Hi everyone, hope you’re all well. I just wanted to ask about a blood test result I got today to see if anyone could give me some advice please?
My index saturation of transferrin was at 11% while the normal test range is 25% to 50%. So I’m well below the range here.
I’ve been feeling a bit odd recently - like my brain has been stuck in second gear and I’ve been struggling with motivation etc. Which is very far from normal for me. But seeing this is makes more sense now.
The thing is, I take iron supplements every day, along with folic acid and I inject myself with B12 every 3 weeks or so.
I just wondered if anyone could give me their thoughts on why this is still so low please?
My sideremia - this is in Spanish although I don’t know what that is to be honest in English as the translation came up the same but I’ve never heard of it - was also a bit low at 39µg/dL with the range at 50-170µg/dL.
Is there anything else I should be doing to raise these please? I did the usual dropping off of T4 and T3 24 hours before the test but I can’t see this would have made any difference.
Thanks in advance for any help and suggestions, I really appreciate it.
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ironchica
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Hi Regenallotment, many thanks for your reply. I will attach my results a bit later as I have to pop out just now. 🙏🏻
Yes perimenopause could be part of it, but to be honest that has been with me for a while so I think I would have felt the same before now. So I’m thinking it is much more likely that it is the low iron or something else that is out of balance.
Yes I was wondering about that. I don’t convert T4 well so I also take T3, but either way, I agree it is very low. I’m currently on 150mg T4 and 0.025mg T3 Cynomel split into two doses morning and evening.
I’m wondering about raising T4 to 175mg or maybe 200mg…?
Would levels this low make it hard for my body to absorb the iron from the supplements?
careful with the units, I think its micrograms mcg that you mean for the 150mcg T4.
Although the 0.025mg is probably correct, the decimal is the giveaway so this is likely 25mcg T3.
Low levels of anything affect everything else, so you do need to address all of it in a sensible way. Change one thing at a time and wait and test and then change one other thing.
One thing is for sure, on that dose you don't absorb well either. Are you autoimmune or central hypo? You don't say in your bio.
how about diet and digestion, are you taking or eating anything at the same time as your Levothyroxine?
Thanks for this - yes I always get the units confused. I'm Hashimoto's and I also have a condition which is related to my immune system called Mast Cell Activation Syndrome. This makes it hard to eat sometimes as it affects my stomach quite badly.
Re eating at the same time as taking Levo, no I usually leave at least 30-60 minutes before I eat anything as I know this is not a good idea...I don't have caffeine in anything so no caffeine either.
What I think baffles me most is how my levels can be so low when I'm taking supplements. But as you say, if my T4 is too low, then it may mean the supplements are less helpful than they would be if my T4 was optimal.
Check its water only for 60 minutes from Levo. (Fine to take lio with Levo)
No supplements for 2 hours
No iron or magnesium for 4 hours
Try a heme iron like 3 arrows which is more easily absorbed, not affected by diet/drink.
eg chocolate, coffee and tea including herbal teas all reduce iron absorption from iron supplements by as much as 40-50% if taken within an hour either side.
I’ve been feeling a bit odd recently - like my brain has been stuck in second gear and I’ve been struggling with motivation etc.
I lose motivation when my iron is too low. My husband once asked me how I felt when my iron was low and I remember saying I felt defeated.
Your transferrin saturation at 11% is far too low suggesting you need more iron. What is your current supplement, how much iron does it contain, how much do you take, and how often?
Hi Humanbean, many thanks for your reply and sorry for the delay in mine. Defeated is a great description! Yes, exactly that!
I agree re 11% being far too low, it is a bit of a shock given I take supplements. So, I take ferrous fumarate each day - usually two tablets of something we have here called Foliferron. The dose it says per tablet is 100mg/0,150mg (the second dose I think is folic acid but I also take Acfol which is 5mg of folic acid per day per tablet). So I guess mine is double that each day..
I’m wondering if I’m not absorbing it properly for some reason? Which is why I’m wondering if my B12 is too low? I inject 1.000 micrograms of that every 3 weeks. Maybe I need to increase this? Even in the short term?
Thanks so much for all your help. I will check out those links you have kindly passed on too. 🙏🏻
The dose it says per tablet is 100mg/0,150mg (the second dose I think is folic acid but I also take Acfol which is 5mg of folic acid per day per tablet).
The 100mg is probably a reasonable dose for someone who struggles to absorb iron. Taking higher doses is probably not going to be helpful. See this paper for the reasons why:
Title : Alternate day versus consecutive day oral iron supplementation in iron-depleted women: a randomized double-blind placebo-controlled study
I started treating my iron with ferrous fumarate at a high dose a long time before hepcidin (described in the above link) was either discovered or discussed in research (I'm not sure which), and it took me 7 or 8 years to get my iron where I wanted it. The above paper probably explains why I was struggling for such a long time. I also wonder if I have some genetic faults in relation to iron - because my results are often a bit strange, and a lot of females in my extended family are prone to anaemia and iron deficiency throughout life - and lots of us have hypothyroidism. Whether these things all conspired to make it hard for me to absorb iron, I can't say with certainty, but it seems likely.
Taking too high a dose of iron is definitely not to be recommended - but I don't know what is an acceptable dose. People have to be prepared to experiment with what they take, how much they take, and how often they take it. Unfortunately this does imply that frequent testing is required to see what is working and doctors really don't co-operate with that, and the costs of private testing are too high for many people.
I think, for people who struggle to absorb iron, that iron infusions are probably the best way of improving levels. But, unfortunately, doctors think all they have to do is get levels somewhere - anywhere - within range with tablets and their job is done. The fact that patients are low or deficient again within weeks is ignored - or at least it was with me.
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I am not convinced that taking folic acid is ever a good idea under any circumstances. And I've never found out why it is so often associated with iron supplements. To be useful to the body folic acid has to be converted into methylfolate - and about 50% of the global population has genes that make that conversion very slow and difficult. Folic acid was first developed in the early 1940s. It is artificial and doesn't exist in nature to any great extent which is why such a large percentage of humans haven't evolved to make use of it very well.
A quote from the NHS on the subject of treating iron deficiency anaemia from this link :
When people are low in folate and take high dose folic acid there is a possibility that they end up with very high levels of unmetabolised folic acid in their bloodstream. The last two links above suggest this isn't a good idea, particularly if it happens in conjunction with low Vitamin B12.
If someone is low in folate it is best to avoid folic acid and supplement with methylfolate instead which is easily sourced on websites that sell supplements. A few people struggle to tolerate methylfolate but if that happens starting with a low dose and gradually increasing it should help. This link should be helpful if you get side effects :
Sorry I can't be more definite in terms of dosing or suggesting a supplement. If getting an infusion is not possible I would suggest trying Three Arrows iron if you haven't done so already. There are lots of references to it on the forum.
Ah this is awesome info, thanks Humanbean, I really appreciate it. Yes, I'll go through all of these links and see what I can work out.
My dad and my mum both had/have anaemia, so it sounds like there is a genetic element perhaps to my low iron as well. I may be able to get a private iron infusion here, but I'd need to work out where and who might be able to help with this. Thank you.
I really appreciate you taking the time to send such a detailed message, thank you again Humanbean. 🙏
Hi Poniesrfun, many thanks for your reply. It’s interesting to hear you were tagged as critical - I don’t feel ‘critical’ but then maybe I’ve just got used to feeling this way…🤔
Ahhh OK. Yes then that makes sense. If you don’t mind me asking, what happened to get your levels back up? Did you have to go into hospital for an infusion? Understand if you prefer not to answer, no problem.
I had my infusions at the infusion center at the hospital where the hematologist was. This is in the US. There are also commercial infusion centers where you can go here with a prescription from a doctor.
If you are going to be talking with doctors in the UK about iron, this is the latest guideline from the British Society of Gastroenterology about iron deficiency anaemia :
Your free T4 is very low, so you definitely would need an increase. I know that you are taking T3 but have you measured your free T3 recently? I am wondering if your T3 levels are also too low, despite you taking T3.
As you know, T3 is your active thyroid hormone and responsible for many metabolic processes, including glucose and lipid metabolism. Your ALT is slightly elevated (liver enzyme), which can suggest that your liver might be struggling to process certain items (such as glucose), hence the levels rise. This can happen when T3 is too low. Your HbA1c is a bit elevated and just two points below the diabetic range - it is called impaired glucose tolerance (your level is 6.8mmol/mol, IGT starts at 6.0mmol/mol). T3 is also responsible for clearing glucose from your circulation, so when your levels are low, glucose concentrations can rise and levels can increase to the pre-diabetic or even diabetic stage. This has nothing to do with your diet, this is a metabolic problem caused by your hypothyroidism and should be addressed with an increase in thyroid hormones first.
I would check your T3 levels and if they are low, you might need to increase your T3 as well, as the increase in T4 might not be sufficient to raise your T3 substantially, if you are a poor converter. Most people need their T4 and T3 60-70% through the range, so you may need several increases.
You have some inflammation going on as well, as your CRP is a bit elevated, as is your fibrinogen and your monocytes (white blood cells). But if you have been ill recently, that is a normal inflammatory response to an infection.
Thanks Tina_Maria, yes it probably is all a bit low to be honest. I'd have to look up the last time I had T3 tested, but I can't remember when that was. I think I have to have that tested privately, which I can do for sure.
I've been trying to get my T3 from my usually pharmacy for the last few weeks but they tell me it isn't available at the warehouse. So I'm running low on supplies of that too just now. I tried Thybon previously but it didn't suit me as well. I may just have to go with it though if that's all I can get.
When you are on T3 you need to test your levels on a regular basis. Usually when you are on T3 therapy, your TSH would be very low, in some cases even suppressed. Your TSH is still within the range, which could mean that the T3 dose is too low and you have room to increase. Hope you will get it sorted soon.
Yes agreed, many thanks. Last time I had my T4 and TSH tested, my doc suggested lowering my T4 from 150mcg as I had suppressed TSH - and it was greygoose who kindly pointed out that with T3, TSH was basically irrelevant. So I ignored the advice, and carried on as I was. But that was a little while ago now, and I think you are right about having room to up the T3 as well. Thanks for your suggestions, I have a lot of work to do I think to optimise everything again.
It's funny, so many of these things change so slowly that it isn't always easy to work out what is going wrong until you see some new data, and even then it's hard to work out without other people looking at results and making suggestions. This is why I love this forum. Thanks again to everyone for your help.
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Iron vs. Ferritin - do we need both optimal to feel best?
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I'm looking for an answer, my doctors are apparently useless.
Iron deficiency anemia yes or no?? 
