Hello everyone, I’ve been lurking in these threads for a while now and figured I would post my recent results [below] in case anybody has advice for me. Over 10 years ago, thyroid antibodies were detected during one of my routine blood tests (I was around 25 at the time, 35 now). Since that time, I’ve been tested many times, and my antibodies are always above range, while my tsh/t3/t4 are always within “optimal” range.
I’m not sure I’ve had an official diagnosis of Hashimoto’s, but I do remember my doctor at time (in the US -- I am now in the UK) suggesting it. Aside from that, I was discovered to have iron deficiency anemia around 20 years ago. In the last 3 years, my vitamin levels have also generally been below range for vitamin D.
Symptoms-wise, I have suffered from what I now believe to be low grade depression over the last 10 years, alongside difficulty maintaining my weight (I gain easily & find it hard to lose), memory issues, slow digestion, itchy skin, and in recent years, joint pains and bouts of anxiety.
I’ve tried to cut out gluten in the past, but stopped as I didn’t notice any differences in how I felt. I avoid processed soy as much as possible. I currently supplement (albeit inconsistently) with iron, folate + b12, vitamin d, & Brazil nuts lately to try to get some selenium. I’ve just gotten back my latest test results for the advanced thyroid panel through MediChecks and mainly want to make sure there’s nothing I should be doing that I’m not doing based on the results. It just feels wrong to me to have had such high antibodies for so long without requiring any action on my part.
Ferritin: 4.87 ug/L (13 - 150) — low
Folate - Serum: 4.93 ug/L (> 3.89)
Vitamin B12 - Active: 98.8 pmol/L (>37.5)
Vitamin D: 36.4 nmol/L (50-175) — low
TSH: 1.93 mIU/L (0.27 - 4.2)
Free T3: 4.28 pmol/L (3.1 - 6.8)
Free Thyroxine: 13.5 pmol/L (12 - 22)
Thyroglobulin Antibodies: 651 kIU/L (< 115) — high
Thyroid Peroxidase Antibodies: 274 kIU/L (< 34) — high
CRP HS: 0.91 mg/L (< 5 R)
Any thoughts or recommendations would be greatly appreciated! Apologies if I’ve formatted anything incorrectly—please let me know & I’ll edit accordingly. Thanks in advance!
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jenny999
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Ft4 is very low. Ft3 struggling. TSH higher than average
Suggest you work hard on improving low vitamin levels for next 2-3 months
Then retest, likely to either see improvement in thyroid levels because vitamins are better, or rise in TSH so you can get started on levothyroxine
Ferritin is extremely low, so low that you likely need iron infusion. Certainly iron supplements
First step is to get full iron panel test for anaemia via GP
Never supplement iron without doing full iron panel test for anaemia first
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 is another option that contain folate, but is large capsule
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
Thank you for all of the info! I think I may need to find a new GP as mine refuses to test for anything and is happy with my levels & only prescribes iron. I may have to find a private doctor to convince anyone that my thyroid levels are not normal for somebody with Hashimito’s. I did already request the doctors list from TUK, but have been unsure whether I should invest my savings in this since I’ve always been told my numbers are in range. I think I will have a read of all of your links to try to improve what I can while I think about where to go next.
I’m not vegetarian or vegan, but yes I do have very heavy periods. My doctors & gynos in the past have always accepted this as the reason for my anemia.
Uh i so wish GP’s would stop blaming heavy periods on anaemia and say well that’s that. It’s just so bizarre what women have to put up with!! Your heavy periods are probably very much linked to being hypothyroid and low in Vits and minerals. Try and improve them in the next 3mths and then push for Levo because your FT4/3 are really awful and no wonde you feel like pants. When you treat your hypo you’re periods won’t be so heavy. It’s all linked.
Even if it were the reason, the issue needs to be addressed!
I suggest considering trying heme based supplements - along with standard things like ferrous fumarate. They are absorbed by different pathways and both can be absorbed at once.
However, ferritin alone is not sufficient to full understand your iron status. You could do with a full iron panel. And a Complete Blood Count.
I have booked a consultation through my private healthcare to see if they'll order me more thorough iron tests. I did do a more complete iron panel this June and the numbers were:
Total iron-binding capacity (TIBC): 78.85 umol/L (41-77) — high
Unsaturated iron binding capacity (UIBC): 71.7 umol/L (24.2-70.1) — abnormal
Ferritin: 7.06 ug/L (44-150) — low
Iron: 7.15 umol/L (5.8-34.5)
Transferrin saturation: 9.07% (20-50) — low
I'll try to do them again, though my NHS GP's advice has always been just to supplement with iron as I have been. Unfortunately, any testing my GP has done prior to when I started my own testing -- the office has refused to send me the results or even tell me them verbally, and only give me the option of going in to pay for a printed copy.
Unfortunately, any testing my GP has done prior to when I started my own testing -- the office has refused to send me the results or even tell me them verbally, and only give me the option of going in to pay for a printed copy
You are legally entitled to printed copies of your blood test results and ranges.
The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results
UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.
Last time I tried (granted that was probably 2 years back) they had refused to give me my results in an way other than paying for a print-out, but last week I called up & was able to be granted online access in addition to having all of my previous records shared with me! I can even already see the results of the tests posted yesterday. They are below:
Hopefully humanbean or SeasideSusie may comment on iron results
When was thyroid testing done?
Was thyroid test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
How much levothyroxine are you currently taking
TSH is too high at 2
Obviously need TSH, Ft4 and Ft3 need testing together
The thyroid results at the top of this post were from 5 Jan this year (just 9 days before these latest iron ones). Yes they were done fasting and with no levothyroxine (as you noted below, I've not been prescribed it yet). My GP also did order thyroid tests alongside these iron ones as she didn't seem to want to know about the private ones, but those results haven't been posted online yet for me to see. I assume they will be similar to the ones a few weeks ago though, we'll see. Not sure they will include Ft3 or not though
Oh Actually just realized that it was just TSH in the test, so I guess those are the full results. Either way, the previous ones are very recent & contain TSH, Ft4, & Ft3 together so presumably I don't need another full test?
Just realised......I don’t think you are on any levothyroxine
No wonder you are struggling
Getting ferritin and folate, B12 and vitamin D improved to OPTIMAL Levels should increase TSH so that you can get diagnosed and started on levothyroxine
Work on improving all four vitamins to optimal levels
Strictly gluten free diet might help maintain vitamins at higher levels, but your still going to need significant levels of supplements, especially to improve dire ferritin
Get FULL thyroid and vitamin testing done in say 2-4 months
Remember to stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results
If testing iron and ferritin stop iron supplements a week before testing
Always do all thyroid tests as early as possible in morning before eating or drinking anything other than water
Only do private test early Monday or Tuesday morning and post back via 24 hour tracked postal service
Your iron-related results are appalling. Expecting you to fix your anaemia using just iron pills seems to be extreme sadism on the part of your doctors.
What iron pills do you take, at what dose, and how often? What investigations and other treatments have your doctors tried?
You are clearly extremely anaemic. According to the World Health Organisation anaemia is defined as a haemoglobin level below 120 g/L. Yours is 97 g/L.
Serum Iron - optimal given the reference range from your test is 21.6 - 25.9.
TIBC and UIBC - Very roughly, these should be mid-range.
Transferrin saturation : Needs to be 35% - 45%.
Ferritin : Optimal given the reference range from your test is mid-range or a bit over i.e. about 82 - 120 or 82 - 130.
As you can see you have a long way to go.
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I struggle to absorb iron, and have been anaemic or iron deficient most of my life. Doctors would, very occasionally, give me iron pills for 2 or 3 months then would consider that must be enough - they almost never re-tested, and within another month or two I would probably be iron deficient again. But it might be years before I got another prescription again. So I can empathise with you completely.
To improve my own iron and ferritin I had to start treating and testing myself. I discovered that prescription-strength iron supplements prescribed by doctors can be bought without prescription from pharmacies with the permission of a pharmacist. Hallelujah! As soon as I discovered that, I stopped relying on doctors and treated myself. It took me nearly two years to get my ferritin up to optimal, although my serum iron was still very low. I've been taking iron pills for over 7 years now. Once I got my ferritin to optimal I started experimenting to find my maintenance dose. I now take 1 iron tablet 5 days a week, and it seems to keep my levels where I want them.
One thing I had going for me compared to you, is that I am post-menopausal so I no longer lose blood/iron/ferritin in periods. You look young in your avatar so if that is you then I'm guessing you might expect to have periods for a good few years yet, and that will make raising iron much harder for you than it was for me - and it took me nearly two years. But one bit of good news is that women lose more blood in periods when they are anaemic than when their iron levels are good, so if you can get your iron and ferritin up a little bit it might actually reduce your bleeding. I've never investigated why this is, but it is a common observation.
I think helvella 's suggestion of taking different kinds of iron is one you really must try to follow if you can. But the types of supplement you would need (other than iron salts like ferrous fumarate) are difficult to source in the UK and they are expensive. People who take ferritin, for example, often have to import it from the US, I think.
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Have you ever been given an iron transfusion? They are described here and have to be given in a hospital :
There are other injectable irons used for seriously anaemic people, but they all seem to be fairly similar to my untrained eyes.
If there are reasons why you are not suitable for iron transfusion then another option might be a blood transfusion. But I'm not a doctor, and I don't know if this is ever done in place of an iron transfusion.
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Helvella lists iron salts, heme/haem, and ferritin as different ways of taking iron that don't interfere with each other.
Iron salts are easy - they are the supplements that doctors prescribe and can be bought without prescription. They are ferrous fumarate, ferrous sulfate, and ferrous gluconate. For dosing information the British National Formulary (BNF) is the best and most reliable source that I know of. Doctors use it. You need to know the therapeutic dose, and you will need the maximum, if you can tolerate it.
I used ferrous fumarate 210mg, 1 tablet, three times a day to raise my own iron and ferritin. It comes in packets of 84 tablets which will last 28 days when taken at maximum dose. It isn't hugely expensive. It is suggested that people take it on an empty stomach, but I couldn't tolerate that and had to take it with food.
Taking any form of iron supplement with vitamin C will (allegedly) help with absorbing iron.
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I have not found haem supplements available in the UK. Haem iron usually comes from meat, such as liver. For more food sources of iron see these links :
Other sources of haem iron are kidneys, liver pâté and black pudding.
Liver and kidneys can be put into a blender or chopped up finely then used as an ingredient in stews and casseroles if you are put off by the look of it.
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Ferritin supplements are available in the UK, but they aren't cheap, and I only know of one. Always shop around. The one I've given below costs £27 for 60 on Amazon and under £12 on another site, but don't forget delivery charges. If you buy from abroad there may be import duties, admin charges and VAT to pay which can all add substantially to the cost. It is also worth asking for feedback from the forum on any site you use to see if anyone has good/bad experiences of the site.
When I googled ferritin supplements one that was returned was a simple iron salts supplement that people can get from supermarkets for a third of the price - so buyer beware.
Have you been prescribed Tranexamic acid ? It is supposed to reduce bleeding, but I have no idea how effective it is, how safe it is, and whether it would be suitable for you.
I was apparently prescribed this in 2016 "Tranexamic acid 500mg tablets - take two 3 times/day for up to four days" but I don't recall ever knowing I had been prescribed it. I will ask my GP later this week. Thank you for the suggestion
Anaemia will only be diagnosed if Red Blood Cell Count is below range.
In the past doctors have usually diagnosed anaemia by checking serum iron or ferritin or haemoglobin. It seems that doctors will do anything to reduce the chance that they have to spend money, even on something as simple and cheap as iron supplements.
So according to the above link you aren't suffering from iron deficiency anaemia because your RBC is within range. Can you believe it? It's totally absurd!
Thank you for all of the information--it's much appreciated!
I had been going through the cycle of taking iron tablets until my levels were within range, then only taking them during my period until I was tested again and it would always show me anemic again. I'd been taking 1/day of a tablet from the US called "Slow Fe" for approx. 10 years on and off. According to Amazon, "Slow Fe contains 45 mg of elemental iron in each tablet, which is equivalent to 142 mg of ferrous sulfate." -- so I guess that counts as 45mg/day? I'm not sure which number to count there.
I've just looked in my NHS notes and it does show that in 2015 I was prescribed Ferrous fumarate 210mg tablets, 1 tablet 3 times/day. I see that in 2017 some of the levels in my iron blood tests were restored to just within the the lower level of the reference limit, and that year is the year that nobody followed up with me after my tests, and when I called I was told my results were all normal -- which I found very odd! I was wanting to get a copy of my results but they basically told me they couldn't tell me any results over the phone, and I would have to come in and pay for a print out if I wanted anything more.
Having now gotten access to my online history I can see that these results weren't great:
Test result - Full blood count;DIFF COUNT Report, Satisfactory, No Further Action
Red blood cell distribution width (XE2mO) 15.8 % [11 - 15]; Above high reference limit; Fasting
I had always been made to feel like some of my low numbers weren't that big of a deal and it was good enough to have them only just within the lower end of the reference since I knew it was worse to have high iron than low iron, so I kind of always just took them at their word and didn't think I was being largely harmed. I decided to just do my own tests from then on since they refused to give my my test results and decided to keep my numbers as close as possible to the lower end of the normal ranges as my GPs had been doing to manage my anemia in the past. I can see now that this has probably been pretty harmful to my health over the last 20 years & wish I'd taken it more seriously from the outset & investigated more thoroughly!
I do see reference to "Tranexamic acid 500mg tablets - take two 3 times/day for up to four days" in my GP notes from 2016! But I'm not quite sure I ever knew I had that prescription as it's followed by "Failed encounter - no answer when rang back". I will make sure to ask my GP about it in my follow up call this week! The only other treatment that has been recommended for me has been birth control pills for making my periods less heavy and painful, but I tried them around 9 years back and felt so bad about 2 days in that I decided it wasn't worth it (plus I wasn't 100% convinced of their safety at the time, and didn't need the contraceptive). My gynaecologist at the time (in the US) had also ordered me an ultrasound prior to that to rule out fibroids.
As far as the amount of iron i'm supplementing with, I'm embarrassed to say that I'd kind of stopped really taking my supplements consistently at the start of Covid last year. Instead of using my normal tablets from the US, I started buying iron tablets from amazon without paying much attention to how much iron was actually in them. Looking back, I'd been taking only 20mg/day during my periods (Solgar Gentle Iron). After reading all of the information provided on this forum, I can see how that dosage wouldn't make a dent. I don't think I ever really understood the gravity of how low my levels were since I've been anemic for so long--it just felt like my natural state.
Around a month ago I started consistently supplementing daily with the Solgar iron instead of just during my periods. After reading helvella 's posts I've also bought a few different types of iron as well:
- OptiFer F (1 daily =18mg iron, 400mg Folic Acid) -- which apparently "is a heme iron tablet supplement for pregnancy and planned pregnancy. " I hadn't known it was for this purpose, but I would like to be pregnant in the not-too-distant future so hopefully this won't hurt? It was available on Amazon right away so I figured I would try it while I waited for the others -- I have been taking 1/day
- Terry Naturally Liver Fractions (2 daily = 5mg ferrous bisglycinate chelate, 1,300 mg liver fractions, 1,000mg B12) -- I haven't started taking this yet
- Cardiovascular Research Ferritin (1 = 5mg iron "from bovine spleen and as iron aspartame") -- I've taken only 1 of these so far
I'm kind of confused now since these tablets all seem to be quite low-dose given what I should be taking is 210mg 3x/day. This last 2 week I've been taking 1 Solgar tablet in the morning (25mg) and 1 OptiFer in the afternoon (18mg iron) -- which sounds like I've only been taking 48mg daily instead of...630mg daily! What a massive fail on my part. It sounds like I should try to go to the pharmacist and get the 210mg tablets again (in fact, my GP will probably prescribe them to me later this week).
Sorry for the long-winded post, I feel so silly only just realizing how severely I've been under-treating my anemia after 20 being anemic since around the age of 16!
This is a summary of what I have read up and found out about iron supplements over the past few years. I am not in any way medically trained. You are strongly encouraged to check every detail before making any decisions for yourself.
Thank you, I did read that the last time and it's what made me buy some alternative types of iron, but I hadn't properly looked at the "Dosing" section --- must've been information overload at the time.
So then if 210mg ferrous fumerate equals around 70g of elemental iron, would that mean that my previous prescription from my GP (from a few years back) of 1 tablet 3x/day means I should be aiming for around 210mg elemental iron total daily?
Ferrous fumarate 210mg, 1 tablet , three times a day contains (69 x 3)mg of iron which equals 207mg of pure iron.
This confuses a lot of people.
Ferrous Fumarate actually contains Carbon, Hydrogen, Iron and Oxygen.
One tablet of ferrous fumarate 210mg contains 69mg of iron. The rest of the weight is made up of the other parts of the molecule - the carbon, nitrogen and hydrogen.
The thing to look out for in any iron supplement is the weight of elemental iron i.e. the amount of pure iron.
The 207mg of iron in a maximum dose of ferrous fumarate 210mg should be considered to be a maximum dose of iron salts.
Yuk! I actually used make them when I worked in my Uncle's butchers shop many moons ago. I didn't eat them for many years after seeing what went into them.🤢
I have never been able to get liver down until I discovered Nando's chicken livers last year! But they have sadly taken them off their reduced Covid menu at the moment.
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