Folate 14.93ug/L (>5.38) Any comment on whether this level is good, bad, indifferent? Strange reference
Can anyone say what supplements he should be taking to raise everything to optimal and indeed , what IS optimal? His transferrin is above range so what role can iron supplementation play in improving ferritin, iron saturation levels, etc and what’s the relationship between them?
Thank you all
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Noelnoel
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In addition, optimal for ferritin is roughly mid-range or a bit higher.
Ferritin - Optimal = (172 - approx 220) - yours is substantially too low
Serum iron - Optimal = (23.5 - 26.1) - yours is substantially too low
Transferrin - Too high - this should drop with improved serum iron and ferritin
Iron saturation - 35% - 45% Higher end of that for men. I don't know if you're male or female but your result is too low in either case. Saturation will rise with more iron and ferritin.
1) Red blood cell 5.10 (4.3-5.75)
2) Haemoglobin concentration 154 g/L (135-172)
3) Haematocrit 0.455 L/L (0.395-0.505)
4) Mean cell volume 89.4 fL (80-99)
5) Mean cell haemoglobin 30.3 pg (27-33.5)
6) Red cell distribution width 12.6% (11-16)
7) Platelets 249 (150-370)
8) Platelet distribution width 53%
I've never seen no (8) before, so can't tell you anything about it.
All the other results look absolutely fine. The only thing I will say is...
When people have iron deficiency anaemia they usually have low Mean Cell Volume (MCV). When people have low vitamin B12 they will have high MCV. When people have low iron and low B12 the MCV can look perfectly normal.
Since the iron results show quite low iron I wonder if B12 is low too, but you don't have a result for B12.
Folate is not bad at all. Personally I would prefer it to be 15 - 25, but I hate those ranges with no upper limit, they are really unhelpful. If you did have an upper limit for folate, optimal is usually given as upper half of the range. To raise folate just a little bit perhaps a good quality B Complex would be a good option.
The two that are often recommended on this forum are
Igennus Super B (full dose = 2 per day)
Thorne Research Basic B (full dose = 1 per day)
Some people will start with the Igennus or the Thorne, use up 1 bottle then switch to Igennus and take one per day (to save a bit of money). But some people will stick to the Thorne all the time.
Vit D 87.9 nmol/L
To calculate your optimal dose for vitamin D use this link :
Optimal is often stated to be 100 - 150 nmol/L or 125 nmol/L. Your level is really quite good.
Vitamin D supplements should always be vitamin D3, never vitamin D2. Opinions vary on the best kind. Some people like the small capsules containing only oil and vitamin D3, some people like mouth sprays.
There are co-factors required for vitamin D - Magnesium and vitamin K2. Both of these are discussed very frequently on the forum, so please search for them.
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Words of warning about supplementing iron - getting it wrong can be dangerous :
hb, thank you for the reply. I really enjoyed it, there’s lots of easily assimilated info and useful links. Loving the vit d calculator!
Yes, his D level is quite good but we’re aiming for 100, as recommended. I should’ve mentioned in my first post that these results are my son’s
So, to clarify, are you saying transferrin is above range as a consequence of low iron and ferritin?
Would straightforward iron supplement iron rectify this (assuming there are no other health issues with absolution etc)?
You could indeed be right about his normal looking MCV, he’s being investigated for low B12
On a separate note, my husband is having thyroid levels checked again to make sure everything is still normal. He had a routine one done a year ago which was deranged and when repeated a couple of months later, all was normal. I urged him to request a repeat last week to check they’ve remained normal and doctor’s ordered:
THYROID FUNCTION TFT: TSH + ft4 (tpp). Is that exactly what it says, TSH and FT4? Has she left out FT3 and if so, should we insist on it? She always checks my FT3 so can’t understand why she’s omitted his
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.
His diet is fairly wide and varied but since going to flying school in June, he’s been cooking for himself. He tells me he eats well but there’s nothing like a really well-balanced, well-cooked meal daily to help keep healthy, though I suspect his levels were low before leaving home. I requested he be tested for B12 deficiency which led to me asking for FBC and iron loading. He’s 6’4” and 16st, so there’s a lot of him to nourish and no, not vegetarian or vegan
He’s had his thyroid tested and was found to be within range but as I’ve learned from this site, there’s a difference between normal and optimal and his levels certainly weren’t optimal. Hard to know what to do in that instance. I toyed with asking him to take a small dose of metavive (I’m well on it) but then decided against it and having seen that his nutrient levels are poor (malabsorption or his diet wasn’t as good as I’d like to think it was?)
Is it Dr Hedberg’s article (the link you provided) that talks about Hashi/hypo patients feeling worse if ferritin drops below 80?
I was going to say, SD that having found his nutrients are low, I’m wondering if getting them more optimal by using supplements will improve his thyroid function? I hope it can all be that simple!
I’m GF but he and my husband won’t hear of it. They’re stubborn and dare I say, stupid? Particularly my husband. He barely knows where his heart is and yet tells me I’m talking rubbish when I try to make changes to improve his health. I know that sounds a bit strong, he’s is actually a great guy but exasperating when it comes to meddling with his diet. He’s half Italian and passionate about food and will never entertain the idea of eating rubbish bread, awful GF pasta or giving up meat/dairy. Our diet is very good already but I’ve only just re-introduced liver after many years without it because the children would always leave it on their plates
I have to say I agree with him, being very much into food myself but I’ve managed to wean myself off gluten and tolerate gf pasta but recently, I’m right off pasta, even the nice kind and I’m losing weight. Only slowly but I can only attribute it to having ditched two pasta meals a week
That’s interesting. It doesn’t surprise that they have high numbers of people with coeliac disease. I’m of the opinion that if you have too much of a thing, problems will occur. With pasta being a staple since Columbus’ travels the Italians have possibly developed digestive issues. Peoples from the part of the world where noodles are a staple are probably fine. Maybe Europeans just aren’t built to tolerate it. Columbus (or was it Polo) should’ve left well alone. Just a mad theory but the amount of gluten we as a society consume; bread, cakes, all manner baked goods and refined rubbish and pasta, not only are we developing obesity but digestive issues too. I grew up in the 60s and pasta was virtually unheard of. Now, many families eat it several times a week! How we didn’t see obesity and sickness coming is a mystery to me. Just a thought. Rant over
I’ve not been diagnosed but I definitely have a gluten issue and as long as I’m gluten free, my digestive system is comfortable
I had zero gut issues.......but like vast majority of Hashimoto’s patients, turned out to be severely gluten intolerant (confirmed by endoscopy, more on my profile)
Sorry to hear that. Frustrating she had to have suffer when the answer was so terribly simple and you too but I’m guessing that gluten intolerance/sensitivity was less known not that long ago. Surprises me still when people are sceptical about its existence
I was going to say, SD that having found his nutrients are low, I’m wondering if getting them more optimal by using supplements will improve his thyroid function?
I almost missed your reply to me because you didn't use the Reply button on the post I wrote. You actually just replied to yourself.
If you want to reply to a specific post, always use the Reply button on the post you want to reply to. That way the person you are replying to gets notified that they have been replied to.
If I hadn't looked to see if there was a reply I wouldn't have known about your further questions. And I usually don't look for a reply if I haven't had a notification.
• Low in range indicates lack of capacity for additional iron
• High in range indicates body's need for supplemental iron
So if your son supplements iron his transferrin should lower.
Would straightforward iron supplement iron rectify this?
It should do, as long as your son can successfully absorb iron. It can be a slow process in some people. It took me nearly two years to optimise my ferritin, and despite that my serum iron was still too low.
When supplementing iron remember that a lot of people can't tolerate high doses of iron very well, so don't start at maximum dose - build up to it. And always take iron four hours away from any thyroid hormones.
THYROID FUNCTION TFT: TSH + ft4 (tpp). Is that exactly what it says, TSH and FT4? Has she left out FT3 and if so, should we insist on it? She always checks my FT3 so can’t understand why she’s omitted his
Yes, that looks like just TSH and Free T4 have been ordered. I don't know what tpp means. If your husband's TSH is within range it is very common for no other tests to be done, not even Free T4 - it is the lab that decides, not the doctor.
And yes, a doctor leaving out Free T3 from a Thyroid Function Test request is often normal practice if people are assumed to be healthy or hypothyroid. Free T3 is most often requested when hyperthyroidism is suspected.
So the normal way labs do the test is :
1) Test TSH.
2) If TSH is in range don't test Free T4 or Free T3.
If TSH is out of range test Free T4.
3) Test Free T4.
4) If TSH is below range and Free T4 is above range then test Free T3. For any other combination of results just stop testing.
Doctors can sometimes get TSH, Free T4 and Free T3 tested in some cases if they write certain things on a request. But what those words are I don't know. I think if a patient is declared as taking T3 that might help. And if Central Hypothyroidism is suspected that might help too. But I wouldn't bet on it.
If your son takes iron supplements it is vital that regular testing is done to make sure he doesn't overdo it. Iron / ferritin is poisonous in overdose.
I still take an iron supplement despite having optimised my ferritin. But I only take a maintenance dose, not a dose intended to raise my levels. If I stop taking iron altogether my iron and ferritin drop like a stone. And I still check my own iron levels regularly. If things change e.g. with diet, then this can alter absorption of iron. My iron absorption improved when I went gluten free. If I hadn't been testing regularly I wouldn't have known that I was absorbing it a lot faster than I had been before.
hb, thank you for letting me know and for checking. Thank you also for the extra info you’ve just posted. I will read it all carefully later
Yes, I saw in one of the previous links you sent about the dangers of iron supplementation. His doctor is calling us tonight to discuss. Are there any questions I really should ask?
Is it correct to say that if ferritin is low then its capacity to store iron is compromised? Or, will its levels rise in correspondence with rising levels of iron to enable accommodation of the extra iron?
Please be aware that I have no medical training so this might not be 100% accurate.
Ferritin is actually an iron storage molecule. Each molecule contains up to 4500 atoms of iron in a way that protects us against having excess free iron in the blood stream, and it prevents pathogens from accessing our supply of iron.
Serum iron is the free iron in the blood stream that is available for the body to use immediately, for example, making more red blood cells in the bone marrow as the liver destroys old ones and recycles what it can.
In a body which handles iron and ferritin correctly the body will transfer iron from ferritin into free iron and from free iron into ferritin many times a day as necessary.
The one thing people can't do is take iron supplements and say "That iron will go into my ferritin" or "That iron will increase my serum iron". Basically, people can take iron supplements and all they can do is hope it goes where it is required.
This is why testing frequently is essential. You can't tell when you take each iron pill where it will end up. All sorts of things can happen e.g.
Low iron/high ferritin
High iron/low ferritin
High iron/high ferritin
Good level of iron/ good level of ferritin
For a better explanation than I could ever give read this link :
Thanks so much, you explain it well without getting technical. I've been reading a link you sent that talks about the merits of eating liver. Raw too, fascinating. I like the idea of freezing pill-sized portions and taking them daily. What a beautifully simple solution
I would struggle to eat raw liver. Well, actually that's not true. I would refuse point blank!
I raised my iron/ferritin with ferrous fumarate 210mg. It worked for me, but I know a lot of people can't tolerate iron salts. However, based on comments on this website, most people are getting prescribed ferrous sulfate nowadays, and yet lots of people have huge problems with it. The sulfate is cheaper than the fumarate by a small amount, but it explains all the prescriptions for ferrous sulfate. I tolerated ferrous fumarate but simply couldn't cope with ferrous sulfate. I buy my own iron supplements - much easier than begging for help from a doctor. I got fed up of begging years ago because it never did me any good.
Also, sorry if you’re feeling bombarded but would a raw liver supplente be safer and more effective way of taking it, especially in smaller doses than the recommended dose? And perhaps kinder on the stomach and more easily tolerated?
Doctors think standard iron supplements are safe. If they didn't they wouldn't be allowed to prescribe them.
But certainly, lots of people do take liver supplements to improve their iron and ferritin levels. The only thing I can suggest is that your son tries them. Alternatively he could eat liver once a week. I know SeasideSusie has had success in improving her iron and ferritin by eating liver.
Thyroglobulin and/or thyroid peroxidase antibodies are usually present in blood testing among those suffering from Hashi's. Although doctors generally only make a diagnosis of Hashi’s when these antibodies are above range, many in the forward-thinking community recognise that any antibodies indicates Hashi’s. If antibodies are low, it usually means the thyroid is not currently under attack.
I was unaware that ANY antibodies indicated Hashi’s. In other words, even though the test will show a patient is within the normal range and whether high or low within the range, the “forward-thinking community” recognises this as a Hashi diagnosis
Please be aware that this reply is stretching my knowledge of (auto)antibodies to breaking point and beyond. So please do your own research on this subject - I am not reliable.
Antibodies are an indicator of Hashi's aka "autoimmune thyroid disease".
There are antibodies and autoantibodies.
Antibodies attach themselves to pathogens e.g. a cold virus, and the immune system then recognises the antibody as marking an enemy and destroys the pathogen it is attached to, or at least destroys enough of it to render the pathogen harmless.
In people with autoimmune disease (of any kind) the body creates autoantibodies. These work in the same way as antibodies, but attach themselves to cells that are necessary for the host's well being. That could be any kind of cell e.g. a muscle cell, a bone marrow cell, a skin cell, a blood cell, an enzyme, a hormone.
So, in autoimmune thyroid disease, for some reason the body creates autoantibodies that then attach themselves to cells that the immune system then destroys - but what is being destroyed is something the body really should be hanging on to not destroying. I don't know if anyone knows why the body suddenly starts attacking itself - I certainly don't.
So the autoantibodies that attack the thyroid (or something involved in making the thyroid work) are (and this list is not complete) :
TPO Antibodies (found in Hashi's and Graves') - these attach themselves to thyroid peroxidase cells :
It is the destruction of cells essential to the function of the thyroid that is the signature of Hashimoto's Thyroiditis and Ord's Thyroiditis. As the disease progresses the thyroid becomes more and more damaged and the output of thyroid hormones drops more and more.
I know that the antibodies found in Graves' Disease work differently to those in thyroiditis, because in Graves' the damage is done to the cells that respond appropriately to TSH, not to the cells that produce thyroid hormones. But beyond that I know nothing.
The bit I think wrong is about Thyroid Peroxidase antibodies - which attach the the enzyme Thyroid Peroxidase, which should only exist inside the follicles of the thyroid gland.
Why has it leaked into the bloodstream, been detected by the immune system, and caused generation of TPO antibodies?
Similarly, the protein Thyroglobulin.
TPO and TG antibodies do not, so far as I have ever been able to determine, attack cells at all.
Do you remember sweeping sand? Or even sweeping a floor with ice cubes?
Spread sweeping sand or ice cubes on a floor. Sweep with a broom. Picks up all the dirt because the dirt attaches to the sand grains or the ice cubes.
That is the role of these antibodies. To act like the sand or the ice cubes.
What attacks the thyroid are lymphocytes. Hence the term lymphocytic infiltration - which allows some of the contents of the thyroid to spill out. Why? I certainly do not know.
TPO and TG antibodies do not, so far as I have ever been able to determine, attack cells at all.
I though that antibodies attached themselves to their target cells and indicated that the marked cells were "marked for destruction", and then the immune system came along and destroyed all cells with the antibody markers.
I find this chap's slow, clear words, and building up the drawing line by line, very helpful. None of the excessively coloured, whizzy things and crashing music so many videos have.
At the end, he points at the epitope on the pathogen. The only difference to the situation with TPOab and TGab is that the epitope is just a part of the Thyroid Peroxidase or Thyroglobulin molecules - rather than a little bit of the surface of a pathogen. Remembering that the surface of a pathogen is just lots of molecules stuck together. Whereas the TPO and TG are molecules floating around on their own not forming a cell.
If that worked for you, try some of his other ones, like:
That was interesting hellvella, thank you. Too complex for me at this particular time though. It may be an age thing too but I strongly believe that Hashi’s has affected my ability to learn. I hope it improves as my hypothyroidism gets better managed
Ah no, don’t do that. You’re a well of information, as is hellvella, slowdragon, seasidesusie and so many others. I value your comments and the exchange you’ve just had with hellvella is so informative and had you not commented we’d be all the poorer for not hearing what you said
In my view, be very careful about any raw meat products. You need to have the utmost faith in your supplier.
Also, I suggest considering more than one iron source. For example, some sort of haem or ferritin product AND an iron salt product (such as humanbean mentioned).
You might get a little information from my somewhat old iron document:
Hellvella, thank you. The article says to freeze for 14 days to ensure pathogens and bacteria don’t survive. Thisbe know to be fact but It also says it’s a myth that liver stores toxins, this part I’m unsure of. It you know differently or there are other reasons to be careful, I would greatly appreciate the information
I don't think that is covered on their current website. I'd be wary of trusting things from archived websites because sometimes they contain items that were removed as they were wrong! Great that the archive exists, but be careful.
I’m reposting the entire original to make a couple of corrections because the site wouldn’t allow me to edit/highlight just the part that needed correction
hb, thank you for the reply. I really enjoyed it, there’s lots of easily assimilated info and useful links. Loving the vit d calculator!
Yes, his D level is quite good but we’re aiming for 100, as recommended. I should’ve mentioned in my first post that these results are my son’s
So, to clarify, are you saying transferrin is above range as a consequence of low iron and ferritin?
Would straightforward iron supplemention rectify this (assuming there are no other health issues with absorption etc)?
You could indeed be right about his normal looking MCV, he’s being investigated for low B12
On a separate note, my husband is having thyroid levels checked again to make sure everything is still normal. He had a routine one done a year ago which was deranged and when repeated a couple of months later, all was normal. I urged him to request a repeat last week to check they’ve remained normal and doctor’s ordered:
THYROID FUNCTION TFT: TSH + ft4 (tpp). Is that exactly what it says, TSH and FT4? Has she left out FT3 and if so, should we insist on it? She always checks my FT3 so can’t understand why she’s omitted his
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Can you give me advice on my blood results please?
Key Vitamin test results and assistance with others...
Advice on high Transferrin saturation 
Blood test results in full. Can anyone find a cause in there for my continued fatigue etc?
RECENT BLOOD TESTS RESULTS
