High ferritin compromises t4 to t3 conversion

[Roulette26]

I’m having my telephone consultation today, first time in 12 months with the actual consultant.

So I don’t make an absolute fool of myself, he’s already annoyed with me because I’ve insisted on levo increases via the nurse, now on 125mcg, can someone confirm high ferritin can compromise t4 to t3 conversion. I’m post menopausal, ferritin 345ug/L (13-150). I’m aware that it can be high in post menopausal women, I’ve stopped taking Vit C and don’t take any other supplements that might affect it.

Thanks I’m advance.

[NIKEGIRL]

Hi. I had high ferritin and my 4 to T3 ratio was very good. I can’t confirm it sorry from my experience.

[pennyannie]

I think you'll find it is low ferritin that can compromise conversion :

Why is the ferritin so over range would be a question ?

Do we have any other results to advise on before appointment ?

OK - just looked back and you have had RAI thyroid ablation and in effect " lost " your own thyroid hormone production and whilst the NHS have reinstated a guess estimate of your T4 they haven't reinstated any of your own natural production of T3 which is said to be at around 10mcg a day alongside around 100mcg of T4 daily.

Good luck :

Keep us in the loop :

[Roulette26 in reply to pennyannie]

Just had telephone meeting. After one month of alternating the dose 100/125 results were, TSH 1.72, t4 20, previously TSH 1.08, t4 22.7. No wonder I felt like rubbish.

Will monitor me for the next 4 months on 125 levo but said if it goes too high I’ll have to go back to 100/125. I told him repeatedly I’m unwell on that regime and did enquire about t3. Good news is he does prescribe it but only in certain cases and on a trial basis. Maybe all hope is not lost!!

Thanks again.

[pennyannie in reply to Roulette26]

OK then - well done for doing it - it is like prepping for an exam - you're not wrong.

When do you see him next - how ill do you have to be before he considers prescribing a trial of T3 ?

Who and what does he consider " certain cases " ? and yes it's generally a 3 month trial and if this works for you your surgery then have to pick up the bill for the Liothyronine.

[Lalatoot]

I agree with pennyannie. Studies have shown that low ferritin affects conversion.

[Roulette26]

Thanks guys , I feel as though I’m preparing for an exam! He’s not interested in the ferritin and the various GPs have puzzled over it , one has said it was normal. Your support has really helped me, I feel as though it’s a constant battle to get back to normal. He wanted me to try alternating 100/125 levo, I finally relented even though I could feel changes going on, t4 went to 24 when levo first raised to 125, after 6 weeks private bloods showed a drop to 22.7. At this point I started his regime just to show willing. After a week I started going downhill, the final straw was getting depressed and tearful for no reason. I’m back on 125 and slowly getting better.

I just hope he listens to me!

[NIKEGIRL]

When my ferritin was high my Graves’ disease was quite bad so the body was throwing out inflammation causing the ferritin to be high. Once I got my T4 and T3 better controlled but not within ranges the ferritin came back down. Good luck. You know you best.

[jimh111]

I've not seen high or low ferritin within reasonable bounds affecting T4 to T3 conversion. Obviously abnormal thyroid hormone high or low could affect ferritin and other things. Your fT4 isn't that far out when you consider it is typical for patients on TSH supressive therapy after thyroid cancer. NIKEGIRL comment is interesting but I suspect her hormone levels were much higher.

[pennyannie in reply to jimh111]

Hey there Jimh :

I think you'll find the O/P was diagnosed Graves Disease after treatment for breast cancer back in 2017:

Graves treated with RAI thyroid ablation and this is where we are now :

[jimh111 in reply to pennyannie]

Thanks, I hadn't looked at her profile. It was a toxic nodule rather than Graves' but the end result is the same, a thyroid destroyed (probably necessary) by RAI.

if Roulette feels better on the higher levo dose then it is quite appropriate, the fT4 is only slightly high and 2.5% of the population will have a high fT4 - that's what a 95% reference interval is, 2.5% of healthy people are outside the upper or lower limit. I would prefer to add in a little liothyronine instead but we all know how difficult it is to get it prescribed.

[pennyannie in reply to jimh111]

Thanks for that - my like button doesn't like me !!

Sorry I didn't get the bit about the toxic nodule -need to reread and not jump to conclusions.