confused about thyroid and adrenal treatment

OK, I feel totally confused now:

I was diagnosed, in January 2012, with adrenal fatigue, hypothyroidism (after being on thyroxine for 10 years), low estrogen, progesterone, testosterone, DHEA, pregnenolone, and growth hormone levels. My new doctor switched me from thyroxine (200 mcg daily) to Armour. I decreased thyroxine by 25 mcg per week, while adding 15 mg of Armour at the same time. After about three months, I had reached 300 mg or 5 grains of Armour, and I also took 6 mg of Medrol daily, along with estrogel, progesterone, testosterone, DHEA and pregnenolone.

I really did great for about six months. I started to lose weight (about 8 kilograms in six months), much of it water weight, my skin looked better, my eyes brighter, people around me started to comment on how great I looked...and I felt just as great. I took 15, 30, 60, 90 and 120 mg pills of Armour, and combined them to get the right dose.

After six months, I was switched to 240 mg pills along with smaller pills (15 and 30 mg). It made sense at the time, as the bigger pills are more cost-effective when you take as high a dose as I do.

But...

I started to crash pretty quickly. Within a couple of weeks on the 240 mg pills (combined with 2x15 mg or 1 30 mg pill), I started gaining weight again. I felt and looked puffy (when I came back to work after the holidays, someone even asked me jokingly if I had been partying all summer, because I looked like it - pale, puffy, dark circles under my eyes...). All the things that had disappeared during the first six months on Armour now reappeared with a vengeance.

I was able to use a prescription for Armour to order some Erfa Thyroid. I felt great once on it, started to lose some weight again but, all of a sudden, the weight loss came to a halt and the scale hasn't budged since.

I was on Medrol (6 mg daily) for a little over a year, but then my GP diagnosed me with prediabetes, and sent me to an endo who freaked out when he found out I was taking Medrol. He told me to get off it asap, although I had to wean off it very slowly to avoid horrible withdrawal symptoms. Today, I have been off Medrol for almost two months, and I've had both good and bad days. I have no real withdrawal symptoms, but I still look and feel puffy...and feel slightly more hypo than before. Neither Armour nor Erfa seem to be doing the trick (anymore), but those are currently the only options where I live.

The fact is that I have both hypo and hyper symptoms at the same time:

Hyper symptoms: rapid heartbeat, sweating easily, difficulties falling asleep, waking up several times during the night, easily scared or upset (adrenal?), hair loss

Hypo symptoms: feeling cold most of the time, dry, flaking skin, weight gain or impossible to lose weight, high BP, dark circles under eyes, hair loss

Hair loss can be a sign of both hypo and hyper, as far as I've understood?

My questions are:

How could I do great on Armour for the first six months, and then crash, although my Medrol dose was the same (6 mg)? Is it possible that I got some batches of the old (pre-reformulation) Armour, although my pills expired in late 2012, so they must have been manufactured some time in late 2010?

How could I feel great on Erfa at first, and then feel much less great all of a sudden...on the same dose?

How do I know if and when my adrenals have healed? My hormone doctor said some need to stay on adrenal support for the rest of their lives, but the risk of getting diabetes on Medrol scared me enough to make me wean off it. I've raised the possibility of taking hydrocortisone with my hormone doc, but was told that as long as I tend to retain fluid, Medrol is a better option.

How can I tell if Armour or Erfa works best for me?

Another thing that made me confused was that I could take as much as 8 grains (480 mg) of Armour without getting hyper symptoms, while I could not go beyond 5.5 grains (330 mg) of Erfa before feeling hyper...while remaining hypo in the sense that I could not lose weight, body temp below 36.5 C in the afternoon, and below 36.3 C in the morning before rising.

Erfa is said to be the purest NDT drug on the market, and only contain three or four ingredients. So I don't know why I don't feel great on it all the time? My hormone doctor has some patients who have not done great on it either, and actually do better on Armour, so I was encouraged to find out what works best for me through trial and error...easier said than done, though. I know the whole endocrine system needs to be in balance, and that the thyroid cannot function without the adrenal glands, and vice versa, but I've never understood if the adrenals need to be rebalanced before starting on NDT, or if NDT will eventually heal the adrenals...it's all very confusing, and information in various internet forums is contradictory to say the least...

During the first six months on NDT, I was chewing Armour up, and had no problems with the taste. However, the 240 mg pills taste really bad, and I ended up dreading having to take them because of the bad taste. They melted quickly enough, and did not feel grainy, but tasted awful. I've read somewhere that the smaller pills seem to be working better since the reformulation, the theory behind this being that they contain less cellulose than the larger pills. Anyone knows if there is any truth to this?

It also seems Forest labs claims that Armour was reformulated to improve absorption, although many claim that you get the opposite effect with increased cellulose...

The Erfa pills taste very sweet and actually delicious, but I've had mixed experiences with it; some batches make me feel great, while others have not been that great (maybe it's unrelated to Erfa, and has more to do with my adrenal status or hormonal status in general)? I chew the Erfa pills up as well, as I definitely feel a difference between swallowing and chewing them up (much more effective when chewed up, then swallowed).

I really wanted Erfa to work, as the manufacturer seems to have a great communication policy, while Forest (manufacturer of Armour) does not even seem to have an email address for customers to contact them...but I have to admit that neither Erfa nor Armour have been ideal for me. Because my adrenals were not working optimally? Because of other hormonal imbalances? I have no idea. My hormone doc says it will take time before everything falls into place but, after a year and a half, I'm getting impatient. I've spent a fortune on labs and drugs, and I want results sooner than later.

My most recent labs, on Armour and Erfa respectively (same dosage, 5 grains, labs done 24 h after taking pills):

Armour: TSH <0.01, FT4 1.1 (ref 0.7-1.5), FT3 2.9 (ref 1.7-3.7)

Erfa: TSH <0.01, FT4 0.9 (ref 0.7-1.5), FT3 3.3 (ref 1.7-3.7)

What is the best treatment for adrenal fatigue? Is the treatment usually life-long? I was hoping I'd not need prescription drugs for more than a year and so, and that my adrenals would then heal, but maybe some need to be on adrenal support for the rest of their lives, or at least for more than a year? In that case, what is the best treatment for adrenal fatigue; Medrol, HC, OTC products, or supplements like vitamins C and B, licorice root, ashwagandha, etc?

I really feel confused, and have the impression that, after almost 18 months on HRT, I still have not found the optimal treatment for me. Therefore, I'd really appreciate any input from you. I have a great doctor, but I know that patient experience is invaluable.

Thanks.

Anna

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After your long and wonderfully documented question I feel it deserves the same carefully considered reply. I wish I could give you a simple answer, but all I can do is explain my daughter's situation and make a couple of suggestions. My daughter (33) has tried Armour, Erfa and Nature-Throid and ultimately couldn't tolerate any of them. It turns out that she has to have T3 only, like many on this site.

She has over the years also been on Medrol, hydrocortisone, fludrocortisone, progesterone, oestrogen and growth hormone. These MAY have had limited effect, but ultimately made her feel very toxic so she slowly weaned herself off all of them, and has felt none the worse for it. Some doctors believe that adrenal support is only needed for a limited time to support a struggling thyroid, and once thyroid medication is optimised then adrenal replacement is no longer needed.

The same problem arises with every individual with thyroid problems - there is no one size fits all recovery plan - each individual is just that - individual! Your symptoms are your best guide as to whether you are on the correct dose of replacement Thyroid Hormone.

Have you had Vits D, B12, and folates, ferritin and magnesium tested? The correct levels of these can sometimes have a dramatic effect on your recovery.

Having said all of that we researched for many years before we discovered what was really behind my daughter's thyroid problems, and she is now on the long road to recovery.

thyroiduk.healthunlocked.co...

Firstly though I'd ask your doctor for the above vitamin/mineral tests. They might possibly be your answer.

Jane x