Iodine Deficiency or just low Ferratin

[Pepekins]

I had my thyroid gland removed 18 years ago. I take 100mcg Levo daily but have not been feeling great lately. I also have and have had for years tiny red spots over the trunk of my body. I recently read that this could be a sign of iodine shortage. Would it be dangerous for me to take a little iodine supplement just to see if it helps with all these butterflies and twitches in my legs. My ferratin is 37 which I also think is on the low side.

[SlowDragon Administrator]

As Levothyroxine contains iodine, it's unlikely iodide deficiency

100mcg is a relatively low dose after complete thyroidectomy and many people need the addition of small dose of T3

Can you add your most recent blood test results and ranges - TSH, FT4 and FT3 plus vitamin D, folate and B12

For full Thyroid evaluation you need TSH, FT4 and FT3 tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if on too low a dose of Levothyroxine

What's the range on ferritin result please?

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw). This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you do your tests?

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

Strongly suggest you get FULL Thyroid and vitamin testing if not everything has been tested

[Pepekins in reply to SlowDragon]

Ferratin was 37 and Folate 6.6 Thank you.

[SlowDragon Administrator in reply to Pepekins]

Without ranges on blood test they mean little.

Each lab has different ranges on tests

But generally

Ferritin needs to be above 70 - assuming range of 15-150

Folate - at least in top third - so around 15 -assuming range of 3.3-19

B12 at least over 500

Vitamin D - assuming UK nmol units - at least over 80nmol

On Levothyroxine most need

TSH under 1 (often substantially lower)

FT4 right at top of range eg 19-20 if range is 12-22

FT3 in top third if not higher eg 5.5 if range is 3.3-6.5

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many especially after thyroidectomy

We frequently need addition of small dose of T3 otherwise require high FT4 and suppressed TSH in order to have high enough FT3

rcpe.ac.uk/sites/default/fi...

Patients struggle to get referral to endocrinologist for T3 trial due to cost

british-thyroid-association...

New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

[SeasideSusie Remembering]

Best to test for iodine deficiency before considering supplementing. If you are deficient, find an experienced practioner, there is a protocola and cofactors.

This is an easy, good test from Genova Diagnostics:

Urine Iodine Test:

Specimen requirements: Urine

Cost: £71.00

Order Code: END25

Turnaround time: 5 - 10 days

Iodine is an essential trace element, vital for healthy thyroid function. Adequate levels are required to enable the production of T3 and T4 thyroid hormones, whilst also being required in other areas of health. Deficiencies can lead to impaired heat and energy production, mental function and slow metabolism. Urine iodine is one of the best measures of iodine status. This test is not performed as a loading test, but can be used to establish existing levels or to monitor iodine supplementation.

You'd need to order with ThyroidUK as your "Practioner":

thyroiduk.org/tuk/testing/g...

[MaisieGray]

I'd guess there's a strong possibility that your red spots are common petechiae, which can potentially have any number of different causes, both other conditions and drugs, and nutritional deficiencies, but which are more likely to be perfectly benign and nothing to worry about. I've had them for years, and when a new Endo saw them, thought they indicated I had Fabry's Disease, which of course, I didn't. As I understand it, the more important specific link to iodine is the petechiae developing as a rare toxic reaction to contrast medium, or other iodine-containing compounds, so in those cases, the reverse of having a deficit of iodine. But a deficiency in most if not all vitamin and minerals might add to your susceptibility to developing the spots, and so a comprehensive set of tests for any deficiencies or low levels should always inform your decision to supplement; and certainly never supplement iodine without first having it properly tested.