However, just because a patient presented taking a T4-containing medicine does not necessarily mean she is hypothyroid. If it is felt the patient may not be hypothyroid, she may be challenged by gradually weaning her off the T3 therapy without T4-support to see if she can maintain her temperature and clinical status on her own. When challenged, if her temperature begins to drop as soon as the weaning process begins, she is probably being weaned too quickly. However, if her temperature holds well through several decrements in T3 dose it suggests that the patient is not being weaned too quickly. Then as the patient continues to wean if she then hits a “wall” where the T3 dose cannot be decreased any further without the temperature dropping, the patient probably is hypothyroid and cannot make sufficient T4 on her own to provide for sufficient levels of T3. When it is felt a patient should be supported with T4, add back a small amount of T4 (.0125mg – .05mg) even if the patient presented on .2 mg. Because after cycling on T3 therapy, patients can often do much better even on much less T4 medicine. Continue the process above, and add back more T4 if another “wall” is encountered. It’s best to have patients remain on the smallest amount of T4 possible (The taller the tree, the harder it falls. I believe patients on the smallest dose of T4 needed to do the job are less susceptible to a relapse of Wilson’s Temperature Syndrome). If she can stay off T4 then she is probably not hypothyroid and may be cycled on and off the T3 therapy in the usual fashion. And she can be watched expectantly for 1 – 2 months after the last cycle of T3 has been weaned to see if her symptoms relapse or if low T4/ high TSH levels appear. If T4 is added back, and another T3 cycle is to be started, go through Module 1: Wean T4-containing medicine before T3 cycle first.