Let us take a moment to discuss different types of thyroid medications available. Some medicines contain only levothyroxine (T4), while others contain only liothyronine (T3), while still others contain a combination of T4 and T3. A distinction can also be made between thyroid medicines that originate from animal sources, and those that are made synthetically. In thyroid hormone supplementation, it is important that each dose of the same strength of medication given contain extremely similar amounts of the medication to help provide normal and steady levels. Medications prepared from animal sources are not considered to have as much consistency as compared to synthetic preparations. Consistency is particularly important in the WT3 protocol. T3 medication is prepared synthetically. With the WT3 protocol, steadiness and consistency are everything and I recommend the use of a special T3 preparation that incorporates a sustained-release agent or vehicle used in many sustained-release medicines on the market. It is to be taken every 12 hours.
To review, T3, T4, and RT3 look exactly the same, the way 3 keys look exactly the same except having one notch that’s different (see diagram 2-3). The interesting thing is that RT3 has no activity at all, T4 has a little activity, and T3 has four times more activity than T4 at the active site. Interestingly, T4 is converted to T3.
It takes 7 1/2 days for 50% of a certain amount of T4 to be degraded by the body, giving it a “half-life” of 7 1/2 days. The half-life of T3 is shorter than that of T4 being only 2 1/2 days. Since T3 is four times more active and is a third as long acting, and since the whole goal of the WT3 protocol is to provide normal and steady T3 levels to the active site in order to provide normal and steady body temperature patterns, it becomes apparent that the WT3 protocol is most effective when done in a precise manner. T4 medication having such a long half-life needs to be taken only once a day and can provide steady levels of T4 and T3. Unfortunately, as pointed out previously, Wilson’s Temperature Syndrome sufferers who have a hard time converting their own T4 to T3 often cannot convert T4 medication sufficiently to provide sufficient levels of T3 at the active site in a sustained manner, nor in a manner that could help reverse the vicious cycle that contributes to persistent T4 to T3 conversion impairment. T4 is usually not helpful in the treatment of Wilson’s Temperature Syndrome because it is not useful in systematically reducing RT3 levels, and because improvement of Wilson’s Temperature Syndrome symptoms with T4 medication is usually short-lived (usually about 3 months, if achieved at all). Increases in T4 therapy are then required to maintain the improvements, thereby, often feeding the vicious cycle rather than helping to reverse it. In fact, further increases in the T4 therapy can then even begin to make the Wilson’s Temperature Syndrome symptoms worse.
T4 medicine is a very good medicine, and is the treatment of choice for the other causes of DTSF. But since it is not generally useful in accomplishing the two subgoals of treatment for Wilson’s Temperature Syndrome, the WT3 protocol is the treatment of choice. The whole trick to the WT3 protocol is to keep the levels of T3 steady. This requires some care, consideration, and effort considering the short half-life of T3. Most doctors seem to think of thyroid hormone medication in terms of weeks and months, possibly because it takes weeks for T4 medication to provide a “steady state” or prescribed level of T3. However, T3 can be thought of in terms of minutes, days, and weeks since it can start being absorbed into the body within 35 to 45 minutes after the dose and can begin having an effect at the nuclear membrane receptors soon thereafter. This is especially true with the WT3 protocol since it is already “active” and does not need to wait around to be activated by the body.
Available medical resources suggest that T3 levels are more steady when patients are given T4 than when T3 is given directly, and that side effects are more likely when T3 levels are unsteady; yet they also suggest that T4 medication and T3 medication both be given once a day. This does not even make pharmacological sense. Normally, T4 is converted to T3 a little at a time, thousands of times around the clock 24 hours a day. Is it any wonder that this steady supply of T3 can’t be closely approximated with T3 given only once a day, or even several times a day? Is it any surprise that T3 levels may be more unsteady when T3 is supplied only once a day as compared to thousand of times around the clock? Perhaps this is one reason why the usefulness of T3 has been overlooked for so long and it may be why the WT3 protocol is sometimes considered to be somewhat prone to causing side effects. Of course, all medicines are prone to being less useful and more likely to cause side effects when taken in ways that do not make pharmacological sense.
There is nothing inadequate about T3 as a medicine or as a molecule, apparently only our understanding and application of it has been inadequate. In fact, it is one of the most important and useful of all medicines, and is a molecule the body can’t live without. There are some studies and people that have “concluded” this and “determined” that about T3, the way one can look through the wrong end of a pair of binoculars and “conclude” that they are not useful for seeing long distances. It is amazing how using something correctly can make all the difference in the world.
Some patients can tolerate the WT3 protocol given in single daily doses, some tolerate doses taken twice a day, some three time a day. However, in my experience, taking all patients as a whole, I feel that instant-release T3 medicine should be taken at least every three hours, six times a day, consistently by the clock in order to decrease the chances of side effects, and to increase the chances of benefits. A new approach, however, involves incorporating T3 into a sustained-release vehicle used in many sustained-release medicines on the market. It is intended to be taken every twelve hours and to deliver a little T3 thousands of times over a 12-hour period to provide a more steady supply of T3. When taken twice a day, such a preparation is designed to provide a more steady supply of T3 24 hours a day. So it is easy to understand why such a preparation is far more effective in the treatment of Wilson’s Temperature Syndrome than instant-release T3. Since the possible side effects of T3 are most often related to unsteady T3 levels, it is easy to understand also, why there are far less side effects with the WT3 protocol incorporating a sustained-release vehicle as compared to instant-release T3, and why it is much better tolerated. The T3 incorporating a sustained-release vehicle needs to be taken only twice a day as compared to six times a day, which makes it far easier for the patients to take the medicine properly, and on time. Such a preparation incorporating a sustained-release vehicle is not being mass-produced on the market, but is being custom made or “compounded” by some pharmacists with a special interest in compounding (for example, Wellness Pharmacy).
There are a few (approximately five percent of patients) who do respond better to instant-release T3 than the T3 mixed with a sustained-release agent. However, by far most patients respond far more quickly, far more completely, and with far less side effects to a T3 preparation incorporating a sustained release agent. In fact, the incidence and severity of side effects of the WT3 protocol can be reduced approximately 20-fold through the use of such a T3 preparation, as compared to instant release T3.
Many medications such as antihistamines, asthma medicines, blood pressure medicines, and many others have proven to be much more efficacious and better tolerated when administered in slow-release or time-release preparations that maintain more constant delivery and blood levels. Considering the importance of steady T3 levels, it is understandable why T3 in a sustained-release vehicle would prove to be much more efficacious and better tolerated than instant release T3. For this reason, I use, almost exclusively, such a preparation taken by mouth every 12 hours in the patients that I treat for Wilson’s Temperature Syndrome. It is important that the such a preparation be taken by mouth every 12 hours, 30 days a month, at the same time every day. If a patient misses a dose by an hour, he or she will probably notice no side effects and might conclude, therefore, that the timing of the dose doesn’t really matter. However, I always recommend to my patients that if they want the medicine to work exceptionally well, then they should take the doses right to the minute, not even three minutes late. It is also best that the preparation be compounded with great care and precision. I even recommend using a timer that automatically goes off every 12 hours. Because being off 20 minutes here, and 30 minutes there can add up over a period of a couple of weeks decreasing the potential benefits. Restoring the potential once decreased can take two weeks or more and may require cycling.