Patients’ hypothyroid symptoms not improving at all with normalization of their body temperatures strongly suggests unsteady T3 levels. The purpose of going up on T3 therapy is to reset the thyroid system. It is nice when T3 levels can be held steady enough in the meantime for the patient to notice an improvement clinically while on a given cycle (p74, p76). If a patient’s temperature goes up to normal but the patient is still feeling no improvement; it is very likely to be because of unsteadiness of the T3 level. This is one instance in which a T4 test dose might be illustrative. If the patient’s symptoms improve within an hour or so of the test dose, then that is a good indicator that it’s just a matter of the patient’s T3 levels not being quite steady enough. If the patient responds tremendously well to the T4 test dose, then one could consider continuing the present T3 cycle, and using the T4 test dose prn (please repeat as necessary). But if the symptomatic resolution with the T4 test dose is not sufficient, then it would be best to wean the present T3 cycle. As patients wean off the T3 therapy, their own T3 production comes back up, and their T3 levels become more and more endogenously steady. And as they do, the patients’ symptoms often begin to resolve if their temperatures hold while weaning. If their temperatures don’t hold, and the patients notice no symptomatic improvement while weaning off the T3, then they will often be able to get their temperatures up on less medicine on the next cycle. With the patients on less medicine it is easier to keep T3 levels steady, and they are much more likely to notice an improvement in their symptoms. This is why I often refer to the first cycle as a “reset cycle,” and why I consider a therapeutic trial of T3 as sometimes requiring two cycles (p125).