I was hoping to get some advice on my iron status. A bit of background, I have just recently increased levo to 88mcg a couple of weeks ago, and was on 75mcg before that. So, I am aware that my thyroid hormone is still too low. It's a slow process getting docs to increase!
My question is regarding my iron. Here are my latest results from a blood test around two weeks ago:
Iron 84μg/dL (49-151)
Ferritin 87ng/mL (10-120)
Transferrin 223mg/dL (200-360)
Transferrin saturation 29.7% (17.1-30.6)
Hemogram:
WBC 8.4 (4.2-10.5)
RBC 4.08 (3.9-5.2)
Hemoglobin 12.6g/dL (12-16)
Hematocrit 37.4% (35.5-45)
Mean Corpuscular Volume(MCV) 91.7FL (80-101)
Mean corpuscular hemoglobin 30.9pg (27-34)
Mean corpuscular hemoglobin concentration (MCHC) 33.7 g/dL (31.5-36)
Platelet count 299 (130-450)
ESR 51mm/h (5-25)
A few extra details—I last got tested for these August 2022. Iron only slightly higher at 92 (60-180), and ferritin was lower at 41. Let me know if I should post complete results for August 2022, but I don't know how relevant it is now. I have supplemented a little this year, on and off, as I was feeling exhausted after my periods, and because the Aug 2022 results were low in the range, but I was also very hesitant as I know iron can be dangerous if not supplemented correctly. I think at the time it did help me feel better, but it hasn't had much effect on my levels (in fact there has been a slight drop).
I think my ferritin may be higher now due to inflammation, as my ESR is also raised. I have also read that with chronic illness ferritin should be closer to 100?
Technically everything is in range, but my hemogram is at the edge of the ranges, especially hemoglobin, and from what I've read iron isn't optimal either. But I'm really not sure.
Can anyone give me advice on my iron status? Does it look ok? Or could there be some iron deficiency (with or without anemia)? Should I be supplementing iron and if so how/how much?
Thanks in advance for any advice!
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catpotter44
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I copied some guidelines from previous posts if they are of any help. humanbean can often help with iron related questions
NICE guidelines on iron deficiency anaemia (cks.nice.org.uk/topics/anae... say to check ferritin for anyone with MCV (mean cell volume) less than 95fL, They also say anaemia is indicated with haemoglobin below 120
and ferritin of less than 30 indicates iron deficiency,
Iron : Optimal is 55% - 70% of the way through the range i.e. 21 - 24.
UIBC : Optimal is very approximately mid-range i.e. approx 47.
TIBC : Optimal is very approximately mid-range i.e. approx 59. According to the link I gave above :
Low in range indicates lack of capacity for additional iron
Ferritin : Optimal is mid range or a little bit over i.e. approx 82 - 120 or 82 - 130.
Thanks for the reply! Great info. Hopefully humanbean will reply as I think I'm kinda borderline so a bit confused. Unfortunately I can't access that link as not in the UK.
For ferritin (iron stores) specifically, I use this link, which at least gives some numbers rather than being vague, even though the lower level for the range is too small in my opinion. NICE suggests anything under 30 ng/mL is iron deficiency :
Normal ferritin levels for women are between 20 and 200 ng/mL. According to some experts, ferritin levels of at least 40 ng/ml are required to stop hair loss, while levels of at least 70 ng/ml are needed for hair regrowth. The optimal ferritin level for thyroid function is between 90-110 ng/ml.
I don't have optimal levels for everything.
When doing an analysis of iron results it is quite common for people to have contradictory results i.e. one result might suggest more iron is needed while another one suggests there is already plenty of iron.
I'm going to have a problem with your results because the reference ranges are quite different to those in common use in the UK - but I'll do what I can.
...
Iron : According to the suggested optimal results for iron it should be
• 55 to 70% of the range
• higher end for men
Your result is 34% through the range which suggests you need more iron - but your result isn't dreadful.
.
Transferrin :
• Low in range indicates lack of capacity for additional iron
• High in range indicates body's need for supplemental iron
With this kind of suggested optimal I assume mid-range is a reasonable result. Your result of 14% through the range is low in range suggesting that you lack capacity for more iron.
Transferrin can be reduced by chronic illness and inflammation.
.
Transferrin saturation 29.7% (17.1-30.6)
• optimal is 35 to 45%
• higher end for men
This is one of the places where I have a problem with your reference range. Your range is much lower than the ones I usually see. The last time I had a result for transferrin saturation myself the range was 15% - 45% which suggests that optimal saturation can be quite high in range and be okay. On that rather flimsy basis I would say your saturation is high in your range, and is fine.
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Ferritin 87ng/mL (10-120) 70% through the range
The optimal ferritin level for thyroid function is between 90-110 ng/ml.
Another result with a totally different range to the one I'm used to. Personally I like my own ferritin to be around 100 ng/mL which might work for you. It's fits within your range and also within the optimal level given in the link from thyroidpharmacist.com above. This suggests that your result isn't too bad at all but could be a smidgen higher.
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Just as a general comment I would say that your iron results aren't awful, and you don't need iron supplements. The one thing to avoid with both iron and ferritin is them going over the range. Having too much iron is dangerous because the body can't get rid of the excess and it could end up being deposited in the brain, muscles, or other organs. Just a small increase in your iron intake is worth trying to see if it helps you to feel better. Alternatively, if you eat a meal with generous amounts of iron in it then drink some orange juice with the meal. Vitamin C helps the body to absorb iron from the diet.
Something that helps some people, but not everybody, is taking supplements containing "methyl groups".
This old reply I wrote gives more details on methylation and methyl groups :
Those four compounds listed would need more research than I've done, but I've taken methylfolate and methylcobalamin for years. They are all methyl donors that can be bought without prescription on sites like Amazon and Ebay.
What these methyl donors do for some people is they can alter the proportion of iron and ferritin in the body to something more healthy.
One factor to consider is that the body stores more iron in ferritin than serum iron when someone has lots of inflammation or has an infection. This is because serum iron is available for pathogens to use in their own reproduction, which is obviously a bad idea. So to prevent that the body stores more iron in ferritin than having it floating around free in the bloodstream.
I'll give you some info on the result of your Full Blood Count (FBC) in another reply.
A high level suggests that you have some form of inflammation or infection. Your level is not bad. Reducing the WBC would require you to optimise everything you can, such as nutrients, thyroid and cortisol, which are the usual things affected by thyroid disease.
A low level could indicate low levels of nutrients, particularly iron, folate and B12, or possibly malnutrition. There are other possibilities, see the link.
In the UK hemoglobin is the result that many doctors appear to use to diagnose anaemia. In my own experience low in range or below range iron/ferritin won't trigger a diagnosis of anaemia or any treatment if haemoglobin is in range. I think some doctors may look at RBC for a diagnosis of anaemia. Other doctors than mine may be more compassionate, you never know. Iron supplements, if needed, can be bought from pharmacies in the UK without a prescription.
Your result could be better, but you wouldn't be classed as officially anaemic in the UK. To improve haemoglobin would require optimising the basic nutrients. Improving gut health might help too. And of course, optimising thyroid hormone levels. I'm referring to Free T3 and Free T4, rather than TSH.
Mean Corpuscular Volume(MCV) 91.7FL (80-101) 56% through the range
MCV tells you how big or small your red blood cells are.
When B12 and/or folate are too low it causes MCV to be high.
When iron and/or ferritin are too low it causes MCV to be low.
If someone has low B12 and/or folate, and low iron and/or ferritin then MCV can be big, small, or somewhere in the middle, so it can't be relied upon to predict what nutrients might be low and which might be fine.
When MCV is not at a good level then red blood cells don't carry oxygen very efficiently, which is one reason why anaemia can make people breathless.
Thank you humanbean for all the info and analysis!
When doing an analysis of iron results it is quite common for people to have contradictory results
Yes, this is exactly why I needed some help. Had done my own research but was finding it a bit confusing.
Your result of 14% through the range is low in range suggesting that you lack capacity for more iron. Transferrin can be reduced by chronic illness and inflammation.
Thank you for this! I had read the lack of capacity part, but didn't know why or if it could be addressed. Chronic illness/inflammation makes a lot of sense.
Just as a general comment I would say that your iron results aren't awful, and you don't need iron supplements.
This was my biggest doubt, so thank you. For now I think I will focus on trying to increase my dietary intake and see how things go.
Your result could be better, but you wouldn't be classed as officially anaemic in the UK.
Basically I think things are probably either borderline 'anemia of chronic illness' or simply that my iron isn't optimal because my thyroid isn't optimal yet. (A bit of both maybe). I had wanted to address iron if necessary, as I have read on this forum before how important optimised nutrient are to even use thyroid hormone correctly, but also seems there is a limit to what I can do before t4 is optimised. Bit of a chicken and egg conundrum!
My folate is in range but not optimal. B12 is now just over range after supplementing with a sublingual option. I'm planning on switching to the Igennus B-complex I've seen recommended on here.
Regarding ferritin, I'm pretty sure it is elevated due to inflammation. I have seen recommended, I can't remember where just now, aiming for 100 when you have chronic conditions, to account for inflammation.
A high level (WBC) suggests that you have some form of inflammation or infection.
Also very interesting, I had noticed that this has increased since my previous FBC.
Other doctors than mine may be more compassionate, you never know.
Things aren't much better in Spain, in my experience.
What I don't know is what classifies as high for ESR as far as doctors are concerned? Is it 50? 500? 5000?
THIS! How do we know whether to be concerned, it's so vague! I had a substitute doctor go through these results and he was rubbish. I also had to fight with him to increase my levo from 75mcg to 88mcg. I have an appointment with another (new)doctor this week, fingers crossed that she is more helpful and sympathetic!
Crazy how we all have to self educate and fight for some kind of decent minimal level of care. It has been so great finding this forum and seeing my own difficulties mirrored. It's nice to have a feeling of solidarity at the same time as it is frustrating to see how widespread bad care is.
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