Iron and Levothyroxine: We see a lot of people... - Thyroid UK

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Iron and Levothyroxine


We see a lot of people asking questions about iron here. One thing that is frequently repeated is that you must take any iron supplement well away from levothyroxine. As with so many topics, the basic idea of taking iron well away from levothyroxine is well known and understood. The underlying reasons are far less often discussed. Hopefully this abstract will back up the idea and might even explain!

Ann Intern Med. 1992 Dec 15;117(12):1010-3.

Ferrous sulfate reduces thyroxine efficacy in patients with hypothyroidism.

Campbell NR1, Hasinoff BB, Stalts H, Rao B, Wong NC.



To determine whether simultaneous ingestion of ferrous sulfate and thyroxine reduces the efficacy of thyroid hormone in patients with primary hypothyroidism.


Uncontrolled clinical trial.


Outpatient research clinic of a tertiary care center.


Fourteen patients with established primary hypothyroidism on stable thyroxine replacement.


All patients were instructed to ingest simultaneously, a 300-mg ferrous sulfate tablet and their usual thyroxine dose every day for 12 weeks.


After 12 weeks of ferrous sulfate ingestion with thyroxine, the mean level of serum thyrotropin (thyroid stimulating hormone, TSH) rose from 1.6 +/- 0.4 to 5.4 +/- 2.8 mU/L (P < 0.01), but the free thyroxine index did not change significantly. Subjective evaluation using a clinical score showed that nine patients had an increase in symptoms and signs of hypothyroidism; the mean score for the 14 patients changed from 0 to 1.3 +/- 0.4 (P = 0.011). When iron and thyroxine were mixed together in vitro, a poorly soluble purple complex appeared that indicated the binding of iron to thyroxine.


Simultaneous ingestion of ferrous sulfate and thyroxine causes a variable reduction in thyroxine efficacy that is clinically significant in some patients. The interaction is probably caused by the binding of iron to thyroxine.



In case anyone is uncertain, sulfate is the modern approved spelling of sulphate. :-)


Image: André Karwath aka Aka - Own work

This image shows a 2.1 billion years old rock containing black-banded ironstone, which has a weight of about 8.5 tons. The approximately two meter high, three meter wide, and one meter thick block of stone was found in North America and belongs to the National Museum of Mineralogy and Geology in Dresden, Germany. The rock is located at +51°2'34.84" +13°45'26.67".

3 Replies

Thanks Rod, great picture too!

Fascinating. Do you know, the endo I saw actually said, when questioned about my ferritin levels, that he was there as an endo, and wasn't going to discuss that side of things. At which point I stopped trying to make him understand. Idiot.

I queried this with my pharmacist and he said there was no reason I couldn't just chuck all my pills down at the same time! Levothyroxine, ferrous fumerate, fluoxetine, omeprazole and cocodamol. I never know what is best to do as so much conflicting advice :/

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