Microdosing T3 (triiodothyronine) for Hypothyroidism

THIS DOCUMENT IS A WORKING DOCUMENT AND IS NOT YET FULLY COMPLETE

Thousands, if not millions, of those who post on thyroid forums complain that the traditional method of using conventional T4 (Levothyroxine) and gauging results by TSH and T4. Whilst it may work for some, it can have complications, particularly with athletes.

NB. The article's contents may contradict my earlier writings on graves disease, using T4 and using minimal 6.25mcg T3s PRN when you are fatigued.

This method runs utterly contrary to what your endocrinologist will prescribe you.

A lot of my thinking coincided with the methods written in the book Recovering With T3 by Paul Robinson. Note that he is not a doctor, but the book's foreword is written by one.

I have had this bastard autoimmune Graves disease since I was 21, and it completely derailed my life. I honestly believe that endocrinologists should not be allowed to treat graves disease unless they have it themselves.

If a doctor had written this, he could get struck off or labelled a quack. The method runs completely contrary to what they are supposed to practice - which I now believe to be completely wrong (certainly for active people or those who wish to be high achievers).

Sure, you can take the T4, get your levels dialled in and hope for the best. If you aren't active or are not too bothered, this may work just fine for you. But the conversion of T4 to T3 when taken by mouth is not consistent and will not match your circadian rhythm. Levothyroxine has a half-life of 6 - 7 days, so if you have the dosage too high or too low, you have a long period of living hell.

Let's talk about T3.

T3 has a much shorter half-life (in serum, it is in hours, but blood tests do not reveal the amount of T3 which has entered the system, e.g. muscles)

This is why I believe that microdosing T3 is now the ultimate strategy. I have battled this for nearly 20 years, and I strongly recommend you buy and read the above-mentioned book.

However, I can't entirely agree with some of it. Some of it may read as outright quackery compared to conventional medicine - but it isn't. He is very considerate about monitoring and optimising the dosage, including using a body temperature sensor, blood pressure and many more systems to ensure you are not inadvertently hyper.

Personally, I consider the best method to establish dosages to be 1) insomnia, 2) temperature (with a temperature gun), and 3) palpitations and blood pressure.

Take your temperature before each dosage. It should be normal or slightly below.

You must exhaust T4 to 0 for this to work. You can start micro dosing T4 before it winds down, but you may be hyper. Certainly, skip the evening dosage, or you won't sleep.

My T3 microdosing protocols

Here is my T3 only protocol, assuming waking at 7 am and going to bed at 10 pm:

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5am: 25mcg T3

10am: 12.5mcg T3

2pm: 12.5mcg T3

5pm: 12.5mcg T3

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T3 with a small amount of T4 protocol

Here is another protocol with a small amount of T4, which may be preferable to some:

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5am: 25mcg T3 + 50mcg T4

10am: 12.5mcg T3

2pm: 6.25mcg T3

5pm: 6.25mcg T3

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At the time of writing, I prefer the protocol without any T4 whatsoever. However, the minor concern remains that the downstream thyroid hormones such as T1, T2 etc. are currently believed to be inert. But if they later are discovered to play a role in biological processes, you will be missing them with T3 only.

In theory, you could dose 5 or 6 times a day if you prefer, requiring some experimentation. However, evidence suggests that each dosage needs a certain amount to enter the serum at a given time (a pulse, if you like) for it to reach the target tissues. e.g. microdosing 2mcg T3 every 2 hours may not be effective.

The other issue is compliance: 4x per day is very easy to comply with. 6x complicates the issue. 3x is probably insufficient to get yourself as close to a normal human as possible.

The 6 am dosage is highest to match a normal circadian rhythm and match the cortisol spike.

Downsides

You control your own circadian rythm

When you take control of your own circadian rhythm by microdosing T3, you mostly lose the ability to stay up late at impromptu times. So if you want to stay out one evening, it gets tricky. As your "shut off time" is preprogrammed by your dosing protocol, you will feel fatigued.

So what do you do? Take another small dosage of T3? Possibly, but only do that occasionally, or you will create havoc. If you're a night owl or don't keep to a regular sleep schedule, this protocol may not be for you.

Your endocrinologist won't like it

Unless you are lucky enough to find an endocrinologist who is prepared to treat you with T3 only (I do not know of any), then you will either have to abandon his advice and take matters into your own hands, or tell him what you are doing.

Blood tests no longer have a real meaning

If you have no thyroid like me (either nuked with RAI, or had a thyroidectomy, or it was destroyed long term by hashimotos), the TSH and T4 traditional tests will have no real meaning. T3 will be at times above normal and below normal. This is not a bad thing.
Remember, the T3 test is based on serum T3, not the amount that has penetrated tissues.