Low iron/ferritin common when inadequately treated for hypothyroidism
What are you currently taking
Levothyroxine? ….how much and which brand
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
On T3 or NDT …day before test split T3 as 2 or 3 smaller doses spread through the day with last dose 8-12 hours before test
What are your most recent thyroid results and ranges
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. ‘
Thanks for replying SlowdragonI had thyroid test in early May that is the last test done
Thyroid function test
Serum TSH level 0.88 mu/L [0.27 - 4.2]
Serum free T4 level 12.7 pmol/L [10.0 - 21.0]
I am on NDT and have recently increased to 3.5 grains.
I was thinking it might be an absorption problem with the iron
Could I convince the GP to do a full iron panel. I also think an iron infusion would be helpful but I have the problem of trying to convince the doctors to do it.
The GP has prescribed iron gluconate and said she wants to try this before a referral to haematology.
Thanks for the links I will have a read.
I do eat meat. I have also been eating liver twice a week. That is why I am surprised with the very low result.
I have low ferritin (15/18). My GP has referred me to specialists for an iron infusion. A haematologist refused to see me! I cannot absorb iron through my stomach. I have ordered iron and vitamin V patches off t he internet. Using for 2 months, recent tests sh owed I'm still at 18. Gastroenterogist (I have a telephone appt mid December) refused iron infusion. A lot of hair has fallen out, not quite as fatigued as I was a few months ago but not full of energy. I am well medicated with l evothyroxine. Why are specialists so uninterested in providing an iron infusion, at the expense of my health?
Thanks for your reply. I have found GPS's very unhelpful in the past. My low ferritin is going on many years now. This gp wants to try things before she refers me. My worry is if the ferritin does raise by even a little they might refuse to help. What is the criteria for getting an iron infusion?
Yes, I worry about that too because I am using iron and vitamin C patches. I am not sure what the criteria are. My GP seemed to agree with me about getting an iron infusion but the specialists didn't. Even though I am iron defficient it hasn't affected my haemaglobin ...YET...but it could do if the measure kept dropping, then it becomes serious.
My GP prescribed tablets, then a liquid supplement. Made no difference to my ferritin level. Cannot absorb through my stomach so reluctant to try more supplements. Am using iron and vitamin C patches now. Not sure they are doing much good either.
Absorption is likely to be the problem and oral iron therefore not appropriate. I was actually refused an NHS infusion when my ferritin was 41 and haemoglobin was 120. It was only when ferritin dropped to 30 that they changed their minds. They didn't consider iron deficiency without anaemia (IDWA).
yes, I must have iron deficiency without anaemia. I don't absorbe zinc either. I've had a lot of hair drop out which is very upsetting and I get more tired than I should do. I'm speaking to a gastroenterologist in December. See what happens then.
I recommend seeing an iron specialist asap. You'd benefit from an infusion but may well have to go privately. Feel free to message me for his details. He's also a B12 specialist.
You're most welcome. I sincerely hope they finally help you. If you're not done a full blood count recently, including vitamin D & B12, do that asap. You'll need those results if you choose the private option.
I had to pay for a private iron infusion as the NHS didn’t even mention it and my ferritin was 11. My folic acid was 2 mg. I could barely get upstairs without being breathless. My tongue was swollen and sore. The rheumatologist didn’t even mention the levels as they on the border line.
I asked for my results and a private doctor found my transferrin levels weren’t good.
I took folic acid high dose before transfusion. They gave me vit D and B12 injections and I have felt fantastic for 18 months. Just started to feel exhausted again. I am having my bloods tested with the NHS this week.
I hope this helps to know the iron transfusion works
The GP may not have a choice about an infusion, depending on your full iron panel results. I was offered one on the NHS when my ferritin was 30 and transferrin saturation % was 18. Post again when you've had that and other relevant tests.
I can't comment on your case without knowing the details and no two cases will be the same. Left to my own GP's judgement, and their paltry knowledge of biochemistry, I wouldn't have gotten as far as a full iron panel.
I requested that test and then had a consultation with an iron specialist who confirmed a significant deficiency.
Oral therapy is usually the first line of treatment but as I'd been supplementing for years and couldn't get ferritin higher than 50, the infusion was the best way to replenish levels.
As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.
This can help keep all B vitamins in balance and may help maintain B12 levels between injections
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)
This can help keep all B vitamins in balance and will help improve B12 levels too
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)
Post discussing how biotin can affect test results
HiThanks for replying. I get injections every 8 weeks at the doctors but I self injections every week too. I will get the b complex as suggest Thanks. Just worried about the low ferritin really
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B12 - Folate & Ferritin Test Results
Iron results 
Help with supplements please
Please comment on my ferritin,folate & B12 results
My blood results 
