The CT3M (sometimes called the T3CM), created by UK patient Paul Robinson, is stated to be another way to help raise your low cortisol levels (as proven by a 24 hour saliva cortisol test) without the use of hydrocortisone (HC). But note: it seems to work best for those who only have a MORNING low cortisol issue, not at all four times. If your cortisol is low at other times as well, this may not be the treatment for you. 

It’s also not a stand-alone treatment. We have learned since its introduction that most will need to be treating any other issues, such as methyl blocks, sex hormones if problematic, lowering inflammation (very important), good nutrition, neurotransmitters and more.

The T3 needs to be direct, NOT slow-release, explains Paul. Turns out that by patient experiences, NDT can work for this, too, because of its T3 content, and it’s best to swallow it for the early morning dose to release the T3 more immediately. If you have HARD tablets, chew them up first. Use an acid in your drink like a small amount of Apple Cider Vinegar or lemon juice. But Paul prefers using direct T3.

You canNOT have hypopituitary or Addison’s disease for this to work. If you have Diabetes or blood sugar issues, you’ll need to adequately treat those for this to work. To rule out hypopituitary, do an Insulin Tolerance Test. To rule out Addison’s, do a Synacthen/ACTH Stimulation test. 

**KEY POINTS CONCERNING PROMOTING BETTER ADRENAL FUNCTION WITH THE T3CM from PAUL: 

  1. Important fact one: Most of the day’s cortisol is made in the last four hours of sleep,i.e. the four hours before you normally wake up. So, for example, if one normally wakes up around 8 am, most cortisol is made from 4 -8 am. i.e. that four hour window is when your adrenals work the hardest.
  2. Important fact two: Just like ANY organ in your body, your adrenals are made up of cells. And ALL cells in your body need T3. Your brain needs T3. Your kidneys need T3The adrenals need T3 and especially during that four hour window before one wakes up. And, says Robinson, you can’t really expect your adrenals to work well if the mitochondria that make ATP for those cells and the cell nuclei have an inadequate level of T3 thyroid hormone
  3. No one should “assume” or “guess” they have low cortisol. It’s critical to do a 24-hour adrenal saliva test to show what’s going on. If saliva shows you’ve got low morning cortisol, you are a candidate for the CT3M.
  4. With the above in mind, it made sense that if adrenals are struggling, they can need T3 in that early morning 4-hour window in order to function better. How to do it? A T3 dose of 10 mcg (or one grain NDT swallowed) is usually started about 1 1/2 hours before one wakes up, and data taken right after waking up–pulse, BP and temps. (Some sensitive individuals start on 5 mcg or half a grain NDT.) Then give the beginning dose a week see if it produces a positive response in any of the above, or symptoms such as waking up better. If not, patients raise that dose by 2.5 – 5 mcg T3 (or go to 1 1/2 grains NDT), while still at the same time, looking for that positive response.  Many patients report 12.5 – 15 mcg T3 giving a positive response; it’s individual. Once a clear positive response is found, the same dose is moved earlier by 30 minutes i.e. to the to 2-hour mark before waking. A half hour move gives a continued but more subtle improvement, says Paul. (Some patients feel that a 15 minute movement earlier, rather than 30 minutes, is better!!) Patients then hold up to a week to see if more is needed at that new time. Do not go too fast, as you need to give your adrenals TIME to respond, says Paul. The worse your adrenal fatigue has been, the slower you need to go.  Some find the 2 hour time to be perfect; some are 2 1/2, etc. . **Note that T3-only may be your best bet for the early morning dosing if you have a bad RT3 problem.
  5. If you are using NDT or any hard-tableted NDT, chew it up before swallowing, or simply swallow it. Do not do the early morning NDT sublingually! Also have an acid in your drink to promote better absorption, like lemon juice or small amount of Apple Cider Vinegar. Robinson feels that some will need to use T3-only for their circadian dose to stop the competition from the T4, or the buildup of RT3. Some patient experience has found a combo of T3 and NDT to work well.
  6. If you get TOO much of a response at a certain time you have moved earlier to, then you move forward to the previous time. So, if for example, 4:30 am produces TOO much of an adrenal response, as indicated by data or symptoms, and you were doing better 15 – 30 minutes later, you move back to that later time.
  7. Many end up on around 12.5 -25 mcg T3. Other T3 or NDT doses are continued throughout the day, as needed. This is an average; it may or may not be your right amount.
  8. How long to get a full response? Robinson has seen the adrenals “pick up virtually straight away”, but many patient experiences show that several months can be needed.
  9. Can you be on HC when you start the T3CM?  How do I wean HC when I start?  Yes, but patients found out that they needed to wean HC fairly quickly, after getting a good response, to counter the high cortisol they can end up having from the combination of your HC and the T3CM. Symptoms of too much cortisol can include nausea, high heartrate or BP, high blood glucose, etc.  Additionally, staying on HC when doing the T3CM can inhibit the work of the method–HC suppresses while the T3CM is the opposite. HC is often weaned by taking the first dose later and later in the morning, while dropping 2.5 at a time. Patients then end up only three doses of HC, and weaning those. Blood pressure/heartrate/temps are watched carefully. For many, once their have weaned down to 10 mg daily total of HC, they are able to drop that totally. Most are totally off HC in a month. Patients doing the T3CM give themselves at least two weeks off the HC to assess how they are doing and before making any changes. Many who were on HC, and now off, restart with 10 mg T3 (or one grain NDT) at the 1 1/2 hour mark. As far as Medrol, weaning needs to go VERY slow, say those who are working on it.
  10. What if I’m on Florinef? If on Florinef with HC when starting the T3CM, Florinef is weaned first, 1/4 tablet at a time (plus wean SR potassium proportionately if you were on that), then patients start weaning HC when off Florinef. If high blood pressure shows up while weaning Florinef, some have started the HC wean before they are off Florinef as a result.
  11. Side effects or problems with using the CT3M?  Apparently so, report several patients. And these have even occurred when it’s being followed very correctly. Some patients report worsening problems while doing it. Some report it doesn’t raise their noon low cortisol at all (which is why it seems to work best if only the morning is low). Some report getting good results, only to see them fall sooner than later. Some report is did absolutely nothing for their low aldosterone. You have to find out for yourself, since others soar on the CT3M.
  12. Supplements needed:  1) high potency B complex  with 50 mg of B1-B6 in it twice a day (B1 key for mitochondria) 2) B12 500 ug or 100 ug (even if no detected B12 issue) 3) vitamin C 500 mg 4-6 times per day in divided doses – for adrenals 4) vitamin D 2500 IUs (even if no 25 hydroxy vitamin D bad result) 5) a good chelated multi mineral with all trace / macro minerals in it 6) chelated magnesium 400mg twice a day- enables the sodium potassium pump in the cells to work right.
  13. When your adrenals kick back in, you may find you don’t need as much T3 or NDT. 

DID YOU KNOW YOU CAN USE THE CT3M SIMPLY TO WEAN OFF HC??

Yes! This is an exciting aspect of doing the CT3M. Some patients (who know by testing with their doctor that they don’t have Addison’s) want to be off their HC in order to redo saliva testing (which shouldn’t be done while on HC). And using the CT3M is a great way to wean off–it does it faster than weaning off HC alone (which by itself, would need to take several months, as compared to one month on average when using the CT3M), besides continuing to promote good cortisol. Once off HC, you can stop the CT3M…wait a few weeks, then redo saliva.

QUESTIONS and ANSWERS from Paul:

1) Why can’t we use time-released T3?

Slow-release T3 prevents the large peaks of cellular T3 that some people actually need to overcome what I call ‘impaired cellular response to thyroid hormone’. Some people just do not respond well to normal blood levels of thyroid hormones. My book outlines several medically validated reasons why this can occur (even though the doctors are lightyears behind on this – the researchers are not). In order to overcome these then enough peak cellular T3 needs to be reached. In my book ‘Recovering with T3’ I liken this to a wave of T3 that has to reach the interior of the cells. A small wave is only able to throw the foamy top of the wave onto the targets in the cells. A much larger wave will dump a large amount of the wave onto the targets within the cells. Slow release T3 is incapable of being fin-tuned to deliver a big enough wave – it is fundamentally a poor tool for the treatment of ‘impaired cellular response to thyroid hormone’.

2) Exactly what do patients notice in the data (BP, pulse, and temp) when they feel they have found their correct time, like 4:30 am?

Normal BP (rises to normal usually), pulse (usually comes down to normal), temp (rises to normal usually). More importantly energy levels and sense of well being usually floods into the body.

3) What if someone’s sleep schedule is messed up due to the adrenal/thyroid mess? i.e. they are waking up at 10 am instead of their normal 8 am? Do they look at a four hour window with the messed up schedule, or the previous normal 8 am wakeup?

Trial and error. Make best guess and then slowly titrate the dose in time and size. The results help to tell you what’s going on.

4) For those who end up staying on HC when doing the T3 circadian protocol (because it’s too miserable to wean down and takes too long to do it safely), would they notice a raise in BP/temp when their adrenals pick up?

I’d want some reduction in HC because what is the point of attempting this otherwise and how would you know it was working? If the adrenals don’t need to work any harder because the HC is making up the difference then providing extra T3 won’t do much if the pituitary doesn’t want to ask the adrenals to do something. If BP was still low and temp was still low because even with the HC the adrenals a re still struggling then I’d expect to see some improvements in signs like these and a general sense of well being and energy. You have to feel your way but it would be important to only use a small early T3 dose (10-20 mcg) to avoid getting a massive surge of cortisol and a bad reaction. This last point applies anyway.

5) How long have your adrenals been healed as author?

About 3 days after I started to use the early T3 dose. I don’t think my adrenals were ever truly damaged they were just T3 starved. Most adrenal damage is via autoantibodies in Addison’s disease. Sure adrenals can be knocked about, battered and world weary but that isn’t the kind of destruction present in Addison’s. I haven’t used any adrenal support for nearly 15 years. Some peoples’ adrenals mhay be damaged of course and they may always need some level of adrenal support

6) Do you still use the T3 in the early morning hours?

Yes – can’t manage without it. My last dose of T3 is in the early evening – there is no way I can keep my cellular levels of T3 high enough until when the adrenals work without using an early T3 dose. (from Janie: some may be able to achieve good levels of T3 just by being very optimal in the day time.)

7) What do you feel has been the most difficult part for you with using T3-only?

Depends what you compare it with. Nothing else works for me due to my strange reactions to T4, so it’s not difficult compared to being sick. I guess when things change then the T3 needs to be adjusted. Over time my thyroid has been totally destroyed, my autoantibodies have dropped to zero and my adrenals have recovered. Once I found a good dosage I have every few years had to adjust it slightly to account for internal changes like this – but nothing has been really difficult once I understood what was going on

To order his book,  go here: http://www.stopthethyroidmadness.com/books-on-thyroid It’s mostly about the use of T3-only for those who can’t use other forms of thyroid treatment, or for those who choose to be on T3-only, but Chapter 16 covers this use of T3 for the adrenals. His handbook “The CT3M HANDBOOK: Recovering Adrenal Health using the Circadian T3 Method” is specifically about the CT3M.

Detailed info on weaning off HC and Florinef when doing CT3M here. More from Paul here.

His Facebook group: https://www.facebook.com/groups/RecoveringWithT3/

BELOW ARE PATIENTS WHO HAVE MET SUCCESS WITH THE PROTOCOL. If you have a story of success, even if you are still work in progress, use the Contact at the bottom of the page to send me your story!

DAWN (who has used NDT with the Circadian Protocol and proved that even the T3 in desiccated thyroid can make a difference.)

TAYLOR (who was on 30 mg HC and has been able to drop down to almost NO HC)

MATT (who couldn’t tolerate T3 until he strenghtened his adrenals with early T3)

JANET (who couldn’t tolerate T4 due to her adrenals/high RT3, and is now using T3 in the early morning hours successfully. )

SUZANNE (who used NDT to do the protocol–a detailed blow-by-blow account!)

SANDRA W. (who since going the T3CM, has stopped shaking and now wakes up feeling energetic)

JAYNINE (who now wakes up with energy and feels like this method has made a great change in her life!)

MARY (who started on both NTH and the T3CM with great results!)

ERIC (whose life has been more  most focused, stable and happy in the last 20 years)

SANDRA (who didn’t like what HC was doing for her at all, started the T3CM with T3-only, weaned of HC in two weeks, and got her life back!)

MIA (has weaned from 30 mg HC to 17.5, doing SO much better, and expects to be completely off. Stay tuned.)