I came across this article which I found very interesting, the emphasises are my own --
Abstract from 'Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease', by Margaret P Rayman --
"It is important to recognise that low iron stores may contribute to symptom persistence in patients treated for hypothyroidism in 5–10 % of whom symptoms remain despite being treated with levothyroxine (L-T4). An example is afforded by a small study in twenty-five Finnish women with persistent symptoms of hypothyroidism, despite appropriate L-T4 therapy, who became symptom-free when treated with oral iron supplements for 6–12 months. None of the women had anaemia or erythrocyte indices outside the reference range although all had serum ferritin <60 µg/l. Restoration of serum ferritin above 100 µg/l ameliorated the symptoms in two-thirds of the women. At least 30–50 % of hypothyroid patients with persisting symptoms despite adequate L-T4 therapy may, in fact, have covert Iron Deficiency." -
Note the levels here are significantly above what GPs consider to be "low". [The NHS say 25! I had ferritin level of 14 a year or so ago and my GP was not all that concerned!!!]
I also find it interesting that two thirds of those women who did not respond to T4 got symptom relief when they got ferritin over 100 ug/l due to (presumably) better T4 to T3 conversion, other healing of the thyroid and adrenals, and/or their hypo symptoms were actually covert iron deficiency.
I have also read that ferritin brings down RT3 (reverse T3) levels which again links into this as to why T4 didn't work until ferritin was raised.
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blogfrog
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Thanks for posting. On levothyroxine only I found it extremely difficult to raise my ferritin level, even after months of taking 420 mg per day I never saw my ferritin level go above 55. After I added T3, within a couple of months my ferritin was 125! I don't know how I'd reach a ferritin of >100 on levothyroxine only.
That's really interesting. I suppose the question would be, now your ferritin is raised, would you be okay back on T4 and without T3? Perhaps T3 may be a temporary stop gap for the majority of iron deficient patients who are not T4 poor converters when their iron levels are good. Perhaps some "poor converters" have been misdiagnosed and been stressed about long term sourcing of T3 from overseas when that's not the key? Just musing....
I don't think so, I've continued on 25 mcg on T3 for two years and I'd never go back to levothyroxine only. The difference to my quality of life is like night and day.
I don't blame you for not wanting to go back. I know the difference between non working T4 and wonderful T3. I am a whole different person on it. BUT maybe that is because I have been iron deficient for many years and not because I am a poor converter of T4 because of genetic reasons.
Hi @Zazbag, how have you been prescribed T3? I am in the UK and my GP says it would only be prescribed in exceptional cases and costs a fortune... maybe I should go private and find out the actual cost! I have low ferritin and average iron (recently and for many years, and often tired). Thanks!
I buy it from the US online without a prescription and self-medicate. I have an NHS endocrinologist who oversees my self-medicating but his hospital has a policy of not prescribing it. In some areas it's easier to get it on the NHS but I'm not sure which ones. Private it also an option but didn't feel worth it to me. It used to be expensive (£250 per month for a 20 mcg dose) because there was only one manufacturer in the UK for a few years and they abused their market position and inflated the price by 6,000%, however, they got fined by the CMA for this and now the price is down to about £60 per month so much cheaper then it was.
I can say for certain that this didn’t work for me. I had an iron infusion 3 years ago and was still housebound on Levo after that. Just adding T3 now.
I feel like this is a stupid question but- if low ferritin how do you raise levels, do you have to take a ferritin supplement separately to iron supplements. Or would ferritin raise when iron gets to normal levels?
Ferritin is a stored form of iron. Your body manufactures ferritin. (A complex protein which has lots of "holes" to hold iron atoms.)
First, do you have sufficient iron?
Second, why is ferritin not rising if/when there is sufficient iron?
You can take a supplement of ferritin - and that can be a good way of increasing iron levels. (Ferritin absorption in the gut works separately and in parallel with haem and other iron absorption.) But there are few ferritin supplements available. And it doesn't go from food to ferritin in your blood.
Iron is a vitally important aspect of nutrition and health.
Despite being in the USA, this is one fo the best iron websites.
Welcome to Iron Disorders Institute
A Voluntary Health Agency
More than 90 million Americans are affected in some way by Iron-out-of-Balance™. Ethnicity, age, gender, occupation, general health, diet, and genetics define the severity. For more than twenty years we have endeavored to develop or identify products that help people. We promote books, articles, supplements, and approaches because it is our personal experience that these work and align with our mission.
Cheryl Garrison Garrett, Co-Founder, Iron Disorders Institute
While ferrous sulfate is an option, some find they do not do well on it as it causes stomach issues, etc. I wouldn't be surprised if it is one of the4 most untaken medicines as so many get it prescribed then give up. (If you are tolerating it, that is fine.)
There is a section in my vade mecum about iron (just an introductory/overview bit).
helvella - Vade Mecum for Thyroid
The term vade mecum means:
1. A referential book such as a handbook or manual.
2. A useful object, constantly carried on one’s person.
Please don't get put off by the number of pages!
Nor by the fact it is targeted at people interested in thyroid issues. Much of its contents could be of use to many involved in health issues. Things like abbreviations, lists, general reference information, an Appendix of links to many useful websites.
And do keep up to date. I edit it frequently- sometimes trivially, sometimes extensively. If your copy is more than a few weeks old, please download it again. (You must download - not just view in a browser- for the Table of Contents to work.)
In particular, it is not intended that you sit and read the document. Just that you download it and know you can look things up.
If there is anything you'd like me to add, let me know.
Me too. I was given Ferrous Glucinate pills by my GP. There are the cheapest form, being the NHS, but I take one every other other day as according to studies, this helps serum levels better than if taking them daily. Each 300 mcg pill contains around 60 mcg of iron.
By the way, have you found the ferrous sulphate helped? I initially felt a little worse on it - my stomach is ok on it if taken every other day and near food to help as although it should be taken on an empty stomach for max absorption it is not the end of the world if you cannot, same as you do not HAVE to have it with Vit C - but I read that feeling a little worse on it can be a common reaction - people can get a "herx" reaction with iron especially when they are real low but people should ride it out as it will pass. I don't know how my bloods are doing and will be interesting to see but I have also been working on my B12 and folate etc at the same time.
I wanted to see how i was getting on with the tablets before responding :), actually, so far so good, no ill- effects / constipation etc. I was nervous because i had read a lot on here about the negative effects of ferrous sulphate tablets. I am curious about dosing every other day though, so have asked you about that! I am still taking 1-2 a day at the moment.
Given I am now supplementing with high levels of methylated B12 as well as ferritin, it will be interesting to see what my next blood tests reveal. If ferritin has gone down or hasn't gone up anyway, the B12 masking may be the reason.
I find this very interesting. I was recently diagnosed with slightly elevated TSH/Hashimoto and RLS. And in the RLS forum a big discussion is how Ferritin should not just be in normal range, but should be up to 100. Mine was only 30. (which is in normal so no docs every said anything!). So I started Iron Bisglycinate, (take with vitamin C to absorb) and take every other night. This is new for me, I haven't had new blood work done, will do it in December. I am also increasing my meat intake a little. You will find more about this in the RLS forum.
Yeah I read some of those posts last night, they are basing that info I believe on the same iron deficiency study which mentions restless legs as well as thyroid in it, by a Finnish doc, a Dr Sopl I think (can't currently find the study to link).
It will be interesting to see what happens with you as your ferritin levels increase.
Although I have been increasing my ferritin, I have also been increasing Vitamin D and Bs etc and taking T3 too, so although I feel miles better in the space of 6 weeks I cannot point to one thing alone and say it was that. It will be interesting to see my next bloods. I suppose my ultimate test will be, if I ever dare to risk it, is if my ferritin ever gets high enough, to try T4 again exclusively and see if it works when it has never done before and has always made me worse.
My last ferritin was about 55 I think. It mainly rose due to me not having 3 week long periods anymore as I hit menopause and got put on HRT versus iron supplements though. However, I felt not a lot better at 55 than when my ferritin was 14. I still felt "faint" a lot etc and got even more hypo and could not tolerate levo. Perhaps 100 is the magic number.
Wishing you luck and that perhaps our supplementing helps us! My big test will be if my Ferritin goes up perhaps I can go down on my Pregabalin for my restless legs. And as this is all occurring I have back pain and the X-ray showed osteopenia! So although I eat dairy and exercise, I somehow have calcium leaving my bones. It seems for me at least, this is all hitting post menopause, I am 56. There is a reason behind taking the iron every other night as opposed to every night...but I can't look for link right now. I will keep looking for your updates!
Yeah good luck to you too! I know the iron studies you mention about taking it every other day for better absorption and blood serum levels versus every day.
I also read in your post it says "slightly elevated" TSH - does that mean your doc is not treating you with thyroid drugs? Slightly elevated for a normal doctor is "need urgent thyroid intervention" for most people in reality. Did he/she test your FT3 and T4?
thanks for your interest. My TSH was slightly out of normal range, now in normal range but I am waiting to see if Levo 25 mg will bring to low normal range as I saw on posts. My symptoms of fatigue is much better, even on the low Levo. T3 and T4 completely normal. So I will have this all retested in Dec too.
Just be aware your doc's version of "normal' often is not what is right for you. I am glad you are feeling much better though - long may that continue!
Oh blogfrog - first of all thank you for the link - I think I thanked the wrong person earlier but your comment - ‘Slightly elevated for a normal doctor is "need urgent thyroid intervention" for most people in reality.’
I love it - you’ve really summed things up haven’t you 😉
This is fascinating, we seem to be walking the same path! I added T3 and all the supplements in early August but I am using Heme Iron (sourced from America) I don't tolerate meat well due to histamine intolerance but I have been eating some chicken liver pate.... I couldn't get a quick answer from my GP if I was ok to add iron (consultation Friday finally) I'm going to get tested next week 🤞
Feel so much better but like you I think most of it is due to the T3 as mine was 3! (T4 21) But hoping that the vit's and ferritin (started at 32ug/ml) will help get me back to a fully functioning optimised point and then move forward and fine tune my T3/T4 intake 🙏
I don't run my car with the oil at the bottom of the dipstick! Why do GP's not give us the heads up sooner 😧
HI blogfrog, you and others have mentioned taking iron tablets every other day which has been proven to be more effective than every day. I am currently prescribed 2 x 200mg tablets a day, so would you take the two tablets every other day or would you just take one tablet every other day?
My ferritin was around 90 for past 4 years. This past summer I stopped my iron supplement bec i couldn't figure out how to take it in between my 3 doses of T3. Now my ferritin is 66! I was wondering why i was losing energy again and falling asleep mid afternoon. I plan to start supplementing again to see if low ferritin is the cause. I use Solgar Gentle Iron and it doesn't bother my stomach in any way.
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Hypothyroid - low serum iron and saturation, but normal Ferritin
Help with results please
My Serum ferritin level is 52 ug / l 
my List of References recommending GP's keep TSH lower in range : feel free to add any others you have in replies. 
