Hi and happy new year! Last time you were so helpful, thank you, wondering if anyone can help again please-
Underactive thyroid / hashimotos for 7 years following first child.
Was on dose of 75mcg levothyroxine and tried 100mcg under care of endocrinologist, felt worse and no more energy, also TSH nearly zero, so was happy to go back to 75mcg.
However I still feel physically exhausted, I’ll try to post all my blood results but looks like low ferritin 32 (range 13-150) endo not concerned. Also testosterone less than 0.1 (0.2-1.65) sure I’m perimenopausal. I’m struggling so much with energy levels, also brain fog, muscle weakness and low mood.
Winter doesn’t help, I get SAD but try to get outside as much as possible.
Also have SIBO which interferes with absorption in gut and often makes me feel dreadful if not careful with diet and how/when I eat. I’m gluten, dairy, alcohol free and low sugar.
Would love any advice please, I feel a bit lost!
Written by
Hopetoheal22
To view profiles and participate in discussions please or .
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
We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes:
Males 16-60: 30-400 ug/L
Female's: 16-60: 30-150
Both >60: 30-650
The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘
thank you so much for your quick and helpful reply SlowDragon, much appreciated. I’ll check out the links shortly. I eat lots of meat including red meat and liver, also green leafy veg, lemons, oranges, dark choc. However my ferritin continues to bump along at a low level. Endo not worried, said it’s normal.
Wonder if the SIBO is preventing absorption? I don’t drink caffeine (well only one green tea, well after Levo in the morning) & drink lemon water with meals. Perhaps low testosterone not helping energy levels? Doc suggested HRT - I’m 43 with fairly regular periods but slight changes to length and symptoms. Thanks again 😊
I can vouch for adding a little testosterone back into your life, it adds the joie de vivre, your GP can prescribe only for libido (magic word), but ideally you want to balance all your sex hormones at the same time as they are likely flagging, you need progesterone to convert T4 to T3 and estrogen to keep you sane 🤣 🤗
Thank you Eeyore for your very helpful reply. Much appreciated. I’d love some more joie de vivre! Interesting about needing progesterone to convert T4-T3, I think my progesterone levels were tested a couple of times and were ‘in range’ but the trouble with hormones is they can fluctuate so wildly in such a short space of time! I will look into the links, thanks again. Wishing you a very happy, healthy 2023 😊
If you speak with a menopause clinic, if your GP isn't up to speed, they tend to go by symptoms rather than blood tests as like you say when Peri... all over the place 🤗
Thank so much SlowDragon for your very helpful reply. Yes looks like a terrible conversion rate!
I take Teva. Seems to agree with me more than Accord. I try to take it an hour before breakfast but sometimes it’s less. I don’t have dairy or much caffeine (one green tea) for breakfast so hope it’s ok.
Good idea I could try the small increase, but not sure how I get such a small amount, get some 25mcg and halve pills. Maybe they can change my prescription; they’re very strict about how they give it!
Endo mentioned T3 but wasn’t encouraging. Said I’d have to get it privately and can be very expensive. Also said not proven how much difference it makes (I can’t exactly remember what they said here but words to this effect) and that one small study showed a link to psychosis?!
Would you suggest trying T3 as I have poor conversion? To me it makes sense, my T4 is low so I take T4, why wouldn’t I take T3 for low T3! It’s all so difficult isn’t it 😬
I self treated for SIBO symptoms following Izabella Wentz Auto Immune diet protocol which has helped me lots. I also followed allSlowDragon advice on all things and 12 months on am much improved, sleeping better, have more energy and IBS mostly resolved (occasional issues linked to triggers) hope you find some solutions. Careful with HRT it can lead to needing a Levo increase, easier to treat one thing at a time despite it being a pain and time consuming. My hormones have settled since my Levo is more optimal and vits improving. Hope you find your answers 🌱🦋🌱
thanks so much for your helpful and hopeful reply Regenallotment. Wonderful to hear you’re much improved, and gives me hope! Was that from her hashimotos protocol book? I have read most of it but apart from cutting gluten out, little dairy, no alcohol, low sugar and some supps, I haven’t implemented much - poor excuses but I am so tired with two young kids and always hungry so find anything limiting food/ making things more time consuming very hard! I do eat very healthily, I feel awful if I don’t.
Anything in particular that really helped you? I’d love to know if you’re happy to share. I find meal spacing of 3/4 hr gaps between eating eases SIBO symptoms but then I get so hungry in the afternoon!
Totally agree re HRT and treating one thing at a time, it is so time consuming but for me I feel it makes sense and easier to see what’s causing what.
Thanks again and wishing you a very happy, healthy 2023 😊
That’s the lovely thing about this forum, shared experiences 😊
If you click the tree pic next to my name it’ll take you to my bio, scroll to the bottom to see my regular supplements etc. I have all 3 IW books, there is some overlap between them but I needed the repetition for the info to stick. I went through them a second time and used post it notes, tried one thing at a time and worked out what suited me and my symptoms. Still work in progress, my gut health is improving but very sensitive. Each incorrect choice takes 3-5 days to resolve. But I can get up in the morning, don’t need a 3pm nap anymore. Holding down an almost full time teaching job (with a very understanding line manager and HR department).
let us know how you get on, feel free to ask me more if you think I can help. Others will pitch in too with their experience. If you view my previous posts you can see the questions I had at the start.
Wow Regenallotment, amazing how you’ve created your treatment plan and stuck to it when you are so incredibly busy! Well done, inspirational. No idea how you manage to do so much including teaching, must be exhausting!! (3pm is when I most need a nap too 😴) interesting mine started with postpartum thyroiditis after my first child, and I had a head injury with whiplash and concussion a few years before that. All steadily downhill from there. Wonder if some vagus nerve / gut / MMC connection issue?
I’m reading Izabella wentz too and very helpful but I need to be as methodical as you because I read her book before I fall asleep at night and remember nothing in the morning! Find it hard to get through the day and always tired (have two young kids, always on the go) so implementing diet changes when I’m tired and cooking other meals for them and husband is too much!
Yes the wrong food choices do come at a price 😣 I had an Indian curry the other night and felt so hungover and awful the night day I could barely function. Had some wheat over Xmas and still paying the price, or perhaps from something else, so hard to know…
Doc is offering HRT as I’m perimenopausal and symptoms way worse before period and when I’m ovulating but reluctant to take as already trying to fix SIBO and work on hashimotos. Or perhaps it might help with some if the symptoms?
Your thoughts are so gratefully received thank you 🙏 really well done on making so such amazing progress, you’re an inspiration ⭐️
Agree your Ferritin is so low it will be making you feel exhausted and likely giving you all the symptoms of anaemia. Your endo is wrong and unaware of recent thinking in this area - Ferritin needs to be at least 50 in menstruating women, but really to feel better nearer 100, and 32 is definitely a deficiency. I’d address this first - you could try one Ferrous Fumarate tablet every second day (can buy otc from chemist) but be aware it will take a few months. There is a growing awareness of the effect of low Ferritin in some (but not all!) medical specialities. Low Ferritin with normal haemoglobin is known as Iron Deficiency Without Anaemia.
I’d get your GP to test for Iron Deficiency Anaemia too by checking your haemoglobin.
Note that if Ferritin is low and haemoglobin is normal you can still supplement with iron tablets - your ferritin stores will be replaced first before your circulating iron is increased. (My iron was at the very top of range but dropped after I had an iron infusion to increase my Ferritin - your body works very hard to ensure circulating iron remains high when Ferritin is low).
Re the low testosterone - GPs are unlikely to prescribe this until you are on max dose oestrogen and progesterone HRT. My GP also won’t do it without a Gynaes agreement.
I’m not sure about your thyroid levels. For me I would feel dreadful with these numbers. I am unable to get T3 prescribed for me and personally need T4 and T3 higher which for me means taking a higher dose of Levo with a corresponding super suppressed TSH (<0.001). But really I should be getting a small amount of T3 added.
Thank you so much csj113, very helpful and interesting. Are there any side effects to the Ferrous Fumarate? The levels you mentioned make sense, I really need to work on bringing them up. At least then if I still feel exhausted I can discount it being an iron issue!
Bit wary of taking the testosterone with or without oestrogen and progesterone at the moment, I think my doc would prescribe it but with the thyroid and SIBO issues and probable perimenopause it’s hard to know what’s causing what and I’m worried it might cause an imbalance or other issues.
sorry you can’t get T3, seems so wrong when it might help you so much. Does your doc / endo mind the super suppressed TSH? Thanks again and hope 2023 is a very happy healthy one for you 😊
Ferrous Fumarate can be hard on the gut but if you take one tablet every other day and take it with vitamin C you can bring your levels up slowly with hopefully minimal side effects. I would definitely get this sorted because with so many possible issues it's best to tackle them one by one - and this is easy compared to HRT which can be a bit of a black art!
My GP and Endo reluctantly agreed to the suppressed TSH though they sent me for a bone scan (which was fine as I train hard on a road bike / lift heavy weights and have a lot of muscle). I do worry about cardiac effects though.
All the very best with whatever you try, hope you can feel better soon.
Thank you so much csj113, good advice re the iron supplement. Trying to do it with liver and red meat with vitamin C but doesn’t seem to increase.
Thank you for reminding me to work on my muscle and bone mass too! That’s great you lift weights and cycle. I am very active and do exercise but not hard as it wipes me out which is annoying.
Sorry I don’t know, what are the cardiac effects of suppressed TSH?
SIBO is so debilitating, I followed Isabella Wentz autoimmune diet protocol and took Betaine with Pepsin, S. Boulardii and black seed oil and L glutamine and NAC (Introducing one at a time 2 weeks apart) and have way more energy and better sleep. I hope you find your answers, I feel for you it’s so tough when you are low 🌱🦋🌱
So sorry you’ve had SIBO too 😣 it’s awful isn’t it, and just when I think I’m getting better it seems to flare up again. I’ve tried antibiotics twice (Rifaximin twice, once with metronidazole) and also restricted diets alongside berberine and also a parasite cleanse (as I had a minor one 😱) but after a few weeks all SIBO symptoms come back. Terrible bloating, aches and pains, headaches, nausea, hungover feeling, brain fog (symptoms which overlap with those of my other issues!)
I struggle with restricted diets as I’m so tired and hungry and lose weight quickly when i diet (not good as I’m already underweight)
Now been recommended oregano supp with NAC and SIBO diet but leaves little to eat in the way of carbs which fill me up (rice, potatoes, porridge etc)
Any tips would be so gratefully received 🙏 thanks so much x
That is interesting, wow you have tried a lot. The NAC soup sounds good, it’s definitely helped me, I stir a tiny spoon into orange juice. I have recurrences from time to time, usually when I eat out or something I haven’t prepared myself which is annoying. Being dairy and gluten free is consistently my best approach so far. 🌱
That’s helpful thank you. I only have a little butter and Parmesan (mainly went dairy free as it makes me very snotty and sore throat) what do you use instead of butter? I use it in baking and sometimes on a little GF toast as I like it and am trying to avoid seed oils
beef dripping is my favourite (homemade from Sunday roasts), lard, coconut oil, homemade pate, hemp, avocado and olive oils. I can’t handle GF breads except for homemade linseed bread recipe from Dr Sarah Myhill. Unfortunately maize starch and tapioca starch give me symptoms 🌱
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Low TSH & Low T4
Thyroid levels ‘in normal range’, no dose increase 
Blood results on 50mcg, increase dose to 75mcg
Test Results and Symptoms 
