Help with iron labs

I'm hypothyroid on 75 mcg Synthroid with a long story, but right now I just need some advice on my recent labs. 

Ferritin 59   range 13 - 300 ng/ml

Iron 74         range 35 - 175.  ug/do

Folate 17.8  range 9.1 - 30.9

TIBC  278     range 250 - 400 ug/do

Vitamin D, 25-OH, total  26   range >30 ng/ml

B12 871 range 200 - 1100

I take these supplements:

B12 1000 mcg

Calcium Citrate 1000 mg

Magnesium 400 mg

Kelp iodine 150 mcg

So, should I be adding an iron supplement too? 

I have low energy and am in the process of evaluating my thyroid treatment. I'm also searching for a new doctor to replace my former doctor who has retired.Thank you for your help! I haven't posted much yet, but I'm an avid reader of this forum!

30 Replies

Hi Rivergirl, I'm going to post the optimal labs and you will see that you have to raise your ferritin and iron.  Your TIBC is not too bad though which means you may not be anemic but since you are taking B12, the result is possibly be due to the extra B12 if you took it at the time of the test.  You probably should supplement with iron because you are taking Synthroid which is only T4.  That T4 needs good iron levels to convert to FT3 which is needed to remove symptoms.

You should be taking methylcobalamin B12 and also methylfolate rather than folic acid. 

You said it's a long story when you mentioned Synthroid so I'll just say that 75 mcgs is not a very high dose for most people to be optimal so I hope you have seen your TSH, FT4 and FT3 results. 

Be careful with any numbers quoted on STTM. The author rarely mentions units of measurement, and rarely mentions reference ranges.

Thanks @humanbean! I will definitely keep that in mind.

Hi HB, I think they may have revised this article and considers a lot of what you mentioned.   She points to areas of ranges and the difference between Europe and U.S.  measurements except for vitamin D which has a quite different range.   At the end is this:

I still don't think the way Janie has written the information is explicit enough for all her likely audiences.

The section on ferritin, for example, starts with this :

Ferritin: Measures your levels of storage iron, which can be chronically low in hypothyroid patients. If your Ferritin result is less than 50, your levels are too low and can be causing problems…as well as leading you into anemia as you fall lower, which will give you symptoms similar to hypo, such as depression, achiness, fatigue. If you are lower than the 50’s, you are scooting by. Optimally, females shoot for 70-90 at the minimum (Janie’s is 80 when her iron is good); men tend to be slightly above 100.

Janie may discuss reference ranges elsewhere on the page, but I don't think that is really sufficient in all cases. People will dip in and out of the page looking for a specific recommendation and many of them won't read it all every time.

I haven't found anything better to help interpret blood tests, though, have you?  We need to see where we can improve our labs if not feeling well but will her doctor even try is the question.

I haven't found anything better either. I just hope that people who read the STTM info will take into account the units and ranges. But I imagine many people won't even be aware this is an issue.

Thank you Heloise. I didn't post my thyroid labs because it really is a whole other story. I've been on Synthroid for 30 years, and just started feeling like the dose wasn't optimal this past year, right when my doctor retired.  I didn't post those thyroid labs because the most recent ones were drawn 5 hours after I had taken my meds., and I don't believe they're accurate. I'm going to have then redrawn and start T3 when other issues are resolved like this intractable insomnia I've had the past 2 months. I do thank you for your advice on iron supplementation! 

I'll have to check those figures on the labs although I don't think any are hard and fast numbers and there may be a difference between European and U.S. measurements.   She often just points to which part of ranges to aim for and also which measurement was used.  At the bottom of the article there is a link regarding the blood testing in general.

I had been on a certain dose (of Armour) for many years and then really had to increase it later so perhaps that is what is needed or the addition of T3 which bypasses the need for conversion of your T4. 

Best wishes!

I wouldn't reach straight for the iron supplements just yet. When iron is mainly responsible for low energy then you will probably find that serum iron is at the bottom of the range or even below. Yours is in range and your iron stores (ferritin) are at a level that makes out-and-out deficiency unlikely. You have a pattern in your iron labs that suggests inflammation - probably not a surprise as you have thyroid disease. Iron is pro-inflammatory and competes with other minerals for absorption so is to be used with caution.

Much has been written about using iodine and how it should not be given without selenium otherwise you can unbalance the thyroid further. That might be worth looking into as you don't say you're taking any selenium. I believe studies have shown that taking selenium can reduce antibodies if you have Hashi's.

The gut is a common source of inflammation too so concentrating on gut health can be really useful. I used to have serum iron that was below range and couldn't get it in line with iron supplements. I had to change my diet in order to get it to pick up again and get my energy back.

Thank you Poing! The doctor that I was most recently seeing didn't think I needed the iron supplement either, but I did not have much trust in him either.  I'm in the process of finding another doctor since mine of 30 years has retired his practice. In the meantime I don't feel well and have been trying to educate myself on my Thyroid disease. 

I tested negative for Hashi's 2 months ago. I eat two Brazil nuts everyday for my selenium, a recommendation from one of the many thyroid books I've been devouring. I have changed my diet too after eating mostly vegetarian for over a decade.

Hello Poing and thank-you for this interesting reply to Rivergirl.  Please could you tell me more, by PM so that I don't interrupt rivergirls messages, about iron being pro-inflammatory (an expression I haven't heard before) and about the pattern you can see in iron labs?  

I ask because I am currently taking Ferrous Fumarate (prescribed by GP) to bring up ferritin (from 15).  Can you tell me more about which minerals it competes with please as well?

Why are you taking calcium? I Don't see any test for calcium? Did a previous test for calcium show low? I wouldn't be surprised, given that your vit D is so low. But calcium isn't a good thing to take - especially with Vit D that low - and especially as you aren't taking any vit K2.

What are you doing about that low vit D? Your supplementation is very unbalanced. If you're taking vit B12, you should be taking a B complex, to balance the Bs, because they all work together.

Did you get tested for iodine before you started taking iodine? If it isn't low, and your taking Synthroid, I very much doubt you need to supplement. I know it's supposed to be 'good' for thyroid, but did you ever ask yourself why? Do you have Hashi's?

Very difficult to be helpful with so little information. As is often said, the devil is in the detail. 

I'm sorry for not much more of my story yet Greygoose. It's complicated. I do have a brief bio in my profile, but things are really up in the air right now. My thyroid labs for the last 30 years have always been drawn after I took my meds. Historically my FT4 has been mid to upper range of normal. 4 years ago my doctor, who has now retired, started testing FT3. Looking back on those results, it was always at the bottom of the normal range, but my doctor never addressed that.  My own assumption is that my body is not converting  T4 to T3. I tried a new doctor who started me on a super low dose of generic Liothyronine 5mcg which I took for 6 weeks. Again we retested labs 5 hours after I took my thyroid meds. Long story, but labs are drawn in his office, and they couldn't take me in until 10:00 a.m. to draw my blood. So, both FT3 and FT4 were at the extreme too of normal as expected after taking the meds! 

I think I was feeling better on that low dose of Liothyronine, but it was hard to tell because at the same time I developed a terrible nightly insomnia which I'm still struggling with two months later. I was told to quit the Liothyronine because of this, and I did. I still have the insomnia two weeks after quitting that med, and that's where I am now. I also quit that new doctor because I did not feel he was competent for many reasons that I won't get into. 

Anyway, that is why I have not posted my Thyroid labs. When I'm retested when I haven't taken my thyroid meds or eaten, I will post that long story! 

I take Calcium because I was diagnosed with osteopenia, most likely due to having my ovaries removed at age 34 due to uterine cancer.

I've tried taking a B Complex supplement, but felt jittery and had sleeping problems so I gave it up. It was a few years ago, and I don't remember the amounts of each B.

I've increased my dose of D3 from 1000 to 2000 i.u.'s. Perhaps I should do more? I will start a regimen of K2. 

I did not have my iodine tested, but I though taking the minimal daily requirement of 150 mcg couldn't hurt. Is that wrong? I tested negative for Hashi's two months ago.

Thank you for your input Geygoose!

Well, I didn't actually ask you for your thyroid labs. lol But thanks anyway. lol You're right, it is complicated, isn't it. And, I think, a lot of it was due to you not being tested correctly. Anyway...

I really think you ought to research calcium suppléments yourself. I've posted a couple of articles on that subject, you can find them on my profile. 

They really are not a good thing. Taking vit D3 will increase your absorption of calcium from food, anyway. And calcium isn't the only thing needed for strong bones - magnesium is, actually, more important than calcium, we've just been brain-washed into thinking we need high levels of calcium by Big Food, who are making a fortune out of adding calcium to various products like yoghurt. Are you taking magnesium? It works together with vit D3 and zinc. No point in getting it tested because it will always come back in range, due to the way the body handles it. Just take some.

As for iodine, you aren't just taking the RDA, are you. Because you are getting iodine from your food, and iodine from your Synthroid, plus you are supplementing. So that all adds up to more than the RDA. And excess iodine just isn't a good thing. If you Don't have Hashi's, it could induce Hashi's.

In any case, one negative test does not completely rule out Hashi's, because the antibodies fluctuate. And I expect they only tested the TPOab, didn't they? There's another test that they rarely do - TgAB - and if that is positive, you have Hashi's.       

Thank you so much for that info, Greygoose. Sorry if I provided too much info. I was just trying to put my situation in a nut shell, and found that fairly difficult to do!

I will do some research on Calcium. It's just scary having osteopenia, and that is whT they told me to take since I won't take those other drugs they prescribe for osteoporosis.

The antibodies they tested me for Hashi's were Thyroid Perioxidase Abs and Thyroglobulin Abs.  I don't know why I was initially put on Synthroid 30 years ago, but remember the doctor saying that my TSH was on the higher side of normal range, and it was probably autoimmune. Could they even test for the antibodies back then? I don't have my records for that far back. 

Thanks especially for the info on iodine!

No, please Don't apologise! The more info the better. I just thought I'd put you to a lot of trouble for nothing. Yes, when a problem goes on for years and years, with doctors that have no idea what they're doing, it's very difficult to resume it all in a nut shell.

But, I think you have to ask yourself : what is osteopenia? Doctors would say it's pre-osteoporosis. Well, I think most of us would qualify for that when we get older. I Don't know how old you are, but, at sixty, we can't expect to have the bones of a twenty year-old. Some loss is natural. But, Big Pharma, who wants to turn all things natural into a disease, just see this as another way to make money.

Also, if you are long-term hypo, it's bound to have an effect on your bones. It has an effect on just about everything. I think that your next step should be to get tested for calcium again, and see just where you are.     

So pleased to read the bit about Calcium Grey Goose - I was involved in Clinical Audit about 25 years ago and have been saying the same ever since but people believe the advertising!

Even doctors believe it! They Don't seem to know that bones are made up of a mixture of minerals, not just calcium. Taking calcium suppléments is like eating rocks. It's not well absorbed.

Yes, you're right Greygoose, because it is my gynecologist who prescribed the Calcium most recently. Before that my GP did too.

Doctors Don't learn anything about nutrition in med school. So, for things like that, they rely on information given to them by drug company reps. And drug company reps have their own agenda. So, you really have to do your own research, and make your own informed décisions.

Yes Greygoose, and, my GP warned me about 15 years ago, taking calcium can lead to kidney stones - we don't want any of those!!!

And not just kidney stones!

And heart attacks and strokes! Thanks for alerting me to the latest studies about calcium supplements. It's amazing that doctors just keep on recommending it.

Not really, they still keep trying to put people on statins, despite all the science saying they shouldn't!

Hello Rivergirl, please read up more about iodine, for those of us who are hypothyroid it can do harm.  

One suggestion I have relates to progesterone because we have such similar history with the cancer at 34 except that luckily for me my ovaries were not removed.  After reaching mid-fifties I found progesterone seemed to help the thyroid problem, though that's only my perception, I didn't have tests to monitor it.

Hi Thyr01d. Interesting that you too had cancer at age 34. I was told that the type of CA that I had was rare for someone my age. I wish I had demanded to keep my ovaries! I had early stage endometrial CA, and maybe that would have been ok. But I was so naive and scared at the time.  

I took estrogen and progesterone for over a decade after my surgery, but I didn't   like the way progesterone made me feel. Is there any research on progesterone and thyroid?

Hi Rivergirl, I think it is quite rare at that age, I've never met anyone else, you're the only other I've had contact with.   One of my lovely students died a few years ago from cancer that stared in her ovaries so you probably had the right thing done.

I don't know about research, I just believed what was written on the cream, could of course be a placebo effect!  I don't have oestrogen, just progesterone, would that agree with you?

I'm not sure how progesterone would affect me now, Thyr01d. I last took it 25 years ago, and back then it made me feel like I always had PMS! Yikes!

Oh heck!  No wonder you gave it up.

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