It is no wonder you have those hypothyroid symptoms since your FT4 of ,98 is only at 29% of the range which is lower than optimal, and your FT3 is way below range. The TPO ab is an indication of Hashi's as the cause for your hypothyroidism.
Along with the T3 med it would be a good idea to also add some T4 to bring your FT4 up to mid-range. Note the conclusion from a recent, excellent scientific study: "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range."
In addition there are a number of other variables that can affect your thyroid status so you should ask to be tested for Vitamin D, B12 and ferritin and then supplement as needed to optimize. D should be at least 50 ng/mL, B12 in the upper part of its range and ferritin should be at least 100.
A good thyroid doctor will diagnose and treat mainly based on symptoms, rather than just biochemical test results. From the experience with your doctor I am not confident that he will be willing to adjust FT4 and FT3 as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. If you want to confirm what I have said, click on my name and then scroll down to my Journal and read at least the one page overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.
I don't have any specific recommendations on diet or lifestyle changes for you to consider, other than foods that will help increase Vitamin D, B12 and iron. Best thing is to just search the internet and you will find multiple sources for info.
Being in a remote area certainly does decrease your likelihood of finding a good thyroid doctor. You may have to become your own best advocate for what you need by reading and learning about how best to treat hypothyroidism and then give info like the paper linked in my Journal to your doctor and get him to to read and reconsider his standard of care for you. If the doctor will read the paper fully and go through the extensive reference material he will have a hard time refuting the concept of clinical treatment, rather than just relying on biochemical tests.
Interesting that this Dr took a T3 only approach. That is extremely uncommon. most Dr ONLY believe in T4 only and only reluctantly would ever even approach the idea of prescribing T3.
Are you absolutely sure that it is T3 Cytomel that he prescribed and not T4 (Synthroid, Levvo etc)?
The rule of thumb here has always been that you need to have BOTH of the following:
1) Free T4 to be 50% of the range or slightly higher. As stated you are at 29%.
AND- that means in addition to #1
2) Free T3 to be 50% and many need it to be closer t 67% of the range.
Free T3 is the Active form. It is used in HOURS. And many people cannot tolerage going from zero thyroid basically and taking 25 mcg of T3. many cannot seem to tolerate much over about 10 mcg to start. And t hen work up dosage over time.
Because T3 is used up in HOURS,- that is after taking it the levels peak in your blood about 2 to 4 hours later and is pretty much gone by 8 hours. As a result, you want to split your dose so you take half in the morning and the other half in the early afternoon. This way the morning dose is wanning away by the time you take the 2nd dose and it is ramping up. and helps keep a more level amount of thyroid in your blood.
I would recommend at least at first if you stick to the T3 only protocol, I would recommend you take the 25 mcg pill and cut it into quarters. Which would give you 6.25 mcg. and take one quarter of the pill in the morning, and the other quarter in the early evening, and do this for about a week or two, then go to half a pill in the morning and half in the afternoon. After this ge re-tested.
But I also agree with gimel. I think you really also need T4 to get your FT4 level up. ANd some of that will convert into T3 which should also help.
If you do not keep your Vitamin D level up you will not optimize how you feel. You say that 30 is good for you, and that's great. But it is sitll not enough in my or gimel opinion, but we are not Dr's, but there is evidence and other articles for health that show getting it up to 50 to 60 is closer to optimum for health.
Yep you have an uphill battle. He is what we call “reference range endocrineology. And frankly it almoat never works. As the reference ranges are created with flawed methodology. The bottom HALF of the range is extremely questionable. And experience has shown that to be true with most (not all) people’s response.
T3 only is actually quite rare and moatly controversial. The fact that this doctor seems unaware that T4 converts to T3 and that you being somlow in the range if free T4 that suggests. No it screams to find a different doctor.
If things get bad enough and you cannot wducate your Dr. There are a few places that counsel online and are licensed to practice in all 50 states. Of course you have to have labs done but rhey can prescribe medications and treat you well. I know several leople who have had great success with this. Mostly for testosterone and sex hormones but they also treat thyroid. At meast it may beban option to keep in Your back pocket.
Selenium is shown to lower TPOAb in numerous clinical trials. I had a 15% reduction in 6 months after eating Brazil nuts daily. I have 5 autoimmune diseases. Grrrr.