Can anyone help me understand my iron panel?

[Eton]

Can anyone help with my iron panel results please? Many thanks for your help and expertise.

Iron =16.9 (10-30)

TIBC=49.6 (45-81)

UIBC = (32.7 (13-56)

Trans sat=34.1 (25-45)

Ferritin=91.50 (30-332)

[Jo5454]

Hi Eton, I've just done an iron panel and some of your numbers are similar to mine, so can pass on what I've kindly been told on here...My iron is 17.5, which is 37.5 thro range & was advised to help support adrenals this should be at least 55-70% through range.

My TIBC=51.7, which is 19% through range. Lower through range means lack of capacity for more iron, higher means towards iron deficiency.

UIBC- This is the portion if iron not binded binded, thus higher equals iron deficiency.

TRANS SAT-33.8 which is 44%.I was advised 35-45% is optimal, thus lower indicates iron deficiency, so it seems yours is optimal on this area.

My ferritin is 60, yrs is higher, at this stage we differ. Mind you, mine was 110 last wk, 85 week before that & now settling downwards, so guess it's the iron panel which is important.

You're probably as baffled as me now, as to why it indicates we need Iron to get onto better range fir adrenals, but all the other results pointing to the fact we don't have much capacity for supplementing! I'm going to ask my Dr end of nxt wk, but he doesn't show much interest in iron!

I'm concerned ferritin will lower further if I don't supplement and I was just starting to see a slight improvement in some symptoms after it being 37 abt 6 wks ago.

I've been advised to eat plenty of iron rich foods, which I do & expect you do.too?

Expect someone will be able to help further & sorry to make you as baffled as me, but what a coincidence our numbers are so similar!

[Eton in reply to Jo5454]

Hi JoJo thank you for your reply. I have given more details to FallinginReverse below.

Yes we are quite a mystery really!

[Jo5454 in reply to Eton]

Hi Eton, yre welcome & glad you've found some answers. Looks like you've got the iron under control then which is great. A good feeling to get something worked out when we've lots of areas to.try to get balanced! Now I've just got to get my nearly twin results, ferritin in the same place as yours Take care...

[Eton in reply to Jo5454]

Good luck JoJo.

[Jo5454 in reply to Eton]

Thank you! x

[Jo5454 in reply to Eton]

Thank you. You too...x

[FallingInReverse]

Can you confirm you are/aren’t taking any iron supplements.

What kind of iron in your diet? Did you eat any high iron food prior to this blood draw?

Are you hypo/hyper and being treated for any thyroid issue?

Have you ever had a CRP-hs measure of inflammation along with your iron panel/ferritin result?

Any other past iron panel daily’s you can share?

Any symptoms?

Bottom line - with that panel you should not consider supplementing if you aren’t already. Depending on answers to above we can share possible actions. But not enough info to say in what youve shared - other than don’t start supplementing.

[Eton in reply to FallingInReverse]

Hi FallinginReverse. Thank you for your reply. Here is some more information.

I have an underactive thyroid and take 75mcg Levo. My Medichecks results from last week taken 24 hrs after last levo and fasting, and no b vits for a week:

TSH=0.04 (0.27--4.20)

T3=3.2 (3.1-6.80)

T4=19.7 (12-22)

CRP=<0.15

Vit D= 74.9 (50-250)

Active B12 = 71.1 (37.5-187.5)

Folate=12.7 (7-35)

Ferritin 92.6 (30-332)

Antibodies low

My tsh has been suppressed since I tried T3 some years ago. However as you will see in my profile, prior to medication my tsh never ever increased despite horrendously low hormone levels. My NHS endo who I saw on Friday was going over my history and suggested I should decrease my levo. He just kept on about osteoporosis risks (I already have osteoporosis diagnosis) and the dangers of AF.

I am not supplementing any iron and do not eat much red meat. Mainly chicken and vegetables, occasional very small piece of meat, and not fortified foods (except perhaps 1 or 2 slice of bread daily).

I July 2023 my GP iron results were:

Iron =13 (6-35)

Transferrin =2.52(2-3.6)

Ferritin = 69 (13-300 for post meno )

Transferrin saturation=21%

After these results my GP said I could supplement iron to see if it helped my fatigue. I took 3 arrows (1 capsule daily) until

After 3 months my GP test showed

Iron =16 (6-35)

Transferrin =2.17(2-3.6)

Ferritin = 129 (13-300 for post meno )

Transferrin saturation=29%

After these results I dropped 3 Arrows to 2 capsules per week.

A medichecks test on 13 Dec suggested iron overload so I stopped all iron and havent taken it since. Those Dec results were:

Iron =19.2 (10-30)

TIBC=43.9 (45-81)

UIBC = (24.7 (13-56)

Trans sat=43.7 (25-45)

Ferritin=146 (30-650) Range is very wide?

I also have a history of below range white cells (neutrophils) and below range platelets which are monitored ever 3-4 months.

I have all the usual hypo symptoms - very very very cold, constipated, really flaky skin, tired, periodic headaches, stomach problems which mean that I eat a bland (boring) diet, dont drink alcohol or any caffeinated drinks.

I supplement vit D (2000iu daily), have recently started B Complex, Vit k, Fish oil capsule.

Thank you for any advice you can provide. I know I am a complex case!

[FallingInReverse in reply to Eton]

Great info!!!

So - without supplementing since December and maintaining your ferritin and saturation as you have indicates you are absorbing the iron you take in.

Remember that our bodies do not make iron… all the iron we get we need to ingest (food or pills).

The trick is this:

Target iron at 55-70% through range without going over that over time. Rememeber iron can go up and down quickly… even after an iron-rich meal. So this is one measure, but obviously the others are needed too. Your results all look good in context.

Saturation percent is the next I look at. It is derived from how much iron is saturated into the transferrin in your blood… transferrin being the Ubers of iron carrying the iron you do have around to the cells in your body that need it. This is one you really want to watch. It’s less volatile, and you want to target mid range. Which you’ve done and smart move stopping the iron supplements when you hit near top range/45%.

Your ferritin is solid/high. I have ZERO experience with top range ferritin having low ferritin myself. But know we target 100… but…

SlowDragon shared this at some point and I copied/pasted as helpful for avoiding scaremongering at higher in-range ferritin:

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 264

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.

So.

If I were you I would consider consciously increasing iron rich foods in your diet. If you have non-animal sources iron, pair it with vitamin c.

In a few months you can see if that keeps your levels in a good place. If not you might choose to work in one three arrows a week, or similar.

You’ve got a great iron profile right now, with no supplementing for so long it does look like you’re absorbing it well.

Every single one of us absorbs iron at different rates. You need to learn from your own results, as you’re doing.

As you probably know, our bodies have no way to excrete excess iron in our blood, and over time it settles in our organs and causes irreversible damage. Unless you have an issue with something like hemochromatosis (too much iron), you can’t eat yourself into iron toxicity. So safe move is for you to eat more iron and avoid supplements until your next test.

[Eton in reply to FallingInReverse]

Thank you so much for your expertise and explaining things so clearly. I wish my thyroid readings were as good!

I love in hope that they will improve eventually.

Best wishes.

[FallingInReverse in reply to Eton]

Yes - obviously you w got some room for optimization with your thyroid and essential vitamins!

But at least right now you know you have enough iron to make use of the T3 that you do have - however little!

[Jo5454 in reply to FallingInReverse]

Hi FallingInReverseI wonder if I may ask you about some of the answers yve given to Eton please?

My iron panel lst wk was very similar in results apart from ferritin at 59.9.

Ferritin has been doing funny things recently.

March=48(prior loading dose). Took 1 ferrous fumarate 210 every or every other day.

Mid-June lowered to 37.

Stopped taking 10 days before pinprick thyroid test end July,ferritin =85(large jump,short time?)

Nxt wk iron panel. ferritin 110.

Retested following wk, ferritin dropped to 59 & iron panel near identical to Etons as above.

Had a b12 inj day after the 85 result, so ferritin increased further aft that,then dropped?

Have three arrows at ready but darent take yet-eat iron rich foods reg,but not before test. Dairy/gluten free.

CRP always low it seems, however I'm feeling!

Past iron panels while bk showed a big need for iron when ferritin 50ish.

Still V. tired, waking early, breathless a bit better,but not great, dry skin,itchy, brainfog,v.littke stamina/power but period last wk easier as have been so heavy, waking at nght pounding heart,feeling faint,plus some b12 related symptoms?etc.

Worried if I don't keep.iron up this will quickly worsen?

Tsh 2.44(early morn/fast), ft4 29% and ft3 37% through range, on no meds.antibods fine.

Vit d 60( taking 1000 daily)

Folate 7.5

Not sure if it's all about not enough b12,iron, folate, untreated thyroid??

Awaiting Dr appt to discuss & requested a full blood count due to raised mch last time,but not looking likely!

Any thoughts much appreciated please?Many thanks...

[FallingInReverse in reply to Jo5454]

You’ve gotten a lot of the biological/scientific answers in other posts.

I think the reason you are still asking is that you think there is a black and white answer - but really 1) it’s highly individual and 2) requires a methodical approach to eliminating variables so you can isolate what’s having the impact. The age old concept of “change one thing at a time” While 3) keep taking advantage of the blood tests you can get, explore full blood panels, liver functions, inflammation markers, to see if something non-thyroid related can be found.

That means you muddy the water when you take a b12 shot, or change labs, change thyroid hormone replacement. Your period and other blood loss also dings ferritin. Changing labs “shouldn’t” cause huge discrepancies-but of course there is a normal margin of error, and can be an actual error or differences.

But unless you isolate that one change there will be absolutely no way for you or any of us to know.

Also while you look for the CAUSE of your iron profile, managing it is still the same rule. MAINTAIN your iron 55-70% through range, keep your transferrin saturation mid range (which is somewhere between 30-40% as a result… remember to look at the actual percent result… this is not one where you need to calculate the percent through the percent range 🙃). Ferritin is a RESULT of optimal iron… increasing ferritin is done by finding your the amount of iron you need to take in to mainten that. Somewhere in the equation your body is requiring more iron than your blood can supply, so it’s drawing from its ferritin stores.

You either have typical volatility from having trouble absorbing iron due to hypo or your b12 situation, or you have inconsistencies in your approach making results incomparable, or you have some other thing most of us won’t have any experience in like liver disease or some other non-thyroid thing.

But at this point you need more blood work if you want to confirm non-thyroid or non-PA or whatever it might be, or you need to be more scientific about your testing/titrating periods so that when something changes you can isolate the reason.

Too many variables for a conclusion. You need a different approach if you want to be able to conclude what’s happening.

Disclaimer - Not a doctor. I am Hypo and anemic. That’s pretty much it for me. I have no idea about b12/pa other than being both iron dj b12 deficient makes the analysis even more nuanced and out of my experience.

[Jo5454 in reply to FallingInReverse]

Thanks very much for all of that info. Sorry I will correct the above so as not to confuse anyone, Transferrin Sat is 44%, not through range, thanks for pointing out.

Yes you’re right, I’m asking something that can’t be answered until I find out more. I just wondered how I can maintain iron and raise ferritin if the transferrin is telling me not to take it, but as you say, that’s the part to solve,why it’s showing that up!

I’ve drawn a table now, vits, thyroid,etc along top, years down side, so can try to see patterns and at what levels I was more well.

Then I will try to record better my approach as to what I take/try in a similar way. Thank you for the tips and stopping me from asking the same old things over and over seems to be a bad confusing habit at moment!

[FallingInReverse in reply to Jo5454]

Hi! We are all so happy to puzzle on these things with you 😀

One last thought. You may know this, but I think it will help you decide what to do.

It is practically impossible to eat yourself into iron toxicity. You would need to eat a prohibitive amount of food, and even then the complex digestion food requires , and our body’s natural defenses protect against iron overload.

That’s why eating iron rich foods is always a good idea.

I’m not referring back to your posts details as I write this part - but I actually think you might be absorbing pretty well. Barring something we don’t know, knowing your CRP is normal, then your ferritin is jumping up. Your body knows it has enough iron and you are effectively storing it.

For comparison - take me. My ferritin has taken 6-12 months (losing count now) to increase from 5!!! To mid 20s. In the early days my iron was below range. Within a month of supplementing it was above range. And my ferritin stayed under 10.

So unless there is some other acute reaction going on…. You are absorbing and storing iron.

And unless there is some error in testing, or some unknown blood loss, or some unrelated liver failure or things I don’t know. AnyThing about…. Then when your ferritin drops it’s because your body needed more iron and it called it out from storage.

I’m still not sure if it’s test error, or blood loss, or significantly increase acute need for iron (maybe interplay with b12 but absolutely no idea).

My point is - if your ferritin is going up and down and it’s because of how you use iron, then you are actually absorbing it.

And for that reason I would “reset” your tracking and testing and changing one thing at a time and eliminating variable like different labs and stuff.

And take a month to track and eat as much iron rich foods as you can. I did it for a few months. It was a huge pain, but I learned for myself that I just couldn’t absorb iron no matter how much I ate.

[Jo5454 in reply to FallingInReverse]

Thank you, your & the support and words of wisdom on here are brilliant!Yes that's a very good point, I'll try and add even more iron rich foods in,that can't do any harm & it'll be 3mnths round from ferritin nhs test mid Sept so I may be able to squeeze one out of them! Good thinking!

That's hard not being able to absorb it easily from food, whatever you ate but as you say, at least you worked that out & couldn't be told just to eat more. Yrs,I've had times when iron is overange, but ferritin low, you technically think why not put it into storage when that happens.

They've checked my diet when weights been down to 6 1/2 stone & thankfully all my vits etc were off top of the scale, b12 was 570% a day?!Iron was 122%,but id say its far better than that now as have learnt more abt iron rich foods along way.

My ferritin has been down to 11 at times and usually takes months to shift...at least I'm getting speedier at something after hitting 50,lol!

Thanks again off to make another chart to keep an eye on iron Had beef for lunch,good start,with watermelon as part of dessert!

[Auders in reply to FallingInReverse]

love the thought of Transferrin being Ubers!😃

[SlowDragon Administrator]

low Ft3 will frequently result in low vitamin levels

Low FT3 tends to result in low stomach acid and then poor nutrient absorption

Free T4 (fT4) 19.7 pmol/L (12 - 22) 77.0%

Free T3 (fT3) 3.2 pmol/L (3.1 - 6.8) 2.7%

My tsh has been suppressed since I tried T3 some years ago.

why did you stop T3

Look at improving vitamin level

Retest again in another 2-3 months

Likely Ft3 still low

Then look at getting T3 reinstated on prescription

[Eton in reply to SlowDragon]

Hi SlowDragon I stopped T3 mainly because it didn’t seem to resolve my symptoms of constant feeling cold, very constipated, tired, low Bp, and dry flakey skin. It wasn’t provided by NHS as my NHS endo has made it clear he does not prescribe t3. In fact when I saw him last week he said he thought I needed to reduce my levo due to suppressed tsh, even though my T4 is not as top of range and my t3 barely scrapes into the lowest end of the range.

I m supplementing with Pink Tribes liposomal b complex, vitamin K, 2000iu Vit D and fish oils. Is there anything else you would recommend?

[SlowDragon Administrator in reply to Eton]

Suggest you look at finding different endocrinologist

When taking T3, almost inevitable that TSH will become suppressed……therefore essential that You need to be taking high enough dose

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)

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

What were thyroid and vitamin results when on T3?

[Eton in reply to SlowDragon]

When I was on 75mcg levo and 3x5mcg T3 in Dec last year my T4 was 17.6 and t3 was 4.8 - ranges as before. Tsh was 0.013.

At that stage my ferritin was 132, folate 21.2, B12 87.7 and vitamin d was 102. This was a Medichecks test done under the recommended conditions.

[SlowDragon Administrator in reply to Eton]

Free T4 (fT4) 17.6 pmol/L (12 - 22) 56.0%

Free T3 (fT3) 4.8 pmol/L (3.1 - 6.8) 45.9%

So you needed next increase in Levo or T3

only increase one or other

Probably trying increase in T3 first up to 20mcg as 3 or 4 split doses per day

[SlowDragon Administrator in reply to Eton]

Vit D= 74.9 (50-250)

Active B12 = 71.1 (37.5-187.5)

Folate=12.7 (7-35)

Vitamin levels now

Vitamin levels previously

folate 21.2, B12 87.7 and vitamin d was 102.

Levels have dropped, most likely because of low thyroid levels

[Eton in reply to SlowDragon]

Thank you Slow dragon. So I will start back on T3 again and slowly work up to 20mcg testing both thyroid and vitamin levels asI go along.Best wishes

[SlowDragon Administrator]

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations

thyroiduk.org/contact-us/ge...

over 66,000 prescriptions for T3 in England in last year and numbers steadily increasing

searchable by ICB area

openprescribing.net/analyse...