Thyroid UK

Iron, thyroid patients and gut health

Just put up a new blog post on iron, thyroid patients and gut health.

I hope it is helpful to some of you.

Find it on my 'Recovering with T3' book Facebook page:

Or go directly to:

Best wishes,


23 Replies

Very useful blog, Paul. I have been wary till now of high Iron- but have changed tack now I'm on Levo.

I put a ? up on here about Iron & Ferritin co-relationship. Can you comment on that? No takers so far!



This system logs me out if I blink my eyelids!

Can someone please sort this out so that if someone logs in then they stay logged in for a few weeks. It is TEDIOUS BEYOND BELIEF to have to continue to log in (sometimes within a few hours) ..... never had this experience with any other system.


Ferritin is key and it usually tracks transferrin saturation %. Serum iron is the least useful measure as it just shows current iron levels in the blood.

Thyroid patients need good (not low end of normal or barely mid range) ferritin levels and good transferrin saturation percentages. Serum iron is really not helpful at all on its own.

Ferritin can also be a problem. In cases of low iron, ferritin can sometimes appear to be high - due to inflammation. It is easy to spot because serum iron is low and ferritin is high and the thyroid patient either has multiple symptoms of inflammation or laboratory results that suggest inflammation. In these, latter cases, ferritin has to be ignored and the low iron treated as inflammation is also addressed.

I have no idea if I've even got close to answering your question Tegz but I have told you some of what I know that might vaguely be relevant to your question. :)



Please report your logging in / out problem to the technical team via the Support link on the green bar at the top of the page.

Thanks :)


Paul wrote

Can't someone else do that ..... super busy!

Paul, In order to trace the source of the problem that you are experiencing, the technical team may need to know the details of the OS and browser that you are using to access this site. Hence no-one else can report your problem for you.

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Yeah- that's big help. Thanks.

The background too my 'being wary' was looking into Haematomachromiosis [spelt from memory :) a few years back which stressed men don't need the extra iron-Full Stop.

It is apparently the most common undiagnosed genetic illness in Europe right now- and at the time I got onto the case.

My Doc as of then said 'No problem , unless you see golden flecks in the iris' [Copper, I think]- which was a bit of a loose diagnosis, as I thought then.

My self help notes said anyrthing below 80 Ferritin was OK.

Now- I think a boost wouldn't hurt as Thyroid's a lot bigger pain in the butt to deal with.

I don't have serum Iron back numbers.


The rest of us haven't got anything better to do?

You are whinging. You complain to HU.

We have spent days and weeks playing our parts in putting forward the evidence and complaints to HU.

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p.s. for future reference 'whinging' is designed to be quite inflammatory and not likely to add any calming tones or layers on a difficult situation.

I got really annoyed by that word. I am over it now and assume that you didn't mean it in the kind of nasty way that it read.

I really do not have the time to interact with IT groups.

Anyway, I hope they work it all out and that they provide you and everyone else with a working system .... hope that happens.

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I've now told them that I am on Chrome - the most standard and best of all browsers. Hopefully that will give them some insight!


I don't think it's Chrome that's the problem. I'm using Chrome and that's one problem I don't have. I hope they get all these problems sorted out soon. It is extremely frustrating!

Thanks for the very interesting blog :)


:) Thank you CarolynB


Hi Paul,

thanks for the interesting article re iron levels.

I wonder if you know what the situation might be where:

- serum iron is 140 ug/dL(note I've converted this from my reading which was 25.1 umol/L using 'x5.5847' which I got from a laboratory conversion table for serum iron tests), which seems fairly high; and

- serum ferritin is 50 ng/mL - which seems low; and

- percentage iron saturation is 54.4% - which is also high

I'm confused as it appears my ferritin is pretty low and yet my iron is good and my percentage saturation is actually too high (I understand the 'normal' range for this to be up to 45%). .

Any ideas what/where I should be looking?

Thanks for all your hard work Paul!



They measured saturation % for you did they?

Can you state the reference range you had for the serum iron and the ferritin for your lab.

Did you take any product containing iron during the two weeks prior to the test?

Ferritin is low.


Yes, they measured saturation % at 54.4% but didn't put the range on my results - I had looked that up subsequently and found it to be 12-45%.

It was the same for the other iron tests that they did - they gave me a print out of the results but there weren't any ranges included. I looked them up online for standard lab tests so realise they might be slightly out as I know the reference ranges change sometimes.

Other Iron tests were:

Serum TIBC 46 umol/L (range 45-66 umol/L)

Serum iron level 25.1 umol/L (range 9-30 umol/L)

Serum folate 8.6 ug/L (range 2.1-20 ug/L)

Serum ferritin 50 ng/mL (range 50-90 ng/mL)

I wasn't taking any iron supplements at the time of the tests (still not now); I was taking AdCal D3 (prescribed); and other than that just 100 mcg T4, which wasn't helping at all and my TSH was 12 and my FT4 was 5 and my FT3 was 2, so I was still pretty hypo. I've since managed to persuade my endocrinologist to give me some T3 and I'm now on 150mcg T4 plus 40mcg T3 (split). Not great though - but that's another matter. He's effectively washed his hands of me now though - he told me at my last appointment that as I have T3 (against his better judgement....) plus T4, there's nothing more he can do - as I continue to have hypo symptoms he said these can't be to do with thyroid and I must in fact have CFS! Seems this is his default position for patients who don't get better with him.

Anyway, I'm looking at other areas that might be struggling so was interested in your Gut/Iron article. So it looks to me as though iron is good and percentage saturation is actually too high, yet TIBC, folate and ferritin are all low - do you have any idea what this could be indicating?

In case its relevant - I'm totally gluten free and largely dairy free (and was at the time of the iron tests) as I was having lots of gut problems. These are much improved since losing wheat/gluten again so I'll stick to this for the foreseeable future now.

Thanks again!


Looks like you do need iron supplementation to get ferritin up but you can't take a lot given TIBC being low - so taking a low level of iron meds (20 mg or less of elemental iron supplement until TIBC gets higher) and eating plenty of organic red meat would be a good thing for you.

I strongly suspect that your T4 meds are too high and you are making too much rT3.

Folate and B12 may need supplementing also.

Best wishes,



Thanks again Paul.

I'll look for a low level iron supplement and I agree re the T4 - I was wondering about switching to T3-only (I've got your book) to heal adrenals as they are pretty bad (other than high cortisol on waking, it's on the floor for the rest of the day - which I think would indicate I wouldn't need to do an early dose wouldn't it?) and this would then deal with any RT3 issue too I presume. I've tried adrenal support as per Dr Peatfield, but I couldn't tolerate it - made me feel awful.

My DHEA was also very low - endo agreed to test DHEA (to humour me I think), but when it came back incredibly low he admitted he didn't have a clue what to do about it and what it meant......I've started supplementing that myself now though and think it is definitely helping.

I do supplement B12 as that too was low but I'll also look at a folate supplement now too.

Thanks again!



Switching to T3 only is a bit radical and I wouldn't suggest starting there. I'd do a smoother transition with some T3 and less T4 perhaps by using natural desiccated thyroid. Not sure if you'd need CT3M. It may be that you need a lot more T3 in your meds and less T4 - that alone may be enough.


Thanks Paul, really useful advice. :o)


You are very welcome Helen.


Interesting discussion all round.

Have you looked at Spatone [Iron water] as a kindly Fe version? Readily available.

[It can be taken by pregnant women safely, also 2yo's and upwards from the label.]

Someone here flagged it up -and I'm trying it now.

Seems OK.


Paul- I have a 'friendly' Endo prepared to consider T3 for me for high RT3 and poor metabolism. This after 3 previous disappointments via NHS clinics.

I couldn't tolerate T4 feeling much more Hypo and flu like on it.

Seeing your comment earlier about care with 'T3 only' and considering trying your CT3M protocol has made me wonder if this is a good thing, right now.

I do have high Arsenic in HTMA and Blood serum as a follow up check I did privately.

This is known to depress thyroid conversion from my reading.

Any comment?


What exactly is your question Trevg?

What are you worried is a good thing or not?

T3 only is more complicated to use than T4 BUT it can be done and has been done thousands of times. For those that can't tolerate T4 at all then it is a life saver.

My two books help as can forums where there is expertise on T3 only.

Good luck!



Sorry- post was a bit of a ramble. I've been waiting so long to get a decent hearing from an NHS Endo and now I have a good chance to push for T3 I wondered if it was better to actually include T4 to make it an easier lift off? The problem is my TSH has reduced from 5 to 3 in the time since T4 trial and I worry that I'm fighting last years battle. My one reading of RT3 was over the limit- but the NHS doesn't test for this.

Rather than dive into T3 only forums, I thought you could comment as I have already mentioned your protocol to him and not sure how to move forward in the new scenario, with him rather more helpful -who I'll see again in a few weeks.

The Arsenic rider was a side comment- I'm still waiting for a re-check on the high serum level, after 3 weeks since blood draw.

It may be a factor,too.

I'm worried that Adrenal insufficiency or heavy metal Chelation needs may not be good for T3 only trial, basically.


I think you will probably need support with T3 dosing anyway. I won't do that here as it isn't a suitable vehicle for doing it. If you have read my first book then this will give you some clue on dosing.

However, as for T4 - some people can do OK with a little T3 (often dosed twice or three times per day) but others just do not cope well until the T4 is removed.

Something else to bear in mind is that as T3 is added TSH gets reduced. As this happens conversion of T4 gets worse and you get more rT3 (see: So, for some people you really do need to remove the T4. A good technique is to go T3 only and when dosed correctly to add some T4 back in later on.

It really all depends on whether a little top up of T3 actually helps or not. If it doesn't then I'd use T3 only. If you do that then a T3 forum like mine can help to provide input as can my book, as T3 dosing isn't simple.

If you have adrenal issues then using CT3M can actually help them a lot.

Good luck anyway,



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