Query low ferritin? Any help with iron results please :-)

Hi all

Here again asking probably a similar question to one a few months ago

I feel I have some issues with iron. My bloods are in normal limits with very low ferritin reading, but I’m having increasingly significant hair loss, fatigue, shortness of breath (all chest x rays and scans clear), weakness, tremor, increase in anxiety and often pale.

I know it’s been said here not to supplement and I haven’t and I’ve eaten chicken liver pate etc. My ferritin increased to 70 but it’s fallen back again. Not sure what else to do to try and increase.

My gut feeling is that it’s impacting my health. I’ve yet to discuss results with GP but wondered if anyone could shed light? What supplement would increase Ferritin? I obviously don’t want to go over as I know how awful/ dangerous this can be, but my chicken liver pate plan isn’t working and I’m sure that the low ferritin is an issue. I have had considerable stress recently and wrangling with menopause symptoms and adjusting HRT but I’m instinctively feeling low ferritin is a problem for me.

My thyroid bloods T4 at 70% (8 hours post meds as was called in on the day for bloods so not able to do the usual protocol) TSH 0.4

No T3 done. Will test privately in a few weeks.

Bloods as follows:

FBC normal range

White cells 9.7 (3.7-11)

Red BC 4.43 (3.8-5.8)

Haemaglobin 141 g/L (115-165)

Haematocrit 0.43 (0.77-0.4)

MCV 97.6 fL (76-100)

MCH 31.8 pg (27-32)

MCHC 326 g/L (320-365)

RBC width 12.8 (11.5-14.5)

Platelet 306 (150-450)

B12 565 ng/L (160-820)

Ferritin 33 ug/L (10-291)

Folate 5.0 ug/L (4.1- )

I’d really appreciate any thoughts on what this suggests. Also, how can I increase ferritin with supplements (and what?) without pushing myself into haemacrotosis?

Thanks in advance, as always

🦋 x

[SlowDragon Administrator]

Folate is low

What B vitamins are you currently taking?

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and separate B12

Essential to test vitamin D too

vitamindtest.org.uk

[SlowDragon Administrator]

how much levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

Has levothyroxine been increased since starting HRT

Is HRT patches or tablets

Many people find they need to increase levothyroxine on HRT tablets

[Hidden in reply to SlowDragon]

Hi SlowDragon

Thank you for replying

I am on 100mcg T4 (same brand) and 15mcg T3 in 3X5mcg doses. I’ve been in HRT transdermal for a few years but moved back to gel recently.

I haven’t been using my Thorne Basics so will add in these again as I’ve noticed my B12 has decreased from about 800 since dropping the Bs supplement. I’ll add back in daily. Thank you for the prompt about the separate folate pre bloods. I think I bought some so will have those on back up pre blood draw. Is it likely the low folate is causing these additional symptoms do you think?

X

[SlowDragon Administrator in reply to Hidden]

suspect you need to alter levothyroxine or T3 dose…but essential to get all four vitamins optimal before considering changing dose levothyroxine or T3

Obviously if on T3 it’s especially essential to test TSH, Ft4 and ft3 together

You may need iron supplements

humanbean or SeasideSusie may pop along and comment on iron/ferritin

Are you vegetarian or vegan

Gluten free or dairy free?

[Hidden in reply to SlowDragon]

thank you

I’m GF but not eliminated diary and not Vegan or veggie. I need to get back on my supplementation and will retest before any change in T3/T4 but will post here first before changing anything with you to date TFT results.

Thank you SD, as always, for your valuable input!

[SeasideSusie Remembering]

Butterfly1942

Ferritin 33 ug/L (10-291)

You need an iron panel to see if you have iron deficiency. Your FBC doesn't suggest anaemia, you can have iron deficiency with or without anaemia.

If you have iron deficiency then your GP should prescribe iron and regularly monitor your levels with an iron panel.

[Hidden in reply to SeasideSusie]

thanks always Seaside Susie

Is this not an iron panel? Is it the TIBC and Transferritin I need? The doctor said she was doing one. I will speak to her as a follow up. Is there any harm in adding in some gentle iron in the meantime do you think? I’m getting a bit desperate to try something as I’ve had this low reading since becoming quite poorly a year ago and my ferritin had been low throughout my instinctive feeling is that I may have iron deficiency without anemia. I saw an article that said many doctors ignore this if other levels are ok? X

[SeasideSusie Remembering in reply to Hidden]

An iron panel is

Serum iron

Total Iron Binding Capacity (TIBC)

Transferrin Saturation

Ferritin

Low serum iron and saturation would suggest iron deficiency. If you already have good levels of these and start taking iron supplements then this would raise these levels too high and too much iron is as bad as too little, this is why we suggest not supplementing without a full iron panel. When we do supplement with iron it's important to regularly test with an iron panel (every 2-3 months) to make sure levels of serum iron and saturation don't go too high.

[Hidden in reply to SeasideSusie]

thanks Seaside

I will order from Medichecks and post here although last time my Transferritin saturation was about 50% I think- I’ll need to check! I don’t want to go over with supplementation but I’m just not sure how to increase ferritin as I’m doing the chicken liver thing and it’s not impacting. X

[SeasideSusie Remembering in reply to Hidden]

These are the optimal levels for an iron panel according to rt3-adrenals.org/Iron_test_...

Serum iron

• 55 to 70% of the range

• higher end for men

TIBC (total iron binding capacity) or Transferrin

• Low in range indicates lack of capacity for additional iron

• High in range indicates body's need for supplemental iron

Saturation

• optimal is 35 to 45%

• higher end for men

aAs for ferritin, it's always suggested here that ferritin is half way through range although some experts say that the optimal level for thyroid function is 90-110ug/L. Ferritin should be looked at alongside an inflammation marker such as CRP because ferritin rises with inflammation, so if CRP is elevated then ferritin will be too so you wont get a true ferritin reading.

[Hidden in reply to SeasideSusie]

Hi

Thank you so much for your time on this

Results 12 June 22 Medichecks: 

Iron 24.5 umol /L (5.8-34.5) 

TIBC 50.9 umol / L (45-81)

UIBC 26.4 umol/ L (24.2-70.1) 

Transferritin saturation 48% (20-50)

Ferritin 40 ug/ L (13-150) 

29th June 22 (Private GP):

TIBC 51 umol/ L (41-77) 

Transferritin saturation 33% (20-55) 

Ferritin 52 ug/ L (13-150)

 Heamoglobin A1c 5.4%. (4-6) 

HbA1c nmol 35.9. (20-42)

Does the TIBC seem low in range? Lack of capacity? Therefore no need to supplement? Does this mean I don’t ‘use’ iron sufficiently. Just wondering what lack of capacity might mean 🤔My CRP is normal I’ve had it checked twice when having bloods and chest x rays recently at the hospital X

[SeasideSusie Remembering in reply to Hidden]

12 June 22 Medichecks:

Iron 24.5 umol /L (5.8-34.5) = 65.16% through range which is very good and maybe higher than necessary for a female.

TIBC 50.9 umol / L (45-81) = low in range, no need for iron supplements.

UIBC 26.4 umol/ L (24.2-70.1) - This test measures how much transferrin isn’t attached to iron but I have no recommendations for this.

Transferritin saturation 48% (20-50) = higher than optimal

Ferritin 40 ug/ L (13-150)

No iron deficiency, just low ferritin.

29th June 22 (Private GP):

TIBC 51 umol/ L (41-77) = approx 1/4 of the way through range so at the lower end and no need for iron su0pplements.

Transferritin saturation 33% (20-55) = lower than last time but close to the optimal level for a female according to rt3adrenals.org

Ferritin 52 ug/ L (13-150) = slightly higher than other test but nothing is static and one might expect different results on different testing equipment.

No serum iron result here.

Heamoglobin A1c 5.4%. (4-6) = no suggestion of anaemia.

HbA1c nmol 35.9. (20-42) = diabetest test and an excellent result

[Hidden in reply to SeasideSusie]

thank you so much SeasideSusie

I’m so grateful! I think I’m scooting about for answers for my ongoing fatigue etc so I can rule this out and focus on eating the pate etc.

I think SlowDragon’s suggestion I may need an increase in either T3/T4 is a good one. It’s likely undermedication leading to symptoms and hair shedding etc I’m less worried about my hair (probably should be!) but the life impacting fatigue etc has to be addressed now. I’ll aim to get on top of HRT in the next few weeks, test thyroid and post for advice on which to increase first. I really appreciate your time and SD’s as ever

X