There are certain principles of T3 therapy that I think every doctor using T3 should understand. These principles are based on the physiology of the thyroid system and its hormones. They are essential in obtaining amazing results, for avoiding side effects, and are thoroughly described in the Chapters of this manual. However, these principals can be applied with a variety of methods. I’ve included below some methods other doctors are using.
For example, the importance of letting the T4/RT3 preponderance dissipate before increasing T3 to unnecessarily high levels is explained on page 157. On that page, the principle is used to explain why it makes sense to allow the T4 from T4-containing medicines to dissipate before chasing patients’ temperatures with T3. Dr. Leighton’s approach below applies this same principle in patients who aren’t weaning off T4-containing medicine. When the patients’ pulse rates increase but their temps don’t come up he sees that as an indication that there is enough T3 to decrease the patients’ T4/RT3 backlog but perhaps too much of a backlog for it to be a good time to chase the patients’ temps with T3. So he leaves them on that dose as a plateau for at least 4 weeks. On the other hand, when patients’ temps come up normally without much increase in pulse rate, apparently there is not too much of a backlog problem. I like Dr. Leighton’s variation because although it is more conservative it may not be giving up much benefit, and may even gain benefit, depending on how long it takes for the T4/RT3 preponderance to wash out. My protocol is based on the idea that it is depleted quickly, his is based more on the idea that it may take longer to clear. I think you may find the methods of each of the doctors below useful in the treatment of some of your patients.
In Addition, every method carries with it a different risk versus benefit consideration. More conservative approaches may be better suited for some patients but may not provide all the same benefits quite as quickly, if at all.
You may find other methods on our web site: www.WilsonsTemperatureSyndrome.com
Leighton
I think that heart rate is often a more sensitive indicator of thyroid stimulation than body temperature. If patients’ heart rates rise on the order of 20 points during the taper up phase of the treatment cycle, or after establishing on a plateau dose (rising, say, from 65 beats/minute before treatment to around 85 beats/minute while on the T3) it is clearly a thyroid effect. I cycle patients up on the T3 therapy until one or more of 5 criteria are met:
1) Their temperature rises into a “normal” range of 97.8 to 98.6
2) Their heart rate rises from 15 – 25 beats per minute (taken at the same time each day)
3) Their symptoms clearly improve (no sense in going beyond the point of symptomatic improvement)
4) They reach the maximal level of 90 mcg of T-3 Q12h, or
5) They develop signs or symptoms of excessive thyroid stimulation (tremors, palpitations, anxiety…similar to drinking too much caffeine).
It has happened, not infrequently, that these signs will not develop until after the patient has been at the maximal dose of 90 mcg Q12h for 1 to 3 weeks. Then it seems as though a “light switch” has turned on and suddenly they develop evidence of too much thyroid stimulation. This makes sense when considering this from the aspect of clearing the RT3 from the receptor sites
Stephen L. Leighton, MD
Family Care Health & Wellness Center, Inc.
Winston-Salem, NC 27101
Resseger
I judge total replacement by normal body temperatures and pulse below 92.
One frustration has been that about 5 percent of patients do get symptoms of hyperthyroidism when on enough T3 to get their body temperatures normal. The symptoms include rapid pulse and elevated body temperatures. In these people, what I’ve done is dropped to just below the toxic level and stayed there for 6-8 weeks and then tapered them off. Most of these patients will maintain their normal temperature as you taper them off.
I have had a few patients that I have left on T3 (sometimes combining the doses into one daily dose) because they do so much better on the sustained T3 than they do on any other method of treatment.
Dr. Charles Resseger, DO
President-elect, AAEM
Norwalk, OH
Nesbit
Dr. Ian Nesbit, ND
Billings, MT
Hunninghake
Although the results may take longer, many patients can still benefit from a conservative low dose T3 therapy approach. Though there are some patients who feel better fairly soon with such an approach it’s normally a longer haul, which is characteristic of a more naturalistic approach. In some patients I use a “mini cycling” approach where I give them a 7.5 mcg dose of sustained release T3 once a day. In a sense, they “wean on” during the day, and “wean off” at night. I have seen several patients who have seemed to do quite well with that over time.
In addition, I’m often less interested in very fast results and in being able to reset people’s system so that they’ll be able to remain off T3 therapy than I am with wanting to help people feel better as safely and conveniently as possible. Therefore I often start patients on 1/2 grain of Armour thyroid, which contains T4. But if the 1/2 grain is not enough, instead of increasing the Armour, I’ll add low dose sustained-release T3. I’m kind of giving them a low dose T3 therapy, with Armour as the stabilizing influence.
I pay attention to their adrenal systems as well. To me, when patients don’t do well on thyroid treatment that’s almost diagnostic of adrenal fatigue. However, on low dose hydrocortisone such patients almost never have side effects to the thyroid. They start much more smoothly on the thyroid when they already have adrenal support going. I often give patients a cortrosyn challenge test and give them cortisol as described in the book, Safe Uses of Cortisol by William Jefferies, MD. Conversely, sometimes low doses of thyroid can improve adrenal function (as reflected in adrenal saliva testing) as well.
Ron Hunninghake, MD
Wichita, KS
Denton
I find monitoring the pulse more beneficial than monitoring the temperature, especially in women, where there is so much fluctuation.While cycling the patient down, I feel it’s also important to have patients notice any changes for the worse and stop before proceeding further down. I then step it up one dose and park there for awhile before trying to wean them totally off the T3. Some patients stay at this dose two or three weeks before I try to go to the next dose. About 10% of patients continue to need T3 indefinitely and demonstrate good health while taking it and poor health when they attempt to stop it. These patients are no longer willing to try to wean off and are faithful in taking their dose 12 hours apart.
Dr. Sandra Denton, MD
Anchorage, AK