Your Free T4 is at the very bottom of low range...not good. Your T4 should be mid normal range to be optimal. If you were getting enough T4, then you would probably convert more to increase your T3 level.
The reason why your TSH looks good at 1.90, is because T3 medicine (Cytomel) will inaccurately suppress your TSH to make it look lower than what it really is. Whenever a patient is on a combination of T4 and T3 meds, they should be treated by Free T4 and Free T3 results, not by the TSH results.
You are still so sick because you are still so hypo. Your Free T4 and T3 should at least be mid normal range in order to be optimal. I hope this helps. :)
You need ot have your medication increased. Ignore TSH, FT3 and FT4 should both be about mid-range or slightly above AND you should feel good.
I agree with the others that you need an increase in T4 medication. Are you taking the cytomel all once or splitting it into 2 doses?
I agree that if your FT4 comes up, you might convert more to FT3; I'd try increasing just the T4 before increasing the cytomel.
Have you tried taking Selenium? Its a dietary supplement that is supposed to increase your energy. My specialist is insistant on it. Plus Vitamin D and of course regular mulitvitamin. I am on Tirosint, just switched from horrible Synthroid. It seems to be really helping with my energy level. I felt like the walking dead before. My hashimoto (thyroid peroxidase antibodies) is at 2510! Thryroglobin 50 and tsh 1.0. This was in July and going back for retesting on the new meds next month, but I can already tell its working. 75 mcg on Tirosint. BUT it is causing me to get canker sores, which I am not liking too much. I still feel foggy a bit and can't focus great though. I have heard it can take years to get your levels straightened out. Hang in there.
Selenium doesn't specifically help increase energy, but studies are showing that it can increase the conversion of FT4 to FT3, which is the active thyroid hormone, and does alot to control energy levels. Be aware that selenium can be toxic if you get too much, so do be careful.
Jen, I'm on Tirsint also; have been for over a year; I've had some issues with canker sores, too. I find that rinsing my mouth out with peroxide (don't swallow it) helps a lot to get rid of them and keep them at bay. Talk to your doctor about it.