It is, yes. With a ferritin that low, your doctor ought to be considering ordering more tests. If you’re as anaemic as it appears you might be, it would take a goodly while for iron tablets to make things better. An iron infusion might be better.
You are definitely iron deficient. Any ferritin less than 10 is diagnostic. This is also indicated by how small your red blood cells are. They are eeny weeny from having no iron. Your folate is also quite low. I’m surprised you aren’t anemic.
You should be worked up for bleeding if this happened over a short period of time. Low thyroid can also cause low blood cell count but your indices point strictly towards iron deficiency.
Ask your doc what’s next? They should give you an iron infusion if you’re feeling really unwell and can’t tolerate oral. Otherwise ferrous gluconate every other day and meals out of a cast iron skillet would do the trick. You should also start taking folic acid. Your B12 is also borderline low but not low enough to cause symptoms which usually happens below 300. I don’t think taking B12 would hurt either. Get sublingual so you absorb it.
Vitamin D level looks good. Anything over 50 is sufficient.
Let us know how you get on. Your doc should def give you a ring about these results. They aren’t borderline.
Just FYI my endocrinologist says 50nmol for vit d is not at all sufficient. Should be 100 at least - so you could do with improving that. Good luck with the iron
I mean if you’ve become iron deficient say over days or a few weeks then that would be indicative of a possible slow bleed. But not always. It can also be due to an autoimmune flare or malabsorption of nutrients (this may be the case for you as this is linked to thyroid issues). I just think a slow bleed should be ruled out esp if you’re having any stomach issues.
The only way to rid yourself of iron is through bleeding or stool (not so much in stool). Many females are iron deficient because we get menstrual cycles but iron loss happens over a long period of time with periods. We only lose a tablespoon or 2 of blood each cycle (maybe more if you’re a heavy bleeder).
Cooking stuff in a cast iron pan can infuse iron into your food. So cooking in it helps.
I hope your GP can give you better answers because they know your history and current situation. Please keep us up to date with what they say!
Your ferritin is dire. Has your GP said anything, the note on the print out even sayhs "Below range". Your GP should do an iron panel and this may very well show iron deficiency which your GP should treat.
Your folate at 2.89 is lower than any range I've seen on here so you may very well have folate deficiency, again something your GP should treat.
You should arrrange an urgent appointment with your GP to discuss the above.
Vit D at 78.8 nmol/L is on the low side. The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L.
To reach the recommended level from your current level, based on the Vit D Council's suggestions you could supplement with 3,000iu D3 daily.
Retest after 3 months.
Once you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
B12 at 361ng/L (ng/L is the same as pg.ml) is too low. 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."
Do you have any signs of B12 deficiency – check here:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.
Your GP should prescribe folic acid for your folate deficiency, if you have any signs of B12 deficiency it's essential that you do not start the folic acid until after further testing of B12 and B12 injections or supplements commenced as it will mask signs of deficiency and skew results.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
To interpret your thyroid results we need the reference ranges please as these vary from lab to lab.
Hi, my gp is calling me tomorrow. The receptionist just said about my iron levels but I’m feeling rubbish , my memory is terrible, my joints are aching and I’m tired😔 so I wanted advice from you guys as to what to say to my gp.
I’ve read through the b12 symptoms and have quite a few. So I will ask the front tomorrow to test for b12 deficiency.
Do you think this is why my memory is so bad? I just want to feel better now.
The aim of a treated hypo patient on Levo, generally, is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well.
Your TSH is too high.
Ate you sure your FT4 range is 12-26 ad not 12-22 which is the usual range when TSH and FT3 ranges are the same as you've given. If it's 12-22 then you are 34% through range, if it's 12-26 you are even lower at 24.29%
Your FT3 is just 13.51% through range.
You are very undermedicated to have your hormone levels (FT4 and FT3) that low. You need an increase in your dose, 25mcg now and retest in 6-8 weeks, very likely you will need to repeat every 6-8 weeks until your levels are where they need to be.
Your TPO antibodies are right at the top of the range suggesting that you have autoimmune thyroid disease, known to patients as Hashimoto's which is where the immune system attacks the thyroid and gradually destroys it. Some members find that a gluten free diet can help, also supplementing with selenium l-selenomethionine 200mcg daily.
I don't know why you think they won't want to give you an increase in dose. But as hypo patients we have to fight for what we need to get well. If he tries to tell you your dose is in range and therefore OK, tell him you feel you need a higher dose to bring your TSH down lower and to increase your free T3 and free T4 with a new test in 6-8 weeks. Insist. Don't be placid with doctors. Tell them what you need to try next.
So both folate and B12 are very low, but not low enough for GP to treat
NHS only treats deficiencies, but on levothyroxine we need optimal vitamin levels....this frequently requires self supplementing virtually continuously to maintain optimal vitamin levels
Obviously ferritin is EXTREMELY deficient and GP must treat
What sort of age are you?
Heavy periods? Common and classic sign of being hypothyroid
Are you vegetarian or vegan?
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)
Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Vitamins are likely low because you are only on 75mcg levothyroxine...this is only one step up from starter dose
guidelines on dose levothyroxine by weight
Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.
RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
You are clearly very under medicated and need 25mcg dose increase in levothyroxine
Bloods should be retested 6-8 weeks later
FT4 range is 12-26 ad not 12-22 which is the usual range when TSH and FT3 ranges are the same as you've given.
If it's 12-22 Ft4 34% through range, if it's 12-26 you are even lower at 24.29%
Your FT3 is just 13.51% through range.
all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
The aim of levothyroxine is to increase dose upwards until Ft4 is in top third of range and Ft3 at least half way through range (regardless of where TSH is) ...important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
Dr called and has increased my Levo by 25mg so now on 100mg. Prescribed iron tablets 210mg 3 x daily but says I need to leave 4 hours between doses .Going to re test in 6-8 weeks and then re asses the situation.
I startedthe iron over a week ago and no side effects would you recommend now adding a b complex too? I have the Thorne B Complex but not sure when and how many to take.
So you are now on 100mcg ....are you getting same brand levothyroxine as before (Mercury Pharma?)
Bloods should be retested 6-10 weeks after each dose change in levothyroxine
thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient)
B complex, best taken after breakfast in morning. Can occasionally make you feel a bit “wired” for first few days ....but normally that wares off after 3-5 days
When you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Come back with new post once you get full thyroid and vitamin testing - about 3 months time
There are some foods and drinks that don't mix well with levothyroxine.
Drinks containing caffeine, like coffee, tea and some fizzy drinks, can reduce the amount of levothyroxine your body takes in. Leave at least 30 minutes after taking levothyroxine before you drink them.
Calcium-rich foods, such as milk, cheese, yoghurt and broccoli, can reduce the amount of levothyroxine your body takes in. Leave at least 4 hours between taking levothyroxine and eating calcium-rich foods.
Soya in food and supplements may stop levothyroxine working properly. If you regularly eat soya or take soya supplements your doctor might need to do extra blood tests to make sure you're getting enough levothyroxine.
Kelp (a type of seaweed) can contain high levels of iodine, which sometimes makes an underactive thyroid worse. Do not take supplements containing kelp if you're taking levothyroxine.
Many people find taking levothyroxine at bedtime is more convenient and can be more effective
Thank you so much I was always lead to believe that taking Levothyroxin at night kept you awake. If this isn’t the case then I definitely going to change to a night time.
So it doesn’t really matter about the vitamins, I can take them pretty much as and when I need them.
To answer your question about memory loss - both high TSH and low ferritin can lead to this. I’ve had it with each. I have the feeling of “brain fog” even when my thyroid is well medicated, and I am on a much higher TSH dose than you are on.
My ferritin has only been under 10 a couple of times but I have felt terrible - tired, forgetful, low ebb - when that has been the case.
How long has it been since you had your previous blood test?
And what is your memory loss leading to you doing? Are you leaving your keys in the door & letting pans burn, or is it more insidious? I use the pinger on my oven and set reminders on my phone but when organisational memory / cognitive ability is bad, too, that is harder to compensate for although lists help.
Also - I didn’t see this above - doctors always recommend taking Vit C at the time of taking iron. Eating an orange (or something else that’s fibrous) even better than juice, but juice’ll do.
I find going for walks helps my memory and general well-being when I am anaemic / hypo. As you are so anaemic, though, don’t overdo it!
Hi, I’m forget our works telephone number, I’m asking repeatedly the same questions to colleagues and not remembering the answers, struggling to find words. It really knocking my confidence.
Hi, I’ve not had my estrogen or progesterone tested and I’m not taking anything that I’m aware of that it’s included in.
I’ve not heard of ashwagandha
Ive not overdone anything, infact the complete opposite, I usually go spinning but since lockdown I’ve not been to any classes and I’m back at work so not been able to go walking.
Dr called and has increased my Levo by 25mg so now on 100mg. Prescribed iron tablets 3 x daily but says I need to leave 4 hours between. Going to re test in 6-8 weeks and then re asses the situation.
I’ll start the iron tomorrow, would you recommend them adding a b complex too?
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