Iron and thyroid interactions

[JenniferW]

Bear with me because I am trying to get my head around this. I have hashis and take levothyroxine

Two years ago I had an iron test and the result was

Serum ferritin level 65.3 ug/L [10.0 - 291.0]

My GP said nothing but a few weeks later I had a rheumatologist appointment (Rheumatoid Arthritis and Lupus) and they mentioned it and said it's something they keep an eye on and to take a supplement.

I started taking spatone (5mg a day) and did feel a bit more energetic although I have so many conditions plus the menopause at the moment it's hard to tell what's causing what.

In June I had another iron test along with cortisol and got a result of

Ferritin 50.2 ug/L [10.0 - 291.0 ug/L]

I have had problems with my thyroid over the last eighteen months, due to the menopause and HRT and also me just being quite sensitive to the levo dose I am on. I didn't realise at the time that my iron levels had dropped, but my thyroid level was a bit low.

TSH 2.26 mU/L [0.35 - 5.50 mU/L]

Free T4 14.3 pmol/L [10.5 - 21.0 pmol/L]

My GP agreed to increase my levo dose a little. A couple of weeks ago I saw discussions on this forum about iron and its effect on the thyroid and how low iron can cause poor T4 to T3 conversion. I looked up the symptoms of low iron and I have quite a few including crumbling nails and falling out hair. I spoke to my GP and she thinks that my thyroid levels are moving around because of the menopause but offered to do an iron panel. I have the results back today along with the thyroid test

TSH 1.22 mU/L [0.35 - 5.50 mU/L]

Free T4 17.2 pmol/L [10.5 - 21.0 pmol/L]

Ferritin 81.2 ug/L [10.0 - 291.0 ug/L]

A normal ferritin may not exclude iron deficiency if levels are at the lower end of the normal range or in the presence of inflammation.

Serum Iron 21.5 umol/L []10.0 - 30.4 umol/L

Transferrin 2.13 g/L [2.50 - 3.80 g/L]

% Saturation 44 % [16 - 50 %]

So this all looks good and I am very pleased, but I am confused by how my ferritin has gone up so fast. I did take some extra supplements last week, but not in the last three days and as the doctor said to alternate the days I take iron because this helps with the iron receptors I have only taken a little extra iron. I started using the oral iron spray from Better You which is 10mg

Does sorting out your thyroid levels improve your iron ferritin levels or does your ferritin just wander around randomly depending on levels of inflammation? I don't have periods because I am on the mini pill so there has been no change there.

Should I carry on with both the spray and spatone? Or replace the spatone with the spray? I have felt better the last week, but my thyroid has settled down too, so it's hard to tell what has caused what. Than you for any help, it's all very confusing.

[radd]

JenniferW,

Ferritin levels are frequently used as an indicator of iron levels but unless you are well with iron mechanisms working as they should, it can be very deceptive.

Your serum iron is good & ferritin levels are improving. Transferrin is a protein carrier that binds iron to prevent it being free (which is toxic) and carries it around the body. T/S% is a calculation of other iron stats & yours is becoming high because transferrin is too low for the amount of serum iron you have. Therefore, you need to show caution with supplementing iron and if you were to continue (because it is only a low amount) you should ask to be monitored to ensure T/S% doesn’t go any higher.

Ferritin isn't iron but a storage protein that again binds iron. It is used as an inflammatory marker but doesn’t go up & down just in the presence of inflammation and can actually be low in some instance of inflammation. Hypothyroidism can be both a cause and effect of iron issues, and as you have adequate serum iron, it’s difficult to tell if your ferritin levels have directly be effected by thyroid hormones.

Perhaps a better indicator would be to have a FBC that measures the health of RBC’s & haemoglobin to see how well iron is actually working. Ironically, increasing thyroid hormones or getting them working better can speed up the whole erythropoiesis process which can increase demand for iron and start reducing levels until mechanisms rebalance out.

Similar to thyroid hormone T3 it may be just a small amount of supplemented iron was all that was needed to get mechanisms working better and a long, slow journey will eventually see iron levels returning to normal 🤞, eg T/S% reducing whilst serum iron & transferrin, and ferritin maintain good levels,

To add to the confusion, inflammation can stop iron from working correctly no matter what amount of iron we supplement, and this is when we see transferrin levels that do not correlate with serum iron like yours. Hashi causes high or low level systemic inflammation and if you have Lupus also and other health conditions, inflammation will most certainly be playing a part. Ordinary inflammation created to heal the body is beneficial but any inflammation created by autoimmune disease is damaging and should be reduced. This is why we aim to reduce thyroid antibodies which can also be used as a general indicator of unwanted inflammation in someone who is symptomatic.

Taking Vit C together with iron sups can he helpful. Also drinking orange juice with iron rich foods at dinner.

[JenniferW in reply to radd]

That's a brilliant reply, thank you so much for that explanation. I will just continue with the small spatone dose then and not risk taking too much iron. I will get another iron test in three months with the extra tests you mentioned to see how things are going.

[Pomegranate64 in reply to JenniferW]

Many thanks for asking the question. I wasn’t sure why people say to get ferritin and other iron level blood tests done and this has helped me to understand a bit better. I’ll have to read through a few times and look some things up but I’m off to get some iron and vit C supplements this morning. 😊

[JenniferW in reply to radd]

The new supplement I tried being an oral spray may have made a disproportionate difference to my intake, because I take methotrexate for the lupus and RA and it messes up my digestion. I have also stopped drinking coffee recently which may have helped my iron absorption.

[radd in reply to JenniferW]

Caffeine is a low iron inhibitor but if you take it with milk, and drink with a meal then those percentages rise drastically. Same with tea and it’s so very British to have a cup of tea with lunch or whatever. That’s why I suggested to eat all meals with orange juice for increased iron absorption. Alcohol works a treat as well 😜.

My sister has RA and I'm always trying to get her to see a function practitioner for immune modulation as opposed to the severe suppressant effects of methotrexate, along with all the unwanted side effects. But I don't have RA and don't suffer the terrible pain so am not really qualified to comment 😊.

[JenniferW in reply to radd]

Ah, that would explain a lot, I have milky coffee.Methotrexate has so many side effects I sometimes wonder if its worth it, but even a small reduction in dose leads to a recurrence in pain. I already take biologics with it, so I am stuck with it until they come up with a better alternative.