JadeFox 100% agree with Jaydee however you jump in, ramp up. I started on 10 T3 all at once and it took me 9 months for the constant palpitations to stop. Now, I was also under-replaced for that time but the palpitations happened immediately when starting T3. I would never do that again!
Your ferritin is a little low. Here is a picture of typical ferritin levels researchgate.net/figure/Mea... , there are other studies showing similar results.
Hypothyroidism can lead to low ferritin but I've seen no evidence of the reverse so there is no point in delaying your liothyronine. You may want to reduce your levothyroxine dose if you start to get hyper signs or symptoms. It's not good to have above average fT4 leves as they are associated with increase cancer and cardiac risk.
The first graph in your link is shocking. It seems that doctors are happy for women to be exhausted throughout their lives due to low iron/ferritin. Why are such low levels acceptable? And where is the proof that women need a lot less iron/ferritin than men for good health throughout their lives?
And, for any doctors reading this, please note that anti-depressants do not replace iron. But improving iron and ferritin does a better job than anti-depressants in reducing depression and anxiety in my experience.
The first time I was diagnosed with iron deficiency anaemia I was only 10, so for me the rot set in early.
This graph was a second best choice, I've lost the reference to the one I wanted. It shows the distribution of ferritin in women with an average of I think around 40 ish and most below 70. Since only a minority have anaemic symptoms this shows that these levels are fine.Of course a ferritin below 20 is a problem and ferritin is not always reliable, you can be anaemic with decent looking ferritin levels.
Young women in particular should be aware of anaemia and hypothyroidism seems to have a role in causing anaemia.
I was thinking of calling my GP as this has been a difficult journey to get T3 and the impact of low ferritin levels on the success..see what he thinks of an iron infusion? Considering its lower than it was last July 25.9 and I was on a supplement for 3months..
think the nice guidelines say under 30 but GPs say much lower.,
Do you think this is a good idea? And would having an infusion make a big difference?
I don't have enough knowledge to answer your question. I do know that ferritin is not always reliable and there are other tests that can be done. If you have signs and symptoms that may be due to anaemia maybe ask for a referral to a haematologist.
Iron and T3 will help each other rise and work effectively. Therefore, if I was you I would try introducing T3 but very low at say 2.5mcg and remaining on this dose until your body tolerates well (eg you aren't getting any adverse effects) before raising further.
Iron often refuses to raise because the body is unable to use it effectively, so remains at low levels like a safety mechanism to protect from free iron. However, as thyroid levels slowly slowly increase so will the whole erythropoiesis process (making of red blood cells) and the utilisation of iron will reawaken and hopefully allow T3 meds to bring well being.
Hi Radd, I’m getting my T3 tomorrow..are you suggesting that I start on 2x 2.5mcg a day? Do you have any recommendations on the time of day etc.. my endo has given me nothing.. many thanks
Some members have troubles introducing T3 with low iron (and/or low cortisol). Some members also find T3 amazingly powerful (I did, hence my caution to start low & slow).
If I was you I would start the first week with just 2.5mcg T3 once a day, then increase to morning and afternoon doses of 2.5mcg for a week. Then raise morning dose to 5mcg for a week, and then raise afternoon dose to 5mcg for a week.
You will now be on 10mcg T3 a day and I would hold this for another two weeks and then test levels and assess improvements because for many 10mcg T3 with Levo would be enough. Then if you need to increase (again slowly) you can. It is easier to add than take away as untolerated or excess meds make you feel simply awful.
I wouldn't tell endo the plan but keep all T3 prescriptions as they are, in case you eventually require the whole 20mcg dose. Don't raise the dose if you are still feeling any side effects until they have gone. I experienced a headache and an inner heat when I started T3 and with every dose raise, which diminished after 2 - 4 days. This appears to be quite common.
I have read some members empty the capsule a bit at a time as they need it into a small glass of water, but it’s not great as even with the best intentions amounts will vary a little. Maybe start on 5mcg (half a capsule) instead of my cautious suggestion of 2.5mcg?
You might like to buy some empty capsules so that you can decant some of the contents of your capsules into a fresh empty capsule.
Empty capsules are easily sourced from Amazon, but they do come in lots of different sizes so you'll have to work out for yourself what size you need if you decide to purchase any.
Empty capsules are sold in non-vegetarian versions (gelatine) and also vegetarian/vegan versions.
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.
It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:
Females 18 ≤ age < 40. 30 to 180
Females 40 ≤ age < 50. 30 to 207
Females 50 ≤ age < 60. 30 to 264l
Females Age ≥ 60. 30 to 332
Males 18 ≤ age < 40 30 to 442
Males Age ≥ 40 30 to 518
The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.
when I looked at the results last week and remembered how pleased I was in September's when t3 had improved from 3.9 to 4.1 had made a few changes and assumed it was that..however on reflection realise it was probably the ferritin supplement.. I’ve been a bit impatient as a lot is riding on this( like my whole life) so spoke to GP last week and he agreed and ordered the test and sent a prescription through.. Im waiting to be tested as i take supplements like 1000mg of Vit C etc just taking selenium.. probiotic & magnesium and fish oil.. as I want a good idea of what’s going on.. I’m also vegetarian so no chicken liver for me..
is that a good plan?
Thanks everyone for responding with great advice..
Serum B12 1356 (180.0-1000.0) above high reference limit.
Serum folate 23.5ug/L(>4.0)
I have been taking a B complex which contains biotin..I’ve stopped that and have some B12 on its way..
I’m 60 and taking HRT I’m not going to lie I’ve had years of struggling with not being able to lose any weight..the usual story of restricting my food intake.,
My diet has improved and I eat more and improving my sleep..
the ferritin ranges are helpful to me, thanks, I’ve had annual health check bloods and asked nurse to test vitamin D,folate,ferritin, not B12 as just had injection as these aren’t done usually, ferritin came back 13, was asked to get full iron panel done as dr thought it could be a one off! Bearing in mind I’ve had to have ferritin infusions in the past, full iron panel was good as always but ferritin still 13, nobody got back to me so of course I had to ring and question about my ferritin level, answer was your full bloods are fine ,no concern about the ferritin.
The lab range is ( 5-204) and flagged <15 indicates iron deficiency , I think I am concerned as have been housebound for over 3 weeks feeling so unwell and weak, this probably explains why. Trying to get an appointment with someone who will listen and actually look at my records.
Yes at 33 well in range for nhs..but not for hypothyroidism., I’ll share my latest results and see how it goes.,I’ve found Paul Robinson book really helpful recovering with T3
The present review of the literature regarding B12 status among vegetarians shows that the rates of B12 depletion and deficiency are high. It is, therefore, recommended that health professionals alert vegetarians about the risk of developing subnormal B12 status. Vegetarians should also take preventive measures to ensure adequate intake of this vitamin, including the regular intake of B12 supplements to prevent deficiency.
Considering the low absorption rate of B12 from supplements, a dose of at least 250 μg should be ingested for the best results.3
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
A week later add a separate vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can affect test results
Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential
A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first as per NICE Guidelines
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial
With loads of vegan dairy alternatives these days it’s not as difficult as in the past
yes I have both..just waiting a few days without vit C etc.. so should have the results late next week..have ferritin supplement ready and will start taking them as soon as I’ve had the test.. thanks for all your great knowledge..
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Increasing TSH with normal T3 levels. 
Ferritin and folate levels
High ferritin level and skin problems 
Please could I have help interpreting my new results after 6 weeks adding T3 to my Levo? 
Any tips on starting T3?
