Hi all just wanted to give you an update and ask a quick question about optimal levels of ferritin and folate.
I recently went up from 50mg of thyroxine to 75mg (now on TEVA)
Results:
22 June Serum B12 551 ng/L (120-900) - not retested today
22 June Serum TSH 9.39 (0.3-5) - 28 July: 5.75
22 June fT4 11.2pmol/L (7.9-16) 28 July: 15.2
22 June fT3 not tested 28 July: 4.3 (3.8-6.0)
28 July only: ferritin 18 (15+)
28 July only: folate 14.9 (2.5+)
22 June only: vitamin D 65 nmol/L (50-150)
I take my thyroxine at night away from food. I stopped it 24 hours before blood test and did this fasting and first thing in morning drinking only water. I stopped my b vitamin complex 7 days before.
I now take 4000 iu vitamin D, a b12 complex, a probiotic and a prebiotic
From these results I am wondering if i have a problem converting to T3. The doctor could see this and was worried about pushing my T4 too high (I said that didnt matter as its just the thyroxine drug in your blood) and my TSH is still too high. She said she is happy to increase me to 100mg a day.
I am also going to start to take an iron liquid - is floradix recommended and how much should i take? I am feeling very tired and fatigued so hope this would help.
Can anyone advise optimal folate level and optimum ferritin level? (Doctor said over 15 was fine but seems VERY low to me)
She is happy to retest before 14 Sept which seems a good time frame.
Thanks all for any advice
Written by
jsy_girl
To view profiles and participate in discussions please or .
I take my thyroxine at night away from food. I stopped it 24 hours before blood test and did this fasting and first thing in morning drinking only water. I stopped my b vitamin complex 7 days before.
Did you alter the timing of your Levo the day or two before the test? If you normally take it at night and your test was first thing in the morning, and you didn't alter the time you took your Levo there could be one of two things:
1) You took your Levo the night before and tested in the morning, so that would be about 12 or so hours. This would be too close to your test and your FT4 result will be a false high.
2) You left off your Levo the night before and it was the previous night that you took your last dose, so that would be more like 36 hours or so. This would be too far away and your FT4 result will be a false low.
So when exactly did you take your last dose of Levo before the test?
22 June Serum TSH 9.39 (0.3-5) - 28 July: 5.75
22 June fT4 11.2pmol/L (7.9-16) 28 July: 15.2
22 June fT3 not tested 28 July: 4.3 (3.8-6.0)
July results show that everything thyroid-wise is going in the right direction, your TSH is reducing and your FT4 is increasing.
From these results I am wondering if i have a problem converting to T3. The doctor could see this and was worried about pushing my T4 too high (I said that didnt matter as its just the thyroxine drug in your blood) and my TSH is still too high. She said she is happy to increase me to 100mg a day.
Far, far too early to tell if you have a conversion problem. You need to get your TSH down to below 1 which gives you the highest possible FT4 and then look at the FT3. If FT4 is high and FT3 is low then conversion is poor. If FT4 and FT3 are fairly well balanced then conversion is fine.
The fact that your TSH remains over range with an FT4 level at the top of it's range is strange. This is why we need to know exactly how many hours before the test you took your last dose of Levo.
28 July only: ferritin 18 (15+)
There has to be an upper limit to that range, is it 15-300?
It is very low and low ferritin can suggest iron deficiency or iron deficiency anaemia. You need an iron panel (will tell you if you have iron deficiency) and a full blood count (will show if you have anaemia). As your GP to do these tests. Do not start self supplementing, iron is complicated. With a ferritin level that low then your GP should be investigating and if necessary iron tablets should be prescribed and your levels regularly monitored by your GP.
Ferritin is recommended to be half way through it's range.
According to some experts, ferritin levels of at least 40 ng/ml are required to stop hair loss, while levels of at least 70 ng/ml are needed for hair regrowth and the optimal ferritin level for thyroid function is between 90-110 ng/ml.
Folate is recommended to be at least half way through it's range. If there is no proper range and just >XX then I'd want mine into double figures.
Hi thanks for your response. The doctor didn’t suggest anything about doing further iron tests she was just happy for me to self supplement. She said they were low but didn’t seem too worried. I’ll ring back and see if I can get another appointment.
I did adjust the timings so I took Sunday nights on Monday morning at c. 7am and then had the blood test at 7.55am on Tuesday morning.
I did think it looked odd myself but as my vitamin D is lowish and iron and folate could be low too maybe I am struggling to convert.
There was no upper range according to the doctor. She gave me these results verbally...when I get access I’ll check but as you say it possibly needs further testing. I guess I’m lucky not to be experiencing hair loss with what you’re saying. Wow.
You need the iron panel as well. For an iron panel you need to fast for 12 hours, although you can have water, so it's best to have an early morning blood draw so you don't have to fast throughout the day.
Unless you have a proper range for folate, one with a lower and upper limit, then there's nothing wrong with your folate level. As I said, if it just says >XX, or in your case 2.5+, then I'd want mine in double figures, which yours is.
What I would suggest though is a B Complex. Your result is 551 ng/L (120-900) and ng/L is the same as pg/ml. According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
So it would be an idea to improve your B12 level. A good B Complex containing methylcobalamin and methylfolate will improve your B12 level and also help your folate level. Consider Thorne Basic B or Igennus Super B.
Is an iron panel standard? He only wanted to do a full blood count. Is that something they would do next depending on the results of the full blood count?
I’m just reading that it’s nowadays only done really if they think you have too much iron in your blood? They now use ferritin as the measure of stored iron rather than that in your blood?
Ferritin is your stored iron - like a pantry stocked full of baked beans.
You can have a decent amount of serum iron (the baked beans) but not much in the pantry (ferritin). This is why you need an iron panel. If your serum iron is already at a decent level then you wouldn't want to take iron supplements because that would raise your serum iron and possibly take it too high.
This is why you can't just take iron supplements for low ferritin. You need to know if you are actually iron deficient, which the iron panel will tell you, and if you have anaemia (iron deficiency anaemia) and the full blood count tells you if you have anaemia. You can have iron deficiency with or without anaemia.
The iron panel includes serum iron, transferrin saturation %, Total Iron Binding Capacity, and ferritin.
I just rang them and doctor said my iron levels are normal so no need to test. How does one deal with this it’s infuriating?!!! I’ll ring and try another GP tomorrow but this is crazy.
Hi just to check it doesn’t matter if I take my thyroxine at night as per normal to do the iron panel does it? I am doing it 12 hours fasting just water except for taking my thyroxine. Thought best I check...
It's OK to take your Levo as normal. With a iron test you would leave off any iron supplement for 7 days before test (and not eat liver or other iron rich foods in the 7 days before test) and, of course, leave off Biotin or a B Complex containing Biotin as that can affect any blood test if biotin is used in the testing procedure.
I just wondered when I retest vitamin D, B12 and folate should I stop any tablets containing those one week before to see how they’re doing?
With B12, if you want a baseline to see how much you are holding on to then you'd need to be off the supplement for 4-5 months.
It's usual to continue supplementing all those and the result tells you if the dose your taking is appropriate. If your level comes back too high then reduce the dose, if it comes back too low then increase the dose. Just don't take them before the test on the day, take them after the blood draw.
Ferritin 18 (15-300)
This is extremely low and as mentioned above can suggest iron deficiency or iron deficiency anaemia, essential to test FBC and iron panel as mentioned above, you can't self supplement for a level that low, it needs a diagnosis and appropriate treatment and monitoring from your GP.
If your GP says your ferritin is normal because it's in range then you say yes, but just 1.05% through the range and she'd still say it's normal if your result was 160 which would be 50% through the range, so there's no way you can possibly be at an optimal level at just 1.05% through range.
Yes they’ve prescribed ferrous fumerate 2 tablets a day 210mg tablets which I’m going to start after the full blood count on Friday. I’ll post results here Of iron panel as they refused to test that via NHS, notes from my patient record from gp:
Ringing to request having serum iron, TIBC etc done on bloods before starts iron repelacement. Explained that these tests arent routinely done in primary care and wouldnt offer much valuable information.
So helpful!
Do you think now you can see folate range that is too low or still okay?
Yes they’ve prescribed ferrous fumerate 2 tablets a day 210mg tablets which I’m going to start after the full blood count on Friday
You said before that you'd been told to self supplement.
Whether you are self supplementing or are prescribed iron tablets, take each tablet with some Vit C (500 or 1000mg) to aid absorption and help prevent constipation. Take iron 4 hours away from thyroid meds and 2 hours away from any other supplements or medication.
It's important to monitor iron and Ferritin levels regularly when supplementing.
Do you think now you can see folate range that is too low or still okay
Folate of 14.9 (2.5-9,999)
As you can see, that is a particularly stupid range, nobody is going to have a Folate level as high as 9 thousand plus.
Ranges that we see here are usually something like
3.89 - 19.45
8.9 - 68ish (can't remember exactly)
>3.89 (with no upper limit)
Yours will come under the last example and in that case we'd say a level in double figures would be OK.
Yes I was planning to self supplement but when I looked at the likes of floradix I could see how little iron was in them and figured I probably need something more so when I rang about iron panel I asked to be prescribed.
I’ve ordered vitamins c powder to take alongside iron and will take in morning first thing. I take Levo at night.
How can this be? Is Ferritin this odd? does it go up and down? I assume I shouldn't supplement on this basis? certainly not the iron tablets the doctor gave me (200mg ferrous fumerate) - maybe get some floradix and take every other day? I do eat a fair amount of beef and 90% dark chocolate and chia seeds etc which I think all have small amounts of iron in - and i eat the dark choc with strawberries so probably helps absorb it.
Serum iron: 55 to 70% of the range, higher end for men - yours is 51.72% assuming you mean the bottom end of the range is 5.8 so that's a pretty good result.
Saturation: optimal is 35 to 45%, higher end for men - yours is just slightly under at 31.54% so again pretty good.
TIBC: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - yours is 75.7% through range so it's towards the upper end of the range.
UIBC: Low in range indicates that you may have too much iron in your blood which may be due to iron overload syndrome (hereditary haemochromatosis). High in range signifies iron deficiency - yours is 44.88% through range.
Ferritin: Low level virtually always indicates need for iron supplementation; High level with low serum iron/low saturation indicates inflammation or infection; High level with high serum iron and low TIBC indicates excess iron; Over range with saturation above 45% suggests hemochromatosis - your ferritin level with this test isn't too bad, could be better as 82 is half way through range which is where ferritin is recommended to be.
So all in all this iron panel isn't too bad at all. It might be worth discussing this with your GP and pointing out the difference in the ferritin results and see what he says.
Taking these Medichecks results there is no indication that you need iron tablets, if anything I'd just eat liver regularly (no more than 200g per week due to it's high Vit A content) to try and get your ferritin up to half way through range, even 100, and then every couple of weeks to maintain the level. Liver pate and black pudding are also fine. Other iron rich foods listed here: apjcn.nhri.org.tw/server/in...
Your full blood count looks fine, no suggestion of anaemia.
It’s weird isn’t it? I just don’t understand the random low ferritin result in that case. I won’t supplement and I’ll look into eating liver pate. I can just add a bit to lunch or something. Haha.
Thanks so much for looking at them for me and also including that link for interpreting. I am probably okay vitamin wise then, and it all comes down to T4 and how well I convert. Thanks.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
TSH low, ft3 low, ft4 high... Still feel awful!
Low FT4, Normal TSH, Fluctuating FT3
Is there Relationship between TSH, FT3, and FT4? How could I Improve my FT4 and FT3 levels? 
Low tsh, normal ft4/ft3
Folate supplement/Test results
