New thyroid and iron panel results - trying to conceive

[Becsf]

Hi everyone,

Further to my previous posts, I have now received the results from my recent blood tests ordered by an endocrinologist. There are others which I don't understand but here are the ones I have some understanding of, and have been monitoring since receiving diagnosis of Hashis and while I'm trying to conceive.

This test was done at 9.20am, with no food or supplements beforehand, no biotin supplements for a week before and no levo for 24+ hours. Since late January I've been on 100mcg of levo per day. I used the nifty calculator posted here to work out the ranges.

TSH 1.84 mIU/L (4.20 - 0.27)

Free T4 (fT4) 14 pmol/L (12 - 22) 20.0%

Free T3 (fT3) 4.3 pmol/L (3.1 - 6.1) 40.0%

T4:T3 Ratio 3.256 

Thyroid Peroxidase Antibodies (TPO) 323 IU/mL (≤ 34)

Folate - blood 10 ug/L (2.9 - 50.4) 14.9%

Ferritin 19 ug/L (14 - 148) 3.7%

TIBC 54.9 umol/L (53 - 85) 5.9%

Iron Saturation blood 34.6  (14 - 148) 15.4%

B12 serum 624 ng/L (160-925) 60.7%

Selenium 1.74 umol/L (0.8 - 2) 78.3%

Zinc  11.6  (11.5 - 17) 1.8%

My TSH has much improved (was 3.76 in Nov), but my T4 and T3 have gone down a little bit (from 15.9 and 5) which surprises me because I'd increase my levo dose and I've been feeling better. Does T3/T4 just take a bit longer to respond? Or does my levo dose need changing? Or is trying T3 now indicated? I feel pretty good on this dose - definitely have more energy and less hair is falling out when I wash it. Think my hands and feet are a bit less cold as well. Any other recommendations for improving the conversion rate? I'm presuming a big thing will be improving my iron levels which brings me to...

My iron panel results - I can see that my iron has gone up (in Nov was 12.9 - 5.8-34.5) but but my ferritin has gone down, and it was only 22.2 (13-150) last time. My folate has also gone down but not by as much. Since December I have been supplementing with heme/ferrous bisgylcinate, alternating each day (having read advice from this forum) but this doesn't seem to be working, or maybe it just takes more time? Should I start on something stronger/that works quicker - maybe ferrous gluconate (as also advised here)? Can anyone recommend a brand without the extra B vitamins (which I'm already taking)? I tried ferrous sulphate but it made me constipated, although did up my ferritin, so maybe I should go back to it... And should I go back to adding extra B12? I know I really need to improve this for my thyroid results and for getting/staying pregnant.

The doctor didn't order a vitamin D test but last time was just in the 'optimal' (84nmol/L 50-200) and I've been continuing supplementing with it. I will get this retested at some point.

My zinc level is low in the range too, even though I've been supplementing with it - in liquid form - since around October. Is that surprising? Or just part of being hypo and less able to absorb nutrients? Is my Selenium now at a good enough level for thyroid conversion?

And are there other follow up tests/actions I should request from the endo? I do have the results for lots of other things (full blood count, fertility hormones, sex binding globulin, urea and electrolytes, potassium, sodium) but I haven't posted them as I don't yet understand them and thought this is enough for one post. But I can do if any would be helpful to make sense of things?

I'm gluten, soy and lactose free and am supplementing with magnesium, l-carnitine, black seed oil, coq10, D3+k2, zinc, probiotics, digestive and systemic enzymes (when I remember), NAC, selenium and B12 complex (incl folate).

Any advice or suggestions very welcome. Thanks for reading this v long post.

[SlowDragon Administrator]

Approx how much do you weigh in kilo

Guidelines on dose levothyroxine by weight is that it’s likely approximately 1.6mcg levothyroxine per kilo per day

Your results suggest you need next dose increase in levothyroxine to 125mcg daily

Ft4 is very low

Retest again 6-8 weeks after increasing dose

Which brand levothyroxine are you currently taking

Ideally stick on same brand adding 25mcg

ferritin level is far too low …..it may start to improve once thyroid levels improve

Are you vegetarian or vegan

Meanwhile …..Look at increasing iron rich foods in your diet

Red meat every day and liver or liver pate once a week

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

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 

Medichecks iron panel test 

medichecks.com/products/iro...

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

List of iron rich foods

dailyiron.net

Links about iron and ferritin

An article that explains why Low ferritin and low thyroid levels are often linked and miscarriage

preventmiscarriage.com/iron...

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin 

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

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.

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin 

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Excellent article on iron and thyroid 

cambridge.org/core/journals...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron 

healthline.com/nutrition/he...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Ferritin over 100 to alleviate symptoms 

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary 

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism 

healthunlocked.com/thyroidu...

Ferritin range on Medichecks 

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

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. ‘

[Becsf in reply to SlowDragon]

Thanks for the advice. I weigh 59kg so am already over those guidelines. But of course they are only guidelines.

[SlowDragon Administrator in reply to Becsf]

Are you taking levothyroxine on empty stomach and then nothing apart from water for at least an hour after

No other medications or supplements within 2 hours

No magnesium, iron, calcium, HRT or vitamin D tablets within 4 hours

[Becsf in reply to SlowDragon]

Yup, I've always followed all those recommendations. Get mercury or accord each time - tried and failed to request the same brand but I never notice any difference between these anyway.

[SlowDragon Administrator in reply to Becsf]

As you are lactose free you may need lactose free levothyroxine

Teva or Aristo only two options

 Many patients do NOT get on well with Teva brand of Levothyroxine. Teva is lactose free.

Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

But for some people (usually if lactose intolerant, Teva is by far the best option)

Aristo (currently 100mcg only) is lactose free and mannitol free. 

March 2023 - Aristo now called Vencamil

Cut extra 100mcg into 1/4’s to get 25mcg

healthunlocked.com/thyroidu...

[Becsf in reply to SlowDragon]

I'm not sure if I'm lactose intolerance - I think it's likely. I seem fine if I just have milk in my coffee or cereal but had a stomach pain after eating gluten-free pancakes recently so have cut it out now. I asked the endo to request a lactose free version, specifically Aristo, but haven't had a prescription from her yet - will do now these results have come back. I had asked in various pharmacies (before I knew about Aristo) but none knew of any lactose-free brands except Teva. One which changes the gut biome doesn't sound great to me.

[SlowDragon Administrator in reply to Becsf]

The fact your thyroid results are low and already on higher dose than guidelines suggests poor absorption

In-depth article discussing this

academic.oup.com/edrv/artic...

Have you been tested for SIBO or H Pylori

[Becsf in reply to SlowDragon]

Thanks for this, I'll read it tomorrow. I've been tested for h pylori (negative) but not SIBO. I mentioned it to my GP and he didn't seem to have heard about it! But he is going to conduct more stomach related tests with a view to referring me to a gastro specialist.

[Imaaan in reply to Becsf]

Many are utterly clueless when it comes to SIBO.

[SlowDragon Administrator in reply to Becsf]

Also …..In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement eg Jarrow Methyl folate

If that doesn’t improve levels at next test

Your folate is so low …perhaps take vitamin B complex 4 days and folate 3 days week

[Imaaan]

How much ferrous sulphate were you taking ? How much heme iron are you taking and how much iron bisglycinate are you taking? Instead of alternating between the heme and iron bisglycinate it would probably benefit you if you combined them and took them everyday.

I try to take around 33mg of heme iron plus 60mg iron bisglycinate everyday

Your folate is in dire shape and you may benefit from bumping your b12 a lil more. I'm currently trailing Thorne Ferrasorb. It has iron bisglycinate, b12, folate and a lil b6

[Becsf in reply to Imaaan]

I think it was 2x200g of ferrous sulphate, as suggested by doctor.

And with the others I take low doses, having read that with higher ones the pathways get blocked -that's why I alternated them. So 14mg of iron bisglycinate and 11g heme iron (optifer, without folic acid).

That ferrosorb looks good. Is it OK to take on top of B complex (I take the vitablossom lipsomal one, recommended here). And what brand heme iron do you take?

Ive been taking 400mg of methylfolate daily for the past two years so it really has no right being so low!

Thanks

[Imaaan in reply to Becsf]

So 14mg of iron bisglycinate and 11g heme iron

^^^For your needs what you're taking isnt anywhere close to enough. Yes a mechanism kicks in when too much iron is ingested but my God you're no where near that.

If your stomach can take it you're gonna need to increase the amount you're on. With your levels I would be sick with symptoms. Mine begin when my levels drop to midway.

Like you , I take Optifera but i do 3 tablets along with iron bisglycinate. Another brand that i was introduced to by a UK member on this forum is Three Arrows Heme. I like their Heme Plus because it contains 20mg of heme iron plus a lil b12 and folate in each capsule.

Regarding a b complex, I use Thorne Basic B which is recommended often on here. I absolutely love it.

***One thing I'll mention about the Ferrasorb is that I'm not particularly fond of the 5mg b6 in it but since my Thorne basic b only has 10mg I'm fine with a total of 15mg of b6 a day. Too much can be detrimental so I take 1 pill of ferrasorb and take another Thorne iron bisglycinate to get the remaining iron.

*** When my digestion is acting up I drop down to 50-60mg a day until the flare up subsides

3 Arrow Heme Plus

[radd]

Becsf,

It’s difficult to comment regarding your iron because you haven’t posted serum iron results? Your TIBC is low that classically indicates iron overload but can be low for other reasons.

Also blood saturation is a calculation of other results and as such doesn’t have a percentage as is already a percentage. I’m wondering if you have mixed up these results? 

Of course you must only post what you are comfortable with but the more results members can see, the more rounded replies you can receive. For instance the FBC will tell if you have anaemic tendencies and SHBG will tell if your body is likely to have an excess of oestrogen (or even testosterone if you had certain symptoms) or are raising thyroid meds too quickly. 

When Hashi diagnosed I was very deficient in zinc too. The liposomal is the easiest form for availability but it still took me three or four bottles to make any difference. It’s a case of a long slow drip feed of as much as your body can accept. Similar to iron, absorption doesn’t always improve with higher doses as the body has safety mechanisms that have to be persuaded to lower their defences. 

Others have already commented regarding the rest.

[csj113]

hi, you’ve had lots of advice but just to echo on the Ferritin front:

Your Ferritin is in the “severely deficient “ category. Is an infusion a possibility for you? (If in England you can have them privately in Manchester and London). Pregnant women become anaemic because their blood volume increases but haemoglobin doesn’t - it’s a normal physiological reaction in pregnancy). I think you need to focus on getting Ferritin up pre-pregnancy.

Supplements will push Ferritin up but slowly - at your level it will take months. While Ferritin is so low it is unlikely your haemoglobin would become too high but you can keep an eye (my haemoglobin, which was right at the top of the range, went down a bit when my Ferritin went up post-infusion - apparently that’s normal).

Best of luck!

[Bhattinsami]

how about your prolactin level ? if its too high then its difficult to conceive

[Becsf in reply to Bhattinsami]

Hi, thank you for asking. My prolactin wasn't tested this time but it was by the fertility clinic, and they didn't suggest any issues. Results are attached.This test was done in July 2022, I think they specified that it needed to be done at the very beginning of my cycle. Which confuses me about this most recent test where they also included LH, and other fertility hormones (see earlier attachment) but didn't specify the cycle day.

Prolactin results

[Becsf in reply to Becsf]

Sorry I've just realised I sent the wrong image and these aren't prolactin. Here's the one I meant. Does look high in range - is there anything I can do to lower it?

Thank you for bringing my attention to this.

prolactin results

[Becsf]

Thanks so much everyone.

I'll try to respond to everyone but I'm in a rush right now.

Yes I can see I'm not taking nearly enough iron. I was feeling better with more energy/less hair loss so this is a surprise! I will look into an infusion and get on some higher doses, as well as more folate. (I did take folate in another form when off the biotin before the results)

In terms of the iron results I think I posted as they came to me, so if something is missing I need to ask for that tested again. But then I'm not always the best with details, especially when they involve numbers! I will send screenshots of the whole load of results in a second, which might answer some other questions to those who know more than me. In particular, can the urea and electrolytes reveal anything about how my adrenals are doing?

Thank you!!

blood test results

[Becsf]

more results - blood count

blood test results

[Becsf in reply to Becsf]

Iron test results

blood test results

[Becsf]

sodium and potassium

blood test results

[Becsf]

urea/creatinine, thyroid and zinc/selenium

blood test results

[Becsf in reply to Becsf]

fertility hormones

blood test results

[Becsf in reply to Becsf]

testosterone and other things

blood test results

[Becsf in reply to Becsf]

Sorry for all the messages - couldn't think of a simpler way of doing that!

[helvella in reply to Becsf]

Afraid the text is so small they are very difficult to read.

I'm not sure what you have in front of you? Pieces of paper? Photos/scans? Red underlines suggests it is a word processor document?

You don't need the first column. And you could just put the date once at the top. And remove the blank columns.

Maybe you could get them all onto one or two screenshots (at decent scale) and attach them?

[radd in reply to helvella]

helvella,

I’m on a phone today and can see all results well. Maybe they’re not showing so well on a larger screen 🤷‍♀️

[helvella in reply to radd]

This is what I see - below. Text is less than half standard display text size and I can't make out, for example, an 8 from a 9 reliably. Just about make out some things.

Screenshot showing post, image and expanded image.

[radd in reply to Becsf]

Great way of posting results 👍.

Serum iron is within the iron panel and under range. Transferrin saturation is high because the number of transferrin proteins (carriers are low). You are severely iron deficient but haemoglobin levels are holding out for now.

On my phone so will look at other results later if others haven’t already commented.

[Becsf in reply to radd]

Thank you. So which is the serum iron?

[radd in reply to Becsf]

Very top results within the iron panel.

10 (11-36)

[Becsf]

Oh, sorry they were so hard to read. They are screenshots from what the endo secretary sent me. Here they are again, hopefully bigger.

results

[Becsf]

blood count cont.

results

[Becsf]

cont.

results

[Becsf]

iron results

results

[Becsf]

urea, creatinine, eGFR, thyroid, zinc, selenium

results

[Becsf]

androgen index, fertility hormones

results

[Becsf]

last one!

results

[Litatamon]

There is a staple in Costa Rica called Carao juice. It is a blood builder. I have a friend who was severely anemic her entire life, including pica as a child, and this is the only thing that positively impacted her iron panel. And she tried everything, over decades.

The supplier that she used -

tropicalhealthfoods.com/

caraofruit.com/en/

He gives discounts for cases, if it works. Note some people feel it tastes & smells putrid. I don't, but be aware.

There are some more reasonable choices on Amazon & it is much cheaper to buy locally of course.

[Becsf in reply to Litatamon]

Thank you for this. Couldn't see any versions on amazon but if the other cheaper options don't work I will definitely consider this.

[Litatamon in reply to Becsf]

Not UK, another option -

amazon.com/CARAO-FRUIT-EXTR...

All the best.

[Becsf in reply to Litatamon]

Thank you

[Becsf]

So I've looked into the iron supplements and the gentler ones are just too expensive at the high doses I clearly need. Would it be alright to take the ones which might cause some constipation (and not that bad) for a short time to get my levels up, and then to use the gentler ones longer term to maintain them? Would that work? I'm wary because I'm also trying to do all I can to improve my digestion so it seems a risk taking something which will disrupt or change it. Is there anything I can do to mitigate the disruption?

And I will add some extra B12, folate and zinc to my supplement regimen.

Thanks so much for all the advice everyone. Would be lost without this place!