Bit scared - now I've got high iron and tsat%, but low ferritin. Any ideas?

[montluna]

Hi,

My latest blood tests show iron near the top of the range, and tsat% over-range. I've stopped iron and vitamin C supplements for fear I poison myself ! I'd only been supplementing iron 5 weeks since end of Dec 24, 20mg of iron bisglycinate every 2-3 days, sometimes not at all. I was trying to see if I could improve my lack of energy.

Is it normal for blood iron and tsat% to shoot so high so fast, while ferretin stays low? I thought they went up together?

Blood test 6/2/25 8.30am

(overnight fasting, no iron rich meals, iron & biotin supplements stopped 7 days before)

Ferritin 33.3 (10.0-291.0 ng/ml);

CRP 0.5 (<5 mg/l);

Iron 31 umol (1.7 mgl) range 10.7-32.2 umol/L (0.6-1.8 mgl/l) ;

Transferrin saturation 49% (range 15-35%);

TIBC 63 (50-70 umol/L);

Transferrin 2.54 (2.00-3.60 g/L)

I haven't supplemented iron before. I'm vegetarian, aged 53, 7 years post menopause. I don't really get much iron in my diet, so it's a bit of a mystery to me why it's gone so high so fast.

I was above 2000 metres altitude (6500ft) for 7 days on holiday, got back down to 1000 metres where I live, 5 days before the test. I also took a high dose betacarotine supplement once a week as my night vision was getting bad. Could it be that?

If my iron and t-sat are high, but my ferritin low, how do I increase my ferritin? Do I need to? Apologies but I find it all so confusing. I'm hoping some kind person could point me in the right direction again about what to do.

My thyroid results at least look a bit better, even if I don't feel any different (tired, irritable, low libido, muscle aches, attacks of restless legs. hot flushes early am, energy crash 3pm):

Blood test 06/02/2025

TSH 1.45 (0.55-4.78 mUI/l)

FT3 5.0 (3.5-6.5 pmol/l) 50.00 %

FT4: 17.24 (11.5-22.7pmol/l) %51.25

As do my key vitamins (I'm supplementing them all):

Vitamin D 132.7 (>75 nmol/l )

B12 642 (156-672 pmol/l )

Folate 33.3 (10.0-291.0 ng/ml)

I have hashimoto's antibodies, and a history of hyper flares, but my levels are not currently considered bad enough to take replacement thyroid hormones.

For comparison, my previously posted results:

20/12/2024 (taken before 9am, no biotin for 7 days, no iron rich meals, no iron supplements prior to this test, I started 27/12 for first time).

Vit D: 113.2 (>75 nmol/l)

Ferritin: 53 (10.0-291.0 ng/ml)

CRP: 0.5 (<5 mg/l)

Iron: 19 (10-7-32.2 umol/L)

Transferrin saturation: 30% (15-35%)

TIBC: 63 (50-70 umol/L)

Transferrin: 2.51 (2.00-3.60 g/L)

TSH 0.87 (0.55-4.78 mUI/l);

FT3 4.9 (3.5-6.5 pmol/l) 46.67%;

FT4 14.9 (11.5-22.7pmol/l) 30.36%

22/10/2024 (taken before 9am, no vitamins at all for 7 days, no iron rich meals, never any iron supplements, just spirulina).

Vit D: 75.6 (>75 nmol/l)

Vit B12: 447 (156-672 pmol/l)

Folate: 39.5 (>12.19 nmol/L) 17.4 ng/ml (>5.4 ng/ml)

Ferritin: 31.9 (10.0-291.0 ng/ml)

Iron: 8 (10-7-32.2 umol/L)

Transferrin saturation: 14% (15-35%)

TIBC: 58 (50-70 umol/L)

Transferrin: 2.33 (2.00-3.60 g/L)

TSH 1.09 (0.55-4.78 mUI/l) ;

FT3 4.7 (3.5-6.5 pmol/l ) 40%;

FT4 15.8 (11.5-22.7pmol/l) 38.39%

Many thanks for taking a look.

[Regenallotment Ambassador]

Hi and thanks for your super helpful bio, so good to be able to read the history.

If it were me I’d explore raising FT4 and FT3 first, at 50% though range I’d feel pretty awful. I’d do that slowly, small increases 6 weeks apart. Keep testing.

Low ferritin with normal iron levels is considered Iron deficiency without anaemia (IDWA) a thing in its own right. Interesting about altitude, might be worth retesting in a month to see if it’s similar or gone down.

[montluna in reply to Regenallotment]

Thanks for replying Regenallotment I'm not currently under treatment for hypothyroidism, my doctor doesn't think there's anything wrong with my levels, so I can't raise my FT3/FT4 with levo. I thought maybe it'd get better if I improved my vitamins/iron, hence supplementing. I'm wondering if I should push for trying levo even though I've got normal TSH at the moment. Unless there are other ways I can try to increase it?

Also, could it be IDWA even with high tsat%? Is it still counted as deficient because although it's high in my blood, it's not getting where it's needed? Can't get my head round it for some reason.

[Regenallotment Ambassador in reply to montluna]

Ah apologies I incorrectly assumed you were hypothyroid taking replacement thyroid hormones. Hopefully these replies will attract more replies and advice from members 🙏

[montluna in reply to Regenallotment]

No worries. Fingers crossed

[FallingInReverse]

Please share for comparison last iron panel, date, confirm consistency re gap from last iron supplement, what supplements you were taking (how much and for how long) before that test.

And confirm same for the Feb 6 results above - so 5 weeks on 20 biglycinate a few times a week.

Are you still getting your period and what was the timing of it in relation to your last two tests.

edit - ive scanned previous posts, but still helpful to provide all relevant info in new posts so others can weigh in without too much clicking around.

Question - what kinds of changes took place between your fairly decent iron profile last April and December?

I see you are menopause - confirm date when you stopped bleeding entirely.

Action - until you figure things out, stop supplementing and commit with purpose to increasing iron rich foods in your diet. If you are vegetarian, pair non-heme iron foods with vitamin C.

Ps. It’s very common for iron to bounce around up and down. TSAT not so much, but still can make sense since you obviously absorb iron quite well. Ferritin is slow as molasses - so also very common for all other measures to move out of step while ferritin languishes.

My daughter takes a 20 mg Three Arrows capsule twice a week and this keeps her iron profile safe and optimal, and safe and optimal is what keeps her ferritin creeping upward. So depending on who you are - it can take 20 mgs a couple times a week (my daughter) or 20 mgs twice a day (me) and both of us are actually on the same iron path (both started at about 5 ferritin! And we are both mid 30s ferritin now. And our iron and tsat% are Goldilocks perfect or close to it most blood tests.)

Everyone is different!

[montluna in reply to FallingInReverse]

Thanks FallingInReverse, I've tried editing above as suggested. "Question - what kinds of changes took place between your fairly decent iron profile last April and December?"

I was stressed out and in the middle of a Hashimoto flare up in April 24, with top of range T3 and T4 playing havoc with my system. Between then and October 24, the only major changes I can think of were staying gluten-free the entire period (started in mid March), starting drinking wine again (I'd been zero booze for 6 weeks right up until a few days before that test in April), and taking saccharomyces boulardi(?) for two months in the summer to clear up a possible root cause Blasto infection. I was taking spirulina in April (stopped before test), but not in September/October.

Regarding the action, does that mean it's okay to keep consuming iron from food then even though my iron and tsat% are high at the moment at least? Is that okay/safe to do because the ferritin level is low? If the ferritin were high, then it wouldn't be safe. Have I got that right? Much appreciated.

[FallingInReverse in reply to montluna]

Quick answer regards action - it is impossible to eat your way to iron toxicity. I mean maybe you could but you would have to eat an inordinate and totally impractical amount of iron. Because your body has incredible natural defenses (hepcidin) that are able to combat any excess iron you eat. Also iron you eat is consumed as part of a food matrix (ie, fiber, proteins, other vitamins and minerals) that also protects your body from absorbing too much.

Lastly - you would be surprised at how little even iron rich foods have. The top ones - like liver - only has about 10 ish mgs per serving and you only absorb about 3 of that.

Since you’re vegetarian (right?) you won’t be eating any pate… but for anyone else reading keep in mind that liver should be limited to 1-2 serving a week max to avoid vitamin A toxicity!

Anyway - for non heme iron sources by the numbers I’ve found enriched breads and cereals have the most per serving. Dark chocolate and pumpkin seeds are top of the list for naturally occurring iron. When you start reading labels you will see usually 2-3 mgs per serving are as good as it gets.

This is a good article too - livestrong.com/article/2843...

I’ll come back later and think about your results.

The only thing which I’ll call out - all of my comments assume you don’t have any genetic predispositions to hemochromatosis.

[montluna in reply to FallingInReverse]

That's put my mind at rest about food and iron, thanks so much. I'll be digging into the dark chocolate again tomorrow No family history of hemochromatosis as far as I know. I do have mainly Northern European ancestry.

[elaar in reply to FallingInReverse]

When the body desires more iron, doesn't the liver usually increase Transferrin production, increasing TIBC and hence keeping the Tsat down?

Doctors still normally refuse to consider/test for hemochromatosis unless Ferritin is high, regardless of Tsat results, I was told this just a few hours ago by a GP, as my Tsat is at 60%.

I'm a novice with iron. Is there perhaps a delayed response to increased Transferrin production when serum iron increases fast (ie supplements), thus causing high Tsat? I'm aware that Transferrin can remain lower than required due to issues with the protein mechanism itself, such as liver injury, protein metabolic issues etc.

[FallingInReverse in reply to elaar]

Yes, basically. Futher, transferrin and tibc are indirect measures of iron status, interpretation is complex because there are so many things that influence it. And they def can be further confused by lagged response.

I’m looking forward to HBs replies on the B connection, which I don’t know much about.

Re- hemochromatosis. Forum posts replies are inherently limited, and when any iron measure is over range, who knows what I don’t know so I make the hemochromatosis mention as if that’s at play then everything changes.

[radd in reply to elaar]

elaar,

Great questions

Doctors still normally refuse to consider/test for hemochromatosis unless Ferritin is high, regardless of Tsat results, I was told this just a few hours ago by a GP, as my Tsat is at 60%.

It depends on your GP’s knowledge and how your consultant chooses to treat you. I have heamochromatosis and was diagnosed by both ferritin and T/S% results. My ferritin has never been that high but on diagnosis T/S was 99% indicating venesection was required. Iron in influenced by inflammation and although I have Hashimotos, it is managed and chronic inflammation minimal. More impaired genetics are being discovered all the time.

Is there perhaps a delayed response to increased Transferrin production when serum iron increases fast (ie supplements), thus causing high Tsat?

There are many iron safety mechanisms from consumption through to the erythropoiesis process and bone marrow function. These risk becoming skewed through deficiency and need reversing. In fact long term iron status can often be better analysed through the health and functionality of RBC’s.

I'm aware that Transferrin can remain lower than required due to issues with the protein mechanism itself, such as liver injury, protein metabolic issues etc.

Exactly, and further transferrin production can also be interrupted by chronic inflammation, a very common presence with any unmanaged autoimmune condition. T/S% is a calculation of (serum iron divided by TIBC) x 100. In the case of the O/P there’s a high chance her T/S% has risen because transferrin remains low in range. Therefore, reducing inflammation and increasing proteins could theoretically improve iron status without the need to supplement iron.

[montluna in reply to radd]

Thanks Radd. I did ask about myresults at the lab yesterday, and they said they no longer measure iron directly in the blood, but through a calculation using the other results. Could that be an issue regarding accuracy? Should I try to find a lab that still measures actual iron, or is this standard practice these days?

Also, I do have my CBC results from the December test if that's of use?

Many thanks

[radd in reply to montluna]

montluna,

You have had an iron panel which measures:

Ferritin 33.3 (10.0-291.0 ng/ml);

Iron 31 umol (1.7 mgl) range 10.7-32.2 umol/L (0.6-1.8 mgl/l) ;

Transferrin saturation 49% (range 15-35%);

TIBC 63 (50-70 umol/L);

Transferrin 2.54 (2.00-3.60 g/L

An iron panel offers a better picture of how the different iron mechanisms are working. What other test were you thinking of?

[montluna in reply to radd]

Just my complete blood count, in case that helped corroborate the actual iron result (as they said it's a calculation not the iron itself).

[radd in reply to montluna]

Iron 31 umol (1.7 mgl) range 10.7-32.2 umol/L

This is the measurement of serum blood iron but it is hugely variable as dependant upon what you have eaten the day before and test timings, so is not used alone but in conjunction with other iron variables.

[montluna in reply to radd]

It was odd, but she was insistent that they no longer measure the actual serum iron, the lab now calculates it from other variables in the blood. So, according to her, the serum iron is the result of a calculation, not an actual measurement. This is in France, so perhaps may be a different process from the UK.

[radd in reply to montluna]

Oh yes. I know nothing about France. You could ask greygoose.

[elaar in reply to radd]

Thanks for taking the time to explain in further detail, much appreciated. I have another iron panel being done next week. Depending on the results, I'll do a bit of a novice analysis myself and if necessary ask your advice (if you don't mind).

[humanbean]

06/02/2025

CRP 0.5 (<5 mg/l);

Ferritin 33.3 (10.0-291.0 ng/ml); 8.3% through the range

Iron 31 umol/L (range 10.7-32.2) ; 94.4% through the range

Transferrin saturation 49% (range 15-35%); Over the range

TIBC 63 (50-70 umol/L); 65% through the range

Transferrin 2.54 (2.00-3.60 g/L) 33.75% through the range

Vitamin D 132.7 (>75 nmol/l )

B12 642 (156-672 pmol/l )

Folate 33.3 (10.0-291.0 ng/ml)

20/12/2024 (taken before 9am, no biotin for 7 days, no iron rich meals).

Vit D: 113.2 (>75 nmol/l)

Ferritin: 53 (10.0-291.0 ng/ml) 15.3% through the range

CRP: 0.5 (<5 mg/l)

Iron: 19 (10-7-32.2 umol/L) 38.6% through the range

Transferrin saturation: 30% (15-35%)

TIBC: 63 (50-70 umol/L) 65% through the range

Transferrin: 2.51 (2.00-3.60 g/L) 32% through the range

...

Optimal results for iron-related results :

rt3-adrenals.org/Iron_test_...

Serum iron

• 55 to 70% of the range

• higher end for men

TIBC (total iron binding capacity) or Transferrin

• Low in range indicates lack of capacity for additional iron

• High in range indicates body's need for supplemental iron

Saturation

• optimal is 35 to 45%

• higher end for men

• to calculate divide serum iron by TIBC

• minimum saturation of 30% required to successfully treat with T3

• Low, beginning doses of T3 can be started with saturation at 25%

The information about ferritin in the above link is rather vague, so for ferritin I use this link :

thyroidpharmacist.com/artic...

and notice this section in that link entitled "Iron":

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.

...

Comparing results from 20/12/2024 with results from 06/02/2025

Ferritin : Was 15.3% through the range but has now dropped to 8.3% through the range

Iron : Was 38.6% through the range but has now risen to 94.4% through the range

Transferrin Saturation : Was 30% and has risen to 49%

TIBC : 65% through the range and has stayed the same

One of the commonest reasons for ferritin to drop and for iron and saturation to rise is because of an MTHFR gene, methylation issue. This is very common. About 50% of the global population has less than optimal MTHFR genes.

Read these links :

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/m...

Some people go to the bother and the expense of getting their MTHFR genes tested. But before doing that there is a simple "self-help treatment" that won't cure the problem but might help overcome the results of an MTHFR gene issue. People need to increase the number of methyl donors they take in. This solution is perfectly safe whether the patient has an MTHFR problem or not.

What supplements do you take for B12 and folate, if any?

Once you've told me I'll continue the explanation in another reply.

[montluna in reply to humanbean]

Thanks very much Humanbean. I take "I like it clean" B12 x4 drops a day (=500mcg B12 total) as methyl and adenosylcobalamin. Plus Nature Love Vit B complex, x1 a day (stopped week before blood test), the folate in that is 5MTHF glucosamine folate (400ug per capsule), the B12 is as above, an additional 500ug. If I can avoid gene testing I will, the complexity of it all freaks me out. I can't even get to grips with an iron panel!

[humanbean in reply to montluna]

B12 642 (156-672 pmol/l )

Folate 33.3 (10.0-291.0 ng/ml)

Okay, so you've been taking methylcobalamin and adenosylcobalamin (Vitamin B12), and methylfolate, which is good.

Any substance with the word "methyl" as part of the name contains a methyl donor. Increasing the numbers of methyl donors you have might fix your problem of ferritin staying low and iron going high. Methyl donors change the ratio of ferritin to iron, such that they are both at healthier levels. (Please don't ask me how! My biochemistry isn't up to the job!)

Your level of B12 is almost at the top of the range. But , in my opinion, the range for B12 in the UK starts at a ridiculously low level and doesn't go nearly high enough for good health. I don't know what it is like in France.

You should read these links :

perniciousanemia.org/b12/le...

perniciousanemia.org/b12/le...

If you are concerned about having levels of B12 over the range, see this info on B12 toxicity, B12 is simply not toxic. :

perniciousanemia.org/b12/to...

Your folate looks good, in my opinion. But the top of the range is higher than I've ever seen for folate, apart from when the top of range has been something like > 99999, which I think is ridiculously high. I keep my own folate at around 20. You might find this link of interest :

en.wikipedia.org/wiki/Levom...

I know methylcobalamin (B12) is safe even at extremely high levels, but the same cannot be said of folate, particularly if B12 is allowed to drop. The first link after this paragraph is quite old, the second is quite recent. They are worth knowing about. Be aware that authors of papers often use the names folate, methylfolate, and folic acid interchangeably, which makes it difficult to work out what they are warning about in the case of high levels of folate. Personally, I would never take folic acid for any reason. It wasn't even developed until 1943, so it isn't something humans have evolved to take over the millennia. Stick with the natural form of folate i.e. methylfolate, but don't overdo it.

pmc.ncbi.nlm.nih.gov/articl...

pmc.ncbi.nlm.nih.gov/articl...

If you get to a point where you are happy with both your B12 and your folate levels you can still increase your methyl donors with one of the following substances which can all be bought without prescription on some websites that sell supplements.

en.wikipedia.org/wiki/Dimet...

*** en.wikipedia.org/wiki/Trime...

en.wikipedia.org/wiki/Methy...

If I was going to take one of the above three substances above as a supplement to improve the number of methyl donors I had I think I would choose the second one with the asterisks. But please do your own research on these if they interest you.

I hope this makes sense.

[montluna in reply to humanbean]

Thanks HB, makes sense. I did a Genova metabolix urine test in June that showed amongst other things that I'm a "dirty burner". I'll give the other methyl donor a go too and see, as well as upping my B12 a bit more. In my shoes, would you carry on with the B complex? I worry about my B's getting out of balance with each other. I don't take a separate methyl folate as yet.

[Jr499]

I don't have any suggestions or ideas, but I have experienced the same problem with ferritin and saturation %, so thank you for posting and I look forward to reading replies you get!

[sparkly]

Hi, sorry I'm no help on the iron situation but wondering about your menopause history and if you're on hrt? (tired, irritable, low libido, muscle aches, attacks of restless legs. hot flushes early am, energy crash 3pm):

these can also be menopause symptoms.

It's so difficult to distinguish symptoms when both peri/menopause and thyroid issues are in play.

I know only too well.

All the above could be low estrogen and testosterone but not sure if or what you are already taking. I'm on all 3, and testosterone was the missing piece and gave me my life back.

[montluna in reply to sparkly]

Thanks Sparkly, that's worth another look, perhaps I'm not taking enough. I've been on HRT since 2021. I've tried doubling the dose, as the french doctor left it up to me to find the balance depending on symptoms (he said to remember less is better vs cancer risk, but more is better vs osteoporosis). It didn't seem to make any difference to how I felt, even adding in x1 pea of testosterone cream for a year after seeing a Newson Clinic doctor in the UK. The latter did help with hand aches I think, but nothing else, and I grew hair on my thighs despite not applying it there!

I'm currently on x1 pump estradiol gel + 100mg progesterone. I did get my sex hormones checked a couple of times (high SBHG), but the french gyno wasn't interested, he said the tests were too unreliable to dose from. I'll have to save up and try the Newson Clinic again to see what they say.

[sparkly in reply to montluna]

The high shbg will likely be the reason why you had no benefit from testosterone. It's the answer women are after, how to lower their high shbg but no one really knows.My shgb was low so that would have been a factor as to why I responded so well to testosterone.

I'd blamed my thyroid for years for no energy, brain fog, my aches and pains. I started testosterone and within 3 weeks they were gone and I had amazing well-being feeling. I now can exercise, which in turn has been a huge benefit for my health and thyroid issue. This is why it was the missing piece for me. I don't think many have results like this.

I would recommend seeing your dr about increasing your estrogel as 1 pump isn't really the normal starting does, it's normally 2 pumps.

It can take a month or more to for some symptom relief but I know for me now post menopause i feel an increase very quickly.

I'm on hrt for symptom relief but also hopefully some protection of cardiovascular issues, dementia and osteoporosis. All three are risk factors for me.

[montluna in reply to sparkly]

Brilliant, that's decided it for me. I'm going to look into it again for sure, might be another missing link for me. Much appreciated.

[waveylines in reply to montluna]

Just to add to HBs great explanation (am learning from that too! Thank u) I have to inject b12 daily. Have had to do so for over 6yrs. There is no toxicity with B12. Even NICE states this (B12 deficiency guidelines 2024).. I'm injecting daily for different reasons so not suggesting this for you but just writing it as an example. Please be aware that as you age you absorb less B12 because the acidity level in your stomach reduces. So it maybe you need a higher dose of supplementation than you have done previously.

B12 test ranges are not the most accurate & there are criticism even of the ActiveB12 test. You can only view them as a rough guide. I would've have expected your b12 levels to be higher given the supplementation you are taking so maybe an indication your acidity in your stomach has indeed dropped.

I know nothing about iron!

[montluna in reply to waveylines]

Thanks for that, appreciated. I'm going to up my B12 after reading HB's links. My digestion isn't the best.

[Hectorsmum2]

hi . Might be worth as somebody else as suggested looking at perncious anemia forum for advice and the restless legs forum is very good, some expertise re iron.

[montluna in reply to Hectorsmum2]

Great, thanks, I'll try that.

[Emaych61]

I don’t know if this will be of any help but a few years ago I astonished my then GP by having a ferritin result which was sky high (on the edge of being out of range). Fast forwards to now and a new GP (the old one having retired) we were discussing iron and tests for iron (a few weeks ago) and I mentioned that test result. His reply was that inflammation could result in an abnormally high result for iron tests and he wondered whether that was behind it: it was very much a one off.

[montluna in reply to Emaych61]

Thanks, I'll do another test in a month and see. Hopefully it'll be better.

[FallingInReverse in reply to Emaych61]

You’re correct Em, very helpful to point out the role inflammation plays in ferritin. But note that montluna has low CRP, which is the measure that indicates inflammation is not at play.

[3-T1AM in reply to Emaych61]

Wow, thank you for the iron+inflammation info! I too have high iron and tibo and I have scleroderma. My useless endocrinologist was just annoyed by it. I will do some research.

[3-T1AM]

Hello montluna. Starting levothyroxine is the biggest regret of my life. Many people on here do well on it and have excellent advice. But I still suggest doing some research first. Selenium and myo-inositol supplementation together have been studied with good results for hypothyroidism. I have read older research that levothyroxine raises SHBG but rarely see that topic covered--does anyone on here know more? Thanks!

[montluna in reply to 3-T1AM]

Thanks, I'll look into that. Sorry you've had a bad experience with levo. BTW if you want a response on your SBHG question, I'd recommend starting another post, probably no-one will see it on this one. Good luck!