I agree with both Barb and Moose...diplomacy is SUCH a delicate line of work...lol.
My nickel's worth..I.ask myself these questions in this order:
1) Is FT4 at least midrange? If not, add T4 meds until it is.
2) Have FT3 levels had time to "catch up" to FT4 levels. I find that FT3 often lags the change in FT4 by a fair amount of time. Once FT4 levels are midrange, give it some time as FT3 levels will often continue to rise after FT4 has stabilized and more symptoms will be relieved as the body has time to heal.
3) Are FT3 levels in the upper half to third of the range? If not, then it might be time to consider synthetic T3 meds.
4) Do you still have hypo symptoms even though FT4 is midrange, and FT3 is in the upper half to third? Then, it might be time to try a dessicated med. In addition to T3 and T4, dessicated contains other thyroid hormones (T3 and T4 are the most important, but there are others, too) and trace elements that some of us just seem to need to feel well and to be able to process the T3 and T4 optimally.
Of course, symptoms have to be reevaluated at each step along the way. This is all assuming that you start on a T4-only med since most of us do...there are other paths to take if that's not the case.
I suspect that you are going to have quite a variety of opinions and answers on this one!
If levels of T4 med have been adjusted in order to achieve proper free T3 levels, but T3 levels cannot be met due to inadequate converting from T4 to T3 in your body.
There are some that appear to convert by looking at labs, they have ok free T3 levels - maybe not as high as some here suggest, but will only have symptom relieve with additional T3, weather it be from synthetic cytomel or natural dessicated thyroid. In these cases, they have done all they could and also tried several brands of T4 med before adding T3.
Then there are vary few that are on T3 only due to having a condition called reverse T3. Many doctors consider the reverse t3 test controversial, again that's their opinion, opinions vary on this.
1)So what do your labs look like?
2)How do you feel?
3)What are you taking now?
4)and have you tried several brands of T4?
Cytomel is a T3 only med and is usually given when you aren't converting T4 med to T3. We all have to find the right numbers for us, but a lot of people feel best with their Free T3 in the upper third of the range, with Free T4 about mid range. A T3 med can make you hyper very quickly if you take too much or if you take it when you don't need it.
Normally, a T3 med would be called for if your FT4 is high in it's range, but your FT3 is low in it's range. That could indicate that you might not be converting properly.
Can you post your Free T3 and Free T4 levels so we can see where you are in the ranges?