I saw a new endo this week and have just received the results from some bloods he requested
I believe all look ok other than ferritin.
Serum b12 1095 pg/ml (197-771) I do supplement b12 so not surprised it’s over range
Serum folate >19.5 ug/l (>3.9)
Ferritin 18 ug/l (30-400) note says low ferritin confirms iron deficiency. Suggest check for blood loss then start iron replacement
I will call the GP on Monday but anyone know what they are likely to do to check for blood loss? Any advice to help raise ferritin levels before medication?
Celiac test was negative.
Vitamin D 25OH >170 nmol/L
Had calcium, liver tests too if they would be of use?
Last thyroid tests taken in Feb were:
FT4 13.6 (12-22)
FT3 4.0 (3.1-6.8)
TSH 0.05 (0.3-4.2)
Endo reduced Levo from 150 to 125 and increased T3 from 20 to 40mcg
Thanks in advance for any advice
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Niks76
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I will call the GP on Monday but anyone know what they are likely to do to check for blood loss?
If the doctor does anything at all to check for blood loss, the most he/she is likely to do is to do a faecal occult blood test.
This is the same test that is done when doing bowel cancer screening. The test looks for blood in poo and can, allegedly, find tiny amounts which are too small to be seen with the naked eye.
However, one thing you won't be told is that the faecal occult blood test is a very unreliable test and false positives and false negatives can happen for lots of different reasons. For info on this, see this post :
If you were to get a positive result on the poo test then your doctor would be obliged (I think) to arrange for you to have a flexible sigmoidoscopy or a colonoscopy to find out what is causing the blood.
If your doctor decides not to test for blood in your poo, then he/she is likely to go straight for prescribing iron pills. The NHS has a habit of prescribing the roughest, cheapest iron pills they can. If you find it difficult to tolerate the supplements you are given you can buy your own iron supplements without prescription. Just ask for help.
Another point to remember - taking high dose vitamin C will help your body to absorb any iron you take, and it also helps you to avoid constipation, which is common when taking iron pills.
Thank you humanbean, lots of info there. Knowing my gp practice I assume they’ll go straight for iron tablets. Do you think it’s worth pushing for more tests? Will meds increase my ferritin if I do have a bleed somewhere and it continues?
Do you have any experience or knowledge as to how long it takes for the tablets to make any difference?
I know I have to take 4 hours away from thyroxine, does the same apply for T3 too?
Hi Niks, my ferritin is low in range. My GP just asked a series of questions to determine whether i had any obvious blood loss. No tests were involved.
Knowing my gp practice I assume they’ll go straight for iron tablets. Do you think it’s worth pushing for more tests?
It might be worth asking for a test. But whether it will give you an accurate result is anyone's guess.
Will meds increase my ferritin if I do have a bleed somewhere and it continues?
There are too many variables to know the answer to that. It would depend how bad the bleed was. It would depend on how well you absorbed iron. It would depend on how high a dose of iron you took. It would depend on how much inflammation you had in your body, because inflammation tends to keep iron to a minimum in other body cells and pushes it into ferritin, keeping it higher than might otherwise be justified.
Do you have any experience or knowledge as to how long it takes for the tablets to make any difference?
Again this really depends on lots of other variables. Assuming that you don't have a bleed, and your body is absorbing the iron, speed of absorbing it varies enormously from person to person. I've read of people optimising their iron within 6 months. There are others who take a year, some can take longer than that, and some people never manage to optimise their iron.
I do have personal experience of having blood in my poo. The cause was found and fixed (a bleeding polyp). From the time I was given prescription-strength iron pills to getting my ferritin mid-range took me nearly two years, although my serum iron has never reached mid-range. Going gluten-free has helped. After the first couple of months of prescribed iron pills I took over buying my own supplements (the same as the ones the doctor prescribed) and did my own private testing. Doctors often assume that people only need iron for 2 or 3 months. In my experience they rarely re-test. My doctor would happily have kept me very short of iron, but I wasn't prepared to stay that way.
To test iron levels privately this is the cheapest and best test I know of (testing just ferritin isn't enough) :
There are various things that can go wrong when treating low iron, and so regular testing is essential to make sure nothing is going wrong. It is also a good idea to test before you start supplementing.
The things to look out for are :
1) Serum iron and haemoglobin staying very low and ferritin shooting up very quickly. This is likely to be a sign of Anaemia of Chronic Disease (or Chronic Inflammation). It could indicate that you have an infection or something else undesirable gobbling up the iron and your body is protecting you by putting as much iron as possible in ferritin. In this case stop taking iron immediately (or don't start in the first place). You need to know why this has happened.
2) Ferritin staying low or hardly changing, and serum iron shooting up. This can happen for various reasons. The commonest reason is likely to be a problem with methylation. Methylation problems can be helped, but supplementing iron before getting methylation working is a very bad idea. If this situation arises, stop taking iron immediately.
No, not really. My GP only suggested a multivitamin with iron! I have added more iron-rich foods to my diet but as I am a vegetarian, foods such as liver are not possible. Non-haem iron is not so bioavailable so I might struggle to raise my level by diet alone.
Hope you have better luck with your GP, but if not there's plenty of good advice here on the forum.
Thanks but not holding out much hope for when I call them on Monday.
I think I have some reading to do, I don’t know much about this and have no idea what non-haem iron is!
I donate blood and had donated 3 days before endo requested these tests. The finger prick test they do was fine so can only assume that tests something different.
Have just remembered that if someone has too high a level of stored iron (hemochromatosis), they are told to donate blood regularly as this lowers the level. Perhaps that explains your low ferritin level after giving blood. In fact would the blood donation service take your blood if you tested low in iron? Don't they test your blood first, and if they don't, wouldn't they subsequently advise you of an iron deficiency?
Giving blood surely amounts to the same thing as having a bleed.
Ferritin is the storage version of iron so ferrous fumarate (or similar) tablets are usually prescribed.
If it’s iron you need- spatone is a natural mineral rich water supplement you can buy from boots and Holland and Barrett. I find it far easier on stomach and apparently absorbs a lot better too.
2) Folate doesn’t give a maximum range? But good folate levels are required to use up the b12 effectively - so if it’s not very high u may want to increSe that.
3) also did they test vit D? All required for good t3 to t4 conversion.
4) However I am quite interested in your thyroid results. I know when you’re taking t3 also that t4 results aren’t all that important... but given both your t3 and t4 are very low in range, and your tsh is so very low, with primary hypothyroidism you would expect the opposite. (Very high t4 levels and low tsh if you were overmedicated- hence reducing Levothyroxine). If your t3 is low you would expect your thyroid to be secreting a lot of tsh in order to stimulate thyroxine production.
It appears more like secondary or tertiary hypothyroidism (problem with pituitary or hypothalamus rather than thyroid) based on those results but maybe your original rest results would give a clearer picture. Do you have those from when you were first diagnosed?
I would post a new thread with your thyroid results first to see if other members can give you better advice.
No, iron wasn’t requested, I might ask my gp to do that when I call on Monday.
Folate range just says >3.9 (I assume means greater than?). What is a good level for us thyroid patients?
Vitamin D says >170. In 2015 this was 75.7, I have been supplementing since.
I do have previous results, I will post them. The endo has reduced T4 and increased T3 so said T4 levels likely to drop further. I asked my previous endo why my TSH could be low despite low T3 & T4, she couldn’t answer. I think I have read that TSH becomes suppressed when taking T3 though?
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