Iron and hypothyroidism
A large body of thyroid patients have been surprised to discover that being hypothyroid also results in having a low iron issue. Let’s look at the entire iron problem.
How do I prepare for iron labs? Although the vast majority of doctors, medical websites and even lab facilities will state to be off iron for a good 12-24 hours before testing, the American Hematochromatosis Society says to, ”Refrain from iron pills for a week prior to the tests.” Since the AHS is concerned with iron overload issues, though, it appears you can be off for five days and be fine. However, if you’re testing for the impact of your iron supplementation, then being off iron pills for 12 hours should be enough.
Which iron labs do I need?
- Serum iron
- % Saturation
This page gives you a general idea of what you are looking for in all these labs and what they mean. Because lab results have nothing to do with just “being in range”.
What is ferritin? Ferritin is an iron-storage protein which keeps your iron in a dissolvable and usable state, making the iron non-toxic to cells around it. So when Ferritin is measured via a blood test, it is basically measuring the iron you have tucked away for safe use. 70 – 90 is often mentioned in literature as a goal, but other iron labs are important with it, as your ferritin can look good, but your other labs reveal the truth. Inflammation tends to thrust iron into storage, so you can’t just look at Ferritin.
Why is measuring storage iron important? You can have so-called “normal” or even optimal serum iron and saturation levels, and even normal hemoglobin and hematocrit, yet a low Ferritin. And some patients report continued problems raising desiccated thyroid even with just low ferritin while the other labs look good. What causes low ferritin when other labs look great? It can point to bacteria and viruses feeding on iron. Even too much of certain herbs like Milk Thistle are said to lower ferritin. Finally, your body will steal needed iron from your storage first, so it needs to get up.
Why do we often have low iron levels? Because being hypothyroid can result in a lowered production of stomach acid which in turn leads to the malabsorption of iron, whether revealed with low ferritin, or with inadequate levels of serum or saturation. It can also lower your body temperature (common for those on T4-only thyroxine, as well) which causes you to make less red blood cells. Some even find themselves with a higher-than-normal temperature with on-going iron problems. Additionally, being hypo can result in heavier periods for women, which causes more iron loss.
Does inflammation lower my iron levels? Yes! If you are having a hard time raising iron, or keeping it up, you may also have a chronic inflammation problem that needs discovery and treatment. Gluten can cause inflammation for those with Hashi’s. Even without Hashi’s, thyroid patients can have chronic inflammation in their joints. An allergy to what you eat can cause inflammation, as happened to thyroid patient Deb who discovered she was allergic to eggs. Once she removed eggs, her iron went up! To see if you have inflammation, go here.
Why is having low iron levels a problem and what are symptoms? First, though the slide into low iron can be symptomless, it eventually becomes the precursor to being anemic, revealed by the other iron labs–saturation and serum iron. And once the latter occurs, you can then have symptoms which mimic hypothyroid–depression, achiness, easy fatigue, weakness, faster heartrate, palpitations, loss of sex drive, hair loss and/or foggy thinking, etc, causing a patient to think they are not on enough desiccated thyroid, or that desiccated thyroid is not working. Excessively low Ferritin as well as low iron can also make it difficult to continue raising your desiccated thyroid, resulting in hyper symptoms when raising desiccated thyroid.
In turn, having low iron levels decreases deiodinase activity, i.e. it slows down the conversion of T4 to T3. Biologically, insufficient iron levels may be affecting the first two of three steps of thyroid hormone synthesis by reducing the activity of the enzyme “thyroid peroxidase”, which is dependent on iron. Thyroid peroxidaxe brings about the chemical reactions of adding iodine to tyrosine (amino acid), which then produces T4 and T3. Insufficient iron levels alter and reduces the conversion of T4 to T3, besides binding T3. Additionally, low iron levels can increase circulating concentrations of TSH (thyroid stimulating hormone).
Even worse, good iron levels are needed in the production of cortisol via the adrenal cortex. This study reveals that an iron-containing protein is present in high amounts in the adrenal cortex and is involved in the synthesis of corticosterone. So by having low iron, you can potentially lower your cortisol levels.
Iron, in addition to iodine, selenium and zinc, are essential for normal thyroid hormone metabolism.
My TIBC is low as is my iron. What does that mean for me? A low TIBC, which stands for Total iron binding capacity, has meant patients have been unable to take high amounts of elemental iron as others do to raise the low iron. Why? Iron needs to be bound in the blood in order to carry it where needed. When that binding is low, iron will accumulate too high in your blood. Thus, patients have learned to take lower amounts of iron to raise the low iron and/or low ferritin, such as less than 100 mg of elemental iron. It will take longer to raise your low iron or low ferritin that those without low TIBC.
What’s the solution to the above? The solution, after you have verified low iron levels with a blood test is to supplement your diet with iron. Foods rich in iron include lean meats, liver, eggs, green leafy vegetables (spinach, collard greens, kale), wheat germ, whole grain breads and cereals, raisins, and molasses. You can also help yourself by cooking foods in a cast iron skillet.
But many patients and their doctors have found it necessary to supplement with iron tablets, which includes Ferrous Sulfate, Ferrous Glutamate, Ferrous Fumerate, etc. Supplementation needs to be spread out during the day, with food, for better absorption. Bluebonnet’s Ferrous Bisglycinate is a favorite among patients, but there are other good brands.
Ferrous Sulfate is usually the cheapest–just be sure you are taking a good Vit. E with it since there is evidence that it’s depleted with the use of Ferrous Sulfate. And always take it with food. The owner of this site had to take 2-3 325 mgs. of Ferrous Sulfate with food and throughout the day, for months to even begin to get her Ferritin up, plus 800 mgs Magnesium.
Ferrous Gluconate may cause fewer symptoms and is milder on stomach. Ferrous Fumerate is often prescribed by doctors as it, too, has fewer side effects, absorbs well, and is easier on the stomach.
Beware of liquid iron that is animal based (heme)–it may be the best absorbable iron, but it can blacken your teeth, as it did to the owner of this site. One suggested solution is to use a straw when taking the liquid iron. VEGETABLE BASED (nonheme) liquid iron avoids this, even if less absorbable. Also, because liquid heme iron is much more absorbable, patients take far less to achieve the same results as tablets.
I was contacted by a physician practicing alternative medicine who highly recommends Floradix Iron and Herbs, or Enzymatic Therapy Liquid Liver. Check in your local health food store or pharmacy. From Canada, there is a chewable non-constipating iron called Hemofactors by Natural Factors, and one patient who wrote me swears by it. It’s Ferric Pyrophosphate, also called SunActive Iron and you’ll want to pay attention to the “elemental iron” amount to get enough. Many thyroid patients like the Bluebonnet brand of iron, saying it causes less constipation.
How much iron supplementation do I need to raise my low levels, and how long do I take it? The first step is to find out how much “elemental iron”–the iron that is absorbable, is in each tablet of whatever iron compound you take. The mg. amount on your bottle does NOT necessarily refer to the “elemental iron”. For example, in one 300 mg tablet of ferrous sulfate, there may only be approx. 50 mg of elemental iron.
Next, patients have discovered they may need 150 to 200 mg of “elemental iron” daily, spread out with meals, in order to adequately raise their ferritin and/or iron levels. And it can still take many weeks, and sometimes 2-3 months, to improve your levels to the desirable goal. Keep track of labwork with your doctor to see where your levels are, because you want to get off the iron once you achieve your goal since iron promotes free radicals. Some women who are menstruating may have to stay on maintenance amounts of iron.
Liquid is far more absorbable, so you may not need as much “elemental iron” as tablets.
WARNING: literature states that if you have cancer, taking iron can promote cancer growth. Talk to your doctor.
Should I take anything with the iron to help? Yes, Vitamin C, as it helps greatly with absorption of iron, and combats the free radicals promoted by iron. How much C? Some take it to tolerance–the amount they can handle before getting too-soft stools. Others are in the 1000-2000 mg range. At the very least, patients have discovered, drink down your iron tablets with orange juice or a drink like Emergen-C.
Also taking a mineral supplement can assist the absorption, as can B-vitamins. One important B-vitamin is Folate (not Folic acid), which promotes red blood cell formation. Adding it to your iron supplementation can be key.
What should I avoid in my stomach at the same time as iron? Avoid calcium foods, coffee, tea or wine (tannins interfere with absorption), the fiber of bran, and chocolate at the same time you take iron. Also avoid mixing iron with your thyroid pills. Keep them all 2-4 hours apart from each other.
What about the constipation I get from taking particular iron supplements? If you do find yourself with constipation or very hard stools, talk to your doctor about adding Magnesium Citrate as a supplement, taken twice a day, until you find the amount that softens your stool. You’ll know within a few days if the amount you are taking is enough….or even too much (i.e. too much will cause diarrhea).
Can I take iron at the same time I swallow my desiccated thyroid? If you swallow your desiccated thyroid instead of doing it sublingually, it’s important to avoid swallowing iron at the same time, since the iron will bind to some of the thyroid hormones as they mix in your stomach and bind some of that NDT. Take your desiccated thyroid one hour before you take iron, or several hours later…or try your best to keep them apart somehow. If you are doing your natural thyroid sublingually, some may end up still being swallowed and thus mixed with that iron, but we’re not sure how much of a problem that is…. So just use your best judgment.
How soon do I re-test my iron labs when I’m supplementing iron? Every 4-6 weeks is best, say patients. You don’t want to overload yourself with iron, and some patients have had that happen when doctors make them wait too long! Also, you could have what’s called the MTHFR genetic defect, which can make your body doesn’t do a good job breaking metals down. Thus, your iron could get too high. ALWAYS retest, have learned!
What if I can’t tolerate oral iron? If you have problems absorbing oral iron due to a previous stomach surgery or other issues, another option is to use Venofer – an intravenous iron which helps replenish body iron stores. Talk to your doctor. Or, if iron supplementation gives you a headache, you may have to start on less than others, and slowly build up.
Once I get my ferritin or iron levels back up, will it all stay up? For females, some of us have had our ferritin or iron levels plummet again, so it may be wise to stick with a small dose of supplemental iron or eat iron rich foods, especially if you are female and still menstruating. Once into menopause, your ferritin levels may stay where they need to, but they may not!
What about iron injections or IV? If your ferritin is in the teens, or your iron labs are seriously low, ask your doctor about either an iron injection or prescribing an IV iron infusion. Either will raise your iron levels far quicker—just a few weeks as compared to a few months from supplementation. The IV infusion does require being in a health facility. and it can be expensive, but the plus of raising iron quicker is there. You will be monitored to prevent anaphylactic shock.
Can I raise my iron levels without being on iron? Possibly…if you aren’t severely anemic, and are just not totally optimal! One thyroid patient reports that just by getting on NDT and finding her optimal amount, she saw her iron levels go to an optimal level. You can see where optimal iron results should be, here.
What if I find my ferritin AND other results are super high? This is called an iron overload, such as the inherited disorder called hemochromatosis. Your doctor will usually direct you to give blood in order to lower these harmful higher levels. With hemochromatosis, you can have a low TIBC or UIBC. Another cause of high levels of iron is having a defect in the MTHFR gene. You can also see high levels of homocysteine with this defect, as well as higher levels of copper and other metals.
Are men different than women in their iron lab results? Yes. Men normally have higher levels of iron and ferritin than women without having an infection. It’s common to see healthy men with a ferritin over 100.
Need a good doctor to work with in all this? Go here.–
Get your own iron labs ordered and done via the Recommended Labwork page
You can read more about low iron and thyroid here:
*Iron and selenium deficiencies on iodine and thyroid metabolism found here.
*Iron Deficiency in Goitrous Children article found here.
*Iron Supplementation for Unexplained Fatigue in Non-Anaemic Women article found here.
*One recommendation for 70-90 is found here.
*And this article refers to five of its own references about the 70 – 90 ranges. See the conclusion mentioning those five references below it.
*A good article explaining supplements to take with iron found here.
*Details on iron: http://www.fao.org/DOCREP/004/Y2809E/y2809e0j.htm
*How low iron affects cortisol: http://www.ncbi.nlm.nih.gov/pubmed/1651678
*Impaired conversion of T4 to T3: http://ajpregu.physiology.org/content/239/5/R377
*Low iron and sympathetic system: http://www.ncbi.nlm.nih.gov/pubmed/17660705