Big Ferritin Drop in a Year (over 50%)

[Fluffysheep]

Not a thyroid question, but a ferritin question if anyone is able to advise? Apologies in advance that this is long, just trying to set the scene.

Brief background - I have Hashimoto's and after many years am on T3 monotherapy. I am vegetarian, and take various supplements as recommended on here, and had managed to get my ferritin into a really good place last year - 4th May 2023 my ferritin was at 110, which is it's highest level since I've been testing (range of 13-150).

The very first test I had when I started recording ferritin was in 2019, and it was 58. It got down as low as 44 in 2020, but I started supplementing after that, and it slowly rose. Once I added in T3 to my T4 medication at the end of 2020, that seemed to really help, and it continued to rise as I played around with T3/T4 medication until I eventually stopped thyroxine completely at the end of 2022. I've been T3 monotherapy ever since.

I've recently had a variety of tests, and I asked for b12, vitamin d, folate and ferritin to be added, as I like them to be checked yearly. The other 3 tests are all in a good place (b12 is 634 with a range of 197-771, vitamin d is 202, serum folate is >19.9, with a range of 3-20). CRP is raised at 8, but mine always seems to be between 6-8).

However, my ferritin result was only 52 (same range as 2023), so a huge drop from last years result of 110. Of course, my GP isn't interested, as it's 'in range', and I mentioned it on my phone appointment to my endocrinologist, and he wasn't interested either.

The blood test was done under the same conditions as I always do them - first thing in the morning, no food or drink since the night before, stopped anything with biotin in a week before. I also didn't take my T3 meds that morning even though it wasn't a thyroid test.

In case it's relevant, when my last thyroid blood test was done in March, I was on 80mcg T3 taken in a single dose (and not taken on the morning of the blood test). Results were TSH 0.01, T4 <1.3 and T3 5.2 (range of 3.1-6.8). These results are fairly similar to be last test.

There are only two things that have changed in the last year. One is my T3 dose - I've gone up from 60mcg a day to 80mcg a day since my ferritin test last year. I can't see that making much of a difference though?

The other thing which did have a huge impact on me is that in December I was in hospital for 10 days, and had emergency surgery for a bowel obstruction. I was very very poorly, and I also didn't have any thyroid meds for 4 days (had a tube down my nose so was told I wouldn't absorb anything, plus I was too poorly to care if I'm brutally honest) and didn't have any of the supplements I normally take for a few weeks, maybe even a month. I was also a week without eating anything at all, then was on a a very low fibre diet for around a month.

Nothing else has changed. I've been vegetarian for 40 years, and gluten-free for 4 years. As I said before, since starting supplements, my b12, vitamin d, folate and ferritin have all risen well, and I've been happy where they are.

I'm guessing that the surgery had a huge effect on everything, which totally makes sense. But 6 months down the line, would my body not have recovered? Is it really feasible that that's the reason for my drop in ferritin, and it's just going to take forever to rise?

Sorry for the length of the post!

TLDR - my ferritin has dropped over 50% in a year (from 110 to 52). GP and endocrinologist aren't worried, but I am. Should I be?

[Fluffysheep]

In case it's useful, here is my full blood count test results as well.

Full blood count test results

[GlowCoach Administrator]

The first thing to note is that inflammation will falsly raise ferritin. Your inflammation isn;t huge but its likely having an effect on your level.

Second thing is that during the surgery you will have lost an amount of blood which will affect your ferritin level negatively. So it may just be that the surgery alone has caused this effect.

As a vegetarian its very difficult to raise ferritin so how are you going to address this?

Suggest you get an iron panel run to make sure you have room for a supplement.

Vit D is on the high side. Suggested level should be 100-150. You could scale down the supplementing slightly.

Omega 3 is very good for inflammation. There are algae supplements that are vegetarian.

[Fluffysheep in reply to GlowCoach]

Thank you. Up until the surgery I seemed to be doing a good job in raising my ferritin despite being veggie. Getting it up to 110 from a low of 44 seemed like I was doing well.

I didn't get on particularly well with iron supplements, but once I started taking methol folate L-5-MTHF (this was suggested by someone on here, think it was humanbean I had the conversation with but could be totally wrong about that) then that's when my ferritin started rising (along with adding then increasing T3 medication).

I was probably off my supplements for around a month during/after surgery. I don't think I re-started taking them until I came off the low fibre diet and started eating normally (I can't properly remember though). So lets say that by February I was back on them all.

Will slow down with the vitamin d spray, Perhaps I should just utilise the spray in the winter months, then let the sun do it's thing in summer? Again, it was very low back in mid 2019 (only 28), so I took the 6 week loading dose the GP gave me, then continued on with the better you spray. It's obviously done a good job!

Will take a look at omega 3, thank you for the suggestion. Again, GP has no interest in the fact that CRP is raised. She just compared it to the fact it was in the 70s in January - I had an infection and was quite poorly with it, so not a surprise it was high then and has come down since!

[SlowDragon Administrator in reply to Fluffysheep]

How much vitamin D have you been taking

Suggest you reduce dose rather than stop it completely

Are you taking k2 and magnesium as well

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Recipe ideas

bbc.co.uk/food/articles/mag...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

Definitely get full iron panel test

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

Stop iron supplements 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Ferritin is an acute phase reactant, meaning it rises when you have inflammation, so you may find iron is low

sciencedirect.com/topics/bi...

[Fluffysheep in reply to SlowDragon]

I've been taking the better you vitamin d spray with k2 added. Just going by the dose on the bottle, so three sprays per day.

I take magnesium after dinner. Not on thyroxine, just liothyronine, but I don't take any thyroid meds at night, just first thing in the morning.

It was a fasting test, but although I stopped the complex b supplements a week before due to biotin in them, I didn't stop anything else. My supplements are magnesium, selenium, super b complex (the one recommended on here a lot), vitamin d + k2 spray, and the methyl folate I mentioned above.

I haven't had an iron panel done since last year, although it's possible they tested it whilst I was in hospital in December. I was in ICU for a couple of days after surgery before being moved to a ward. I've got all my notes (put in a SARS request) so will have a scan through. Will try and get one from GP, although not sure they'll agree as they think there is no problem with my ferritin. If not I'll look at the medichecks one you've linked.