Dr. Westin Childs (​www.restartmed.

com​)

How to Calculate your Reverse T3 Ratio & Optimal 

Free T3 and Free T4 Levels 
 
How to use this resource:

- You will need your most recent set of labs in hand. Once you have this
information you can begin to calculate these ranges and determine if your lab
values are in the “optimal” range or not.

Calculating Optimal Reference Ranges for Thyroid 

Lab Tests:  
 
How to calculate your Free T3:Reverse T3 Ratio: 
 
What does this ratio tell you? This ratio is probably the single most important thyroid lab test 
that you can run.  
 
Why? 
 
Because it tells you how much competition exists on your cells for T3 binding. The higher your 
reverse T3 is, the less likely your free T3 will be able to bind to your cells and turn on thyroid 
function.  
 
This ratio has been shown to be the MOST sensitive marker of thyroid function and it starts to 
go out of bounds before ANY other thyroid lab test (including TSH, Free T4 by itself, Free T3 by 
itself, and reverse T3 by itself).  
 
When calculating your Free T3:Reverse T3 ratio all you need to do is divide the values as 
follows: 
 
Let’s say that your Free T3 is 2.8 pg/mL (see image below): 

 
 
And that your reverse T3 is 14.4 ng/dL (see image below):  

For up to date information on thyroid function and treatment please see:

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 Dr. Westin Childs (​www.restartmed.com​)

 
 
Knowing this information we can easily calculate the Free T3:Reverse T3 ratio by dividing 2.8 by 
14.4. 
 
This gives us a value of 0.19.  
 
The Free T3:Reverse T3 ratio should always be LARGER or GREATER than 0.20. If your ratio is 
less than 0.20 (like this example) then you have a problem!  
 
In this example, the ratio is not sufficient which indicates that this particular patient has 
insufficient Free T3 relative to her Reverse T3 and may do better by increasing her free T3 either 
through natural therapies​ or ​through medication​.  
 
When calculating the Free T3:Reverse T3 ratio make sure you use these units:  
 
Free T3 Units: pg/mL 
Reverse T3 units: ng/dL 
 
How to Calculate Optimal Free T3: 
 
You generally want your free T3 in the top 30% of the reference range in order to be optimal:  
 

 
 
 
Reference range = 1.7 to 3.7 
 
Step #1.  
 
Find the spread between the range by subtracting the top end of the range from the bottom end.  
In this case, it’s 3.7 and 1.7. So, 3.7 minus 1.7 equals 2.0.  
This number represents the total range between the top and bottom end of the reference range. 
This range is often very large and so it’s important to find out where you fall within it.  

For up to date information on thyroid function and treatment please see:

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 Dr. Westin Childs (​www.restartmed.com​)

 
Step #2.  
 
Multiply the spread by the percentage value that you are looking to obtain. So if you want to find 
the top 30% of the reference range you would multiply 2.0 by 0.7 (which is 70% of that total 
value).  
In this case, you will get a value of 1.4. 
 
Step #3.  
 
Add 1.4 to the low end of the range.  
In this case that will be 1.7 + 1.4 which equals 3.1.  
You know have your new “tighter” range which is 3.1 to 3.7.  
 
Step #4.   
 
Compare your results to this new reference range that you’ve now created.  
 
 
How to Calculate Optimal Free T4: 
 
You want your free T4 in the top 50% of the reference range in order to be ‘optimal’.  
 

 
 
Reference range - 0.89 to 1.76 ng/dL.  
 
Step #1.  
Find the spread: 
1.76 minus 0.89 = 0.87 
 
Step #2.  
Multiply the spread by 0.5 (50%).  
0.87 x 0.5 = 0.435. 
 
Step #3.  
Add 0.435 to the low end of the reference range.  
0.89 + 0.435 = 1.325.  

For up to date information on thyroid function and treatment please see:

https://www.restartmed.com/blog/
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 Dr. Westin Childs (​www.restartmed.com​)

 
Step #4.  
New optimal range = 1.3 - 1.76.  
Now compare your result to this range.  
 

For up to date information on thyroid function and treatment please see:

https://www.restartmed.com/blog/
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