You may do well with a higher levothyroxine dose. Aim for T4 in the upper range of normal and TSH on lower end of normal. Although I have struggled with low T3 despite suppressed TSH and high T4. Since I started combination therapy of T4 and T3 I finally feel like myself again, after 6 years. More on reddit.com

Absolutely we can have hypo symptoms when TSH is High, but T4 and T3 are normal! The time to begin treating hypo is when TSH is High. If we wait until T4 and T3 are Low, then we may develop very unpleasant symptoms and possibly even other health conditions. I briefly went clinically hypo (Low T4 and Low T3) and had awful digestive symptoms and heart burn. I had never had heart burn before! I also felt depressed and unmotivated. I was surprised by how long it took my mental health to get back to normal. When you are being diagnosed with hypo, they often want to re-check your thyroid hormone levels to confirm that TSH is staying Abnormally High. Once they confirm this, then they are likely to prescribe thyroid medication. They know that the High TSH wasn’t just a fluke, that it’s here to stay, and that you can benefit from medication. If you are pregnant or trying to conceive, TSH needs to be below 2.5. If you are pregnant then Dr should likely prescribe thyroid medication immediately instead of waiting to re-test. The fetus uses our thyroid hormone to grow and develop normally during 1st trimester. Sometime after first trimester you still need normal range TSH to be as healthy as you can be, but baby’s thyroid gland will likely be producing thyroid hormone for baby. More on reddit.com

I dont know about the ratio but when I was on levothyroxine ( generic or branded ) my rt3 was in higher range or above all the time and increased along with my levo dosage . I was feeling like sht all the time I was on Levo ( 3 years) . My Rt3 came down once I switched to Armour and also resolved all of my issues. Armour saved me. More on reddit.com

Sounds like you have central hypothyroidism with those numbers. Which is a bitch to get a diagnosis for. (Ask me how I know. 🙄) I managed to find a doctor to treat me once I showed 2 ft4 values below range. If your doctor isn't being receptive to treatment try showing them this: "The presence of low levels of free T4 with an inappropriately normal to low TSH concentration is the hallmark of central hypothyroidism, along with reduced bioactivity of circulating TSH and variable TSH response to TSH-releasing hormone (TRH) tests." https://www.nature.com/articles/nrendo.2017.47 More on reddit.com