Checking my iron is not part of the regular treatment I receive from the internist for my hypothyroidism. Many years ago a former internist checked my ferritin once per few years and it always seemed at the bottom of the range. He never mentioned it as problematic. I have now asked my GP to check my iron panel, and below I copied the results. The GP says my iron is OK. I do see some low values though, and especially because ferritin is mentioned at this forum so often, I wonder how to interprete these results well and what would be advisable to do. Thanks for any help and suggestions!
Serum iron (9-30) 19.9
Transferrin (2.50-3.80) 1.64
Transferrin saturation (15-50) 49
Lipemie (0-30) 15
Hemolyse (0-15) 15
Icterie (0-2) 1
Hemoglobin (7.5-10.0) 8.8
MCV (80-100) 87
Ferritin NREF (10-291) 38
Written by
Jocelin
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Serum iron: 55 to 70% of the range, higher end for men - yours is 51.9% through range so pretty good.
Saturation: optimal is 35 to 45%, higher end for men - yours is 49% so a bit high.
Transferrin: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - yours is 1.64 (2.50-3.80) so obviously it's below range, maybe discuss with your doctor.
Ferritin: Low level virtually always indicates need for iron supplementation - yours is just 9.96% through range so very low.
Your results don't really suggest iron deficiency and your haemoglobin and MCV don't suggest anaemia so it could just be low ferritin that needs work. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
I have tried to find more information on the internet after reading your interpretation but get a bit lost. I am a bit worried about the contradictive results of the low transferrin and low ferritin and the high transferrin saturation. The first two suggest some shortage of iron and the latter would suggest an overload of iron. I find it difficult to ask my GP, she already found it a big deal to order this iron panel and just turned the results off as 'OK'. She did not bother about the reasons I gave: a faster heartrate than I used to have in rest and my tongue keeps being too swollen (two possible symptoms of an iron deficiency). (Besides that I have many typical low thyroid symptoms despite T4 and T3 supplementing). I have talked with her about minerals a few years ago and she is not trained on that and not interested.
If anyone here could be of help to get more insight in the seemingly contradictory results, I would very much appreciate that! Thanks!
My first comment is I simply don't believe your Haemoglobin result. The range is so wildly different to any range I've ever seen before. What were the units of measurement? Have you got mixed up between the following, which all mention hemoglobin?
Hemoglobin
Mean Cell (or Corpuscular) Hemoglobin
Mean Cell (or Corpuscular) Haemoglobin Concentration
Serum Iron - Your result is very good and doesn't suggest an obvious issue with iron.
Transferrin & Transferrin Saturation - According to link 1 above a high Transferrin Saturation would be found with a low Transferrin in many cases of anaemia. But what the significance of this is in your case, I am not sure.
Hemoglobin - As I said above, I simply don't believe this result. If it was a "real" result I don't know what would be considered to be optimal. When I don't know an optimal level for something I always work on the assumption that mid-range is safe. And your hemoglobin is mid-range so I wouldn't worry about it.
MCV (Mean Cell - or Corpuscular - Volume) - In iron deficiency this is low. In Vitamin B12 or folate deficiency this is high. If you have any of the following combinations MCV might look very "normal" and won't be informative. Your MCV is neither low nor high so isn't informative without knowing your B12 and folate.
low iron+ low B12
low iron + low folate
low iron + low B12 + low folate
Ferritin - Clearly your ferritin is very low. Optimal is mid-range or a little bit higher, and would ideally be around 150 - 200 with the range you've given.
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Having a swollen tongue with thyroid disease and/or nutrient deficiencies is very common on this forum. It isn't just low iron that will make the tongue swell. Low B Vitamins will do it too, as will allergies. Sjogren's Syndrome may be an issue :
You should take a B Complex to see if it will help your tongue and other symptoms. Make sure the product you take contains active B Vitamins rather than inactive ones. Many people with thyroid disease and/or nutrient deficiencies struggle to convert inactive vitamins into active vitamins. For more info on activated B vitamins see this link :
The problem with supplementing iron is that it isn't always obvious where extra iron will end up. Will it raise serum iron? Will it raise ferritin? Will it raise both? Your serum iron has some wiggle room, but not very much. Your ferritin has a LOT of wiggle room and really should go up. But this can never be guaranteed. Nobody can tell their iron supplements to raise ferritin and leave serum iron the same, or vice versa. Your body will do whatever it wants with your iron.
In healthy people whose bodies handle iron well, serum iron will stay at a healthy level when supplementing and supplemented iron will end up in ferritin.
Read this link on the problems that may arise with supplementing, and read the replies too :
With inconsistent iron results it would be worth getting a Liver Function Test done - transferrin is made in the liver.
Another thing to look at is getting zinc and copper tested. Very high levels of copper or very low levels of copper are bad news for anyone with blood problems. A common finding in thyroid disease is for people to have very low zinc and very high copper. Taking zinc supplements will usually lower copper. However I have read a small number of posts on the forum where people have had the reverse situation, therefore it is important to test and not to assume anything before supplementing.
Personal anecdote : Several years ago I had extremely low levels of iron, ferritin, transferrin saturation and TIBC - so my results were inconsistent. (I'd had a GI bleed for a long time.) My TIBC should have been very high but it was actually below range. My liver appeared to be healthy.
I went ahead and supplemented iron anyway. It worked for me - my levels all became much more normal eventually, and the inconsistencies became less pronounced, but I did test very regularly in the first few months because I didn't want to get iron deposited in my organs or my brain. I now take a maintenance dose of iron to keep my levels as close to optimal as I can.
If you decide to supplement you do so at your own risk. I did this and it worked for me, but it might not be good for you, so test regularly to make sure any inconsistencies aren't getting worse. You definitely want to avoid a very high serum iron.
Thank you so much for all the information you gave. I am so glad people like SeasideSusie and you are here!
I have checked on the website of the hospital what the measurement unit is for the hemoglobin (in Dutch noted as hemoglobine): it is in mmol/l.
Lipemie I assume can be translated as lipemic serum: the level of blood lipids (fats) in the blood. I think it has been tested because abnormal blood lipid levels can influence the results of other lab values. I just checked on that and I read that hypothyroidism can raise blood lipids. High blood lipid levels can influence a.o. transferrin and TIBC. With my lipemie result exactly halfway I think my blood lipids are not influencing other values.
Hemolyse is explained as red blood cells falling apart too quickly (instead of after 100 to 130 days they 'starve' already after f.e. 80 days). Intracellular components of these red blood cells, like hemoglobin, end up in the blood stream. The liver has to clear all these residues. The bone marrow has to work extra hard to produce extra red blood cells to keep catching up with the preliminary loss. My hemolyse value is at the top range so gives me extra reason to further check everyting out.
I cannot find much about icterie, it is somewhere mentioned in relation to an elevated bilirubin level in the blood.
I have been supplementing B12 and folate for quite some time so I do not think I am deficient in that. I also just ordered a B50 complex because I indeed thought to be deficient in general in B's (setting aside the B12 and folate to not overdose on these).
Not sure how to know if this B50 complex contains active vitamins. I will read the link you sent.
I am going to take my time to dive into your writings and links you provided further, it's quite a study ;-).
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