Unfortunately Folate and vitamin B12 were not tested due to a lab error but my vitamin B12 levels have previously been on the high side of the range. I haven’t been tested for Folate before so wouldn’t know about that.
Should I try to increase my Ferritin levels to be higher within the range ?
I’m wondering if I should take 50mg Levo 5 days a week and 75mg 2 days in an attempt to get my TSH level up to around 1.5??
Or should I ask to try a different brand of the 25mg, ie the one beginning with W? (can’t remember how to spell it).
When on 50mg my TSH was just below 4, so this extra 25mg has made a big difference
Thankyou so much for your thoughts, I have a GP appointment tomorrow.
I had a NSH blood test for TSH two days after this Blue Horizon one, and my GP messaged me saying she thought I was in danger of going into the Hyperthyroidism range now that I’m on 75mg per day, so will be discussing this with her tomorrow.
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I’m wondering if I should take 50mg Levo 5 days a week and 75mg 2 days in an attempt to get my TSH level up to around 1.5??
Why would you want to do that? It's not about the TSH, it's mainly about the FT3, and yours is low. It's low T3 that causes symptoms, not TSH at any level.
my GP messaged me saying she thought I was in danger of going into the Hyperthyroidism range now that I’m on 75mg per day, so will be discussing this with her tomorrow.
Oh dear! She's very ignorant, isn't she. You are hypo, with only half a thyroid, you cannot 'go hyper'. I suppose she means 'over-medicated' (in which case she should say so!) but the TSH isn't going to tell you that, despite what doctors think.
TSH is a pituitary hormone. When the pituitary decides there's not enough thyroid hormone in the blood it increases output of TSH to stimulate the thyroid to make more hormone. When the TSH goes low, it just shows that the pituitary is satisfied with the amount of thyroid hormone in the blood. But, it cannot distinguish between T4 and T3. Your FT4 is high, because you are a poor converter, but your FT3 is too low for good health. So, whilst you might be taking too much levo, if that levo is not converted to T3, you remain hypo.
So, how do you feel on that dose? How you feel is as important as the numbers on a blood test.
I would suggest that you refuse to reduce your dose based solely on a low TSH, and point out the low FT3 (although she probably won't know what that is!) and the fact that you are a poor converter, as shown by your high FT4. T3 is the active thyroid hormone, needed by every single cell in your body. You don't have very much. Reducing your levo would probably reduce your FT3 even further.
The first thing to do is to optimise your nutrient levels - SlowDragon talks about that below. And, you can try taking selenium, which is essentail for conversion. But, sometimes there's nothing you can do except add some T3 to your dose of levo - which can be difficult to obtain. So try the nutrient route, first.
But, above all don't let her reduce your dose of levo at this point.
Update….. GP agreed to keep my Levothyroxine dose the same for three months, but said I wasn’t Ferritin deficient at 36 because the lowest figure in the range was 13, so nothing to worry about.
Well, just goes to see how ignorant he is! For goodness sakes! You don't have to be right at the bottom of the range to be deficient, the ranges are much too wide! He just doesn't understand what ranges are, that's all. And, even if you're not deficient, your ferritin is far too low for good health. BUT before starting supplements you need to have your serum iron tested because it's possible to have high serum iron but low ferritin, and in that case, it's not a good idea to take iron supplements. I honestly don't know what you can do about that level of ignorance.
I know, scary isn’t it. But how many patients across the country are being told this, the majority wouldn’t do their own research or know about support groups such as this one to make them question their gp. If only the ranges were more logical!! 😤
All I can do is get private blood tests and see a private Consultant.
Although I feel like I want to get iron supplements into me straight away, I promise I will get a Medichecks test first. Many many thanks for your insights , it’s much appreciated.
It is scary, yes! Most people believe that doctors know everything and have their best interests at heart. Neither are true! I often wonder how many people they kill with their ignorance and negligence.
Rather than starting on iron supplements right away, can you increase your consumption of iron-rich foods? But, if you do, make sure you eat a rich source of vit C at the same time to aid absorption - or take vit C supplements.
Yes, from now on I’ll be mindful and I’ll try to eat more iron rich foods alongside vitamin C, but being vegetarian I can’t eat chicken livers etc which I know would give me a big boost. Will do more research into best iron rich vegetarian foods.
I’ve had another blood test to check all my iron levels as you suggested and I now have these results back and would be really grateful if you could take a look and let me know your thoughts please :
Medichecks BLOOD TEST results: 25/4/25:
Iron Status:
Iron. 24 umol/L. (5.8-34.5)
TIBC. 65 umol/L. (45-81)
Transferrin saturation 36.8 %. (20-50)
Ferritin. 52.6 ug/L. (13-150)
Red blood cells:
Haemoglobin. 135 g/L. (120-160)
Haematocrit 0.421 L/L. (0.35-0.47)
Red cell count. 4.6 x10^12/L. (3.8-5.8)
MCV. 91.5 fL (81-98)
MCH. 29.3 pg. (27-33)
MCHC. 321 g/L. (300-350)
RDW. 13.6 %. (11.5-14.4)
Folate. 14.78 ug/L. (3.89-26.8)
Vitamin B12. 150 pmol/L (37.5-150)
Vitamin D. 162 nmol/L. (50-175)
So wondered How do these Iron levels look to you ? Do I need to take iron supplements do you think?
Since my previous test in March, I have been making sure my (vegetarian) meals have contained iron and vitamin C, and was happy to see that my ferritin level has got a bit better.
I have begun taking Iggenus B Vitamins to increase my Folate. (After this blood test)
One more question if I could please …… I would like to try some T3 medication but what levels do my Ferritin and Folate have to be at before I can begin taking T3? My T4 is high in the range and my T3 is on the low side of the range on 75mg Levothyroxine . TSH 0.35.
Thankyou so much for taking the time to read this, I can’t tell you how much I appreciate this knowledgeable forum .
You're serum iron looks low, but I'm afraid my knowledge of iron is very limited. I would suggest you start a new thread with these results so that those that know can reply.
Have just read that NICE consider ferritin levels of under 30 to be deficient, but doctors don't agree - although what they know about it could be written on the back of a postage stamp! So, at 36 you're maybe not deficient, but almost! And in any case, before you get to 'deficient', you have 'too low', which is almost as bad! Funny how they can be so finickity about numbers when it suits them, and other times completely ignore them!
NICE only changed the lower end (in the Clinical Knowledge Summary) fairly recently.
It is not mandatory for anyone to use that revision. Even if it were, it takes time to works its way through.
I'd argue that while 30 is better than 13, being at 30 really isn't good enough - it is just that below 30, serious action is needed. Above 30, maybe less of a panic is needed!
Forgot to say, my selenium levels received yesterday were above range at 3.82. (Range 0.66 - 1.57) so maybe I should take my supplement every other day. So selenium not the cause of my poor T3 converting unfortunately.
Last question, Is it the case that I can’t start to take T3 medication until my Ferritin level has raised? All my other nutrient levels are good. 5 months ago, Folate was 10.7, is this ok? B12 and vitamin D were above range.
Do you take B12 supplements? Folate could be higher. Do you take a good B complex?
I don't know if you can take T3 with low ferritin - I mean, there's nothing to stop you taking it, but the question is: will it do any good? And I don't know about that. Taking it might help, but not as much as it would if your ferritin is optimal. Then again, it might just be a waste of good T3. Maybe try it and see.
I take health leads vitamin b complex currently but only twice a week because I was worried about my B12 levels going even higher than they are already. Thinking it may be dangerous to go sky high? They were 883 pg/ml. But will be changing to the Thorne Basic B complex that I’ve read about on here. What is the optimum figure for Folate?
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
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.
Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:
Females 18 ≤ age < 40. 30 to 180
Females 40 ≤ age < 50. 30 to 207
Females 50 ≤ age < 60. 30 to 264l
Females Age ≥ 60. 30 to 332
Males 18 ≤ age < 40 30 to 442
Males Age ≥ 40 30 to 518
The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.
Thankyou SlowDragon for the links re iron and ferritin. I spent hours yesterday pouring over the information…… I’ve never given any thought to ferritin and iron levels before so it’s a new subject for me to learn about. I’ve never felt the effects of being iron deficient, even though I’ve been vegetarian since the age of 14, but now will be mindful of my diet in respect of iron, especially because I may need T3 medication.
So to confirm, I need to increase my ferritin levels before starting medication for low T3 levels, because that medication doesn’t work well if your Ferritin is low?
I found a blood test run via my gp 5 months ago and my ferritin level then was 42ng and it is now 36.90.
Also at that time 5 months ago, my B12 levels were 883pg (range 197 - 771) so above range
And my Folate level was 10.7ug (<3 being deficiency).
These two were missed off my report this time.
I have just spoken with my Gp who told me I didn’t need a complete iron panel check because I was in range, with 13 being the figure to stay above. I didn’t argue, I just silently resolved to get it done privately.
My GP did however agree today that I could continue on the same dose of Levothyroxine, to be checked again in 3 months.
So to confirm, I need to increase my ferritin levels before starting medication for low T3 levels, because that medication doesn’t work well if your Ferritin is low?
Yes
I have just spoken with my Gp who told me I didn’t need a complete iron panel check because I was in range, with 13 being the figure to stay above. I didn’t argue, I just silently resolved to get it done privately.
From my experience: whatever dose you are taking divide it evenly to take the same amount every day. Do not take some days 50mg and other days 75 mg. I was cutting tablets to have the same amount of levo every day. I actually read it on this site, and it was extremely helpful that the cells in our body react not only to the lack or excess of the hormone, but also to the change of the amount. My case was complicated, I was hyper after thyroidectomy, and fluctuations of doses caused pinch and needles in my whole body. I noticed that when the dose was the same pinch and needles would go away.
Thankyou for replying OlgaB, I had been wondering about the merits of changing doses alternately against cutting a tablet in half and so taking the same quantity each day. So that’s good to know for future reference, Although today I’ve been given the go ahead to stay on 75mg per day ……”for now”…..so I currently haven’t got that problem to deal with. (I was worried my gp was going to reduce me back to 50mg, so I was preparing a compromise!)
The units of measurement for ferritin in your test are micrograms/litre.
The units of measurement for ferritin in the info in bold below are nanograms/millilitre.
1 microgram/litre is exactly the same quantity as 1 nanogram/millilitre
The above link says :
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.
So your ferritin is below optimal and needs to rise to 90 - 110 ng/mL (or 90-110 mcg/L).
The other results you have from an iron panel are all optimal. I would suggest that you don't supplement iron, and just continue your diet as it currently is, or perhaps add in a meal high in iron once or twice a week. The problem with iron is that when people take iron supplements for the first time they can't tell in advance whether their ferritin will rise or their serum iron will rise. I think that the most likely thing to happen to your results is that serum iron would rise and ferritin would stay too low to be optimal. High iron levels in the bloodstream are not healthy because excess iron can get deposited in the organs and the body can't get rid of it very easily.
One thing that might alter the ratio of serum iron to ferritin is to optimise B12 and folate.
Folate. 14.78 ug/L. (3.89-26.8)47.5% through the range
Vitamin B12. 150 pmol/L (37.5-150)
Vitamin D. 162 nmol/L. (50-175)
Optimal for folate is upper half of the range i.e. roughly 15 - 27.
Yours is very close to optimal. If you ever need or want to supplement folate a good supplement is methylfolate rather than folic acid.
B12 - Your result is already top of range. That is fine, but you might want to reduce your supplementing a little, because having a result as high as yours is rather wasteful.
For info on choosing a B12 supplement (if you ever need one)
Your vitamin D is very close to the top of the range. Vitamin D is fat-soluble and excess can be toxic. I would suggest reducing or stopping your supplementing for the summer and then re-test in the autumn.
Hi Humanbean, I can’t thank you enough for looking through my results and for giving me so much information in your reply. You have been so generous with your time 🙏 am sending you a big hug!
I especially appreciated that you calculated my percentage through the range and advised what the optimal figures were, so very helpful to know those!
It’s pleasing to know that my iron levels are pretty good for a vegetarian, apart from the Ferritin of course, which is a bit of a mystery.
Fingers crossed my Endo appointment goes well on Wednesday and I get some T3!! Will post how it goes in the hopes that it helps others.
The key indicator for sufficient iron required for effective cellular use of T3 is your transferrin saturation - this needs to be 25% minimum for T3 to do it's job, and optimal is 35 - 45%. This says that an optimal proportion of transferrin is bound to iron, which is typically a sign of adequate iron availability and certainly enough for T3 to be effective. Not sure I've ever seen anyone on here post with a 35%+ result. And lots of us do indeed start T3 at lower and it does benefit us. So for you, that looks great.
General iron levels are actually pretty good all together, for example:
* Your iron itself is about 65% through range. We target a minimum of 55% and don't go over 70%. So this is great too!
Hemoglobin. 135 g/L. (120-160) - This too needs to be in context of the other numbers, but yours is showing decent numbers indicating that you have enough red blood cells to efficiently carry oxygen around to your cells. Because this process requires iron, this numbers shows that you have enough iron for this process. When you have chronically low iron, hemoglobin decreases. So I don't know the trend, but you are still in range here.
MCV (Mean Corpuscular Volume - average size). 91.5 fL (81-98) - this is interpreted differently when iron anemic vs non-amemic. Fair to say your feritin is the wild card, but with your iron solidly in optimal territory, this would mean you have large (good) blood cells. It's small cells that are typically associated with iron anemia. If it was over range (ie, TOO large), you might look at other vitamin deficiencies or other issues.
In fact - high MCV is associated not with iron anemia but with B12 and folate deficiency. I think the comments above make note of this in regards to your B12 and folate levels needing a boost.
RDW (measures variability in red cell distribution size)13.6 %. (11.5-14.4) This too does not stand on its own, but at face value your cells show normal variability in size, so in context this too likely supports sufficient iron.
In my opinion, this is your challenge and task:
You need to find your homeostatis to keep your IRON number at that great level it is at now, so your body is comfortable sending some to its storage cabinets (your Ferritin.)
I do think that for you, you need to do this for a month or so via diet alone. For myself, I downloaded My Fitness Pal and track all my food (making sure to be accurate on the iron.) I am also testing my iron panel every 5-10 weeks. I am watching how my iron panel changes based on exactly how much iron I am ingesting. And only by knowing exactly how my own body absorbs iron can I be sure to calibrate a "maintenance" level of intake to improve my ferritin while keeping my iron below 70%.
Also keep in mind - it is practically impossible to EAT too much iron and go toxic. Your body has excellent natural defenses for that. But supplementing is TOTALLY DIFFERENT. The blast of concentrated iron in a supplement all at once can easily overwhelm your body's protections. We are all different though. So you need to start a methodical long-term approach to learning about yourself, so you can supplement safely if you choose.
And as I always repeat as often as possible - iron in excess over time is toxic. It causes irreversible organ damage. If you choose to supplement, be vigilant to test frequently, and do not let your iron number go high and stay high.
Thankyou so much for replying to me, I can’t tell you how much I appreciate you taking the time to look at my results and post your very helpful thoughts on these.
Firstly to know that my levels are good enough that I can begin T3 is a big relief ! Also that my iron levels are in the good range, apart from the pesky Ferritin!
Just have to hope now that I come away from my Endo appointment on Wednesday with a prescription for T3.
You have made me feel very proud of my transferrin saturation result! 😊
I absolutely accept my challenge and task and thankyou for telling me how you are tackling your own iron issues. I would rather improve my Ferritin through diet than supplements so as to avoid toxicity. Really good advice to test my iron levels every 5 - 10 weeks!
My B 12 levels are actually above range but my Folate is below Optimal. So it seems I shouldn’t take a multiB supplement, just Folate on its own if that’s possible to purchase, will look into that tomorrow .
Let us know how it goes. If indeed you absorb iron well, I am looking forward to seeing what happens after a more iron rich diet.
If you are not supplementing, you don’t have to worry about testing at longer intervals for the sake of iron toxicity. But it will be interesting for you to see that you are making progress.
As I mentioned - you can’t eat your way to iron toxicity (rather it would be really difficult to as you’d have to eat an inordinate amount of food). So have fun with your dark chocolate, pumpkin seeds, black strap molasses, fortified cereals, etc etc. Since you’re going vegetarian, don’t forget your vitamin C with those iron rich meals. And be aware that some iron rich foods - like spinach, also have calcium, which is an iron blocker!
I will also point out that we shed anywhere from 2-4 mgs of iron a day naturally. You will only absorb about 10-15%-ish of the non heme iron you ingest. So when you target the 18 mgs of iron you see in food labels, you will just actually be absorbing 18 mgs but 10-15-20-ish % of that max. So you are keeping up with what you shed, and hopefully a little more over the top.
Have fun! Keep us posted!
Also did someone mention to make sure you add CRP-hs to your next test? That’s the measure of inflammation that can be another piece to decipher your ferritin.
Absolutely! I am looking forward to my next test for iron levels just to see that what I am doing is working, will definitely let you know, you have been so helpful and interested 🤗 and you have so much knowledge! Thankyou for sharing it.
I will definitely include a CRP-hs test at my next test, thankyou for pointing that out!
Yes, I had read that fact about Spinach also being an iron blocker, so have not been eating that, and have been very careful to not eat or drink anything containing calcium within a couple of hours or more of my iron giving foods. Then there are polyphenols to avoid in some foods plus coffee and tea……😩 it’s such a minefield! But I do now remember my vitamin C alongside iron …. I’ve become very mindful of everything that goes into my mouth, and when!
Oooh, I’ve never had blackstrap molasses, will buy some to try. Am enjoying my pumpkin seeds!!
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