Why The Circadian T3 Method is So Important - Text Version
Why the Circadian T3 Method is so Important
I believe that the Circadian T3 Method (CT3M) should be a standard tool that is used in the treatment of thyroid problems by all doctors and endocrinologists. When a thyroid patient has symptoms of low cortisol or presents with a lower than ideal cortisol test result CT3M can be enormously helpful in improving the cortisol levels and the well being of the thyroid patient. The measurement of cortisol is ideally done via a 24-hour adrenal saliva test, as this test is more insightful because it measures free cortisol samples over the day.
The CT3M Handbook makes it far clearer than anything I've written in the past as to why CT3M is necessary for so many thyroid patients. It also makes it clear why adrenal issues seem to be so common amongst those patients that appear not to respond well to T4 (standard thyroxine therapy).
CT3M attempts to mimic healthy hormone levels.
Let us look at thyroid and cortisol hormone levels over 24 hours in a healthy person. Please click on THIS link to see the graphs.
The first set of graphs show how TSH, FT4 and FT3 vary over 24 hours. It is obvious that in a healthy person TSH peaks after they go to sleep. A substantial peak in FT3 follows this peak of TSH. The peak in FT3 is likely to be due to a combination of increased thyroid output of T3 and increased conversion of FT4 into FT3. There is research that shows that elevations in thyrotropin (TSH) cause increased levels of FT4 to FT3 conversion. Please see my previous blog post for more information on the link between TSH and T4 to T3 conversion: http://recoveringwitht3.com/blog/effect-tsh-thyrotropin-conversion-t4-t3.
For a healthy person a raised TSH at night would request that more T4 and T3 be produced by the thyroid gland. The fact that FT4 lowers and FT3 increases on these graphs may seem strange but it is perfectly explainable due to: a) the effect that TSH has on the conversion rate from FT4 to FT3 and b) the increased thyroid output of T3. These two factors would account for both the substantially raised FT3 level but no increase in FT4 (in fact a slightly lower FT4 level). This is in a healthy person with a working thyroid gland. Note: this explanation is not the one offered in the research article in which the graphs appear. They explain the rise in FT3 due to the extra thyroid production of T3 during the night only. It really doesn't matter too much which of these two views that you hold because the important fact is that FT3 rises a lot. However, I personally believe that the rise is at least in large part due to increased conversion of FT4 to FT3.
This elevation in night time FT3 is natural and it is what our bodies would have done prior to thyroid disease and being on thyroid medication.
The second graph shows the natural cycle of cortisol in the body. It is very clear from the graph that cortisol rises during the early hours of the morning and peaks around the time that someone gets up for the day. This period of intense cortisol production I have termed the 'main cortisol production window' and it is approximately four hours before someone gets up for the day.
My belief is that when pituitary gland is driving the adrenals to produce high levels of cortisol, it requires excellent levels of FT3 in order to do this. The relationship between peaking FT3 levels and the ability of the adrenal glands to produce peak cortisol levels is clear to me. Having seen the results of CT3M in myself and in thousands of other thyroid patients I know this to be true.
Now, what happens with normal thyroid medication and the way in which its use is advised? Well, in the cases of thyroxine, natural desiccated thyroid or T3 the usual advice is to take this in the daytime. That's the advice almost all doctors give and have given since these medications were available.
What is the consequence of taking natural desiccated thyroid (NDT) or T3 medications only in the daytime?
The major consequence is that FT3 levels will peak in the daytime. When someone goes to bed their FT3 levels will fall. As the night goes on the individuals FT3 levels will fall to be around the lowest of the day by the time the adrenals work. This will be even more likely if they are on quite a high dose of NDT or T3, as this will have suppressed TSH making it more likely that no improvement in conversion of FT4 to FT3 can take place. This unnatural inverted FT3 pattern follows from taking daytime thyroid medications. This unnatural pattern is likely to be even worse for patients with damaged thyroid glands, no thyroid glands or suppressed TSH levels.
The use of daytime thyroid medications makes it more likely that a thyroid patient will be prone to having issues with low cortisol. However, not all thyroid patients will have cortisol issues. I believe that some individuals have more margin in their metabolisms than others - stronger systems you might say. However, there does appear to be a somewhat epidemic level of adrenal issues amongst thyroid patients and I believe a lot of this is simply due to the taking of thyroid medications in the daytime and low FT3 levels during the time when the adrenal glands begin to work extremely hard to raise cortisol levels.
The Circadian T3 Method is not a novelty trick. It is a simple method that attempts to use thyroid medications that contain T3 in order to reproduce what our healthy bodies would have done before we had thyroid problems. CT3M mimics nature.
Please be aware that I do not for one minute believe that all thyroid patients with partial adrenal insufficiency have this due to low FT3 levels in the night. There are many other conditions that can result in low cortisol levels. However, CT3M is one tool that appears to be highly relevant in the treatment of partial adrenal insufficiency for many thyroid patients.
CT3M should be a standard tool in the treatment of thyroid disease when there is evidence of low cortisol.
For those of you would would like to read this article with the graphs embedded in the text, or wish to have something to print out with the text and graphs together then please click on THIS.
A Future Vision
I can imagine a time when advanced time-release drug technologies can allow us to take T3 medication before bedtime and have it released at a precise time that will support the pituitary and adrenal glands. I can even imagine that we can have our T3 medication and NDT medication in a container and that we can program a device (maybe an app on our mobile phone) that can state exactly what doses and times we want the medication released and have it happen. Beyond that ... far beyond that we will have technology that can monitor our FT3 levels over twenty four hours and release thyroid medication as needed to ensure that the profile of FT3 is ideal for us .... as unique individuals. A long way off these things ... but they will come!
(Updated in February 2019)