Low t4 postpartum

[Hj101]

Hello, I am 5 months postpartum and struggling with fatigue, brain fog, cold, anxiety, weight gain. Obviously sleep deprivation will be having an impact but I also feel like something is missing physically. I am also breastfeeding. T4 has been low since second trimester of pregnancy, we added 50mcg of levothyroxine in my last trimester but I was instructed to stop this 2 weeks postpartum as my levels should return to relatively normal. Any advice prior to my endo appointment on Friday would be appreciated.

Dose: 3 grains Armour thyroid.

Bloods March 2023 (last 1grain dose of Armour 12 hours before test)

TSH: <0.01mU/L (0.35-5.5)

Free T4- 8.9 (7-17)

Free T3- 5.5 (3.5-6.5)

Serum folate >23.5 ug/l (>3)

Serum ferritin 20ug/L (15-300)

Serum B12 470ng/L (150-900)

Serum total 25OH vit d level 34 nmol/l (no range given, blood results printout advises to supplement, 400iu prescribed by gp)

Supplementing with spatone iron once daily and 3000iu vit d spray since blood test. I haven’t been able to take my usual supplements (b complex etc) as they say not to use when breastfeeding.

I have been strictly gluten free for several years. I am currently also dairy, soya and egg free as my son appears to have allergies to these….I haven’t found this has made any improvement to my energy.

Any thoughts greatly appreciated!

[GlowCoach Administrator]

Congratulations on baby.

Free T4 (fT4) 8.9 pmol/L (7 - 17) 19.0%

Free T3 (fT3) 5.5 pmol/L (3.5 - 6.5) 66.7%

With people on NDT FT4 often is low but some people do benefot from adding a small amount of Levo to top that up.

I think your biggest issue are the low vitamin levels, especially ferritin.

NICE state that a ferritin of 30 or under is a deficiency and your GP/Endo should be prescribing iron. You should also get a full iron panel done, post results here.

Spatone is really very weak and unlikely to raise your levels. Do also focus on iron rich diet - chicken livers, pate, red meat several times a week.

Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Use this calculator to work out how much to take to get your level to 100-150. wildatlantichealth.com/vita...

Link to a post by SeaSideSusie on Vit D supplementing: healthunlocked.com/thyroidu...

Let's ask SeasideSusie about whether it's OK to supplement B vitamins whilst breastfeeding.

[Hj101 in reply to GlowCoach]

Thanks, that’s all really helpful. GP was not interested in discussing iron, I’ll see if I can get my endo to ask for the iron panel.

[GlowCoach Administrator in reply to Hj101]

GPs can be pretty hopeless regarding ferritin. You can try a different one at the same practice as well as Endo. See infographic below re symptoms.

Actually I just checked the NHS website and they say its fine to supplement B12 while breastfeeding.

nhs.uk/medicines/cyanocobal...

low ferritin symptoms

[Hj101 in reply to GlowCoach]

It’s like someone made a poster about me!! Haha.

Thanks, I think I’m going to restart the breastfeeding supplement that I was taking previously and then top this up with the things I’m short of…..everything other than these seems to say not suitable when pregnant or breastfeeding, probably a clever marketing ploy but I don’t want to mess up and take doses that are too high etc. I am currently transitioning little one onto formula so in a few weeks I should be able to take anything I need to.

[SeasideSusie Remembering in reply to GlowCoach]

I'm not qualified to answer that, it wasn't a thing (taking any supplements) when I had my babies over 50 years ago. Best ask your doctor or perhaps you can still contact your midwife or health visitor (or whoever/whatever they do these days).

[SlowDragon Administrator]

Low ferritin will no doubt be contributing to fatigue

Vitamin D is very poor too

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 

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...

Effective supplement 

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. ‘

[Hj101 in reply to SlowDragon]

Thank you, this is really useful. I’ll see if my endo will push the gp to do an iron panel and focus on my diet in the meantime.

[SlowDragon Administrator in reply to Hj101]

Likely to need at least 2000iu vitamin D per day to bring vitamin D up to at least 80nmol

Once your baby is on formula they will get vitamin D in the formula, but when just breast fed they need vitamin D drops