Free T3 is the biologically active thyroid hormone that essentially regulates metabolism in tissue throughout the body. Unfortunately it is typically ignored in both diagnosis and treatment. Free T4 is a prohormone. It is also important because it is the main source of T3,, from conversion. So you should insist on being tested for both FT4 and FT3 every time you go for thyroid tests.
Also, thyroid test results vary from lab to lab so you should always compare results to the lab's reference range. So we need to know that. Also, did you take your thyroid dose in the morning before the blood draw?
For symptom relief and optimizing meatabolism, you may need to add a source of T3 to your dosage. We can assess that when you get FT3 tested. In addition there are 3 more important tests you need to get done. Vitamin D needs to be at least 50 g/ml, B12 in the upper part of its range, and ferritin needs to be at leat 100. If you can get those done also, we can suggest supplement dosages that you may need.
You might find it interesting that I was hypothyroid for probably 35 years during which my doctor finally got me up to 200 mcg of T4 med and I still did not feel well. I found this Forum and learned about the importance of FT3 and got mine tested and found it to be too low in the range, due to inadequate conversion of the T4. I finally convinced my doctor to reduce my T4 and add a source of T3 and after some tweaking of dosage I felt better than I could ever remember.
I totally understand what you mean. With all those symptoms, in spite of your dosage of T4 and the FT over range, it seems clear that you are lacking the biologically active thyroid hormone, Free T3. When taking a full replacement dosage of T4 med, it is quite common for FT4 and FT3 levels together to be too low for symptom relief. As I see it right now, the most important thing for you to do right now is to get your doctor to do some tests for you. If the FT4 is recent, thenI would just request to be tested for Free T3, along with Vitamin D, B12 and ferritin. D affects the response to thyroid hormone. B12 is important in preventing fatigue. Ferritin is a form of iron storage that is readily available for use. Ferritin is very important for its effect on conversion of T4 to T3. D should be at least 50 ng/ml, B12 in the upper part of its range, and ferritin should be at least 100.
If your doctor resists running those tests, give a copy of our paper in the following link and ask again . Explain the importance of Free T3 since it essentially regulates metabolism in cells, so you need to know its level.
If the doctor is adamant that TSH really tells him all he needs to know, then you will need to find a good thyroid doctor that will diagnose and treat clinically, by testing and adjusting FT4 and FT3 as necessary to relieve symptoms. And if you can get the other three tests done we can advise supplements and dosages.
Finding a good thyroid doctor willing to diagnose and treat clinically as described may take a while. If you could get those tests done some other way we could at least help you get started with needed supplements.
Your fear about taking thyroid med is unnecessary. Your T4 dose of 200 is causing your FT4 level to be above its range, but I expect that you will find that your Free T3 levels is low in the range due to inadequate conversion of T4 to T3. Ferritin is important for good conversion.
Which, if any, of the following typical hypothyroid symptoms do you have?
Increased sensitivity to cold
Constipation (have to use laxative or fiber)
Dry skin (have to use skin creme)
Weight gain (difficulty losing weight)
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Slowed heart rate