Thyroid UK
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Could it be just the low ferritin?

My results are :

Tsh 5.62 (0.4-5.5)

Ft4 12. 1 (10-19.8)

Ft3 3.5 (3.8 -)

TPOab 40 (<60)

My ferritin was a bit low 39.6 (20-291)

Now I wonder if my symptoms could be just the low ferritin ? And if I manage to get the ferritin up then I will feel ok? What do you think? I have just started on 25ug levo but if the ferritin will make me feel better then that would be great and maybe I wouldn't need the levo?

Is it safe to take ferrous fumarate 210 mg x3/day? For how long to improve my levels ?

Any advice appreciated .

10 Replies

lisan1 If you go back to your previous posts you'll see that it was explained that 25mcg is a starter dose of Levo and you will likely end up on a much higher dose.

Your vitamins and minerals need to be optimal for Levo to work properly and your ferritin needs to be a minimum of 70 as explained. However, that will help the Levo to work properly but it will not 'cure' your obvious hypothyroidism which is indicated by your over range TSH, under range FT3 and low FT4. Your body can't produce enough of it's own thyroid hormone therefore it has to be replaced. Increasing your ferritin cannot replace the thyroid hormone you're not producing, only Levo (or other thyroid hormone replacement) can do that.

Once your vitamins and minerals are at optimal levels plus adequate thyroid replacement to alleviate your symptoms, then you should feel well.

The aim of a hypo patient is generally for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges if that is where you feel well.

You sound as though you don't want to take Levo. Is that right, and if so what is the problem?

As for the Ferrous Fumarate, for helping to raise ferritin it is recommended to take twice a day (not three times). Finish the packet, which is probably 84 tablets, then retest to see where your level is. Don't forget to take 1000mg Vit C with each tablet to aid absorption and take 4 hours away from Levo. If you want to really boost your ferritin then start eating liver once a week.


Thank you for your answer. Sorry but I'm new to all this and since my doc didn't diagnose me at first I thought that the problem might just be the ferritin levels . That's why I asked you on this forum.


lisan1 I think your doctor is, unfortunately, like many others. They don't take the time to talk to you about anything. He should have explained what hypothyroidism is and why you need to take Levo. Maybe it's because they don't have time, maybe because they have knowledge of it they automatically think every one else does, but whatever the reason I think it's so wrong not to discuss a diagnosis and what it means to the patient. They also don't seem to know anything about vitamins and minerals and how important they are, years ago my old GP told me I was wasting my money even though she never tested for anything to see if I was deficient in any.

Anyway, you know now that your ferritin isn't the problem where your thyroid is concerned and that you need to continue with Levo. From looking at your previous posts, B12 and Vit D are both OK, you know you have to raise your ferritin level, but I don't remember seeing a result for Folate (I may have missed it). If you did have that tested then that should be at least half way through it's range.

Just remember that for future tests you should book the earliest possible appointment of the day, fast overnight (water only) and leave Levo off for 24 hours (take that morning's dose when you get home).

Have you got another blood test booked? The norm is 6 weeks after starting levo or a dose increase, then if meds are changed another test should be carried out after 6 weeks to see what difference the dose change has made and if it needs changing again - yours will be increases at the moment.

The best thing you can do is educate yourself about your hypothyroidism because I don't think you'll learn much from your doctor and if he only goes by your blood tests being 'in range' rather than optimal for you then he will keep you ill. If you know what is involved you can discuss how you feel, dose changes, etc with your doctor with some confidence. Keep a record of your tests: date > test > result > reference range> dose of Levo > how you feel. This will be invaluable in the future if he wants to reduce your dose and you still have symptoms. I keep mine on a spreadsheet.

Have you seen the main Thyroid UK website (this forum is part of Thyroid UK).

Start at "About the Thyroid" on the purple menu, left hand side, and read through the different sections.

Did your GP prescribe the ferrous fumerate or did you buy it yourself? If he wont re-test after the packet is finished, it can be done with an at home fingerprick test with Blue Horizon or Medichecks - Medichecks is cheaper, I've done one today.


Thank you so much for your thorough answer.

Now I know that it's my röror that's the reason for me feeling ill. Do you think 25mcg will lower my tsh so the doc don't want to increase dose ?

I will have a bloodtest again in 6 weeks . They said 8 weeks from start .

I just want to feel well again. Do the docs listen to you if you say you want your ft4 in the upper half? Can 25mcg do that for me with my levels being 12?


lisan1 Unfortunately, with those results you have absolutely no chance of 25mcg lowering your TSH anywhere near enough.

I will copy and paste some of my previous replies to you from this post

"25mcg Levo is a starter dose. Hopefully you have been told to book a re-test for 6-8 weeks' time, the results of which should prompt an increase in dose of 25mcg, then another re-test after another 6-8 weeks resulting in another increase of 25mcg, and so on until you settle on a dose where your symptoms abate.

Your TSH will lower and your FT4 will increase. The aim for a treated hypo patient is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges if that is where you feel well. Don't let your GP dose by test results alone, a lot of doctors believe that once your results are in range, regardless of where in the range they are, then you must be well and if you still have symptoms it can't possibly be your thyroid!"


"No, I don't think 25mcg will be enough, it is a starter dose usually given to children and elderly people or those with heart problems. Usual starter dose is 50mcg, occasionally 100mcg. You will probably end up on 100mcg, maybe more, just whatever is needed for you to feel well. Follow the advice above regarding testing and finding your optimal dose. As I said, don't let your GP dose by numbers, if you don't feel well and still have symptoms you need to be assertive and push for an increase in dose."

Whether the doctor will listen to you about where your levels should be depends on the doctor, also how well you come across as knowing about your condition. He should dose by symptoms not numbers, so you also need to let him know how you feel. If you still have symptoms you must let him know that you are not prepared to continue living like that, it impacts on your life (tell him how) and that you want an increase in your dose until you feel well.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, wrote this in a Pulse Online magazine article:

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

If you email she will let you have a copy of the article which you can print out and show your GP if you are having problems getting a dose increase to where you feel optimally medicated and free from symptoms.


Thank you . I'm just afraid that the 25mcg will lower tsh to a level that the doctor think is good and then I won't get any more help . Is it possible for my dose to lower tsh to under 2.5.


lisan1 I edited the above post to add some more information which might help so you might want to read it again.

1 like

Thank you so much ! Will email her .


You are hypo and if you are on meds, you need a dose increase. TSH over range, FT4 rock bottom of range, FT3 ditto. No wonder you feel bad. Your pituitary is doing its best to get your thyroid to produce more hormone but it just isn't. Optimal ferritin, B12 and folate, plus a little selenium might help, but if your thyroid just can't do it, you need a decent dose of thyroid hormones. 25 is the starter dose for the frail elderly and those with heart problems, You should have an increase to 50 after 6 weeks and another raise again every 6 weeks until you feel well and bloods are optimal.


Is it safe to take ferrous fumarate 210 mg x3/day? For how long to improve my levels ?

Yes it is safe to take that amount of ferrous fumarate. I was prescribed that amount by my doctor when I first started supplementing iron, and after a while I stopped seeing my doctor and just controlled the supplementing and testing myself.

For more info on supplementing iron and what the NHS prescribes :

The important thing to understand about iron supplementing is that people absorb it at different rates. One person with low iron may absorb supplements well and would get their levels to optimal in 3 - 6 months. Another person in the same situation who doesn't absorb well could take a couple of years to get their levels to optimal. Some people may never manage it.

The important thing while supplementing iron is to test regularly - it really isn't an optional extra. Iron is poisonous in overdose and this must be avoided.

The above link is to the cheapest finger-prick iron tests I've found.


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