Alright, seems like you've certainly done your homework.
What I am confused about -- and maybe you can shed some insight on this -- is why both raising and lowering cortisol makes me feel worse. If I take Melatonin, Magnesium, Ashwaghanda etc., I become more hypoglycemic, more stress-intolerant, find it more difficult to sleep (due to increased adrenaline) etc. But if try stuff like Pregnenolone, the adaptogens, etc. I tend to crash as well. Maybe it's some kind of feedback loop issue where my body is sensing the increased cortisol and turning down ACTH?
Ashwagandha will lower cortisol. I've heard the argument that it can raise it when it's low, but I've yet to see evidence of this. Hypoglycemia is a direct sign of cortisol issue, as well as the stress intolerance. Pregnenolone won't necessarily result in increased cortisol if there are signalling issues in the first place. I get nothing but uncomfortable stimulation from it. I think the error in thinking is that these are raising your cortisol.
The #1 thing I would do right away is try out some licorice root as that's going to be the safest way to truly test HIGHER levels of cortisol. All of those other supplements are kind of shooting in the dark, it's hard to really tell the exact mechanism that's helping / hurting; though it does sound like Ashwagandha is lowering cortisol. Adrenal cortex (ADRENergize from Enzymatic Therapy is a great option), and not adrenal glandular which will contain epiniphrine, is also a lightweight option. I've not seen it discussed... but obviously the cortex will contain hydrocortisone which is the thing in it that helps, what else would possibly do that? Thyroid glandular contains T1/2/3/4 etc, so the cortex will contain what it produces.
If that is inconclusive I would recommend the hydrocortisone ointment. Your situation is extreme, and physiological doses of hydrocortisone are not that extreme of a treatment. It's not uncommon for people to take 20 mg for quite a while and easily wean off, though I have heard of people having just odd reactions to it in the first place. Start slow. I tolerate it extremely well as I do most things. It has only helped. My ability to do work on demand has increased massively. The amount of mental effort it used to take just to get myself to do basically anything at all was a several hour long battle.
http://misslizzy.me/...drenal-fatigue/
http://www.stoptheth...renal-info/faq/
Of course it will ALWAYS be better to treat the source and I tried that for many many years, but at some point in time, after enough time passes, you may realize that maybe some quality of life while your searching wouldn't be such a bad thing. I resisted a lot of treatments because I wanted to tough it out and through sheer force of will cure myself, but that has yet to happen and I need help.
There was one week where I didn't feel like I was in remission per se, but it sounds a little like your initial HC experience: after taking a month off coffee, I began drinking it with coconut oil. My resilience to stress was amazing, I didn't feel so off-balance all the time (I could go out and see friends, walk around the city etc., whereas I'm usually scared to shower because of disequilibrium), my cognitive issues disappeared, though I was a little agitated. I grew tolerant after a week and the coffee just crashed me thereafter.
I wondered if it was some kind of synergy between the caffeine and coconut oil -- i.e. the coffee was raising cortisol and the coconut oil was boosting thyroid.
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"My experience with T3 was that if I wasn't supplementing cortisol the T3 didn't really do anything at all, whereas when it was there it was very powerful. Might be something to try.
Natural Dessicated Thyroid didn't help, nor did adaptogens, but the two together had a similar synergy (albeit with similar agitation that forced me to stop)."
Sounds like your HPA recovered a bit then you tapped it out again. Sounds like low cortisol. Licorice root may offer you that same feeling without taxing the system, it just prevents it's breakdown so it remains in the system longer. Make sure you're not getting the DGL licorice root, that removes the Glycyrrhiza is the thing you want.
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StopTheThyroidMadness claims that without cortisol, T3 will "pool" in the blood, unable to get into the cells.
https://www.nahypoth...mone-transport/
"Thus, a high reverse T3 demonstrates that there is either an inhibition of reverse T3 uptake into the cell and/or there is increased T4 to reverse T3 formation. These always occur together in a wide range of physiologic conditions and both cause reduced intracellular T4 and T3 levels and cellular hypothyroidism."
high rT3, which I have, is an anti-thyroid hormone. It will plug up T3 receptors. Getting that under control, which I'm still reading about, can allow T3 to actually do its job. STTM claims that high rT3 is due to adrenal fatigue, but being that I don't think that actually exists I'm not sure what that implicates. If you put STTM's and this together it doesn't seem too far of a stretch to implicate that low cortisol could contribute to the increased rT3. Why/how? No idea.
https://www.nahypoth...ysiology-graph/
"The most important determinant of thyroid activity is the intra-cellular level of T3, and the most important determinant of the intracellular T3 level is the activity of the cellular thyroid transporters (1-67). Reduced thyroid transport into the cell is seen with a wide range of common conditions, including insulin resistance, diabetes, depression, bipolar disorder, hyperlipidemia (high cholesterol and triglycerides), chronic fatigue syndrome, fibromyalgia, neurodegenerative diseases (Alzheimer’s, Parkinson’s and multiple sclerosis), migraines, stress, anxiety, chronic dieting and aging (1-43,46,49,51,52,53,58,60,66,68,69,72-118)."
The reduced thyroid transport seen with these conditions results in an artificial elevation in serum thyroid levels (especially T4), making this a poor marker for tissue thyroid levels as well (5,40,41,49,52,53,62,66,67). An elevated or high-normal reverse T3 is shown to currently be the best marker for reduced transport of thyroid hormones and an indication that a person has low cellular thyroid levels despite the fact that standard thyroid tests such as TSH, free T4, and free T3 are normal (6,32,41,45,62,66,67,125-172)
So I wouldn't quite give up on NDT yet, but perhaps keep it and test it in intervals to see if it can properly work. Maybe it won't at all, who knows. Nature of the beast I guess, test it all. You did mention the adaptogens "activating" the thyroid meds. Perhaps the reduction in stress response helped lower rT3, allowing T3 to actually get in. Plausible.
This sounds extreme man, I'd really consider the HC ointment. It's like $8 for a 2 oz tube with 560 mg in it. I take 10 mg / 10 mg / 5 mg / 5 mg every 4 hours. 1 g / 500 mg of the ointment. My Dr prescribed me generic hydrocortisone but it's completely junk, doesn't work at all. Cortef I got a script for too but might not a pre-auth, it's expensive.
Other than that you already know about what needs to happen to manage stress. Do note too that people can up to double their HC doses for a "stress dose" in times of illness / obvious stressors. I just feel like having your body / mind in this kind of state for this long is significantly more harmful than being on hydrocortisone to normalize your physiology. When you're out of the extreme situation you're in it may be good to ween off but for the time being not doing it seems significantly more damaging.
I wish I had a less habit forming option but also if you think about it people take thyroid meds indefinitely. Why couldn't HC be the same? I don't know if that's how it may work but I know my HPA hasn't improved in the slightest with every nootropic / supplement combo known to man. Perhaps it can't? Thyroid patients don't recover from their dysfunction as far as I know, except some with Paleo.
Good luck!