Would be so grateful for advice on my blood tests and also desperate for advice on how to raise my ferritin levels without upsetting my stomach. I have been taking Levothyroxine for about 8 years, current dose 50mg/75mg on alternate days. I understand little about thyroid hormones but am trying to educate myself by reading posts on this helpful forum. Must admit some stuff is beyond my capacity to understand! I have always (perhaps naively) accepted my GP reassurances that my thyroid hormones are “balanced” and my Levo dose is correct. She will only test TSH levels and says it is not necessary to test the thyroid hormones. However I don’t feel fabulous and am suffering excessive hair fall. This has become distressing, having lost 50% of my hair, I have lost all my confidence and hate leaving the house. I did see a trichologist (in desperation despite struggling to pay the fee) and he believes my low ferritin to be a main cause of the hair loss and suggested supplementing with ferrous sulphate or ferrous fumerate. I tried ferrous sulphate tablets from the pharmacist but these gave me bad stomach pains and constipation so I stopped taking them.
Any help on what iron supplements I might try and tolerate and advice on how best to take them for optimal results will be so appreciated.
I should say my blood tests were taken early morning on empty stomach and before I took my morning Levo. I appreciate that without FT3 and FT4 results you haven’t got the full picture. Thank you in advance.
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I'm so sorry to read your post and just want to send a " hug " or 7 and suggest that there is much you can do for yourself but first we do need to see some results and ranges so to advise you properly.
This is where we all need to start off - getting a private blood thyroid panel actioned and if you go into the Thyroid UK website, who are the charity who support this forum, you will see a list of companies who can undertake the necessary blood test for you, and use one who arrange a nurse to come to my house and draw my blood for me.
We need to see a TSH, T3, T4, antibodies, inflammation, and ferritin, folate, B12 and vitamin D : and yes, you need an early morning appointment, fast overnight and just take in water, and refrain from taking your T4 until after the blood draw.
Is there any inflammation on these results and are these current levels, as we could likely get away with a TSH, T3 and T4 blood test and look at this in conjunction with the above ?
When you have the results and ranges you just start a new post with the results and ranges and you will be talked through what it all means and your next best steps back to better health.
Your ferritin isn't "dire " and at 44 you just need to keep building up :
I read ferritin needs to be over 70 for optimal conversion into T3 and I know I feel better with a ferritin at around 100 : folate at around 20 : serum B2 around 500++ and a vitamin D at around 100 :
As for ferritin, mine was at 22, and couldn't tolerate the prescribed iron tablets as they upset my stomach and as I wasn't offered an alternative this was when I started looking into things myself and started my climb back up the deep hole I found myself in.
You might do better on an iron bisglycinate commonly marketed as a " gentle iron " -
You may also prefer a liquid iron - I also took Spatone - though the iron content very low and I ate liver twice a week :
I now maintain my ferritin with 1 tub of Asda frozen chicken livers a week :
Defrosted and fried down in a little olive oil, I then whizz down into a pate and store in an old jam jar in the fridge - taking a spoonful a day with a dollop of Hellman's helps this medicine go down and I believe a more natural and actually cheaper option than anything else.
Your antibodies " look " over range so do you have a diagnosis of Hashimoto's AI thyroid disease ?
Thank you so much for the replies, lots of reading to do here!! Need to digest the info and plan my actions. So pleased that there are things I can do to help myself. I didn’t know I had Hashi’s, this has never been mentioned by my GP. Last year I had two ultrasounds on my throat and neck (suspected Sjogrens Syndrome) and was told my thyroid was shrunken and shrivelled! The sonographers words not mine. I currently weigh approx 62 kilos post Xmas overeating. Will get myself a private FT4 and FT3 test and post again. Thank you all again for your help.
Well the sonographer has probably summed it up and has the right answer - does this information get reported back to your doctor for consideration. ?
It's likely you will need a referral to an endocrinologist as you'll need full thyroid hormone support rather than monotherapy with T4 only since your thyroid gland is likely badly damaged and not supporting you as it should.
Did you get a lip biopsy to rule Sjogren's in or out of the puzzle ?
You might like to start reading up on Hashimoto's AI disease and there is a section on the Thyroid UK website who are the charity who support this forum.
It's very important to first " heal the gut " as this AI disease generally expresses itself in food intolerances such as gluten, dairy, wheat, and celiac disease may need to be ruled out.
For a much more comprehensive understanding of this AI disease suggest you look to the research and work of Dr Izabella Wentz who has Hashimoto's.
Oh thank you, will follow up as you suggest. Didn’t have a lip biopsy but Sjogrens was eventually ruled out, presumably through blood tests. No-one pursued the thyroid issue , as I was already on Levo I expect they thought I was sorted out in that respect. Will need to be proactive now it seems. Thanks again for your advice.
Your erythrocyte sedimentation rate (ESR) is at the top of it's range, this is a non-specific measure of inflammation and it might be an idea to point this top of range result to your GP as he can do further investigations but I would point out that you have autoimmune thyroid disease (known to patients as Hashimoto's) which is confirmed by your very high thyroid peroxidase antibodies (TPO) and this can cause inflammation. Did you already know you had Hashi's? This is where the immune system attacks and gradually destroys the thyroid.
Your TSH is good for someone on Levo but as you say you don't have the actual thyroid hormone levels and this is what is important. TSH is a signal from the pituitary and doesn't tell us our thyroid status. Your FT4 and FT3 could be low in range and if I were you I'd do a private thyroid panel if your GP can't get one done. The cheapest for just TSH, FT4 and FT3 is MonitorMyHealth which is an NHS lab which offers this as a fingerprick test to the general public for £26.10 with code here:
The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L.
If you want to improve your level you'd be looking at supplementing with 3,500-4,000iu D3 daily to reach the recommended level. Retest after 3 months to see if you need to adjust dose. You'd also need the important cofactors necessary when taking D3.
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. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
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.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The company has told me the K2-MK7 is the Trans form
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, and large doses of D3 can induce depletion of magnesium. 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.
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."
If that was my result I'd be supplementing with a good quality B Complex to provide some B12 plus the other B vitamins to keep them all in balance. My preference is Thorne Basic B. If you look at different brands then look for the words "bioavailable" or "bioactive" and ensure they contain methylcobalamin (not cyanocobalamin) and methylfolate (not folic acid). Avoid any that contain Vit C as this stops the body from using the B12. Vit C and B12 need to be taken 2 hours apart. When taking a B Complex we should leave this off for 3-7 days before any blood test because it contains biotin and this gives false results when biotin is used in the testing procedure (which most labs do).
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.
Ferritin: 44ug/L (10-322)
Ferritin is recommended to be half way through range with some experts saying that the optimal level for thyroid function is 90-110ug/L.
According to some experts, ferritin levels of at least 40 ng/ml are required to stop hair loss, while levels of at least 70 ng/ml are needed for hair regrowth.
I did see a trichologist (in desperation despite struggling to pay the fee) and he believes my low ferritin to be a main cause of the hair loss and suggested supplementing with ferrous sulphate or ferrous fumerate.
Any help on what iron supplements I might try and tolerate and advice on how best to take them for optimal results will be so appreciated.
Iron is complicated and before taking iron tablets a full iron panel should be carried out to see if you have iron deficiency and a full blood count to see if you have anaemia. If you have a decent serum iron level and transferrin saturation is also good then taking iron tablets will take these too high and too much iron is toxic. You can have low ferritin but good iron levels in which case you'd need to look at ways of improving ferritin without taking serum iron too high. So really this is something that your GP should be looking at and if iron tablets are prescribed then regular monitoring of all levels should be done by the GP. GP should also be able to prescribe something other than ferrous sulphate or ferrous fumerate if these cause problems.
This article is about vitamin deficiencies that can cause hair loss which you might find helpful:
Thank you so much for the replies, lots of reading to do here!! Need to digest the info and plan my actions. So pleased that there are things I can do to help myself. I didn’t know I had Hashi’s, this has never been mentioned by my GP. Last year I had two ultrasounds on my throat and neck (suspected Sjogrens Syndrome) and was told my thyroid was shrunken and shrivelled! The sonographers words not mine. I currently weigh approx 62 kilos post Xmas overeating. Will get myself a private FT4 and FT3 test and post again. Thank you all again for your help.
Highly likely you are under medicated thyroid wise
That’s a very low dose levothyroxine
Approx how much do you weigh in kilo
First step is to get full thyroid testing.
TSH, Ft4 and Ft3
Extremely high TPO antibodies confirms autoimmune thyroid disease also called Hashimoto’s
Have you had coeliac blood test done
Are you on absolutely strictly gluten free diet
Vitamins are likely low because you are under medicated
Low vitamin levels tend to lower TSH
So essential for you to improve low vitamin levels too
all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Thank you so much for the replies, lots of reading to do here!! Need to digest the info and plan my actions. So pleased that there are things I can do to help myself. I didn’t know I had Hashi’s, this has never been mentioned by my GP. Last year I had two ultrasounds on my throat and neck (suspected Sjogrens Syndrome) and was told my thyroid was shrunken and shrivelled! The sonographers words not mine. I currently weigh approx 62 kilos post Xmas overeating. Will get myself a private FT4 and FT3 test and post again. Thank you all again for your help.
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis where thyroid shrivels
Both are autoimmune and generally called Hashimoto’s.
In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease (and they usually ignore the autoimmune aspect)
So you have Ord’s thyroiditis - thyroid is shrunken and shrivelled
I have Ord’s
EXTREMELY common to become gluten intolerant with autoimmune thyroid disease
Autoimmune thyroid disease frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but a further 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal
Before considering trial on gluten free diet get coeliac blood test done FIRST just to rule it out ….ideally via GP
If you test positive for coeliac, will need to remain on gluten rich diet until endoscopy (officially 6 weeks wait)
If result is negative can consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits. Can take many months for brain fog to lift.
If no obvious improvement, reintroduce gluten see if symptoms get worse.
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Eliminate Gluten. Even if you don’t have Hashimoto’s. Even if you have “no adverse reactions”. Eliminate gluten. There are no universal rules except this one.
Thank you for all this info which I will need to digest ( no pun intended!) and get a good understanding of. Then I’ll know where to go from here. Really appreciate your advice.
I didn’t know I had Hashi’s, this has never been mentioned by my GP
GP’s only ever call it autoimmune thyroid disease and usually completely ignore the autoimmune aspect of the disease as they have no treatments to offer…..only levothyroxine to replace missing thyroid hormones caused by the destruction of your thyroid
62 kilo x 1.6mcg = 99mcg as likely daily dose levothyroxine required
So you can see you are likely under medicated
Being inadequately treated results in low stomach acid and low vitamin levels
Essential to maintain OPTIMAL vitamin levels by regularly retesting and supplements
guidelines on dose levothyroxine by weight
Even if we frequently 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 eventually on, or near 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.
Thank you again. When I get the thyroid test results (I’m requesting a finger-prick kit) I will post them on here then tackle my GP to look at increasing my Levo. I had a full blood count done last month but unsure what this means for my iron status and whether supplements to increase ferritin levels will be appropriate. Because these results are “normal” my GP has not thought it necessary to talk me through them. I’ll try to post on here in case anyone can make sense of them for me.
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency
Look at increasing iron rich foods in diet
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.
Thyroid disease is as much about optimising vitamins as thyroid hormones
I have read that people have had great results from taking the Ancestral Organ Meat Supplements - Grass Fed Liver, Bone Marrow, Organs, Heart etc , you can read their reviews on amazon. Liver is often recommended for anemia but do read up on it first though because it is high in vitamin A and too much not good once a week probably then add in other things.
Oh thank you for your advice. Am grateful you’ve taken the time to help,I’ll look into this but I haven’t eaten red meat for over 40 years (I’m not a vegetarian cos I do eat fish and chicken) but must admit I’d have to steel myself to take anything derived from organs hearts etc. I am feeling desperate though.
Iron is difficult for a lot of people to tolerate. It often causes lots of gut irritation. The thing which seems to determine tolerance for most people is how much pure iron there is per dose in the chosen supplement.
For example, when I was actively trying to raise my iron some years ago I was taking ferrous fumarate 210mg, 1 tablet 3 times a day. It is one of the strongest iron supplements around with an iron content of 69mg iron per tablet, and I could tolerate it with food but not on an empty stomach.
The big problem for many people is that having failed to tolerate a strong iron supplement they think their only other choice is Spatone with 5mg iron per sachet. It's expensive and in many people (e.g. me) it has no effect at all.
The thing is that there are several options between ferrous fumarate 210mg and Spatone that people seem to be unaware of. For example, there is ferrous gluconate 300mg which contains 35mg pure iron per tablet and the (adult) patient can take up to 6 a day - but if the patient struggles they could just start with 1 tablet a day and see how they cope. Ferrous gluconate can be bought in pharmacies in the UK without a prescription, but you do need the pharmacist's permission.
My only gripe about ferrous gluconate is that it is sold in such small packets with only 28 pills. Ferrous fumarate 210mg, which is one of the strong supplements, come in packets with 84 tablets per packet.
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Advice would be appreciated on latest results please. 
Extreme Hair Loss Advice 
Would appreciate any advice on recent test results please?
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Hashi's and low ferritin. Test results advice please
