
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And then I got used to it. And now I really like it. So I've been making sauerkraut
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and I've been eating that. I make kombucha, yogurt.
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I have different sources of probiotics in my diet. But I know that my gut wants more.
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So I take a capsule every day. I personally use seed because I love that it
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has a prebiotic and a probiotic together in the same capsule.
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Well, together and yet separated. There is got like a capsule within a capsule
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so that it works the best in your body.
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But just like other things that are in synergy, like that protandum NRF2,
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that's a synergizing thing. It works together in combination.
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It's not one plus one equals two. It's like one plus one equals 10.
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And that's what a prebiotic and a probiotic do together. It's that one plus one equals 10.
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That's why I take seed because it does both. And like I said,
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the NRF2 is also a synergistic recipe.
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When you combine those five herbs, which are very common herbs,
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you probably already take one, like ashwagandha or turmeric,
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you're probably already taking that, right? Well, this.
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Little capsule or this little tablet. It is those five herbs in a very specific ratio.
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And they found that when they put those five herbs together,
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they work 18 times more powerfully than just added together.
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It is synergy at its finest.
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And I love to do something, you know, that takes me 10 seconds,
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pop it in my hand and swallow it.
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And that impacts my health in such a huge way.
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All right, so quick recap. Your thyroid produces T4.
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Your body, specifically your liver and your small intestines,
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convert that into T3, which is able to be used by your cells.
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Your cells need T3 to be able to turn on.
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If you don't have enough T3, that means you're either blocking it by elevating
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your reverse T3, which is the brake system, or it means that not enough is being converted.
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So you want to address the reason why. And while you're addressing it,
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you might have to use medications.
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There's nothing wrong with addressing the needs and taking medications.
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And while you're supporting yourself by taking the medications that you need,
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if you fall into that category, also come and join the Holistic Hashimoto's course.
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Because in that course, we're going to talk about all of the root causes so
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that you can support your body and do exactly what you need so that your body
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can do what it's supposed to do.
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That's the goal. We want our best health.
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And so join me in the Holistic Hashimoto's course, where I will take you by
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the hand and help you do the things that you need to do.
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This podcast is for informational and educational purposes only.
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Please discuss any concerns and plans with your trusted healthcare professional.
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If you found this episode helpful,
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would you please share it with a friend? I will see you next week.
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Music.