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Have you ever wondered why you are so tired when you wake up in the morning after sleeping through the entire night?
Or why your mood dips low to lower. Well, if you, too, have experienced such symptoms, you are not alone. An estimated 10% of people suffering from unexplained tiredness and mood disturbances may have underlying thyroid issues that go unnoticed.
Many people suspect thyroid problems and come to visit the doctor. They are told that their TSH (Thyroid-Stimulating Hormone) levels are slightly high, but their T4 (thyroxine) levels are normal. This is diagnosed as subclinical hypothyroidism.
But what if the real issue is somewhere else? And what if it is related to the wrong ratio of T3 and reverse T3 levels?
Let’s go deep into this neglected aspect of thyroid health. Keep reading to uncover links that have been hidden about your thyroid, energy levels, and overall well-being.
T3 is also known as triiodothyronine. It is an active thyroid hormone that lets your body regulate energy, metabolism, and mood.
Consider it a kind of fuel for proper functioning in your body. The thyroid produces T4, which is subsequently transformed into T3 by the liver and other tissues. This method of conversion is significant because T3 is the only usable form by your body.
However, there is an issue. Your body sometimes produces reverse T3 (rT3) instead of usable T3. It is a key that jams in the lock. It competes with T3 but doesn’t actually activate the part of your body responsible for it. When your cells are unable to obtain the required energy needed for essential functions within the body, it leads to signs like:
Common Symptoms of Imbalance with T3 and Reverse T3
Here are some of the most common signs (Wilson & Friedman, 2021) that you can identify:
If any of these symptoms sound familiar, it would be wise to take a deeper look into the functioning of your thyroid.
Most cases of subclinical hypothyroidism present an increase in TSH, while T4 remains normal (Zhang et al., 2024). Your doctor usually tells you everything is mostly fine with your thyroid and to keep track of any changes or start very mild treatment. This seems fine but often overlooks reverse T3 and T3 imbalance.
Advanced test options such as the advanced Dutch test by Genova Diagnostics, add another dimension to the assessment. It assesses the stress hormones which play a critical role in thyroid functioning and overall health.
Why does this matter?
The imbalance of T3 and reverse T3 could tip into full-blown hypothyroid. And you would not be sleeping, eating sounds inefficient, and buzzing in your brain through the most normal activities: forever worn out and torn emotionally by mood swings without any apparent reason for them.
The reason is that even if TSH and T4 are in the normal range, an altered ratio of T3 and reverse T3 could lead to full-blown hypothyroidism. This affects your metabolism and mood, leaving you tired after exhausting and emotionally disturbed.
There are many factors lead toward T4-to-T3 (Jonklaas, 2021) and reverse T3 conversion: Stress: Under stress, high levels of cortisol are produced. They prohibit T3 formation and causes a rise in rT3.
Nutrient Deficiencies: Selenium and zinc are required for the conversion of T4 to T3. Without those, reverse T3 can take over.
Illness or inflammation: Any chronic illness can impair your body’s ability to produce T3.
Diet: Diets low or restrictive on calories slow down thyroid and elevate reverse T3 levels.
Medicines: Certain drugs like beta blockers and steroids also impair T3 production.
When your reverse T3 is elevated, it’s as if your brakes are on, instead of an accelerator. You just feel sluggish and tired with a tired mind.
Without taking into consideration the root reason behind the imbalance of triiodothyronine and reverse triiodothyronine, you are creating a havoc in health in the long run (Feldt-Rasmussen et al., 2023).
Here is what is at risk:
Infertility: Thyroid hormones are very important for reproduction. Their imbalance manifests in the disturbances of the menstrual cycle and fertility.
Cardiovascular Problems: Decreased T3 can affect the heart rate and cholesterol levels, opening many other issues related to heart diseases.
Psychiatric Illness: Mood swings and chronic depression can be seen when thyroid hormone function is altered.
Metabolic Disease: Non-functioning thyroid causes weight gain and an insulin-resistant state leading to diabetes.
Treating hormonal imbalances early prevents these long-term complications and improves the quality of living.
| Symptom | Potential Cause |
| Persistent fatigue | Low T3 or high reverse T3 |
| Brain fog | Impaired cellular energy from thyroid imbalance |
| Weight gain | Reduced metabolism due to T3 deficiency |
| Hair loss | Insufficient active thyroid hormone |
| Irregular periods | Hormonal disruption from thyroid issues |
| Muscle weakness | Impaired energy production in muscle cells |
To detect any suspected thyroid problem do not limit yourself to TSH and T4 tests only. Request a complete thyroid panel to include T3 and reverse T3 from your doctor. It is highly comprehensive, as it catch mismatches that are even not captured in standard testing.
Here are some ways to address these underlying thyroid problems (Aversano et al., 2021):
Reduced Stress: Perform activities like yoga, meditation, or even exercise on a periodic basis to relieve stress.
Better Nutrition: Selenium (found in Brazil nuts), zinc (obtained from seeds or meat), and iodine (metagenic from iodized salt or seaweed) should be sufficient in your diet.
No Strict Dieting: Achieve a full and balanced meal with enough calories for body metabolism.
Get Help: An endocrinologist can help with reverse T3 dominance and optimize the function of your thyroid.
Avoid Iodized Salt: Use Himalayan salt as it contains minerals in its natural balanced forms. Iodized salt is mostly unhealthy and less beneficial for use. It is mostly known from the processed table salt. So, make sure to have himalayan salt always in reach.
Feeling fatigued, irritable, and pissed-off all the time means ignoring the signals from your body. It may be giving you a sign about your thyroid health. Although subclinical hypothyroidism sounds like a mild condition, an imbalance of T3 and reverse T3 lies at the top. It leads to considerable effects on well-being.
The bright side is that with the right tests and treatment, there is hope for improvement. You can get that energy back and feel lively again. Life shouldn’t feel like a constant struggle. So, take control of your health right now. Just don’t settle for “okay.”
Your thyroid might just be the secret to feeling alive and well.
Is your thyroid trying to talk to you? Listen closely. Perhaps the answers you’ve been seeking lie right in the space where you are now standing.
Wilson, J. B., & Friedman, T. C. (2021). Reverse T3 in patients with hypothyroidism, helpful or a waste of time? Journal of the Endocrine Society, 5(Supplement_1), A952. https://doi.org/10.1210/jendso/bvab048.1945
Zhang, X., Zhang, G., Wang, S., Jin, J., Zhang, S., & Teng, X. (2024). The change in thyroid function categories with time in patients with subclinical hypothyroidism: a systematic review and meta-analysis. BMC Endocrine Disorders, 24(1). https://doi.org/10.1186/s12902-024-01754-7
Jonklaas, J. (2021). Optimal thyroid hormone replacement. Endocrine Reviews, 43(2), 366–404. https://doi.org/10.1210/endrev/bnab031
Feldt-Rasmussen, U., Effraimidis, G., Bliddal, S., & Klose, M. (2023). Consequences of undertreatment of hypothyroidism. Endocrine, 84(2), 301–308. https://doi.org/10.1007/s12020-023-03460-1
Aversano, L., Bernardi, M. L., Cimitile, M., Iammarino, M., Macchia, P. E., Nettore, I. C., & Verdone, C. (2021). Thyroid Disease Treatment prediction with machine learning approaches. Procedia Computer Science, 192, 1031–1040. https://doi.org/10.1016/j.procs.2021.08.106
