Iron-related blood test confusions: After nil... - Thyroid UK

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Iron-related blood test confusions


After nil response to my own post a few days ago re iron-related blood tests (unsat. iron low, folate high, transferritin sat high) and reading others which indicate serious confusion, I conclude that there is a total lack of clarity. Maybe this explains why my GP is unconcerned by my out-of-range readings (according to receptionist only!) or maybe it's because of interaction by other things e.g. I was taking B Complex when tested which I subsequently read is not advised.

Happy to share my results if anyone is interested in trying to solve this confusion!

11 Replies

I would love to help you, userotc, but I know nothing about iron. I don't even understand what you're saying above...


userotc I think the reason you didn't get any response is maybe because not many members know much about interpreting iron panel results, and the one or two that do may not have been around at the time.

I don't fully understand them and had to ask for help with mine. I was directed to this pdf, which if you scroll down has a table of iron panel results which may help:

I was also given this information from this website:

Serum iron should be 55% - 70% of the way through the range.

TIBC : High in range indicates body's need for supplemental iron

Saturation : optimal is 35 to 45%

Ferritin : Mid range is good

From your previous post (my comments in italics):

Recent blood test results showed relatively high vit B12 (725 ng/L; range 170-730) - This is not a problem, it is recommended that B12 be at the very top of it's range, even 900-1000. If you are supplementing then just stay at a maintenance dose of 1000mcg sublingual methylcobalamin daily.

and transferritin saturation (44%; 20-50), - 44% would appear to be good

under-range unsat. Fe binding (26 umol/L; 27.8-53.7) - Sorry, no idea what this is, unless it's TIBC (see the table in the pdf)

and over-range serum folate (24 ug/L; 3-19). - Maybe the melthylfolate (or folic acid) in your B Complex is too much for your needs. If you are supplementing B12 you need a B Complex to balance the B vits so you could get one with not too much methylfolate.

Serum Fe is 20.4 umol/L (8-32). - I would say there is absolutely nothing wrong with this result, it is mid range so good.

Following these results, Ive stopped taking vitamin B Complex and multivitamins as I dont seem to need them(?). - Multivitamins are generally a waste of time and money and are not recommended. They tend to contain not much of anything to be of use and generally include the cheapest and wrong form of the ingredients. Best to test and supplement only what is needed, apart from Vit C, also most of us are low in magnesium so that's another useful one.

In trying to recover from my illness (extreme fatigue, brain fog) probably brought on by a prescribed medication stopped 7m ago, Ive questioned my thyroid. However, I understand that the thyroid needs iron to make hormone and since I have plenty of iron and ferritin, that does not seem to be a reason for a low normal level of FT4 (11.5 pmol/L; 9-25) up from 10.7 six months ago). Note TSH 1.96miu/L (0.4-4.0) up from 1.15 six months ago and PTH 2 pmol/L (1.2-5.8) up from 1.1 6m ago. - Maybe consider secondary hypothyroidism. Look at the table under 'Hypothyroidism' here

which mentions normal TSH and low FT4 and states "A normal or low TSH level usually excludes primary hypothyroidism. However, the rare diagnosis of secondary (pituitary) hypothyroidism should be considered if T4 is also low. The commonest cause of this pattern is sick euthyroid syndrome."

I hope this helps but please remember I am not medically trained and you may wish to do your own research.

Seaside Susie

Many thanks, your response is excellent despite your understandable reference to not being trained. Its also consistent with another comment Ive received elsewhere re possible secondary hypothyroidism and also appears to confirm the doctor's under-concern re iron data which I think I can now consider to be normal (Ive stopped B Complex for now but could revisit later when I will take into account your comments re not too much methylfolate).

As I believe that I need a strategy re thyroid, my current one is:

1. Test for FT3, antibodies and iodine - all being tested today.

2. If iodine too low, continue with sea kelp (maybe increase dose slightly from current 150mcg/dy?) otherwise stop.

3. Start Ashwagandha herbal tablets. NB good reports for thyroid eg T4 increase/balance, plus other relevant benefits.

4. Retest thyroid (T4, TSH, PTH minimum) ~Mar '17 i.e. 3m after previous tests.

5. If thyroid condition diagnosed/confirmed, consider NDT or Levo.

NB Wish to avoid drugs for reasons outlined before.

Any comments appreciated.

Hope you have/had a wonderful festive break and thanks again.

in reply to userotc

userotc It's good that you're testing for iodine as it's important to know if you need it before supplementing. Which test are you doing? I did Genova's urine iodine test, I didn't do the iodine loading test because I'd read that it is unreliable in that 98-99% of people who do this test are found to be deficient

Adequate iron intake is relatively easy to get from diet providing you have no absorption problems. Haddock, cod, milk (not organic) and yogurt are high enough in iodine to satisfy our daily needs - check the iodine food fact sheet here

I've not used Ashawaganda so can't comment.

If your antibodies come back positive then you'll know you have autoimmune thyroid disease aka Hashimoto's which may explain the fluctuations in your symptoms of fatigue, etc. I don't get fluctuations like that, I don't have Hashi's, I tend to be tired most of the time and am still working on getting to the bottom of my problem. If your antibodies come back negative, it doesn't rule out Hashi's as the antibodies fluctuate and it would be worth doing the test again another time.

Which 'drugs' are you wishing to avoid and for what?

Have you tested Vit D, B12 and Folate? As well as Ferritin/iron panel, these are always recommended to be tested as part of investigation into possible thyroid problems as they all need to be at optimal levels rather than just in range, it's very common to see deficiencies in most or all of them on here.

Today Im having a Blue Horizon blood test for iodine. It cost ~£75 so hopefully results are reliable.

Re diet, Im essentially paleo (but also dont have milk as I seem to be dairy or lactose intolerant). Hence I supplement where I think needed.

My understanding is that anti-thyroid antibodies are invariably negative/absent with central (secondary or tertiary) hypo. See Table:

Re drugs, I was referring to all. My problems started ~7mths ago after I'd been on a GP-prescribed drug called finasteride for 7 mths. Consequently I now avoid all drugs, where possible.

Re vitamin D, my June test result was only 17.9 nmol/l rising to 77.7 in September (50 - 250) following GP-directed liquid supplement InVita D3 of 25,000units. Since November, I've been supplementing at 2000 IU/day and will be retested in March. Low D is one of several reported side effects of finasteride which Ive experienced.

Latest test results (3 weeks ago) included serum B12 = 725 ng/L (170-730) and serum Folate 24 ug/L (3-19) but youve already commented that these are good in your previous post.

I'll inform you of today's FT3, antibodies and iodine test results when I have them end December/early January.

in reply to userotc

You seem to have got it covered :)

My Vit D was 15 originally - not a side effect of anything, just severely deficient, not GP tested, I've done everything myself. Last test I was over the recommended level at 200 so I reduced my maintenance dose and will retest in the spring.

As you're taking D3, are you also taking it's important co-factors K2-MK7 and magnesium?

Not sure that Ive got anything covered when I feel unwell.

Im taking 200mg/day magnesium (calcinate) but not K2-MK7 - is that recommended?

When you say youre doing it yourself, do you mean private tests rather than NHS?

in reply to userotc

Vit D aids absorption of calcium from food and K2 directs the calcium to bones and teeth where it is needed rather than arteries and soft tissues where it can cause problems such as calcification of arteries, kidney stones, etc.

A couple of sources of information:


I get my Levo on prescription from my GP, I have been hypo over 40 years. They know next to nothing about Hypothyroidism and only go by TSH. If suppressed then you are over medicated regardless of symptoms or how you feel. They're so caring I've not been called for a repeat test for three years! (And there's no way at the moment I'm going to remind them I am overdue.)

I have not been right for about 20 years, tried the popular private specialists, with no support from GP, until I could no longer afford it at the time. At the moment I am able to budget for private tests and have done loads, found I was not converting T4 to T3 well enough, have an adrenal problem plus virtually non existent sex hormones. None of this would have been checked by my GP of course, because I was purely 'over medicated'!!

So I'm addressing the problems myself, initially with the help of a private hormone specialist to interpret all the results and suggest what supplements were necessary, I get all my tests done privately and tweak my thyroid meds as necessary depending on results and how I feel.

Thanks. I suspect I may need to follow a similar route depending on today's test results. Where do I get a private specialist from? I've had a consultation with NHS endo but he was useless.

in reply to userotc

Thyroid specialist? Years ago we had the likes of Dr Skinner, now sadly passed away. Also Dr Durrant Peatfield who does still see people in his clinic at Crawley, he is excellent but he can't prescribe as he gave up his licence after being hounded by the GMC. He now 'advises' and guides you with a treatment plan but he has been unwell so doesn't do his outreach clinics any more.

For other specialists email for the list of thyroid friendly endos, see who it's possible to travel to and ask forum members for feedback so you don't go wasting your money. They tend to be NHS consultants who also see patients privately so a lot of them toe the NHS line and sometimes you won't get anything different from them.

Or ask on the forum for recommendations of any good endos in your area.

Seaside Susie

I forgot to ask, can/does a (your?) thyroid condition result in related symptoms of fatigue etc coming and going? I think Ive read on the forum that it can - personally I have relatively better periods of up to ~2 weeks followed by worse ones of a few days.

Note: For info, UIBC is calculated by subtracting the serum iron from the TIBC so my TBC is 46.4umol/l which seems OK (N range 45-56)

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