The ranges are a bit odd.
His free T4 is pretty high at 76% of the range. I think a bit too high.
Free T3 is 58% of the range which is not horrible, but could be higher for sure.
When the FT3 is lower in the range than the FT4 range, which is the case here. It is a strong indication there is a conversion problem.
Here is what I think is happening. Not enough of the T4 is being created by conversion into free T3. OR is being overly converted into reverse T3 which is inactive. Thus leaving him hypo (low) thyroid at the cellular level. The body (pituitary) senses the low thyroid condition and pumps out TSH to get the thyroid gland to pump out more thyroid hormone(which explains the high TSH). And alsoexplains the high freeT4 levels. But the poor conversion continues leaving lower levels of free T3, And the cycle continues.
This explaines higher TSH yet Hypo symptoms. He doesnt have horrible hypo symptoms because his free T3 levels are not horrible.
The rule of thumb that works for most people, is to have BOTH of the following.
1) free T4 to be about 50% - his are at 76%
2) free T3 to be a min of 50% but most people need it up to about 67%
I suggest that new thyroid panel be run and this time also be sure to include reverse T3.
Selenium can help with conversion of T4 to T3, so this may be worth a try. The OTC selenium is about 200 mcg (micro-grams). Or eat like 1 Brazil nut a day. Do NOT over do it!
B12 range is also odd. Normally see something like 500-1000. Regardless, his b12 appears very low. I would recommend a sublingual B12 supplement.
Agree vitamin D is also low.
Has he had cortisol tested? High cortisol and high stress can go hand in hand and mess up thyroid metabolism.
Finally I would recommend Iron and Ferritin also be tested. Ferritin is needed for proper metabolism and I think aids in conversion process of T4 to T3.
Vitamin D, B12 and iron/ferritin as well as lower thyroid all cause fatigue symptoms if deficient. Your brother has at least two if not more of these!
Yep, he is going through stress, and here in uk, getting cortisol tested isnt easy, we had to pay for these labs privately
here are his iron results
IRON 18.03 umol/L 10.60 -28.30
T.I.B.C 60.13 umol/L 41.00 -77.00
TRANSFERRIN SATURATION 29.99 % 20.00 -55.00
FERRITIN 78.2 ug/L 30.00 -400.00
also, here are my results taken on the same day
THYROID STIMULATING HORMONE 3.6 mIU/L 0.27 - 4.20
FREE THYROXINE 15.400 pmol/L 12.00 - 22.00
FREE T3 5.12 pmol/L 3.10 - 6.80
THYROGLOBULIN ANTIBODY <10 IU/mL 0.00 - 115.00
THYROID PEROXIDASE ANTIBODIES <9.0 IU/mL 0.00 - 34.00