Tracking Thyroid Symptoms and Signs (Vitals)

When using T3-Only or T3-Mostly,  it is not possible to use thyroid blood tests to manage the T3 dosing, i.e. the overall amount of T3, or the right number, sizes and timings of individual T3 doses.

The Recovering with T3 book described a protocol, for determining doses of T3, and for slowly and safely increasing the T3 doses in order to find the optimal dosage.  The protocol uses both Signs and Symptoms. I also refer to symptoms and signs in The CT3M Handbook and in The Thyroid Patient’s Manual books, as symptoms and signs are useful to track regardless of the type of thyroid medication that is being used.

Signs are measurements that are not subjective, i.e. not based on an opinion. An example of a sign is body temperature, measured by a thermometer.

Symptoms are subjective. An example of a symptom is whether someone feels their energy level is good or not (there is no device to measure this). Signs are sometimes also known as vitals (or vital signs).

When using T3-Only it is critical to track both signs and symptoms in a rigorous way and record them.

If this is done EVERY DAY, it is the best way to assess T3 dosage changes and any subtle alteration of signs or symptoms. Blood tests will tell you very little indeed and are often not worth doing at all on T3-Only medication.  The process can also be helpful for those on T4/T3 or NDT medication, although in those cases blood testing may also offer some insight (see The Thyroid Patient’s Manual for more information on managing these medications).
 

Here is a summary of how to go about this:

When to collect sets of signs/symptoms for those on T3 (or T4/T3 or NDT):

1) Do not attempt to take vitals around the time of a CT3M dose (if one is being used), as this will disrupt sleep.

2) On waking/getting up, or within 30 minutes of getting up which is probably more ideal. Do not do it in bed. Actually, get up, get dressed then do it.

3) Just before (5-15 minutes before) the first daytime T3 dose – so you can see what the situation is before the dose was taken. Alternatively, if another T3 dose is not being taken in the morning, take some measurements at least once during the mid-late morning or 3-4 hours after the first morning measurements of signs.

4) 2 hours (3 at the most) after the first daytime T3 dose – which is when it ought to be helping to raise metabolism. The comparison between the results of this measurement and the previous one can be very helpful in assessing dosing.

5) Just before (5-15 minutes before) the second daytime T3 dose.

6) 2 hours (3 at the most) after the second daytime T3 dose. Alternatively, if there is no afternoon dose of T3 being taken, take some measurements in the mid-afternoon.

7) If you have a third daytime dose of T3 then repeat 5) and 6) for that third daytime dose of T3.

8) Once in the evening e.g. 7 or 8 pm.

For those NOT on Thyroid Treatment yet, take them:

1) Within 30 minutes of getting up.

2) Late morning.

3) Mid-late afternoon.

4) Early to mid-evening.

Note: for those people who are still in the process of detailed adjustment of dose sizes and timings, more frequent measurement is helpful. From more frequent measures before a T3 dose and after a T3 dose you can observe the pattern of changing signs (temperature, HR, BP). This can show if a dose is too soon, too late, too high or too low. The pattern of change is often more helpful than absolute values.

HERE IS AN EXAMPLE OF A PATIENT’S SYMPTOMS AND SIGNS IN THE RIGHT FORMAT:

*** START EXAMPLE  ***

DATE: 8th March 2011
Date any T4/NDT Meds were Last Taken: 7 weeks.

GET-UP TIME (we need to see if CT3M was being used): 7:00 am. 

T3 (and other thyroid medications) Dosage:
25mcg T3@07:00 am; 
12.5mcg T3@11:00 am; 
12.5mcg T3@16:00 pm.

SIGNS / VITALS:
TIME  TEMP HR   BP
07:30: 36.7,   95,  107/64
09:30 36.9, 90, 110/70
10:45: 36.8,   97,  101/65
11:30: 36.8,   92,  105/63
12:30: 36.9, 90, 110/69
13:30: 37.0,   97,  109/65
15:30: 37.0,   94,  109/66
16:30, 37.0, 88, 110/70
18:00: 37.0,   92,  106/63

If there had been any new laboratory test results done, the results should be included after the vitals, along with reference ranges and units – as laboratory test results are also signs.

SYMPTOMS SUMMARY:  Tired in the morning with a headache. I did not sleep well the previous night. Felt warm from 12 noon & a bit on edge in the afternoon. Had energy in the afternoon, my body feels ‘lighter’ & head feels clearer.

*** END EXAMPLE ***

The above is clear, organised and only has the essentials in it. This thyroid patient created a diary with time-stamped (dated) entries with this type of information, which made it easy for her to track progress after any thyroid medication change (in this case it was T3-Only medication).

Too much information, with many detailed descriptive comments, is almost as bad as too little, making it very difficult to interpret. Summarising the symptoms and signs collected into a few lines also makes it easy to create a diary that the thyroid patient and their doctor can easily assess. Pages of information with many detailed descriptive comments are much more difficult to use. When the information is summarised tidily, and in a short amount of space, then any obvious patterns or results may be found far more easily.

The format above is ideal and has been proven to be quite easy to interpret.

The get-up time is very important to have as it shows if someone is using CT3M.

Note: Waking temperatures can be lower when a woman’s period is due.

Making a good recording of symptoms and signs before and after T3 doses, and at key times of the day can help to assess whether there is the right number of T3 doses and whether the doses are too high or too low. What is most important is the pattern of how the symptoms and signs change before and after T3 doses. This pattern often provides the most information on what might not be optimal in the dosing of T3.

What if things get very confusing and you are not sure if a dose is too high, too low, too early or too late?

In this case, the thyroid patient can record symptoms and signs more frequently in the hours before a dose is due and in the hours following it. Sometimes doing this every hour is sufficient, but in very confusing situations then recording the information every 30 minutes can begin to make the pattern of change in symptoms and signs more obvious. By recording the signs especially every hour or 30 minutes in the hours before a T3 dose and in the hours following a T3 dose the patterns will become obvious. Sometimes signs worsen as the T3 dose is due and then improve after it. This can indicate that the previous dose was too low or the time between the doses was too large. This work is extremely important if someone wants to really tune their T3 doses and feel really well.

All this information is discussed in more detail in the Recovering with T3 book. I recommend reading Recovering with T3 before anyone even begins to use T3 thyroid hormone, even if it is being used in combination with T4 or in natural desiccated thyroid (NDT). Recovering with T3 can be bought on any Internet bookseller site including Amazon in your own country or in a country near you.

Best wishes,

Paul

(Updated in February 2019)