still confused about my iron results

[Mazes]

I’ve now redone my iron panel with medichecks and have similar results to last time. I can’t work out why my ferritin continues to drop. And what I can do about it as I know I need higher ferritin levels for optimum thyroid hormone function.

…………………………… Ferritin……….Iron……….. Trans. Sat………..TIBC……….UIBC

……………………………..30-264……….10-30……….25-45……………45-81………13-56

Feb 2024………………..49.5…………….24……………42…………………57.2………….33.2

Aug 2023………………..55.3…………….24.9…………44.7…………….55.7…………..30.8

Nov 2022………………..61.8……………14.8………….27.4………..…..54………………39

Oct 2021……………….. 78…………………………………41

Feb 2021………………..120………………21.4………..45.93……………52………………27.3

I re-read all the links that  humanbean shared in response to my last post but none give me an answer for low ferritin, high iron and full transferrin saturation.

My diet has remained broadly the same - I’ve been plant based for a long time. I take hcl, q10, vit c, vit b12, vit d and magnesium and 2g of armour.

My b12 levels have come back as >150 with a a range of 37.5-188 for thee past four tests so no issues there.

My vit D is a little low at around 84 for the past three tests with a range of 50-250. Unsurprising as I’m completely housebound so I’ve upped my dose to 2000mg a day.

My folate is 38.3 at the last test with a range of >7 and I’m hoping that’s a good result.

My T4 is 17.9 with a range of 12-22 and has been fairly steady for a few years.

My T3 is 4.5 with a range of 3.1-6.8 this has been slowly dropping from a high of 7.9 in June 2022.

I’m really hoping someone can help, it feels as if something isn’t quite right but I don’t know what or what to do about it.

ps - it can sometimes take me a while to respond, but I’ll definitely be reading everything.

[Espeegee]

Plant based or entirely plants?

[Mazes in reply to Espeegee]

Vegetarian for 30 years because I don’t like meat, no dairy now because of IBS and I’m not keen on eggs! I’m not vegan because I take NDT but my diet is all plants, nuts , seeds etc. I do eat really well and am very careful to get a range of nutrients - I’m aware of the varying views on a plant based diet and how I can’t get what I need but it’s what works for me.

[radd]

Mazes,

Iron has multiple mechanisms working on multiple levels. Your iron levels are slowly improving which is great, but iron serum results are only snapshot moments and can easily become deficient if adequate isn’t continuously consumed and used appropriately by the body.

Ferritin isn’t iron but a protein that iron attaches to for storage reasons, thus ensuring a continuous supply of iron even when actual iron levels become low. Ideally low ferritin reserves should improve inline with iron levels but this part of the iron mechanism appears impaired in lots of forum members.

Transferrin Saturation (T/S%) is calculated by dividing the serum iron results by TIBC, and then multiplying by 100, (rounding to nearest tenth of a decimal place). It measures the percentage of transferrin (transport protein) that is saturated with iron, demonstrating how much iron is in transport, how much capacity is left to bind iron and move to appropriate sites (such as ferritin). It is largely produced in the liver and helps regulate the absorption of iron into the blood. It binds two molecules of iron and transport it to all tissues, vital organs, bone marrow, or into containment in ferritin.

Therefore T/S % is an excellent measure of how well iron mechanisms are working. To help mechanisms work better and improve iron storage levels look at not only an iron- rich diet/supplements but factors that can impair such as chronic inflammation (eg elevated thyroid antibodies), ineffectively working or inappropriately dosed thyroid hormones that risk clogging the liver (where ferritin is made), and inadequate essential nutrients required to make thyroid hormone work properly.

Also remember ferritin is a protein and we need to eat enough protein to make proteins. Chemically, hormones may also be classified as either proteins or steroids. All of the hormones in the human body (except the sex hormones and those from the adrenal cortex) are proteins or protein derivatives. Without doubt eating more protein made my thyroid hormone meds work better, which could effectively improve your iron mechanisms performance and improve ferritin levels.

Look at a holistic picture as each make each other work more efficiently.

[Mazes in reply to radd]

Thank you so much radd , sorry its taken me a while to respond - I’ve had a difficult week.

This information is all really interesting but I will need to take time to explore and work out what is relevant to me.

Following the MTHFR links below led me to realise that the stress I’m under at the moment might be affecting my results. So I will retake my tests in a few months when, hopefully, my stress levels are lower and re-look at everything then.

[Espeegee in reply to radd]

I'd be very interested Radd if you have any idea why my ferritin has now, for years, been way over the top end of the range. currently 359 range 3-150 and has been in the 600s! I have PA and hypothyroidism in my family and I believe I'm hypo but because I'm scraping into the range I'm not eligible for any medication. High Ferritin presumably contraindicates thyroid issues or is it not related?

[radd in reply to Espeegee]

Espeegee,

Iron is intricately connected to chronic inflammation and short term inflammatory responses, but its difficult to see how iron is working with just a ferritin result?

Do you have iron panel results?

[Espeegee in reply to radd]

I tried lol but I tried to do two tests, for 2 different things, on the same morning, the first was easy but the second failed the assay so I have a new kit for tomorrow morning. They only managed to do the ferritin which was much the same as the first one I did via Blue Horizon. I'll put the results up when I get them, hopefully in a few days

[Espeegee in reply to radd]

Finally got them back, have no idea whether they’re good or bad apart from them all being in the green apart from Ferritin which is always way over the top of the range, the comment said it’s a little high, which of an understatement. I don’t supplement and haven’t since I was last pregnant, some 40 years ago.

A grid with red and green lines

[radd in reply to Espeegee]

Espeegee,

Serum iron levels fluctuate throughout the day and depend on what we’ve eaten, etc so are unreliable measures, hence an iron panel is recommended. Your iron levels initially looks great and working well, but as you say ferritin is much too high.

If you have gut issues, are carrying excess weight, full of aches and pains, I would suggest elevated ferritin might be down to chronic inflammation. However, if you aren’t symptomatic of chronic inflammation, and transferrin saturation level has been climbing, it might be prudent to be tested for haemochromatosis.

Our bodies can not excrete iron (except minute amounts in tears, sweat, etc) and iron absorption (mainly through the duodenum and small intestine) is critical for maintaining iron balance. The amount of absorption is determined by storage, utilisation and recycling, eg the rate bone marrow is producing new RBC’s, haemoglobin concentration, blood oxygen content, etc.

Haemochromatosis means through faulty genetics we lose the ability to control the amount absorbed, resulting in a constant excess to our needs. The body puts excess into storage and ferritin rises. Transferrin saturation corresponds to the ratio of serum iron and total iron-binding capacity (TIBC), and so eventually rises too as every iron mechanism becomes saturated.

Many women are diagnosed during (peri)menopause after periods stop which act as a form of iron release. Particularly if you’ve suffered heavy and prolonged periods as I did due to years of unknown thyroid issues. GP’s generally can’t authorise genetic testing, necessitating a referral to a haematologist. The criteria is long term elevated ferritin and T/S% over 50. Yours is presently 42.2.

'High Ferritin presumably contraindicates thyroid issues or is it not related?'

The increase in ferritin caused by autoimmune chronic inflammation can disturb iron mechanisms needed for good thyroid hormone function, eg impairing conversion leading to low FT3 levels . Inadequate thyroid hormone can disrupt gut health creating iron and nutrient deficiencies. Until equilibrium occurs members can experience iron deficiencies increasing when starting Levothyroxine which speeds up all metabolism including that of iron (meaning more is required).

As I see it -

If you have haemochromatosis and reduce iron/ferritin levels, thyroid hormones could function better eliminating the need for starting thyroid hormone replacement meds.

If you don't have haemochromatosis, then replacing thyroid hormones with meds could encourage better iron function, and for those meds to perform better with conversion.

[Espeegee in reply to radd]

Thank you for taking the time to give me your take on the results. My ferritin has been over the top since it was first tested in 2015, goes up and down but never remotely in range. Yes, I'm overweight, I'm sure I'm hypo too but T4 is at 12 (12-22) so no to any treatment. T3 has always been mid range so I guess I convert well enough. It has been suggested here that I have Central Hypothyroidism, something neither the GP nor the consultants I have seen had any idea about at all. I can't remember ever having an iron assay before so I've no idea if transferrin is climbing, that said it's seems nearly at the top of the range. GP once requested a haemochromatosis test along with some other bloods, the lab rejected the request as they said there was no familial link (not sure how they knew!) Inflammation might be partly responsible, I have ostearthritis in both knees, I have regular herpes break outs and endless mucus. I have some Levo lined up so I guess the next step will be to start it, retest and see what if any difference it makes. Thanks again.

[radd in reply to Espeegee]

Espeegee,

FT3 will often stay higher than FT4 levels when there is a thyroid hormone deficiency. It is the bodys effort in retaining wellbeing for as long as possible. If FT4 remains low, FT3 will eventually fall as well, and symptoms will increase.

Regarding haemochromatosis testing I would lie and tell your GP your sister or cousin have just been diagnosed and given you have such elevated long term ferritin and symptoms, you would like testing too 😬. The labs hold such authority over what tests can be conducted and have no right. There are many more genetics being discovered all the time and whether you're the first in your family for mutations to be discovered or the last, you should still have access to testing.

[GlowCoach Administrator]

I have a table that might be useful but I'm no expert on iron.

What I do know is that the richest sources of iron are in red & offal meat such as chicken livers.

If meat eaters already struggle with keeping ferritin up then vegetarians don't stand a chance.

Your thyroid levels aren't optimal. Your FT4 & FT3 too low if you could persuade GP for an increase?

Free T4 (fT4) 17.9 pmol/L (12 - 22) 59.0%

Free T3 (fT3) 4.5 pmol/L (3.1 - 6.8) 37.8%

Iron results table

[Mazes in reply to GlowCoach]

Thank you GlowCoach , I’m currently taking armour, bought privately and at the moment I can’t afford to take any more. I’m considering supplementing with some t4 to see if my conversion has improved and that helps - of course, that would be free from my gp! Visiting an endo either private or nhs is not an option as I’m housebound with cfs.

[GlowCoach Administrator in reply to Mazes]

I'm sorry to hear that you're housebound. If you switch to Levo then be sure to retest after 6-8 weeks and post results in a new post.

Once on Levo you can always add so T3 if necessary at a later date.

[humanbean]

none give me an answer for low ferritin, high iron and full transferrin saturation.

This could be a genetic, methylation problem with MTHFR genes. See this link :

stopthethyroidmadness.com/h...

I don't think a serum iron result of 24 (10 - 30) is terribly high - it's still well within the range at 70% through the range, and if you were a man it would be at the top of the optimal range. Since you are a woman you would only need to decrease it by a very small amount for it to be optimal.

rt3-adrenals.org/Iron_test_...

If your problem is due to having less than ideal MTHFR genes then it would mean you probably have too few "methyl donors".

I wrote a reply to someone about dealing with methylation problems several years ago, and it is still useful :

healthunlocked.com/thyroidu...

Folate tests (allegedly) give a total of all the folic acid and various forms of folate found within the blood. Eating a diet which has been fortified with folic acid (e.g. a diet heavy in fortified flours or breakfast cereals) could give a good result in a folate test but it could be mostly unmetabolised folic acid rather than the active forms of folate and nobody would be able to tell that this was true with just a folate test result. I haven't found anything which tells me what is being measured in folate testing. I did email Medichecks a year or two ago to ask about this and got a completely moronic answer. I haven't asked again.

I notice that you don't mention taking a B Complex. It is important for anyone with MTHFR problems to make sure any supplements they take are the "active" versions of B vitamins :

This is useful :

jigsawhealth.com/blogs/news...

...

There are a couple of other things that people can supplement with that have inactive and active versions, selenium being one of them. For info on selenium supplements see this reply from SeasideSusie :

healthunlocked.com/thyroidu...

Selenium is one of the ingredients required in the process of converting T4 into T3.

...

Which iron supplements are you taking? At what dose? And how many times a week?

[Mazes in reply to humanbean]

Thank you so much humanbean and I’m sorry it’s taken me a while to respond, I’ve had a difficult week.

Following some of these links led me to realise that the stress I’m currently under could be affecting my results - my digestion is definitely all to pot if nothing else!

I’m going to retest in a few months when hopefully my stress levels are lower and then delve more deeply into into all this fab info.

[Bertiepuss]

Hi Mazes

Radd has given an excellent explanation of how iron and ferritin works. To try to understand what the values mean it's important to know exactly under what conditions you took the tests. Were they fasted, what time of day, had you taken any iron supplements? If you had eaten, had you consumed iron rich foods.

The reason this is important is that every value measured in the iron panel (apart from ferritin which shows iron in storage) tells you what is happening at that current point of time and will change depending on what you've eaten or supplemented within the last 2 hours or so. This means they will go changing.

Your %TSat (Trans.Sat.) is the only one towards the top end of the range and just shows at that point in time the transport molecules were busy moving iron around. It's not super high (like 70%) so really nothing to be concerned. Maybe you had eaten something iron rich or supplemented iron recently before? This is why you need to know under what conditions the test was taken, it really makes a difference.

I am vegan and so is my husband. His ferritin is at 100 and mine was at 8 last September. We eat the same diet but everything else about us is different. For me I believe very heavy periods were causing a problem. You need to work out what may be 'your' cause. Could be diet, absorption issues like coeliac, supplementing other minerals like calcium and magnesium at the same time as eating iron rich foods or supplementing iron as those can block iron absorption, heavy bleeding from periods, endometriosis, fibroids. There are many more reasons too, these are just the most common ones.

If you're on facebook it's worth joining this group - The Iron Protocol (For Iron Deficiency With And without Anaemia) It has a set of guides that gives you all the information you need to understand how to improve ferritin in a safe way and how to take tests and interpret them properly. This has been working for me and my ferritin levels have been rising over the last few months. It's slow going but I now have a much better idea of how to manage this. I highly recommend it, it has so much valuable information.

Not sure if this link works facebook.com/groups/theiron...

[Mazes in reply to Bertiepuss]

Thank you Bertiepuss , I’ve decided to wait a couple of months until my stress levels have, hopefully, come down and then retest and revisit this information. In the meantime, I’ll join the facebook group and start absorbing some information slowly 😊

[Bertiepuss in reply to Mazes]

You're welcome 😊 Makes sense, good luck and hope you find a way forwards🙏

[Batty1]

Interesting Read:

hematology.org/education/pa...

[Mazes in reply to Batty1]

Thank you Batty1 😊

[Mixteca]

B12 deficiency is not about the numbers as such - you could have it when results are in range. Do post on the PAS forum for advice. I recommend consulting an iron specialist re ferritin etc.