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Reverse T3 (rT3), Triiodothyronine, Reverse


Definition


  • Hormonally inactive isomer of T3.
  • Normal range:
    • Birth to 6 days: 600 " �2,500 pg/mL
    • ≥7 days: 90 " �350 pg/mL

Use


  • To distinguish low T3 "sick thyroid " � patients (usually increased) from true hypothyroidism

Interpretation


Increased In


  • Severe nonthyroidal illness except in some liver disorders, HIV, renal failure
  • Usually in hyperthyroidism and increased serum TBG

Decreased In


  • Often in hypothyroidism but overlaps with normal range

Limitations


  • Measurement is occasionally useful in hospitalized patients to distinguish between nonthyroidal illness and central hypothyroidism. Values are lower in central hypothyroidism, because of low production of T4. In patients with mild hypothyroidism, rT3 levels may be normal or even slightly higher limiting its usefulness.
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