This fairly recent review links up FT3 levels in the body with brain and pituitary gland activity. It shows that in T4-treated patients there may be insufficient T3 to prevent brain fog as well as other shortcomings. It also shows that tissue and circulating FT3 levels are closely linked so that blood FT3 measurement does give information about tissue levels..
T3 levels and thyroid hormone signalling
Frontiers in Endocrinology · October 2022 DOI: 10.3389/fendo.2022.1044691
Federico Salas-Lucia , Antonio C. Bianco
Conclusion
Tissue T3 content reflects circulating T3 levels and faithfully informs about TH signaling in most tissues (except for the brain and pituitary gland). The knowledge that in LT4-treated patients serum T3 levels might not be fully restored, raises the concerning possibility that TH signalling in these patients (in most tissues) might also not be fully normalized. Clinicians could consider the potential usefulness of measuring serum T3 levels to monitor the effectiveness of therapy with LT4. Future clinical trials should aim at correlating clinical outcomes with serum T3 levels