Low T3, TSH and Ferritin

[Creekside]

  I've been on Synthroid for 28 years.  First diagnosed with a cold nodule and TSH above 60; normal range T4.  My TSH has been kept low: <.10 in the early years, .45-.8 for the last 10 years.
  I'm on 88 mcg Synthroid.  I've had dry skin, hair loss, and have been easily nodding off for years, but wake early and have no trouble getting up in the morning.  My weight is stable; slightly overweight--BMI 25.1.
  Periods were very heavy, but are beginning to taper off.  I had one very heavy month, followed by a month of hot flashes and night waking, at the end of which I had blood work showing a TSH of .36.  
  Hot flashes ended.  I skipped periods for two months then had a light month.  I then had new labwork where Free T3, Free T4 and Ferritin tests were done for the first time.  
TSH    .7    (.4-5.5)  (usual for me)
Free T4    1.4    (.8-1.8)
Free T3    274     (230-420)
Ferritin    38     (10-32)
  My B12 has not been checked yet; My MCV and MCH values are near the very top of the normal range.
  Do you think I am a candidate for adding a small amount of T3 to my T4?  If so, do I need to address the Ferritin and (possibly) B12 issues before starting T3, or can all be addressed at once?  Would you recommend Cytomel or Armour?
  Is this something my family doctor can handle if he is willing, or do I need to see an endocrinologist?  I'm seeing my family doctor soon, but would need to wait 6 weeks to see the endocrinologist.
  Thank you.

[Mark Lupo, M.D.]

T3 may help -- it's a very individual response -- I usually try with cytomel -- tighter control and flexibility to change t4 and t3 dose/timing independently.  Ferritin is unlikely a major problem.  B12 may be worth testing.  Sounds also like perimenopause.

[Creekside]

Oops.  Typo:  Ferritin range 10-232