If this occurs at a time consistent with a patient’s compensation time, then it may just be due to compensation (p85). However, if this occurs after a patient’s usual compensation time has clearly passed, at a time of severe stress, it may due to a reduction of remaining endogenous T4 to T3 conversion. Finally, if it occurs after a patient’s usual compensation time has clearly passed, and the patient is not under significant stress, it may be due to a “crumbling effect” from an unsteadying of T3 levels (p121). This is very unusual but does occur.

If it is due to compensation or reduced T4 to T3 conversion as mentioned above, then one may continue cycling the patient up on the T3 therapy if there are no complaints.

If it seems due to crumbling, then a T4 test dose may be helpful in steadying the patient’s T3 level, and the patient’s temperature may come back up. If it doesn’t come back up with the T4 test dose, but the patient does notice an improvement, then continue cycling the patient up on the T3 therapy in an effort to raise the temperature back up, with T4 doses taken PRN indications of unsteadiness. If the temperature cannot be raised with this approach without the T3 level steadiness getting more and more out of control, then it may be necessary to wean off the current cycle of T3 to recapture the patient’s T3 level steadiness, and then begin another cycle. This may be necessary to get the patient’s temperature back up to normal, and to keep it normal, often on less medicine than the previous cycle.

Note: T3 dosage level does not always equate, for some reason, with T3 stimulation of the cell. It is clear that the effectiveness or degree of stimulation of a certain amount of T3 has something to do with its steadiness. For instance, I had one patient misunderstand the directions for taking the T3. She continued to increase the dose of T3 she was taking until she was on 800mcg per day. Yet her temperature was still low, and she wasn’t having any complaints. When the error was discovered, she was gradually weaned off the T3, and after a time another cycle was started. On that cycle, she was able to get her temperature up on 150mcg per day when she never could on 800. In some cases the T3 could be increased “until the cows come home,” and the patients’ temperatures never would come up (this is particularly the case when there are indications of unsteady T3 levels).

Another example was a case described in the Lancet, where a woman tried to commit suicide by taking about 1600 mcg of T3 all at once. The case-study was notable in that she did not have more side effects than she did. She wasn’t thrown into thyroid storm.