Your thoughts on husband’s recent thyroid and iron labs would be appreciated

[Noelnoel]

April 21

TPOAb < 28 (0 - 60)

TSH 5.65 (0.35 - 5.5) over range

Ft4 12.3 (10.5 - 21) 17.14% through range

Ft3 5.2 (3.5 - 6.5) 56.67%

Ferritin 23.3 (22 - 322) 0.43%

Serum iron 18.5 (14 - 31.3) 26.01%

Transferrin 2.73 (2.15 - 3.65) 38.67%

% Iron saturation 30% (16 - 50) 41.18%

Dec 21

TSH 6.68 (0.35 - 5.5) even more over range than in April

Ft4 14 (10.5 - 21) 33.33% (almost doubled since April)

Ft3 4.5 (3.5 - 6.5) 33.33% (23% down)

Ferritin 34.5 (22 - 322) 4.17%

Serum iron 20.2 (14 - 31.3) 35.84%

Transferrin 2.68 (2.15 - 3.65) 35.33%

% Iron saturation 33% (16 - 50) 50%

He understands that his thyroid is struggling, so after April’s lab results he started various supplements to try to improve his nutrient levels because they were all abysmally low but he was erratic in remembering and even a bit resistant. Anyway, the hope was that if he could increase his nutrients his thyroid function might stand a chance of improving. His December nutrient levels are testament to his slapdash method of taking his supplements though strangely, his B12 and Vit D are now near the top of the range. His TFTs were done on both occasions before 8.30 on an empty stomach and having ceased taking all supplements for 10 days prior

He takes:

B complex with folate

Vit D

Iron

Vit C

Selenium

Magnesium

His folate and ferritin levels are still in his boots and only creeping up. This will hopefully improve now that he’s taking supplements religiously

As you can see, both sets of results are a mixed bag and so I’m finding it hard to interpret whether overall they’re an improvement. His Ft4 is significantly better but his TSH and Ft3 are worse. As for his iron studies, I’m at a loss. His ferritin as stated is ridiculously low but I have only a very rudimentary understanding of the rest of the iron results

His GP wants a word and I suspect it’s about his TSH rather than his iron levels but we won’t know until she calls him. I’m wondering what our stance should be because ideally hubby would like to try to raise his iron studies and folate quite a bit more to see if that in any way gives enough support to his thyroid to raise its levels and lower TSH. It’s often said on this forum that this can happen and we’re curious but we both understand that he may ultimately be flogging a dead horse and will in the end have to take thyroid replacement but it would be interesting to see …

Your suggestions/thoughts would be gratefully received as I don’t want him to taking unnecessary risks although he has a more care-free approach

Thank you all for reading

[SlowDragon Administrator]

A weekly pill dispenser helps make sure taking vitamin supplements

He only needs to stop vitamin B complex a week before test

Consider taking a separate folate and separate B12 in week before test

And stop taking iron supplements a week before testing iron levels

What’s his diet like….does he eat red meat?

Any obvious reason for low ferritin?

patient.info/doctor/non-ana...

[Noelnoel in reply to SlowDragon]

Thank you SlowDragon

He takes his supplements every day now with the exception of B12. He takes only half the dose on alternate days. He also adds a separate folate to it. He now takes his other supplements every day at the same time as me, so I would hope his next tests will look better

No obvious reason for low ferritin but it’s the same with me. In fact I’m going to post my results once I get some input on his

We both eat meat of some sort every day and have liver once a week. We eat lots of veg too. My ferritin is also very slow to rise

Thank you for the link, I’ll take a look

Consider taking a separate folate and separate B12 in week before test…

Can you clarify? Are you saying he should consider starting a separate B12 and folate before testing?

[SlowDragon Administrator in reply to Noelnoel]

Week before any blood test need to stop vitamin B complex because it contains biotin and biotin can falsely affect test results (biotin used in many lab tests)

You may want to take a separate folate supplement (and separate B12 supplement) during that week of not taking vitamin B complex……otherwise folate levels tend to drop

[SlowDragon Administrator in reply to Noelnoel]

Approx how old is your husband

Stomach acid levels tend to drop as we get older

We need good stomach acid levels to get good nutrient absorption

webmd.com/digestive-disorde...

Have you considered testing for H Pylori

[Noelnoel in reply to SlowDragon]

Thank you SlowDragon, I’ve read the first link you sent and will need to re-read but at first glance it’s comprehensive and easier to understand than some of the articles I’ve read and for the first time I’m getting a grasp on the roles of some of the markers and as I understand it, from what I’ve just read is:

Iron cannot be excreted by humans. Had no idea

Absorption can be inhibited by some plant foods, calcium, tea and coffee. Had no idea

If iron isn’t required by the body then it’s stored by the iron protein, ferritin. Had a vague idea

To me this translates as: if ferritin is low this means that all ingested iron is required for use by the body and therefore none of it is going into storage. Correct or not?

This in turn means that low ferritin is therefore bad because when the body DOES require iron, there’s not much available in the storage “receptacle”, namely ferritin, to be transported via circulation by transferrin. Transferrin is the “vehicle” of choice for movement of iron. Correct or not?

This then means that low transferrin is also bad because there aren’t enough “vehicles”to transport the required amounts of iron to destination. Correct or not?

I realise that this is a simplistic interpretation and would be grateful for any corrections of my “understanding”

To answer your question, he’s 65 and neither of us has had the h pylori test but it’s on my list of things to really consider, as is taking betaine hcl with pepsin. One of the reasons we’re not taking it at the moment is that we’re already taking so much and quite frankly I think my liver is having difficulty coping with the constant onslaught of supplements. Each morning it aches and test show raised enzymes

Going back to my husband and absorption, you point out age-related acid reduction. I suspect this is the case. He has for some while complained of acid reflux that was diagnosed as too much acid but from what I’ve read on here I believe it’s more likely he hasn’t enough. On the days he sips apple cider vinegar, the problem disappears but as I mentioned, he’s resistant but also forgetful and slightly daft

[SlowDragon Administrator in reply to Noelnoel]

Low stomach acid can be a common issue…..and seems to frequently be misdiagnosed as high stomach acid

How to test for low stomach acid

healthygut.com/articles/3-t...

Thousands of posts on here about low stomach acid ….as it’s extremely common with hypothyroidism

healthunlocked.com/search/p...

Web links re low stomach acid and reflux

nutritionjersey.com/high-or...

articles.mercola.com/sites/...

thyroidpharmacist.com/artic...

stopthethyroidmadness.com/s...

naturalendocrinesolutions.c...

meraki-nutrition.co.uk/indi...

huffingtonpost.co.uk/laura-...

lispine.com/blog/10-telling...

Protect your teeth if using ACV with mother

healthunlocked.com/thyroidu...

Hopefully he’s not taking PPI from GP?

[Noelnoel in reply to SlowDragon]

No, not taking PPI. He controls it with apple cider vinegar and kefir. Both seem to work but it would be good I think to introduce betaine hcl. Not sure what pepsin is and it’s role

Are you able to comment on my questions regarding my understanding of the iron study tests?

[SlowDragon Administrator in reply to Noelnoel]

I find iron and ferritin etc very complex complex

Iron can be high and ferritin can be low

Ferritin is storage form of iron

Ferritin can be raised due to inflammation….yet iron can be low (that’s my issue) …no idea how or why ferritin gets high

I like the concept of transferrin being the vehicle….no idea if that’s correct

humanbean may comment…

[Noelnoel in reply to SlowDragon]

You have raised ferritin because of inflammation but your iron’s low?

[SlowDragon Administrator in reply to Noelnoel]

Yep ….well my iron is now ok (on levothyroxine plus T3) but my ferritin is high …..but really ferritin range of 15-150 for women is for pre menopause females

post menopause ferritin often increases for obvious reason. Male ferritin range 15-400

My GP does full iron panel test every year or two just to check iron isn’t too high (or low)

Had hemochromatosis testing in case high ferritin due to that …it isn’t

[Noelnoel in reply to SlowDragon]

post menopause ferritin often increases for obvious reason

Oh, I was unaware of that. What’s the reason?

Glad to hear that at least your iron is now fine

[SlowDragon Administrator in reply to Noelnoel]

if no longer having periods every month your iron/ferritin levels will increase

When hypothyroid many females suffer very heavy periods

Often same applies if low in iron often very heavy periods …..seems poor design…would have hoped body would adapt to low iron with lighter periods

[Noelnoel in reply to SlowDragon]

Would make better sense wouldn’t it

[Kerrierach]

HelloJust wanted to add that if he has taken B12 in any form in 4 months before a B12 serum blood test, then it will be falsely raised quite significantly.

Privately he can get the more reliable active B12 test.

Also, the only B vitamin that can cause toxicity is B6: check how much is in his B complex. B12 is non toxic and any excess is removed in urine. If he has B12 absorption issues, tablets will make little improvement for him but will also falsely raise B12 levels.

[Noelnoel in reply to Kerrierach]

Hi Kerrierach and thank you

I had no idea it could take 4 months!

If he has B12 absorption issues, tablets will make little improvement …

Are you talking of pernicious anaemia when you specifically say B12 absorption issues?

[radd]

Noelnoel,

Why are men so resistant to taking supplements. My husband is the same! 😆

Raising iron levels will improve his thyroid function because is a major component in the production of thyroid hormone. However, it is dependant upon the cause as to whether raising iron will correct the thyroid dysfunction, and you will need to test TGAb in addition to TPOAb to totally eliminate Hashi.

Transferrin is the protein that iron travels on and his iron panel still evidences iron deficiency. Transferrin saturation (usually a good indicator of iron) is only showing good levels because the actual transferrin level is low.

Iron has lots of different mechanisms and trying to raise can take months/years. Supplementing higher levels of iron isn't always beneficial because of the regulatory safety mechanisms that will try to prevent too much free iron and/or toxicity, and because iron balance is regulated by absorption rather than excretion, absorption gets reduced further.

Agree with SlowDragon re possible low stomach acid as this would impair thyroid hormones as well, as a fair proportion are converted in the gut. I supplement Betaine HCL + pepsin with protein rich meals. Also drinking orange juice (or alcohol 😁) with meals will improve iron absorption.

How does your husband feel?

[Noelnoel in reply to radd]

Radd, I have no idea. Whenever I present him with his supplements he says: What? Again? As though yesterday’s dose should’ve done the job! Frustrating and wearing to have to explain every day

However, it is dependant upon the cause as to whether raising iron will correct the thyroid dysfunction

Can you clarify whether you mean it’s dependent on the cause of his low iron levels or his low hormone levels and in the case that it’s the latter, is it necessary to test TGAb to eliminate Hashi’s given that treatment would be the same, but please do put me right on that if I’m talking rubbish

If it’s the former, you’re right and this much I know. I’ve had betaine hcl with pepsin on my mind for some time for both of us but have been lazy about looking into it because the thought of taking yet another supplement wasn’t at all appealing. So thank you very much for mentioning it because it’s given me a nudge. However, I much prefer your idea that alcohol may improve absorption(!) but daren’t try especially as I suspect that the sheer quantity and range of supplements I’m already taking is responsible for my liver ache and raised enzymes. I need to get on though and decide if I’ll take betaine but I think it’s worth hubby trying and if it doesn’t improve the problem then look further into the cause. What brand do you use and what’s the amount of time in which to expect to at least see some change, although I appreciate it would be different for everyone

If taking it corrects the problem, how marvellous would that be. It would result in eventually having to take lower dosages of all the supplements we ingest! Hurrah!

I read SlowDragon’s link (or perhaps it was another paper) but if I understood correctly it seemed to say that taking betaine hcl with pepsin ultimately fixes low stomach acid. Is that right?!!

In answer to your question, he feels well but I’ve noticed a decline in his energy level or it could just be that it’s laziness. He’s always had a tendency to do nothing whenever the opportunity arises but I attributed that to the fact he had a demanding job but for the last couple of years he’s taken on a consultancy role and so has a lot of free time in which he either watches TV or reads. To be fair, he plays walking football and goes to the gym but in between times he’s a bit sloth-like. He’s had a long-standing sleep-time twitch which goes on all night, so I don’t think it’s as simple as restless leg syndrome (RLS) but it drives me insane not least because he’s blissfully unaware of it. I find it worrying because to me it hints of something sinister going on and I’d hoped that magnesium might help but it hasn’t. It might partially explain his lethargy and because although he’s oblivious to it it has to be affecting the quality of his sleep; it’s certainly affecting mine. I’ve read that raising iron levels improves RLS, that would be amazing because because this has been going on for 20 years!

[radd in reply to Noelnoel]

Noelnoel,

I meant for a person not suffering autoimmune conditions then an iron deficiency is likely to be a large contributory factor in impaired thyroid function, and raising iron levels might be enough to avoid Levothyroxine. However, he will need TGAb testing as Hashi is a progressive condition and the likelihood of him eventually needing Levothyoroxine becomes high.

Iron is definitely one of the conditions associated with RLS. I get it too but for the opposite reason, iron overload. It keeps me awake, and sometimes I sleep with my legs curled up underneath me to keep them still and then wake up with terrible pins & needles and muscle cramps.

For years I used Biotics Research Corp Betaine Plus HP (high potency at 700mg) but have found a much cheaper version that comes in a huge container called Betaine HCL, Pepsin & Gentian Bitters by Doctor's Best. Still good potency at 650mg and much better value 😊. Yes, it replaces missing stomach acid and eventually encourages more of your own. Don’t add betaine to your sups, just leave it on the table with your salt & pepper (unless you have young grandchildren around) because you can only take it with food. I keep mine in a fancy container on a high shelf by the dinner table so it’s not obvious to guests.

[Noelnoel in reply to radd]

That must be horrible for you. I know on the odd occasions I get it, I find it makes me feel on edge. Deep breathing techniques do actually help my husband but not totally. The twitches and jerks are still there but less ferociously. Have you tried?

Thank you for the recommendation. Is it a stupid question to ask whether you’ve found it helpful

[radd in reply to Noelnoel]

Noelnoel,

I do yoga 🧘🏼‍♀️, have done 40+ years & yes it helps. I have venesection several times a year for iron overload & that’s what really helps RLS.

I can’t live comfortably without my Betaine 😁. I found I needed less of other supplements/thyroid meds/etc because everything gets absorbed so much better. It also prevents that bloating which happens when food just lays in the stomach. I always used to get that with meat/ protein heavy meals and now it’s gone.

You take the pills whilst eating, and as many as you need until you feel a warmth and then back off. Remember your dose and take one less next time. The warmth is a guide, and not your aim. Protein heavy meals will need more than an avocado salad for example.

I started off with 5 pills with a protein meal which is a lot. Now I can only take 1 or 2 before that warmth. If you take too many, drink some bicarb to take away any burning. I’ve never had burning but these pills are hydrochloric acid so could burn with too many.

[Noelnoel in reply to radd]

Thank you radd for your input

Right, yes, that’s what I read, a warmth/tingling/burning. So with that in mind, you didn’t gradually increase to five, you took five straight off? And what does the added pepsin do? Is it an enzyme? I ask because there are several powder brands that are purely betaine without pepsin and no excipients/additives either

Apart from ingesting too much iron, what other causes are there of iron overload? For those of us with hypothyroidism it’s probably an unusual phenomenon

[radd in reply to Noelnoel]

Noelnoel,

No, don't take five betaine all at once. You will need to build up with confidence in an effort to avoid the burning.

I started with one tablet, then the next day two, etc, until I reached my maximum. Many people only require only two to three tablets so be mindful and take half way through or at the end of a meal. Never take on an empty stomach. You will learn what foods/meals you need more or less with over the weeks.

Yes, pepsin is another enzyme that helps break down proteins. The two work best together. I also take digestive enzymes.

My iron overload is due to haemochromatosis which is a genetic defect impairing the control of iron absorption, ie I absorb all iron whereas you only absorb the amount you need. As varying levels from minuscule to large amounts of iron is in practically everything, it is impossible to control with diet so I rely on venesections to reduce levels. I have actually just started donating blood because of limited hospital resources and now I'm off HRT my blood is welcomed (thyroid meds make no difference).

[Noelnoel in reply to radd]

Well done you for donating but what an extra nuisance it is for you to HAVE to have venesection. I suppose all this becomes a way of life and we adapt. At least that’s what I’m finding

Back to doctor’s best then. The largest I can find is 120/tub. If hubby and I end up taking 3 doses of 5/day my calculation is one tub will last precisely 4 days! Sorry to keep you stuck in this post but would you mind letting me know where you buy your “huge” container?

Thanks so much for your patience

[radd in reply to Noelnoel]

Noelnoel,

My pot has 360 capsules and cost about £26. I guess I take at most now 3-4 tabs a day so lasting over 3 months. It came from America (I think) which I didn’t realise when ordering (think I did it on my phone) but it came quite quick. It was either this one -

bodykind.com/product/7608-d...

or this one -

dolphinfitness.co.uk/en/doc...

Edit - you won't end up taking 5 tabs x 3 times a day because depending upon when you eat 'dinner' you don't need so much with breakfast & lunch. If I eat fruit & a fromage frais for breakfast for instance, I wouldn't bother with a betaine tab. You only need then with protein heavy meals.

[Noelnoel in reply to radd]

Thank you. I use dolphin all the time so will order from them

Thanks again

[Annoynomice]

Is he taking levo? It's just that you mention vitamins but not any medication for his thyroid?

[Noelnoel in reply to Annoynomice]

Not any thyroid replacement at the moment but he has a GP phone appt pending. GP requested this so we’re presuming it’s about his high TSH

[Annoynomice]

Reason I ask is that if he does need thyroid replacement drugs, there's not really anything that he can do to avoid it if he has a failing thyroid. Diet will help absorption but once you have a thyroid condition, I haven't heard of anyone successfully resolving this without either taking T3 or TSH. Once on the replacement, the doctor should put him on 75 Levo and then gradually increase every 6 weeks until his levels are under 1 or until he feels better.

Having the medication should start to resolve lots of issues, some he may be unaware of. I thought I was going through the menopause but it was a random blood test which highlighted I was underactive.

I am very against taking drugs for headaches etc, but I faithfully pop my levo every day and it has made a world of difference. Good diet and gut does make a world of difference but he may need to get his underlying issue treated.

[Noelnoel in reply to Annoynomice]

Thank you and I totally agree Annoynomice but he thought in the first instance he’d get his nutrients raised and take it from there. He’s fully aware that ultimately he’ll have to take thyroid replacement for life in which case he’ll probably intitially try what I take, which is a combination of thyroid glandulars in the form of T- Life l and Nxgen and if they work for him then great.If not then it’s NDT or levo or lio or both. That we won’t know until he embarks on the journey

I’m very glad that you now know what was wrong. If only we’d known about this forum we’d have gone on the wellness journey much sooner. Like you my doctor put my troubles down to menopause and it wasn’t until 20 years on I came to my own conclusions and saw Dr Peatfield. I can’t remember whether I found him or this forum first but this forum has been so informative and helpful. I have a couple of friends whom I’m convinced have thyroid issues but they won’t join the forum or listen. They honestly don’t know what they’re doing and I absolutely know they’ll wish they’d read some of the posts on here

[Annoynomice]

Yes, thought I'd ask because there's lots of natural remedies out there for everything and although alot can be solved by sensible eating and exercise, I think this is one of the ones that does need medication.

I agree this forum is a god send, I was lucky in that I had a great nurse practitioner who unfortunately has left my practice. Now I get a 5 min phone call from a doctor who is desperately trying to crib up on my notes when I'm on the call. If I wasn't able to access this forum, I wouldn't be able to suggest courses of action and reasons, that they can then agree/disagree with.

I've got 2 friends with thyroid issues and one was completely unaware that 75 was a starter dose and another where she's overweight, depressed has a diagnosis of underactive thyroid (happily taking anti depressants but won't take thyroid medication)

I wish you luck on your husbands thyroid journey, at least you can rule out the menopause for him!

🙂

[Noelnoel]

Hahaha. Yes indeed!