What is The Circadian T3 Method?

What is the Circadian T3 Method (CT3M)?

CT3M is an optional part of T3 protocol that I used to regain my health. 

CT3M is ONLY used if the person needs to raise their cortisol levels.

In the book 'Recovering with T3' I describe a T3 dosage management protocol that shows how to use T3 safely, and effectively in order to get well.

This T3 protocol is described in the book within the following chapters:

Chapter 19: Preparation for T3 Replacement Therapy
Chapter 20: The Goals of T3 Dosage Management
Chapter 21: Using Symptoms and Signs
Chapter 22: Taking Body Temperature Readings
Chapter 23: Recognising a T3 Dosage that is Too High
Chapter 24: Phase 1: Clearing T4
Chapter 25: Phase 2: Determining a Safe, Effective and Stable T3 Dosage
Chapter 26: Phase 3: Long-Term Monitoring
Chapter 27: Conclusions on T3 Dosage Management

I believe that the information in the book 'Recovering with T3' presents a best-in-class, safe,  and effective way of using the least amount of T3 in order for someone to get well again. This approach is likely to result in fewer issues and far less chance of tissue over-stimulation occurring than with any other approach. 

The Circadian T3 Method (CT3M) is just one element contained in my T3 protocol. I describe the essence of CT3M in Chapter 16 and the details in Chapter 25.

CT3M may be applied with a variety of thyroid medications:

  1. T3 
  2. Natural desiccated thyroid (NDT)
  3. NDT/T3 combination (often with T3 as the circadian dose)
  4. T4/T3 (with T3 as circadian dose and possibly some other doses during the day)

The T3 protocol is often applied without the need to use CT3M, because the person's cortisol level may be fine.

What is the idea behind CT3M?

Many hormones follow a circadian rhythm with a pattern of secretion that is repeated every twenty-four hours and is typically linked to our cycles of sleeping and waking, or daylight and night. Cortisol is secreted by the adrenal glands, with a steady rise in production during the last four hours of sleep. For someone who gets up out of bed at 8:00 am, this means the highest level of cortisol production occurs between the hours of 4:00 am and 8:00 am. It is the rising level of cortisol that helps us wake up in the morning, with the highest level of cortisol in the bloodstream at around 8:00 am (for your typical person). Cortisol levels then fall gradually during the day and are at their lowest between midnight and 4:00 am in the morning. The exact times may vary depending on when someone gets up in the morning (e.g. shift workers may experience a different circadian rhythm).

The Circadian T3 Method (CT3M) utilises this natural circadian action. It requires thyroid medication, which contains T3 (natural desiccated thyroid may also be used). Once low cortisol has been confirmed with a twenty-four hour cortisoll saliva test, and an 8:00am morning blood test,  then CT3M may be used. The CT3M will not work if the thyroid patient has Addison’s disease or hypopituitarism (these conditions usually require lifetime treatment with adrenal steroids).

The basic idea behind the CT3M is to address low levels of the active thyroid hormone (T3) in the pituitary gland at the time the pituitary is driving the adrenal glands to make their highest volume of cortisol. The thyroid patient sets an alarm clock or mobile phone for a time between 1.5 and 4 hours prior to the normal time that they would get out of bed. A dose of T3  is taken at that time and the thyroid patient then goes back to sleep. By carefully varying the time and the size of this CT3M dose and assessing the results, it is possible to significantly help the adrenal glands to produce more or all of their hormones, including cortisol (which is often low in thyroid patients). Once this process begins to work and the adrenal glands begin to function well, then the quality of the sleep that follows this CT3M dose is often far better than the thyroid patient has been used to experiencing.

In recent years there has been research that confirms that T3 thyroid hormone peaks in the body when the adrenal glands begin to work hard in the early hours of the morning. These research findings support the ideas behind the CT3M. The research article is titled “Free triiodothyronine has a distinct circadian rhythm that is delayed but parallels thyrotropin levels.” and is published in J Clin Endocrinol Metab. 93(6):2300-6. June 2008. A link to the abstract is: http://www.ncbi.nlm.nih.gov/pubmed/18364382

A large number of thyroid patients have successfully used CT3M over the years since I released 'Recovering with T3'. Many of these had previously found that the only way they could cope was through the use of adrenal steroids like hydrocortisone or adrenal glandulars that contain steroids at lower quantities. CT3M often works well enough to allow these patients to slowly reduce and then stop the use of all adrenal steroids.

Some Important Things to Do Before Considering CT3M

​I really can't stress this strongly enough that some laboratory tests really are very important. When people are sick they want to get started on a treatment as soon as possible. However, to recover from thyroid disease many of us have to be 'the tortoise' and not 'the hare'! 

A cortisol saliva test (sometimes called an adrenal stress test) takes four samples of saliva over the day. Because only free cortisol passes into saliva it provides a profile of bio-available cortisol from the morning to the late evening. This test will show any low cortisol and any periods of high cortisol. Just starting CT3M because you or someone else thinks you have low cortisol is not a good idea. Getting the data is helpful because it will show if the CT3M might be relevant and also provides a baseline to compare with in the future. If someone is taking adrenal glandulars or hydrocortisone then they will not get an accurate reading with the adrenal saliva test and they may be suppressing their own adrenal function. In some cases it may be advisable for someone to wean any adrenal glandulars or HC prior to getting an adrenal saliva test but this would need to be discussed with the patient's doctor and done very slowly. Once someone has been off any adrenal steroids (glandulars or other steroids like HC) for 2-3 weeks then an adrenal saliva test could be done. More information on the adrenal saliva test can be found in 'Recovering with T3' Chapter 3, pages 45-46.

An 8:00am morniing cortisol blood test is also a good idea as sometimes the saliva test can report false results e.g. if the patient is using any cream containing progesterone or hydrocortisone.

A full iron panel including serum ferritin, serum iron, transferrin saturation % should also be done, as low iron is a common cause of poor thyroid hormone action. If iron is low then thyroid hormones will be less effective and so will the CT3M. More information on the full iron panel may be found in Chapter 4 of 'Recovering with T3', pages 53-56).

Other tests may need to be done but this may depend on the individual's needs, e.g. B12, folate,  sex hormones. Some patients may have such obvious symptoms of low cortisol that they should have diseases like Addison's disease ruled out via a Synacthen test (ACTH Stimulation test). This type of testing would usually also require that the patient not be on any adrenal glandulars or HC. More information on nutrient deficiencies may be found in Chapter 4 of 'Recovering with T3'.

It is sensible to be consider taking a broad range of basic supplements prior to starting CT3M (or any thyroid hormone treatment). These will tend to avoid basic nutritional deficiencies that might be present and could potentially interfere with the action of thyroid hormone.

For those that want even more information on CT3M, the 'CT3M Handbook' is a companion book which provides even more in-depth information on CT3M.

Finally

CT3M is actually only attempting to mimic the way the body raises FT3 to coincide with the time the pituitary and adrenal glands work at their hardest.

The standard methods of providing T4/T3, T3 or natural thyroid do not mimic this natural physiological pattern, as the T3 content of these medications is nearly always providing during the awaking hours. Far from being a strange concept, the Circadian T3 Method is actually far closer to a physiological replacement of T3 in these medications than any other method of dosing thyroid hormone has ever managed to achieve until now.

There is no magic in CT3M at all. It is simply the application of scientific understanding of the natural circadian rhythm of our hormones in order to mirror nature as much as possible. The only surprise is that it hasn't been used until now.

Please read the 'Recovering with T3' book prior to attempting the CT3M as this will answer many questions that may arise and potentially save an awful lot of time and effort.

Best wishes,

Paul

(Updated in February 2019)