In the blood, thyroid hormones exist in two forms- T4 and T3. T3 is the active form. T3 is primarily synthesized by monodeiodiation of T4 in the peripheral tissues(chiefly in the liver and kidneys) rather than by direct secretion by the thyroid gland.
Physical, mental and environmental stresses can inhibit the deiodinating enzyme, causing less T4 to be converted to T3, and thereby decreasing the amount of active thyroid hormone ft3 available to the cells.
on the other hand , if more T4 is gets shunted towards production of rT3(a bioloigically inactive form of T3) causing an elevation in rT3.
which in your case this which might be hapenning ,normal pituitary is giving normal TSH level ,normal thyroid is giving normal t4 level ,but after this stage the problem .
Total Free T3(FT3) measurement measures T3 and rT3 combined. Therefore, if an rT3 elevation is suspected, a measurement of rT3 must be performed. This is valuable in identifying a condition called "Reverse T3 Dominance".
When a patient produces excessive levels of rT3 they will usually present with hypothyroid symptoms.
Many factors can elevate rT3 levels:
- Chronic illnesses,
- Low protein intake / poor protein digestion,
- High simple carbohydrate intake,
- Starvation diets, fasting,
- Cadmium, mercury and lead toxicity
- Selenium deficiency,
- Potassium and Zinc deficiency,
- High stress levels (especially high cortisol),
- Compromised liver or kidney function.
-some medications
Therefore, in your case, a possible 'Reverse T3 Dominance' needs to be excluded
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