The Circadian T3 Method (CT3M) for Adrenal Fatigue

November 03, 2014

The Circadian T3 Method (CT3M) for Adrenal Fatigue 

Reference: Recovering with T3 by Paul Robinson 

 This is a very simple idea, wrapped up in some complex physiology. To date, we have defined “adrenal fatigue” as someone who is exhausted when they wake up, can’t get out of bed, need three cups of coffee to do anything, and don’t feel rested all day long. When you measure their salivary cortisols four times in a day, you see low morning and/or noon cortisol levels. To date, in traditional Internal Medicine, we have said there is nothing particularly wrong with that, and tell you to go to bed on a regular basis and see an endocrine doctor who says, “There is no such thing as adrenal fatigue!%$&!”. Ok, ok. 

But in traditional anti-aging medicine, we have stated that you have to deal with your adrenals first BEFORE you start to replace thyroid hormone. We acknowledge adrenal fatigue and have lots of relatively slow-acting responses to it, mostly using self-care methods like extra sleep, laughter, friendship, hobbies, and time off from your stressor. A few Chinese herbs and supposedly, you get better. 

Both thyroid hormone and cortisol affect energy – thyroid sets the idle on your engine, cortisol goes out and mobilizes the fuel to be burned. Both are needed to have good energy. Cortisol is clearly secreted in circadian fashion, with multiple small bursts of ACTH in the early morning hours – an hour or so before awakening.   ACTH is made by your pituitary and stimulates your adrenals to make cortisol. The CT3M method that Paul Robinson supports is based on the premise that you can’t make cortisol in your adrenals if you don’t have the free T3 hormone that your body needs at the right time of day. If you are just taking T4 (traditional Synthroid) you are taking the pro-hormone that your body has to alter by lopping off one iodine and turning it into the active hormone called T3.   The enzyme that does that, de-iodinase, is based on selenium. If you don’t have enough selenium, you might not be able to activate thyroid hormones. For that, and many other reasons, you may end up with insufficient T3 hormone to satisfy your adrenal glands. Particularly, by taking T4 (or Synthroid) at one time of day, your effective T3 in the early morning when you are making ACTH may be too low to be effective. 

So, it’s actually low T3 at a critical time of day that leads to low cortisol. (That’s the hypothesis.) Without sufficient T3 at the right time of day, your adrenal glands make no cortisol because they just don’t have enough “umph” to get off the couch and do their job. What’s the method? Consider taking pure T3 (or natural desiccated thyroid with T3 in it) one and one-half hours prior to your wake-up time. If that’s 6 am, do it at 4:30.   If it’s 8, do it at 6:30. We want you to have another full 90-minute sleep cycle after that dose. You have to prepare carefully and lay out the dose on your bedside table with a sip of water, not waking up too much. The usual starting dose is at least 5 mcg of T3, maybe 10. The theory is that taking the free T3 at that time will provide the critical metabolic hormone to your adrenals and pituitary just at the point in time when they are producing pulsatile ACTH and subsequent pulsatile cortisol. 

The key is that you don’t use sustained release thyroid.  If you feel a wee bit better and have more energy upon awakening, that may be attributable to the T3 itself, but also to the fact that your cortisol is responding nicely. Prove it by taking another saliva series and see if your lab confirms your improvement in symptoms. 

 WWW. What Will Work for Me.   I have so many clients with exhaustion and early morning fatigue for whom our traditional methods of help have been slow or ineffective.   T3 is a touchy hormone.   There are reasonable concerns about too much T3 causing heart rhythm disorders, cognitive decline, and bone loss so it needs careful supervision and monitoring. But when I hear credible clients say they weaned off their morning cortisol for the first time in years, I’m paying attention. This may be the opening of a door we hadn’t looked behind before. Time to look a little further.   

 Pop Quiz

  1. You make most of your cortisol in the late afternoon to match your activity level. T or F  Answer:    False. You make it in the morning, and that matches your activity level. That’s why most of us feel most energy and creativity first thing in the morning.
  2. Cortisol is made in your adrenal glands in response to ACTH secreted by your pituitary, in response to CRH secreted by your hypothalamus. T or F              Answer:     True
  3. It doesn’t matter what time of day you take your thyroid hormone. T or F                  Answer:  That’s what we have typically said.
  4. Too much thyroid can cause fatigue too. T or F                        Answer:  True. Many elderly have fatigue when over the top limit of normal thyroid range.
  5. T3 is needed for your adrenals to make adequate Coritisol – T or F.                       Answer:  True, maybe. But maybe not as much as this method suggests. A very interesting idea for research. Cortisol is made in your adrenal glands in response to ACTH secreted by your pituitary, in response to CRH secreted by your hypothalamus. T or F

(Editor's Note:  With the advent of CIRS or "mold disease" we now know the puzzle and cause of extreme, unremitting fatigue. The down regulation of cortisol is part and parcel of the entire gamut of hypothalamic and pituitary hormones down regulated by CIRS.   Note inserted Jan7th, 2022)