Hi, I got diagnosed with underactive thyroid in September 2023. I was put on 50g of Levothyroxine and iron tablets as I had low ferritin and anemic.
My latest results show I'm no longer anemic but my ferritin is still relativity low despite having been on iron tablets for 2 months.
Dr seems to be happy with my thyroid levels and says my fatigue and headaches is probably just the iron so no need to adjust the level at present. I've been on the Levo 6 weeks - is my level likely to keep dropping over the next few weeks without needing adjustment. I think I probably need to take some vitamins and collages for my B12 and D and to improve the dry skin and hair.
I'm looking for some advice on if I should be discussing increasing my Levo with my dr and on vitamins and when to take them to avoid any interactions with my thyroid medicine.
(I took tablets after blood test and only drank water before - taken around 8.30am)
Test results:
13th Sept (NHS):
Serum TSH - 10.4 miU/L (0.35 to 4.94)
Serum ferritin - 5ng/ml (20 to 204); Serum folate - 5.4 ng/ml (3.1 to 20.5)
Vitamin B12 - 231pg/ml (187 to 883); Haemoglobin - 99g/L (115 to 165)
You certainly do need an increase of Levo as a starting point you are aiming to get your TSH around 1 or below.
One of the fabulous admin team will be along with loads of information to get you started, as you say your vits and mins are terrible and may need something more than supplements!!
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
Which brand of levothyroxine are you currently taking
Try to not change brand as you increase dose
Only change one thing at a time
Many people find different brands are not interchangeable
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and a week or so later add a separate vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose
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
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can 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
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
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. ‘
Thank you for all your guidance - this is so helpful. In answer to some of your Qs I'm on Levo, not vegan/vegetarian and eat a good level of meat and greens.
I'm 46 probably in perimenopause but not sure as my symptoms have largely been brain fog, dry brittle hair, hair loss, fatigue etc which seems to be the same as iron and hypothyroid symptoms.
Thanks and I'll be booking an appt to talk to my GP about an increased dose.
If you are eating meat then I would suggest you avoid supplementing B12 as it can give a false high reading on bloods and ask for a course of B12 injections. You are not absorbing B12 very well, maybe because you are hypothyroid, taking tablets probably wont help very much.
your TSH is certainly going in the right direction but it’s still too high meaning you need more thyroxine. Are you keeping your iron medication well away from your levo medication as there is a contraindication between them. Iron tablets effect levothyroxine medication.
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