More on the CT3M

The CT3M is a simple technique and is based on solid science.

In a normal, healthy human being, TSH will peak soon after you go to bed - typically around midnight/1:00am. The rising TSH level drives the thyroid to produce more T4 and some T3. Rising TSH also improves the conversion rate of T4 to T3. Many doctors and even some endocrinologists are not aware that the level of TSH also affects the conversion rate of T4 to T3. So, as TSH rises, you get more  FT3 from the thyroid gland, but also through improving conversion rate.

So, in a healthy person,  FT3 peaks typically between 3 am and 5 am in the morning.

Why is this important?

Wel, lots of other activity begins to occur around 3:00 am - 5:00 am (for people that get up around 8:00 am).

The pituitary gland begins to raise its level of adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal glands to produce cortisol and Dhea.

As a result of higher ACTH, healthy people begin to have a big rise in cortisol.

Very interestingly, the pituitary gland has been shown to have a higher concentration of T3 in it than any other organ in the body. The pituitary also converts T4 to T3 within its own tissues using the D2 deiodinase enzyme. The pituitary needs a good FT3 level to function well.

It is no surprise that the body makes more FT3 during the middle/late hours of the night. A healthy level of FT3 is required to support the intense action that is starting to happen within the pituitary gland and in the adrenal glands (and the sex glands also). This is how it is supposed to work.

For many thyroid patients taking thyroid hormones,  this beautiful rhythm is often lost.

We are told to take thyroid medication when we get up. This causes peak levels of FT3 in the day time,  and freqiuently leaves very low levels of FT3 during the night when the pituitry gland and adrenals are supposed to be working hard. This is not a physiological way of replacing thyroid hormone. For some thyroid patients this results in low levels of the important adrenal steroid cortisol.

The Circadian T3 Method (CT3M) corrects this in those thyroid patients that may need a little more of a natural FT3 pattern.

CT3M is about taking a dose of T3 (possibly NDT), in the night. The time has to be determed and so does the size of the dose. I have a protocol for doing that, which can be found in both the 'Recovering with T3' and 'The CT3M Handbook' books.

CT3M is simple,  and it works very well in many cases and can correct cortisol levels in thyroid patients with low cortisol. It can do this without the need to resort to the use of hydrocortisone (HC) or adrenal glandulars.

In some cases, it does not work so well, or even at all. This is likely because the cause of the low cortisol is simply not going to be fixed with increasing the pituitary FT3 level.

I still believe that most low cortisol issues are associated with the hypothalamic-pituitary system. But some causes of HP dysfunction may simply not be discovered. I do not believe adrenals themselves get fatigued. The adrenal glands themselves are so simple that all they really need is ACTH and enough cholesterol in order to function well. Of course, some people do indeed have Addison's disease (adrenal tissue destruction) but these cases are not that common compared to the typical low cortisol problems that affect many thyroid patients.  This is why I no longer use the term 'adrenal fatigue', I only refer to low cortisol, cortisol insufficiency or hypocortisolism.

CT3M is a great technique for those thyroid patients who discover that they have low cortisol. It definitely is worth trying before rushing straight into using something like HC.

I also also recommend both saliva cortisol testing and an 8:00am morning cortisol blood test. I definitely do not recommend just assuming cortisol is low based on symptoms alone, as many things can cause symptoms that might be due to low cortisol.

I hope you found this interesting.

Best wishes,


(Updated in February 2019)