High tsh (10), normal t3 (liothyronine) and t4, skin changes (dark circles, dilated blood vessels, non-bacterial acne), ridiculously fast metabolism, fatigue, feel constantly warm all the time. is this hyper or hypo?

HighTSH: High TSH is consistent w/ hypothyroidism.May be subclinical hypothyroidism ,ince TSH is hi, T4 normal . Fatigue is hypotwould not the fast metabolism, usually hypothyroidism is slow. But in Hashimotos disease where you have thyroid antibodies you can have periods of hyperthyridism before it burns out into hypothyrodism, Check thyroid peroxidase ab consider selenium suppl. F/Uw/doc

Maybe both!: This is a confusing picture. High TSH suggests you are hypothyroid, possible even with "normal" T3 (liothyronine) and T4, but fast metabolism/feeling warm are symptoms of hyper. I agree with Dr. Gliksman that this is suspicious for thyroiditis. There might be other factors affecting your symptoms too. It would be reasonable to consult with both a thyroid specialist and integrative doc for further evaluation.