Anemia: A Cause of Intolerance to Thyroxine Sodium

[helvella]

This might be fifteen years old, but I cannot remember seeing it posted here! (Occasional repetition isn't such a bad thing either.)

Am well aware that getting iron deficiency anaemia resolved is a mantra round here. Nice to see such a simpe statement.

Anemia: A Cause of Intolerance to Thyroxine Sodium

Capt K.M. Mohamed Shakir, MC, USNcorrespondence

, Capt David Turton, MC, USN

, Capt (SEL) Brian S. Aprill, MC, USN

, Capt (SEL) Almond J. Drake III, MC, USN

, Radm John F. Eisold, MC, USN

Department of Internal Medicine, National Naval Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Md

Usual causes of intolerance to thyroxine sodium include coronary artery disease, advanced age, untreated adrenal insufficiency, and severe hypothyroidism. We describe 4 patients with iron deficiency anemia and primary hypothyroidism. After treatment with thyroxine sodium, these patients developed palpitations and feelings of restlessness, which necessitated discontinuation of the thyroid hormone. After the anemia was treated with ferrous sulfate for 4 to 7 weeks, they were able to tolerate thyroxine sodium therapy. Iron deficiency anemia coexisting with primary hypothyroidism results in a hyperadrenergic state. In such patients, we postulate that thyroid hormone administration causes palpitations, nervousness, and feelings of restlessness. Correction of any existing pronounced anemia in hypothyroid patients who are intolerant to thyroxine sodium therapy may result in tolerance to this agent.

Happily, full text is available here:

mayoclinicproceedings.org/a...

[humanbean]

Nice find!

This is the kind of post I am likely to want to find again to point out to others who come along later. Could it be put into the topic of Research Papers instead of Hypothyroidism please.

The Hypothyroidism topic is just a big lump of posts that can't be searched and useful stuff gets lost.

[helvella in reply to humanbean]

Oh - OK - just for you.

[humanbean in reply to helvella]

Thank you.

[Spareribs]

This is a keeper - what we've felt & being saying for ages.... low Iron & palps...

ta Rodders

[Contra21]

Im hypo and anemic and have been for 2 years having heart flip flops. Had the thyroxine damagrd my heart im confused?

[humanbean in reply to Contra21]

No.

What the paper is saying is that people who are given Levothyroxine while they are also suffering from iron-deficiency anaemia will often develop palpitations and won't be able to tolerate the Levo very well (or at all).

To solve the problem, the patient's iron deficiency needs to be treated for a few weeks. If the patient is then started on Levo again they often cope with it much better.

[Contra21]

Thankyou. I ask because my rhyroid leveks were uo and down being poorly monitored. I have since found a great endocrinologist. My ferritin kevel is 14 and have had on and off anemia all my life but last 2 yrs has been bad. My heart flip floos slowed down could thay have been from too much thyroid meds and iron not being treated ? Also i still get them not as bad they hive me panic and anxiety so bad actually make me not want to leave my home. I never felt palps like this before when i had low iron though. Thoughts? Xx thankyou anyone who replys

[McPammy]

Hi. I have just found this old post as I was searching for thyroid issues when low on iron stores and intolerance to Levothyroxine. This year, after 11 years on Levothyroxine, I found I could not tolerate it anymore after trying and trying for months each time my strength would literally fall away and I would end up either clinging to door frames and walls or crawling along the floor. I’ve just found out that I am iron deficient. My level is 15. No Dr could understand what has happened to me. I’ve since switched to NDT and now I’m better but not enough to live life normally. I’m still weak especially in my legs. I’ve started my Iron tablets yesterday. All along I believe it has been something to do with Levothyroxine but didn’t know why. Maybe it’s because my iron has been too low and my body keeps rejecting it. I don’t know but it seems pretty convincing from this report. I don’t have palpitations my symptoms are different complete weakness. Could be linked with adrenal issues as I’ve had low cortisol on many occasions too when I’ve collapsed.

Very interesting!!

Pam 👍.

[helvella in reply to McPammy]

The idea of needing iron to be at sufficient levels is so burned into my brain, I had completely forgotten this post!

Reading it again, it does make sense.

You just might find something helpful in this link:

dropbox.com/s/g8y4e7alm5ow0...

There are many here who have real experience of iron supplementation - something I have never needed. You just might find that your choice of product and dosing has to be reviewed.

[Saya85]

Thanks for the post!

I’ve continually been told my iron levels are ok despite ferritin levels being low.

Coupled with Fh of anaemia and severe symptoms.

I’ve used spatone more recently and do feel better and if I’ve had a sudden increase in thyroxine dose before I did used to get palpitations but since sorting iron and b12/folate out this year I’m tolerating it Levo a lot better and feel half normal finally.

I knew vitamin deficiencies were extremely important with thyroid issues but the significance of anaemia is a comfort to know that I could sort both issues at once potentially.