High end iron, low ferritin...

Been looking over my last blood test and it occurs to me that something weird is going on with the iron/ferritin balance...serum iron is 25 (11-30) while ferritin is 36.5 (10-200). Researchef this further and am now a little concerned I might be a candidate for hemolytic anemia. But then I maybe being way melodramatic, it's just hard to tell cos there's so little clear information on this subject! I am concerned that if I take iron supplements I'll just be poisoning my blood with too much iron - and if I don't then I'll run out of ferritin.

Could there be a more benign reason for this weird ratio?

Should I take iron or not?

Thank you so much you guys rock :)

26 Replies

  • If you would be developing hemolytic anemia, your hemoglobin would be falling like a rock and you would barely be able to walk up a flight of stairs.

  • Oh okay thanks! I just couldn't be sure because the articles I've read about it are all in doctor speak or missing the key information or both ha ha. So I guess I'd be ok with taking more iron then. Thanks very much x

  • Does this link help at all?


    I've found the table at the bottom of the page very helpful.

  • Thanks humanbean, that is very helpful :) I actually have normal hemoglobin levels so I guess I'm okay. Thank goodness there are people in the world who can make things understandable!

  • I agree. As well as the table on that link, I liked the very brief comments on the terminology that might get used in test results. At least I have something to google!

    And it mentions hypothyroidism as a cause of anaemia. How often does that get mentioned?

  • Very rarely unfortunately! Great stuff, thanks again! Xx

  • I Don't think there's supposed to be any sort of balance or ratio between serum iron and ferritin. Ferritin is where the iron is stored, and your body takes iron out and puts it back in as necessary. The important thing is that there's enough storage iron for the body to call on when needed. But then, I'm not a specialist, and still struggling to understand iron myself.

  • Thanks greygoose, ever concise and reassuring :) and don't worry, I wouldn't sue you if I died from your recommendations ;)

  • :D

  • I'm very similar to you. My serum iron is 19 (6-34.5), transferrin saturation 30.7% (15-45), but ferritin is only 35.1 (13-150).

    Looking at the table Humanbean linked to the only reference to low ferritin is in iron deficiency anaemia in conjunction with low serum iron, low transferrin saturation percentage, low haemoglobin, low MCV and high TIBC.

    I have mid range transferrin saturation, a bit below mid range serum iron but not really low, haemoglobin 136 (115-165), MCV 89 (80-100) and TIBC 62 (45-70). So I don't really reach the criteria for iron deficiency anaemia so iron supplementation isn't really indicated. However, I'm trying a ferritin supplement at the moment (Cardiovascular Research brand) and I will retest when I've finished the bottle to see if it's made any difference. It only has 5mg bioavailable iron. Like you I haven't been able to find out much about it and I haven't involved my GP (long story!) so I'm doing private tests.

    I'll be interested to see if you get any more suggestions.

  • Thanks SeasideSusie! Yes your results are almost exactly the same as mine, ha ha. I had this weird theory that my blood is diluted because my skin is full of mucin, therefore it's pumping lots of watery stuff in through my blood which would explain why I have high RBC and high end iron - like maybe it's putting more of those things into my blood because otherwise I wouldn't get enough oxygen with such diluted blood. And then my ferritin would be low because it keeps using it up to maintain higher iron and RBC levels...totally random and likely flawed theory but you never know! Do you have a lot of mucin in your skin too, by any chance?

  • I'm not sure what mucin in skin is but as I don't have a problem with my skin I guess the answer is no.

    My brain is overloaded with trying to find information about this and a couple of other health issues.

  • Mucin is the jelly like substance in you skin which gets expanded if you have hypothyroidism. If I pinch my skin it feels quite thick, like it's a bit swollen or taught, all over. It would be easy not to notice or think it was fat (as I did for ages!) But that's not really fair because it just isn't fat! I actually think a lot of the "weight" people lose when they are treated properly is mostly mucin...so if you're skin seems thicker than other people's, your thyroid is not optimal yet. It's an interesting thing to read about but the info can be a bit hard to find.

  • I'd have to say no to mucin then, I can't say my skin seems thicker than anyone else's, nor swollen or taught.

    Would that contribute to a typical hypo face? I remember for the couple of years before I was diagnosed (going back 40+ years) my face was puffy, and I had put on a fair bit of weight which did get back to normal some time after starting thyroxine.

  • Bear in mind that it is possible to have more than one cause for anaemia at the same time. And if that happens things get very, very muddy.

    A common thing for people with thyroid issues is that they are both B12 deficient and iron deficient. And without thorough testing it can be impossible to sort that out.

  • I know my B12 is fine - 651 (191-663) when first tested and last test was 991.

  • Could make sense in my case as my b12 is in range but not ideal, 526. Needs more work, ha.

  • Do you feel tired on this level of ferritin? I would expect you to.

  • I certainly do. I reduced my Levo to try and satisfy my GP who doesn't like my suppressed TSH and over the top of range FT4 but in range FT3. She's not up for discussing it though. I reduced from 187.5mcg to 175 and then 162.5. I couldn't cope on 162.5mcg, was needing to lie down during the afternoon most days, and after 6 weeks I put it back up to 175. Not very often needing the afternoon rest now but find it hard to get up on the morning and always unrefreshing sleep.

  • Maybe your t3 isn't high enough, if it's only in range and your t4 is higher? I have heard thyroid needs to be higher than normal in hypos. Or maybe, an adrenal issue? I wish you luck with it, at least we're all in company! :)

  • I've had the 24 hour adrenal saliva test and cortisol follows the right pathway and is nicely in range except for the afternoon one slightly high. DHEA only just in the green band so within range but a bit on the low side.

    With these blood results

    TSH - <0.005 (0.27-4.20)

    FT4 - 28.59 (12-22)

    FT3 - 5.14 (3.1-6.8)

    I'm thinking maybe drop the T4 a bit and replace with a small amount of T3. I have some T3 on the way. I am waiting for urine thyroid test results to arrive to see how much T3 is actually getting to the cells before I decide whether to start taking any T3.

  • Yes I do! However I have no idea if the ferritin alone is causing that, I have plenty other excuses to be tired lol ;) it would be nice to have energy again, forgotten what its like!

  • Well, my understanding is that serum ferritin is storage iron - just that. In the cupboard, waiting until needed. And you have low stores in that cupboard. I think you could consider taking some supplementary iron bisgylcinate - not big doses, just to get your ferritin a bit higher.

    You could see how you felt.

  • I started on iron bisglycinate originally, Solgar Gentle Iron 20mg, and it brought back the constipation I'd always suffered from despite 5g Vit C and magnesium citrate daily. With the Ferritin, 5mg bioavailable iron, I manage to have my bowels open normally most days. It's quite disconcerting to realise just what is remaining in your body when constipated when you realise what "normal" is! I started the Ferritin in the hope that it would increase the ferritin level without raising the other iron results too much.

    I know that ferritin needs to be at least half way in the range for proper conversion of T4 to T3 and I am awaiting the result of a urine thyroid test to give me a better idea. My FT results aren't in balance really

    TSH - <0.005 (0.27-4.20)

    FT4 - 28.59 (12-22)

    FT3 - 5.14 (3.1-6.8)

    So you can understand why my GP doesn't like my results but won't discuss anything other than TSH except for OTT FT4.

    I'm hoping to be able to get another private blood test before Christmas but have to arrange for someone to drive me the 60 miles for the blood draw, I can't get enough blood for a finger prick test as it clots to quickly in the funnel before enough can get into the tube.

  • I'm sorry you're having those troubles, I used to have somewhat wayward bowels too - constipation then bouts of diarrhea. NOTHING helped! A few months ago I started eating lots of fruit, especially dates, and smoothies, and I don't have any issues whatsoever, my digestion is pretty awesome these days! Definitely a first for me and I just started taking the same type of iron as you and it hasn't affected anything so maybe eating fruit would help you, too? I also cut back on dairy and than undoubtedly improved transit time!

  • Yes, that seems like a good plan. Thanks for your input, greatly appreciated xx

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