It depends on how far along a patient is in treatment. For example, suppose you were tuning a radio by turning a knob and you wanted to tune in a station that was on the other end of the dial. You’d probably turn the knob more quickly at first, more slowly as you got closer to the station’s frequency, and most slowly when fine-tuning. Sometimes, patients’ histories suggest that it may take several cycles of T3 therapy to return a patient’s temperature patterns to normal, if at all. Each cycle can take over 4 weeks. At best, such patients may be looking at 3 months worth of therapy before doing very well, so it is usually best not to dillydally. And, whereas, it is good to get as much benefit out of each cycle as possible, the preceding cycles can often be thought of as “coarse-tuning,” with subsequent cycles being thought of as “fine-tuning.” There is little point in fine-tuning a coarse-tuning cycle, it is usually more productive to move on to a more productive cycle. If it is likely that this is not the last cycle, it is usually best to simply decelerate the rate of wean (c12) rather than go back up a dosage increment if the temperature starts to slip a little (also see Q11).
However, what if there is a good chance that this may be the last cycle and the patient is not in a hurry to wean off the medicine? In that case, it may be best to wean down by 7.5 mcg/dose/7to 10 days to give the patient’s body every opportunity to come back up on its own again.
Finally, in cases where patients go up to about 90 mcg’s/dose of T3 and notice no changes whatsoever good or bad- as if they were only taking water- I will frequently try going down a 7.5 mcg dosage decrement every day if the patient has no complaints. It is usually more effective to wean off such a cycle and start another than it is to continue increasing the dose. This is because sometimes a patient can keep increasing the dose and the temperature still doesn’t go up. But interestingly, when the cycle is weaned and another one is started, the temperature can frequently go up on less T3 when it never did on more. Also, it is usually better to wean off a cycle that has demonstrated no effect (in preparation of starting another), than it is to stay on that cycle for weeks hoping it will demonstrate more effect (p100). See also Q9.