Some Clarifications on the Circadian T3 Method (CT3M)
I have been asked to make some clarifications regarding the details of the circadian T3 method (CT3M).
The CT3M is a simple process that has a large scope within it to find ways to best support the adrenal glands. The 'Recovering with T3' book makes the process very clear and having and reading (or re-reading) the Phase 2 process within the book will really help. The book is the best resource available on the CT3M and should be referred to when anything is not clear.
Once the decision has been taken to try to see if the CT3M will help a thyroid patient's adrenal gland performance then some T3-containing medication must be used. A circadian dose (early morning dose) of either standard T3 or natural desiccated thyroid (NDT) may be used. The choice between the two depends on whether the patient has any problems with T4 conversion or high reverse T3. If high rT3 or T4 processing problems are present then standard T3 may be the best choice of medication for the circadian dose. Elevated rT3 is often due to low iron levels or low cortisol. Low cortisol can sometimes be corrected sufficiently with the CT3M to allow natural desiccated thyroid to be an option for the circadian dose from the outset. Any other daytime doses of thyroid medication can be T3 or NDT depending on the nature of the thyroid patient's issues with T4 processing.
Slow release T3 is not an option for the circadian dose as the T3 does not arrive to the adrenal glands fast enough and cannot be titrated with any control - either in dose size or time. Similarly, sub-lingual absorption is also not advisable as often this does not happen quick enough to be used with any confidence. There is also no need to attempt to mix the two and create T3/NDT dose combinations, as this is both over complicated and unnecessary. No harm can come from doing this but it adds greatly to the complexity of managing the dosage of thyroid medication.
Start with a low circadian dose at 1.5 hours. Often this circadian dose is 10 mcg or 12.5 mcg. Find the lowest dose that can be 'felt', i.e. there is some sense that it has been taken. Once this dose is found then it is slowly moved earlier in time, allowing enough time in between time changes to assess the effect - at least several days and maybe a week should be enough.
Somewhere in the 1.5 - 4 hours the time will be optimal. For those that have severe adrenal issues the ideal time is often 3-4 hours back. For those that only have minor problems they may get a good response at 1.5-2 hours.
Once the time has been identified then the dose can be raised if necessary. This is the way the RWT3 book has explained the process and the way I've described it to people.
Keeping the circadian dose as low as possible but still being detectable to begin with is important. If this is not done then if someone raises the first circadian dose too high (say above 15, e.g. to 20 or 25) and then tries to take it back then they can appear to get a better response at 1.5-2 hours and a poor response at earlier times. This is frequently because the circadian dose is too big and causing too much demand on the adrenal glands when it gets to the 3 or 4 hour before getting up time.
If someone really does feel well with a circadian dose taken 1.5-2 hours before getting up then this is great. For those with more serious problems I'd always suggest keeping the dose lower and moving it earlier. In some cases I'd even go below 10 mcg and getting it earlier before ever increasing it. This is especially true for those who appear to be very sensitive to thyroid medication.
For someone who is super sensitive to any T3 meds and gets high heart rates immediately due to low cortisol then starting back at 4 hours with a tiny dose like 2.5 or 5 mcg T3 content can be a cautious option.
Some people need a low dose at 3-4 hours and need to sit there with it for weeks as the adrenals improve before raising it.
The RWT3 book is very clear about finding the lowest dose for the circadian dose that works and then titrating it back. For some thyroid patients it matters a great deal, as getting 3-4 hours back with some T3 really can be the only way forward for long term adrenal improvement.
It has been suggested incorrectly that there may be a peak of adrenal performance when the circadian dose is taken two hours before getting up. This is a false assumption in my opinion and makes no sense based on the basic endocrinology involved. The potential for more response from the adrenal glands is far more likely at 3-4 hours. However, if the circadian dose is too large it can be counterproductive. Some thyroid patients only need a little more adrenal output and so 1.5-2 hours may be ideal for the right amount of adrenal improvement. Additional output of adrenal hormones beyond that can actually tend to block thyroid hormone or cause other undesirable effects. Again, this only applies to those with mild adrenal issues.
The CT3M has the flexibility within it to provide a range of different levels of support to the adrenals, depending on their level of under-performance. The existing process for the CT3M copes with all of this if done correctly and if given enough time of course. Adrenal improvement may not come overnight. Improvement may take months in some cases because years of illness cannot be reversed immediately.
As always thyroid patients should be working with their own personal physician with respect to any changes in medication and whether the CT3M is suitable for them.
I hope this helps.