Hello, I’m new here and would love some advice. I went to the doctor with the following symptoms: weight gain around stomach and hips, dry hair, dry skin, napping more often. (And looking at symptoms I my periods have become even more erratic, my mood has been all over and I’ve had issues sleeping.) My symptoms are mild but have affected my confidence. My thyroid and iron results are below:
TSH 1.34 (range 0.27-4.2 mu/l)
Free T4: 10.4 (range 10.5-24 pmol/l)
Ferritin: 16 (range 13-150)
I had a 2 min conv with the GP who prescribed 25mg of levothyroxine and she said my iron was great (which i thought was bizarre because it was flagged as abnormal when I got my lab results through).
Anyway, my questions are:
a) after doing some research my results indicate secondary hypothyroidism. Should I ask for more tests e.g. to assess my pituitary gland?
b) often GPs do repeat tests if hypo is subclicnical because TSH can change. With low free T4, Is it normal to do a repeat test to check or is this fairly constant?
C) is it odd to have so many symptoms - even though mild - with my results?
I haven’t taken the levothyroxine yet but have started raking ferritin. I have lots more energy which is great. I’m concerned about taking levothyroxine for life but also concerned about gaining more weight. I’ve read iron can impact the thyroid so I’m hoping if I get a repeat test things could be OK.
Any advice would be super helpful thanks
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a) after doing some research my results indicate secondary hypothyroidism. Should I ask for more tests e.g. to assess my pituitary gland?
You do need further testing, yes, because the pituitary doesn't just produce TSH, it produces a lot of other hormones, too. And, they too could be low. But, doubt your GP knows anything about that, and probably couldn't order the tests, anyway. You need a referal to an endo.
b) often GPs do repeat tests if hypo is subclicnical because TSH can change. With low free T4, Is it normal to do a repeat test to check or is this fairly constant?
What time of day was the blood taken? Because TSH levels change throughout the day.
However, with an under-range FT4, it would seem pretty clear that there's a problem. So, waiting any longer for another test would seem unnecessary. It's not a high TSH that makes you hypo, it's the hypo that causes the high TSH - IF your pituitary is working normally. What makes you hypo is low thyroid hormones - especially T3.
C) is it odd to have so many symptoms - even though mild - with my results?
Symptoms are a very individual thing. But, I would say yes, with that low FT4 - never mind the TSH, TSH doesn't cause symptoms whether it's high or low. And, pretty certain that your FT3 is low, too. And, it's low T3 that causes the symptoms. Such a pity that they don't test it!
On the subject of ferritin, your GP is crazy! How anyone could think that result was great, I really don't know. Perhaps she was distracted and mis-read the result, thinking about what she was having for dinner that night, or something. But, in any case, with a ferritin like that, I really don't think you should be self-treating, it's far too serious for that. You should be having further investigations to find out why it's so abnormally low. So, if I were you, I'd go back and see a different doctor, if you can, and insist on further testing.
Thank you. I really appreciate do your response. Was left in the dark and it’s good to get another opinion.
I had test done in afternoon. My ferritin level was even lower 3 years ago (11) and I took some ferritin tablets which helped. My good friend is a blood doctor and told me to get back on the tablets asap. I don’t know why it’s so low though apart from doing 12 hours of running/cycling a week. My diet has lots of iron!
I will ring my practice again and speak to another GP. Thank you greygoose.
So, your TSH would not have been at it's highest. Best to get the blood drawn before 9 am.
My ferritin level was even lower 3 years ago (11) and I took some ferritin tablets which helped.
Helped temporarily, but didn't solve the problem.
This really does need further attention. You could have a gut bleed or something. And your 'good friend' is not doing you any favours by just telling you to take tablets. You need a full iron panel for starters, then probably an appointment with a gastroenterologist, just to be sure.
My diet has lots of iron!
Yes, but you're not what you eat, you're what you absorb. And, as you're hypo, your stomach acid is probablylow, meaning that you will have a problem absorbing nutrients.
Iron is stored in almost all tissues of the body in the form of a protein, namely ferritin. While ferritin is a biomarker of inflammation (6-7), it is also a good biomarker of thyroid function.
A recent study showed a close correlation between serum ferritin levels and thyroid activity (8). In this study, enrolling n=50 diagnosed hypothyroid patients and n= 50 healthy control individuals, serum ferritin levels were shown to be reduced in hypothyroid patients (21.08 ng/mL) as compared to controls (59.89 ng/mL)……
Interestingly, thyroid hormones regulate ferritin expression by a feedback loop mechanism. In a study including patients affected by Hashimoto’s thyroiditis with low ferritin levels, the administration of L-T4 therapy (levothyroxine), restoring an euthyroid function, significantly increases ferritin levels (10). Inversely, the synthesis of thyroid hormones by the enzyme thyroperoxidase requires iron so the depletion of iron store (low ferritin levels) may accentuate the decrease of free T3 and T4 levels (thyroid hormones) although the autoimmune mechanisms (chronic inflammation in the case of Hashimoto’s thyroiditis) are the principal causes of the low production of thyroid hormones. As mentioned previously, ferritin levels could be altered by inflammation and for an accurate interpretation, free iron and CRP levels should also be evaluated.
The take home message is to consider an iron deficiency (as seen by low ferritin levels) as a marker of a possible autoimmune condition such as Hashimoto’s thyroiditis (hypothyroidism) and ferritin levels could be restored with adequate therapy (levothyroxine).
Thank you Slow Dragon. I haven’t been eating much meat at all until the past month (but I eat lots of non-meat iron rich foods). In the past month I’ve reintroduced fish. My initial strategy was to take my iron supplements (along with vitamin b, d and some others - salenium or something?!)!and eat more meat and then get tested in 3 months to see if my iron levels improve my thyroid function. And, in this test, ask the dr to check for other Vit deficiencies, my T3, antibodies, other hormones etc..
I don’t know if I should continue with this strategy after reading these posts. I’ve read lots about how iron and thyroid impact each other. I was hoping to get an idea of which one is impacting the other by trying the iron first. If this helps with T4 - great. If it doesn’t, then more tests/levothyroxine?! I’m not a doctor of course and probably sound quite naive with my limited knowledge.
Fish doesn't contain much iron if any, and non meat sources of iron are more difficult to absorb. I'm a lifelong vegetarian and have struggled with low iron for most of my life. Green leafy veg is very healthy but the form of iron it contains, non- haem, is not as plentiful or as easy for the body to extract, as meat. I dont eat meat for ethical and taste reasons.
If you eat meat then I would suggest increasing your red meat intake. And eating foods rich in vitamin C at the same time helps iron absorption. Iron tablets can cause digestive problems and aren't really a long term answer. However they are good for getting iron levels up quickly.
Maybe if your thyroid issues get sorted it might help with absorption, as the two go hand in hand. But really they need to be investigating why your ferritin is so consistently low.
Thank you sparkling sunshine. I do eat meat but I don’t really want to eat much due to ethical reasons. Do you supplement iron permanently due to being a vegetarian?
Pre menopause I was always on some form of iron supplementation. Either prescribed tablets which I took for years or multi vitamins and iron. I also have low vitamin B12 and get injections every 13 weeks, but that's more of an autoimmune problem than diet.
Post menopause isn't a issue for me had a full iron panel done in October and it all looked good, which pleased and surprised me. After so many years of low iron and anaemia.
Its always going to be more difficult for those of us who eat little or no meat. But I've been veggie since infancy so that's never going to change lol.
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.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron
Thank you all - very helpful replies. I will look at these articles in more depth. I only got tested for serum ferrritn - not a full iron count.
I was also going to go to the optician because my vision has become worse and now I’m concerned it’s linked with all of this (a pituitary growth or something). Gosh, there is a lot to take in. I’m not really tired though - weirdly - just a few more naps than normal.
Hopefully I can get to the bottom of it. Felt pretty low in past 8 months (thought I was going through menopause at age 35) but glad I have at least a starting point.
My periods are all over the place. Last couple were heavy for first couple of days but generally speaking I think they’re fairly normal in terms of heaviness. However, I can go 2 months without a period or longer. When I was previously diagnosed with iron deficiency I wasn’t having periods at all (no period for 1.5 years - I think it was due to too much exercise. They did lots of tests but couldn’t find an issue). They came back when I did less intense exercise.
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please can I have some advice on my latest results?
Can I get some advice on my latest results, please?
My latest lab results
Can I ask for some advice on my test results?
