Why both time and dose size adjustments need to be done in the circadian T3 method (CT3M)

People frequently ask me about the difference between adjusting the time in the circadian T3 method (CT3M) and adjusting the circadian dose (the early dose) size.

I have just been asked why don't we just start at a time four hours before we get up and just adjust the dose size. This is a good question and I know that I have never explained it properly so let me try now.

So, why does 'time' have to be adjusted (titrated) as well as circadian dose size?

It certainly HAS to be done the way I have written it in the book - there is no doubt about it in my mind.

The majority of people with adrenal fatigue (or adrenal insufficiency - doctors do not like the term adrenal fatigue) have it as a secondary consequence to hypothyroidism. The adrenal insufficiency may have been made worse by issues such as immune system stresses, overall health issues, or personal stress. However, in the majority of people the adrenal insufficiency is occurring due to low free T3 levels that have been present for too long. The results that have been seen using the CT3M prove that this is the case. The vast majority of people suffering with adrenal issues fly through an ACTH stimulation test with flying colours. So, in principle the adrenals are capable.

I even thought of describing this it in the same way that hypopituitarism causes secondary adrenal insufficiency. The idea that people need HC or florinef or adrenal glandulars to prop up their tired worn out adrenals is avoidable now with the circadian T3 method. Even before I began working on these forums I believed that the use of these medications was at best a help to the person in difficult times but at worst it was the beginning of an addiction because the adrenals never recover properly when these begin. The notion that the adrenals rest and then get well is a strange concept that I do not believe in and most doctors do not believe in. Perhaps this is why so many people that start using adrenal steroids simply cannot get off them again. These drugs should rarely be given apart from proper Addison's disease (proven via ACTH stim or autoantibody testing) and proper hypopituitarism (proven via insulin tolerance test). I hate these drugs because I've seen thousands of people stuck on them forever - and they don't feel well.

So, low FT3 is the real reason for the majority of these adrenal insufficient patients' problems.

Right, let me discuss the 'time' vs. 'circadian dose size' question.

These two titration methods are quite different.

Adjusting the Time of the Circadian Dose of T3 Containing Medication

The adjustment of the time of the circadian dose provides a gentle change of FT3 level to the adrenal glands. A later T3 dose means slightly less FT3 arrives inside the adrenal cells and we get less response. An earlier T3 dose allows slightly more FT3 within the adrenal cells. Once the T3 dose being used is big enough then the time changes provide a seemingly linear improvement in adrenal function for those patients that have relatively undamaged adrenal glands (and most have quite healthy adrenals - even those who have been sadly encouraged to use heavy duty adrenal hormones).

Once the circadian dose is at the 1.5 hours before waking time and the dose is enough (often 15 mcg of T3 or 1.5 grains of natural thyroid) then this response by even moving 15 minutes is apparent. It still amazes me to see this response - I see it every day in people who are just trying this awesome circadian T3 method.

Consequently, adjusting the time of the circadian dose is the fine-tuning dial on our adrenal glands in the CT3M - there is no doubt.

Adjusting the Circadian Dose Size in the CT3M

T3 acts like a wave. This is described in my book thus:

      "For each divided dose of T3, I discovered that there was definitely a ‘threshold level’ that had to be exceeded before any real benefit was experienced from the hormone. As I increased the dose beyond this threshold level then the effects were greater. If I exceeded the threshold too much then I experienced symptoms of tissue over-stimulation. My threshold level tended to be lower as the day progressed. So, later in the day I required lower doses of T3 to achieve the same effect. This perception may be due in part to some cumulative effect of the previous doses of T3 but the interaction with other hormones, which reduce in level during the day, may also be relevant.
     I often use a specific analogy to describe to other people how T3 appears to behave:
Imagine a sandy beach, which is sheltered from the sea by large rocks. Only a wave that is large and powerful enough is capable of striking the rocks and sending a spray of seawater over them to drench the sand beyond."

The way this works is that as you increase the circadian dose the size of that wave increases and significantly more FT3 becomes available to the adrenals. This is NOT subtle or manageable. It is crude and somewhat unpredictable way to alter the function of the adrenal glands but it is of course necessary.

We need to be able to carefully adjust all the adrenal hormones and get aldosterone, cortisol, Dhea and ALL the other dozens of adrenal hormones correct again. Adjusting the size of the circadian dose by even 2.5 micrograms can produce a profoundly different effect - it is like delivering an extra 2.5 mcg equivalent of FT3 - this can produce a HUGE response.

Consequently, adjusting the size of the circadian dose is the rough-tuning dial on our adrenal glands in the CT3M.

We Need Time and Dose Size Adjustments.

For the CT3M to work we need a rough adjustment and we need fine-tuning. It is too easy to cause too much cortisol or aldosterone to be generated in some people and in others there adrenals take longer to recover and we need to have a circadian dose that is as good as it can be without over-straining the adrenals.

The other things to be aware of is that improvements in cortisol output may not be occurring at the same pace as aldosterone or Dhea improvements. So, the subtle use of the fine-tuning dial of 'time' is essential to strike a compromise during the recovery process.

So, the process is right. Stick with it. Don't try and short cut it. I have used it for 13 years myself and before I released the book I'd observed it's use in dozens of thyroid patients over a five-year period just to prove I had the description written generally enough (and not specific to my physiology).

I hope this is clear.

In summary the typical steps are:

a) The circadian dose size is adjusted so that it begins to work starting typically at around 1.5-hours (possibly 2 hours) before someone gets up on a morning.

b) Then the time of the circadian dose is adjusted.

c) Once an optimal time is found then the circadian dose size may be titrated once again.

d) Once this circadian dose size appears to be about right then the time adjustment is our friend again and we can subtly adjust our adrenal function.

It is a little iterative but there is no way around that.

Best wishes,

Paul