Fasting bloods taken at 08:50 at least six weeks after last Vit B12 injection.
Thyroxine not taken that morning so it was at least 24hrs.
I usually have the same prescription for my thyroxine Accord ( not Teva) 100mcgs and Wockhardt 25mcgs 125mcgs alt die. I have stressed to my pharmacy that I cannot mix brands.
The hospital lab will not do Any other thyroid tests but the results you see.
I take magnesium, Vit D , but not Vit B12 orally . I M every four months.
I believe I have Hashimotos auto immune hypothyroidism.
I know the Ferritin is low and should be nearer 100, but if the iron panel is ok, what to do?
Vitamin D Total 25-hydroxyvitamin D Level 54nmol/L
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
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
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.
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. ‘
Your ferritin is borderline and it makes sense to increase it. The relationship between hypothyroidism and iron deficiency is confusing. I should declare that I have not read loads of studies on the subject, rather I'm trying to apply simple logic as much of the 'evidence' comes from studies in select cohorts.
There is good evidence that hypothyroidism can cause low iron status and resolving this can resolve symptoms. I've seen no good evidence that in practice typical low iron levels actually cause hypothyroidism or 'stops the hormone working'. If it did TSH would be high. This is where confusion can set in since people often feel better when there iron levels rise - is this because iron has improved thyroid hormone action, or because improved thyroid status has improved iron status. I would say the latter - the reason being that a large part of the world's population has anaemia yet they are not hypothyroid.
Some studies have shown improvement when ferritin is at 'high' levels (high compared to population average). It seems that when iron deficiency is longstanding (as it is in hypothyroidism) it takes a long time (six months?) for iron stores to restore.
What I'm trying to address is that it is wrong to say ferritin needs to be at x where x is e.g. 80. For most of the population it is fine for it to be around average which (going from memory) is a little over 40 for females. A small group of people need much higher ferritin levels, at least for a while, hypothyroids are more likely to be in this small group than the general population.
There was an excellent presentation on the subject recently from the Thyroid Trust: "Iron and selenium's role in thyroid function talk by Prof. Margaret Rayman". If they put a video out I will post about it.
it gets complicated. What is often wrongly termed the 'normal range' is usually a 95% reference interval (the numbers in brackets). This is an arbitary guide used in medicine, they take samples from a presumed healthy population and find the cut-off points for the middle 95%. It's a statistical tool. Two and a half percent of the healthy population will have results above the reference interval and two and a half percent below. Some people with results within the reference interval will nonetheless be ill. e.g. be anaemic.
The general guidance tends to be if ferritin is < 15 the person definitely has iron deficiency and if 15 <ferritin < 30 they might be anaemic and should be given a trial of iron supplements if they have signs and symptoms that might be from anaemia. This is a rough guidline and there have been cases of iron deficiency with much higher ferritin levels. It's a question of interpreting the blood tests along with the clinical picture, not saying everyone must have a higher ferritin and not saying you can't be iron deficient if your ferritin is e.g. above 30.
In your case if you have symptoms that might be due to iron deficiency I would take some extra iron, from food or supplements, for several months to see if you get better. I do not have a lot of knowledge of anaemia.
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