- Iron deficiency worsens hypothyroidism by impairing thyroid hormone conversion and your body's ability to use the thyroid medication you're taking.
- Ferritin is your best marker for total body iron stores. Aim for ferritin levels between 70-100 ng/mL for optimal thyroid function, not just barely above the low reference range.
- Taking iron supplements with vitamin C improves absorption significantly, but separate them from calcium, tea, coffee, and thyroid medication by at least 4 hours to prevent interference.
- Test your complete iron panel, including ferritin, serum iron, TIBC, and saturation percentage, to understand your true iron status and rule out iron overload conditions.
- Iron deficiency can cause or worsen hair loss in hypothyroidism, and correcting this deficiency is one of the most impactful changes you can make for symptom improvement.
Did you know that iron deficiency may be one of the reasons your thyroid symptoms remain out of control even while taking thyroid medication?
Iron deficiency is one of the most common nutrient deficiencies seen in hypothyroid patients.
It’s up there with B12 deficiency, magnesium deficiency, and vitamin D deficiency.
Not only is it common, but it is frequently misdiagnosed and/or missed by doctors.
Why? For one very important reason:
Most doctors are trained to look for iron deficiency anemia (1).
They rarely ever miss this diagnosis.
But what they do miss is suboptimal iron levels as measured by ferritin.
When it comes to thyroid function, the measure of your iron stores (and not your serum iron levels) is more important.
Patients who have hypothyroidism deserve special attention and treatment if their iron stores are low because of how important iron is for thyroid hormone function (2).
Today you will learn:
- Why iron is so important for thyroid function.
- How to test both your iron levels and iron storage levels.
- What level of iron is optimal for thyroid function.
- When to supplement with iron and which types of supplemental irons work best.
- How iron impacts thyroid medication absorption and other supplements.
- And much more…
Thyroid Function and Iron Status
Iron is required for proper thyroid function.
Studies are clear on the matter (3).
Not only is iron required for the creation of thyroid hormone (4), but low iron levels are also associated with low levels of free T3 (5).
As a thyroid patient, you are probably well aware that T3 is the single most important and powerful thyroid hormone in your body.
Iron deficiency reduces how much of that hormone your body can produce.
This may explain why some patients still experience the symptoms of hypothyroidism despite taking their thyroid hormone medication.
The association between iron and TSH level is clearly defined in the graph below:
You can see the inverse relationship between transferrin saturation and the TSH.
As your transferrin saturation falls (6), the TSH rises indicating a state of hypothyroidism.
Remember:
A high TSH means low thyroid and a low TSH means high thyroid.
Transferrin saturation is a lab test that tells you how much of the serum iron in your body is bound versus unbound.
A low transferrin saturation indicates low serum iron levels in the body.
When it comes to thyroid hormone production, iron is required due to its effects on heme-dependent thyroid peroxidase.
Heme-dependent is another way to say iron-dependent. In other words, this important enzyme requires iron to function.
In addition, low iron has been shown to impact the effects of iodine supplementation (7).
Meaning the lower your iron levels are the less likely you are to utilize iodine if you are supplementing with it.
This can lead some patients to believe that iodine supplementation is not working for them when, in fact, it may be due to their iron status instead.
The worse part about iron deficiency is that it is so commonly missed.
Most providers will only check iron levels if they find that you have grossly abnormal hemoglobin or red blood cell levels which indicate iron deficiency anemia.
And because iron studies are not routinely checked, many hypothyroid patients are walking around with sub-optimal iron levels that are impairing their thyroid without even realizing it.
Symptoms of Low Iron In Hypothyroidism
So how do you know if you have iron deficiency?
One of the first places to look is at your symptoms.
If present, iron deficiency usually leads to a host of symptoms which we will go over in a second.
Unfortunately, because of the bidirectional relationship between iron deficiency and hypothyroidism, if you experience one you are likely to experience the other.
This complicates the picture because you may experience a combination of both hypothyroid symptoms and iron deficiency symptoms which do have some overlapping features.
As a result, you can’t always trust your symptoms but evaluating your symptoms can help you determine if you need further testing.
Symptoms of iron deficiency in hypothyroid patients include:
- Fatigue
- Weakness
- Pale Skin (especially in the creases of the palms)
- Shortness of Breath
- Dizziness, especially with exertion or exercise
- Cravings for ice (to eat or chew it)
- Cold hands and feet
- Brittle nails and thin/dry Hair
- Headaches
You will notice that many of these symptoms also closely match the symptoms of hypothyroidism.
For instance, both conditions can result in fatigue, weakness, and cold hands and feet.
How do you know if those symptoms are caused by your thyroid or by your iron status?
You won’t know for sure unless you get tested for both (more on that later).
Hashimoto’s Thyroiditis and Iron Deficiency
Do patients with Hashimoto’s also have issues with iron?
The answer to this question is a resounding yes.
While patients with Hashimoto’s thyroiditis are not your garden-variety hypothyroid patients, they still tend to have many of the same issues that hypothyroid patients experience.
The lack of thyroid hormone (or fluctuating thyroid hormone levels as the case may be) is still enough to cause changes to stomach acid (8) levels and alter iron absorption.
Proper iron levels are still required for optimal thyroid function in both hypothyroid and Hashimoto’s patients.
If you have Hashimoto’s make sure that you are also following the information outlined in this post so you can get properly evaluated.
Is your Iron Level Optimal?
When we talk about nutrient status we really need to differentiate between having ‘normal’ levels and having ‘optimal’ levels.
Most physicians are trained to look at reference ranges and base treatment on lab values that fall outside of the normal reference range.
But, unfortunately, the reference range for many nutrients (iron included) spans a wide range.
Take serum iron for instance:
The reference range is from 40-190 micrograms/dL.
Your doctor will most likely only care if you are less than 40 or higher than 190 mcg/dL.
But that leaves so much room in between where you may feel sub-optimal.
The difference between 50 and 150 is huge.
And your doctor may ignore your iron levels if your value is 45, but they may treat you if you are 38.
With this concept in mind, and when I give you my recommended reference ranges, I am always referring to the ‘optimal’ levels of iron in your body.
The optimal levels allow your thyroid to function optimally.
Because most physicians do NOT evaluate your labs with the optimal ranges in mind the chances are very high that you have suboptimal iron levels.
When it comes to evaluating for Iron deficiency I recommend these tests:
(Remember that you can ask your doctor to order these tests at your next visit, he/she shouldn’t have a problem doing this for you)
Iron Lab Tests: Ferritin, Serum Iron, % Saturation, and TIBC
To get your iron status evaluated you need ALL of the following lab tests:
Ferritin – This number represents the total storage of iron in your body.
Serum Iron – This represents circulating iron in your blood.
TIBC (Total Iron Binding Capacity) – This represents your body’s ability to carry iron (It will go up when the iron is low).
Percent Saturation – This is the ratio of serum iron and TIBC.
Your doctor will be used to ordering these labs, but the tricky part is in the interpretation.
I find that patients typically feel better when they fall within these ranges to both reduce symptoms and increase T4 to T3 conversion.
Instead of focusing on the standard reference ranges provided by the lab reporting your results focus on the following ranges.
Optimal iron levels for hypothyroid patients:
Ferritin – Optimal Levels = 40-50 ng/mL.
Serum Iron – Middle of the reference range.
TIBC (Total Iron Binding Capacity) – Middle of the Reference range.
Percent Saturation – 35-38%.
Falling outside of these optimal ranges may indicate that your iron is sub-optimal and may be impacting your thyroid function.
If this is the case then you will want to consider using treatments and/or supplements to bring your iron into the optimal range.
How To Take Iron Supplements Correctly
A word of caution for those thinking about taking an iron supplement:
You never want to take iron unless you know for sure that your level is low.
High levels of iron can be toxic to the body so make sure you check to see if you really need to supplement with iron before doing so.
If you’ve already checked your iron status and know that you need it then these guidelines should be considered:
Take your liquid iron away from food.
Avoid taking other supplements, coffee, or tea when you take your iron supplement (These may limit the absorption of iron).
Take your supplement with vitamin C or a glass of lemon water (both of these help your body absorb iron).
Take your iron with B vitamins – B Vitamins help with the absorption of iron.
Take your iron at least 4 hours away from your thyroid hormone medication (if you are taking any). Iron supplements can bind to thyroid hormone medication and prevent its absorption. If you are taking both then using one in the morning and the other at night works best.
Take your iron at least once per day.
The daily dosing of iron usually works best for those with sub-optimal ferritin but not very low ferritin levels (outside of the normal reference range).
If you find that your ferritin or iron are both below even the normal range then you may need to take your iron supplement several times per day.
Track your Progress by Following Ferritin Levels
When taking iron it is very important that you constantly monitor and track your progress every few weeks to months.
Not tracking may lead to really high levels of iron over time, or you may miss the fact that your body doesn’t tolerate the form of iron you are using.
Iron levels are easy to track.
After 4-6 weeks of taking an iron supplement, you can ask your doctor to recheck your iron panel (list above).
Once you have your results you can determine if the type of iron you are taking is working, if you need to cut back on your dose, or if you need to increase your dose.
Over time you should see your iron studies including serum iron and ferritin increase.
You should also experience a decline in your low iron symptoms and you may even see a decline in your hypothyroid symptoms.
Remember that iron is like Goldilock’s nutrient.
Too little is harmful to the body, but too much can be just as harmful.
You do not want elevated iron stores in your body as this can lead to inflammation and many other conditions (11).
What if your ferritin levels are elevated but you have low serum iron?
This lab pattern can and does happen, especially in patients with Hashimoto’s.
While ferritin is considered a marker of iron storage in the body it is also considered an acute phase reactant (12).
Acute phase reactants are measurements that can be tested in the body that elevate in states of inflammation.
And ferritin is one of these reactants.
This lab pattern of low serum iron with elevated ferritin is common in patients with Hashimoto’s thyroiditis and other inflammatory conditions.
Because Hashimoto’s is primarily a disease of the immune system, it makes sense that many patients with this condition also experience elevated inflammation.
The problem?
This pattern of high ferritin and low serum iron can fool you into thinking that your iron stores are high when in reality they are low.
The body is just in a state of inflammation which is masking the low iron storage.
For this reason, ferritin is a sensitive marker of iron storage when it is low but not when it is high.
If you have this lab pattern then you can often tease out what is really happening by ordering additional tests to check for inflammation.
This will help you determine if you actually need to supplement with iron.
Recap & Final Thoughts
Patients with hypothyroidism and Hashimoto’s frequently experience sub-optimal iron levels.
Iron is critical to thyroid function in the body and these sub-optimal levels can lead to symptoms that may mimic the symptoms of hypothyroidism.
Because of these changes, it is important that you have your iron levels evaluated with optimal ranges in mind.
If you are suffering from hypothyroidism and think you may also have sub-optimal iron levels then you should start by getting a full iron lab test panel.
Replacing low iron may help improve thyroid function by increasing T4 to T3 conversion and helping your thyroid medication do its job.
And while you are at getting your iron levels checked don’t forget to check for other nutrient deficiencies such as vitamin B12, vitamin D, and magnesium.
These are also very common nutrient deficiencies found in hypothyroid patients.
FAQ about Iron and Hypothyroidism
Can an iron deficiency cause hair loss?
Yes, iron is required for proper hair growth and may be one of the main causes of hair loss in patients with hypothyroidism and Hashimoto’s thyroiditis.
Unfortunately, low thyroid hormone itself can also cause hair loss or changes to your hair which can make identifying the true cause of hair loss difficult.
Many patients with hypothyroidism who also have hair issues (hair loss, damaged hair, etc.) have a combination of both iron deficiency and low thyroid hormone.
Replacing iron levels and replacing thyroid hormone in the body are both required for optimal hair growth.
You can read more about how to address hair loss and regrow your hair if you have hypothyroidism in this article.
Will iron deficiency make weight loss more difficult?
The answer is maybe.
Why?
This largely has to do with the interaction between iron and thyroid hormone.
When iron is low your thyroid function will also be blunted.
Low iron decreases thyroid function which may lead to a decreased metabolism which may lead to weight gain.
You can draw a line between iron deficiency and weight gain but it’s not as clean as you might think.
If weight loss is your goal you will want to take a multifaceted approach that addresses nutrient deficiencies, hormone imbalance, thyroid function, inflammation, diet, stress reduction, sleep, and so on.
So while iron is technically included in this list it’s not the most important part.
What is ferritin?
Ferritin is a marker of iron stored in the body.
It is also a marker of inflammation and is often elevated in inflammatory states.
At low levels, it is very sensitive to iron deficiency, but at higher levels, the value becomes less predictive of iron status and more predictive of inflammatory states.
Is ferritin required for hair growth?
Yes, a ferritin level of at least 30 ng/mL is required for optimal hair growth (13).
Studies have shown that levels less than 30 ng/mL may result in hair loss.
Low ferritin, along with low thyroid function, is probably the most important factor for hair growth in thyroid patients.
How long will it take for my iron/ferritin to increase?
As long as you are absorbing the iron supplements that you are taking then you should see an improvement in both measures within 2-3 months.
Ideally, you will want to retest your ferritin and iron studies after 8 weeks of daily iron use.
You may not see a large bump in either at that time, but you should see a slow and steady upward trend (even if minor).
If you do not see any positive change then you may need to evaluate the type of iron you are taking.
For instance:
Are you taking pills or are you taking liquid? What type of iron are you taking? How much are you taking? Is your intestinal tract allowing for absorption?
Answering these questions may help you make changes to your regimen.
What if iron supplements don’t work?
For various reasons, you may be someone who doesn’t respond to oral iron supplements.
If you fall into this category then you may need what is called an iron infusion.
This is a small procedure in which iron is directly infused into your bloodstream.
It is very effective at increasing iron stores in your body but it is typically only used for extreme cases.
This procedure is usually reserved for those suffering from acute iron deficiency, those who are having trouble with constant bleeding, or those who have repeatedly failed oral iron supplements.
This procedure does carry some risks (14) with it so it is typically performed in a hospital-like setting.
If you find that you are not responding to iron supplements, or if you fit any of the categories listed above, you may want to speak to your doctor about an iron infusion.
Now I want to hear from you:
Have you been suffering from iron deficiency as well as hypothyroidism?
What have you done to increase your ferritin levels?
What didn’t work for you?
Leave your comments below!
Scientific References
#1. https://www.ncbi.nlm.nih.gov/books/NBK448065/
#2. https://pubmed.ncbi.nlm.nih.gov/28202844/
#3. https://www.ncbi.nlm.nih.gov/pubmed/12487769
#4. https://www.ncbi.nlm.nih.gov/pubmed/12487769
#5. https://www.ncbi.nlm.nih.gov/pubmed/16500878
#6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729155/
#7. https://www.ncbi.nlm.nih.gov/pubmed/12487769
#8. https://pubmed.ncbi.nlm.nih.gov/12754530/
#9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6185413/
#10. https://www.ncbi.nlm.nih.gov/pubmed/2507689
#11. http://www.irondisorders.org/iron-overload
#12. https://www.ncbi.nlm.nih.gov/books/NBK519570/
#13. https://www.ncbi.nlm.nih.gov/pubmed/23428658
#14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518169/
Dr Childs,
I have had a thyroidectomy. I am struggling with fatigue and I recently had my ferritin levels checked and they were 57. I have been reading on other sites optimum is 70-100 for women? Do you think this may be true for me especially because of no thyroid? I am fatigued but I struggle with exercise intolerance and sire made sense to me reading symptoms of low iron?
Hi Kim,
No, I don’t think it needs to be that high. Most people with hypothyroidism are under-treated but have been told their labs are “normal” which could be happening in your case. Iron is dangerous and you really don’t want a lot of it in your body.
Hi, thank you for this. What if you have high iron but low (30) ferritin?
Hi Lily,
It means your iron stores are low.
Hello Dr. Childs,
I read this article and found it very helpful…especially the relationship between iron and thyroid. Thank you so much. What I didn’t see mentioned is how to adjust the saturation.
I can see that my Ferritin is high and I do know it is due to inflammation. I’m also on T3 only for thyroid.
What is confusing me tho is that my iron labs look normal to me except for the saturation which is considerably low.
Ferritin 40-50 61
Serum Iron Middle of the range 64 (27-159)
TIBC Middle of the range 338 (250-450)
% Saturation 35-38% 19
How do I raise saturation when the rest looks ok? Do I take iron supplements?
Thank you,
Elsa
What about hemochromatosis? Is there considerations or connections here? Any differences/extremes if you carry 1 vs 4 genes?
Hi Dr. Childs,
I was lucky enough to get two iron infusions about a month ago. Since then my hair has begun to fall out more, and I’ve gained about 4-5 pounds (which goes a long way when you’re short). I’m hypo and taking nature-throid. Is it possible that infusions could affect my thyroid functioning?
I didn’t see my particular scenario on here. Iron was 133, saturation was 48%, which was flagged high, and ferretin was 47. Do results like that correlate with anything like a methylation problem? My B-12 was slightly under 400 and Iodine was flagged low. My Dr said that was fine but why would the saturation be flagged? I have all those symptoms above except for hair loss.
Is there a contradiction regarding ferritin..?
In one weight-loss case study (https://www.restartmed.com/weight-loss-hypothyroidism-success/) you are writing:
“Through treating hundreds of patients I’ve found that optimal thyroid function happens when Ferritin is around the 70-80 range.”
..while on this page you say it is 40-50 range.
(“Ferritin – Optimal Levels = 40-50”)
That’s a bit of a difference – which one is correct..?
For someone with BOTH iron deficiency & hashimotos – is it unusual for TIBC to also test low and outside the normal range? TIBC should be higher with low ferritin levels, but my TIBC is also low. Is there any additional testing I should ask my doctor for? Thank-you
Can the liquid iron be safely added to your hypothyroid bundle + your Vit D and Thyroid Regrowth?
It is my understanding that using Turmeric/Curcumin can block absorption of iron. Do you think that spreading out the dose of each by several hours would be ok? I would like to take Turmeric to help with inflammation and nodules from Hashimoto’s, but have very low ferritin that I am trying to resolve as well. I’m just not sure if just taking it in general will negate the iron I take.
Hi Diana,
I’ve never seen it interfere with iron absorption in any meaningful way but if you were concerned then taking it apart is probably a good idea. When it comes down to importance, iron/ferritin would take precedence over turmeric/inflammation, though, so keep that in mind as you make any changes.
Hi, Dr. Childs,
I want to thank you so much for this article. I have been dealing with shortness of breath for nearly three years. I take Armour for Hashimoto’s and my doc and I assumed the breathless had something to do with Hashi’s and/or the medication. After I read your article and recognized that many of the symptoms you listed I was experiencing (and thinking they were thyroid related), I asked my doc to do the tests you recommended. All of my numbers were in the low end of the normal range and my %saturation was 18 (range 20-50). My doc suggested that I eat more foods containing iron, but to no avail. I started using liquid iron about 5 weeks ago. At week four I noticed an absence of breathlessness one day. It was the first day in three years. Although the shortness of breath has not completely resolved, I believe I’m finally headed in the right direction. (In addition, I have more energy, less hair loss, and I’m thinking more clearly too.) So, thank you so much for the work you do, and specifically for this article. I had almost given up.
Best to you.
Hello, can we take the iron capsules with your thyroid daily essentials multivitamin? I notice that multivitamin doesn’t have iron, am I correct?
Hi Esperanza,
It would be best to space out your iron capsules with all of your other supplements and medications including thyroid daily essentials. And, yes, you are correct in that it does not contain iron.
Hi Dr. Childs, I just received lab work and have low iron (66 mcg/dl), 355 binding capacity, 19% saturation, and ferritin of 93 (down from 156 last year). I have been taking homocysteine supreme due to MTHFR that I believe had helped with the ferritin. I have been borderline anemic my whole life which I am now correlating with gluten sensitivity. I also just started cytomel for a high reverse T3 (free T3 3.1, reverse 23).
My instinct was to see if iron levels rise now that I have converted to a gluten free diet. Will the wait and see approach inhibit the ability to feel well and lose weight? Would it be better to start an iron supplement and then taper off once a midrange level is achieved and see if it can naturally be sustained? Thanks for your wisdom!
Hi Corrie,
I would probably try to eat iron-rich foods and go gluten-free to see if you can naturally increase it. You can always try this for a few months to see where this puts you and then determine if you should be using iron at that point.
Hi Doc,
Just a quick question…
When someone who (according to your ranges) is low in ferritin (17 ng/mL) but optimal in serum iron, TIBC and % saturation starts supplementing iron, can they make the assumption that not only the ferritin will increase but the three optimal levels will change, as well? Or is there a way to ensure just the ferritin increases while the other numbers remain optimal and are not thrown out of range?
Thanks for these informative articles – I refer to them frequently!
Hi Victoria,
Taking iron will impact your serum iron levels somewhat but as long as you are dosing correctly you shouldn’t see a big change.
Hi Dr. Childโs. Iโve been suffering from low iron and a have had a host of different strange adverse reactions due to my hypothyroidism.
I take 120mg every day and they started me on 125mg of iron. I take a biglycinated iron. After a week, I went to bed and woke up from a flush throughout my body and my heart shot up to 169bpm followed by terrible tremors.
Since then Iโve been lowering the iron from 3, to 2, to 1 pills a day. Iโll be fine for a while until it happens again. But my iron levels havenโt improved much, even after months. Iโm out of danger for anemia, but just barely. My doctor also lowered my thyroid meds believing it was the culprit. Weโve reversed course since that decision.
Today, Iโm off the iron and hoping Iโll be ok (looking at liquid iron maybe), and my thyroid meds are back up to 120mg.
But I want to knowโฆ What happened? Was it cortisol? Low t3? What caused this sudden, scary side effect?
Hi Dr Childs. Been following your posts for years. This one about Iron and the Thyroid really hits home. Although TSH is 1.7 (I am not on meds) my hair is thin and falling out. It may be my iron which test shows: TIBC 525; UIBC 467; Iron saturation 11. Is it safe for me to take iron supplementation? My Ferritin is 54. Thanks! Denise
Hi Denise,
There are some who think that pushing a ferritin up to 70 or 90 is ideal but I am not one of those people. Before using iron supplements I would first check to make sure your thyroid is optimized and make sure there isn’t some other issue causing your hair loss.
There are also plenty of other treatments that can be used such as those listed here: https://www.restartmed.com/treatments-for-thyroid-hair-loss/
Hi Dr. Childs,
I recently had iron levels checked along with b12 . My iron was 157 (mcg/dl) with a range of 45-160. Saturation 44 (16-45), IBC 358 (250-450) and ferritin was 31 ng/ml. B12 was 623 pg/ml. My question is can I still supplement with b complex vitamins or do I run a risk of pushing my iron even higher? I am 62 so menopausal. I wish I could get my ferritin higher but don’t think I should supplement with iron as Im close to the top part of all ranges. Your thoughts?
Thank you for your time.
Ann
Hi Ann,
You should be fine to continue to use a B complex without the concern of pushing your iron higher. Sometimes it makes sense to use iron to bring up the ferritin but I usually make the decision on a case-by-case basis.
Dr. Westin, I have learned so much from your articles. But I have a question about Iron that this article did not touch on. I recently had my Iron checked. My Iron was 152 Range (45-160), sat. 40 (16-45), TIBC 376 (250-450), Ferritin 26 (16-232). What would be the explanation that serum Iron is high, and Ferritin is low.
Thanks!
Hi Tammy,
Ferritin is a marker of iron storage, not iron in the bloodstream. You can have low iron storage but adequate iron ready to be used in the bloodstream.
My labs say serum ferritin at 141. But I am low TIBC at 206 and UIBC at 98. My doctor didnโt do anything, but I was anemic about a year previously, eating ice like crazy! And diagnosed with Hashimotoโs then. Iโve been hypo for a long time and on Levo.
So what can I do? My ferritin was elevated probably bc of inflammation like you stated. Iโm so weak lately especially after exercise. I have all the symptoms except nail spooning. I took a liquid iron at one time and it really helped with energy, hair loss, etc. I just ordered it again.
Hi Janel,
In cases such as this you will want to look at inflammatory markers such as ESR and CRP to see if the higher than normal ferritin is indeed from inflammation. Other things can contribute such as hemochromatosis which should be ruled out. You really don’t want to assume high ferritin is from inflammation without ruling everything else out first.
Dr. CHILDS, Hashimoto’s for over 12 yrs, recently gone hypothyroid despite being on same Tirosint level for over 5 yrs. Thanks to Covid, doc says, since reports are coming out that virus affects thyroids, whether or not u previously had thyroid issues, and iron. Fighting iron deficiency with levels in single digits for over 8 yrs and only this past Oct got to see hematologist. Despite 100mgs iron pills per day with vitamin C, and a 750mg Injectafer infusion back in Feb, my ferritin went from 5 in Oct to 39 in May. Been trying to get to 100, doc says ideal. Thinking it dropped even more though due to recent D&C to remove polyp and fibroid, and increased fatigue. Considering going to liquid iron, but 3 questions…
* I cannot do Floradix because B12/ Cyanocobalamin aggrevates cobalt allergy/ raises eosinophils, so I like the look of Gaia, just iron. Familiar with that?
* Also, with only 10 mgs of iron in this Gluconate, can it actually be faster than 100mgs of pills, and why/ how?
* My doctors will not test iodine or selenium, nor does endocrinologist think digestive enzymes will help. Should I try to add small amount of selenium and enzymes to try out? Can I take at same time of iron?
Hi MaryC,
I’m not familiar with the iron supplement you mentioned so I can’t speak to it. In regards to your other question, liquid iron is better tolerated but typically requires higher doses for longer periods of time to match the capsules. Lastly, you can take selenium if you’d like but I wouldn’t say it’s required and if you did take it you wouldn’t want to take it at the same time as your iron. Iron should be used away from pretty much everything else.
Hi and thanks for your invaluable articles in a world where noone seems to know much about this. I am on T4 medication and just started a drop of T3. My problem with iron is mysterious-if I do not take iron supplements my nails do not grow -end of story. I start and they grow normally, I stop and they stop and instead split into slices. My ferritin is allegedly high 171 mcg/L, iron 13 mcmol/l which is considered normal? CRP 2mg/l (so no inflammation). (Only other abnormal blood test is cobalamin high (790 pmol/L). Any idea why this is? Should I take iron supplements or not? Its a mystery
Can you speak to the role copper plays with iron deficiency? I was reading about the importance of copper and ensuring it is optimal before resorting to iron supplementation…your thoughts…?
Hi Paula,
Copper deficiency reduces how much iron can be absorbed by the body so taking copper (when deficient) may improve iron levels.
I was today-years-old when I learned about the thyroid/iron connection. I just got my bloodwork back and my T3 is low at 67, so I was searching for reasons this could be and found this blog. I’m a bit of a complex case because I have hereditary hemochromatosis as well as Hashimotos (I also have hEDS/MCAS/POTS). I’m on 88mcg of Levothyroxine and my TSH is 1.48, my Free T4 is 1.23 and my T3 is 67/low. I’m still waiting for my most recent Iron panel, but the last time it was tested 6 months ago: Iron/103; Sat %/31; Ferritin 6.6. My hematologist says she isn’t concerned about my low Ferritin. It’s been below 21 since July 2020. I’ve been controlling my iron levels with diet, so I don’t eat any foods high in iron. I haven’t had to have a phlebotomy for a year. If I eat foods with iron or supplement with iron, then my Sat % gets too high. I can’t take Vit C because I am oxalate toxic. I’m wondering if it makes more sense to add back in some moderately high iron foods and risk my Sat % getting too high – then getting a phlebotomy to balance things out regularly. I guess the short question is: Is it better to get iron levels up to support my thyroid function and get regular phlebotomies? Instead of eating low iron to keep my Sat % in a good range and risking low thyroid function? I definitely have had symptoms arise over the last year of low energy, weight gain, and afternoon energy crash/tiredness. Thanks in advance for any insight you’re able to share…
Hi Kris,
In general, you don’t want to take iron supplements unless absolutely necessary as iron can be toxic to the body which is what occurs with hemochromatosis. There may be situations in which it makes sense for therapeutic phlebotomies but there are so many other contributors to low T3 that starting with iron wouldn’t be a good idea. Other basic factors should be addressed first like diet, lifestyle, sleep, stress, etc. All of these impact thyroid function as well.
Dear Dr Westin Child
I had a compete removal of my thyroid due to Follicular cancer 8 weeks ago and i am on 100 microgram Levothyroxine tablets, my blood test at surgery on the 14 December 22 for Thyroid function test was:
Serum free T4 level 18.5 pmol/L Range (9.0 -25)
Serum TSH Level 0.08 miu/L Range (0.3-5.0)
I am a bit concerned about the low THS Level.
Your blog and information thyroid is very good in good clear manner to understand.
Hi Manoj,
After thyroid removal for thyroid cancer, doctors are generally ok with lower-than-normal TSH levels because it’s thought to reduce the risk of cancer recurrence.
Dr. Childs,
I always love your blogs. I am so happy to see this on ferritin. Iโm kind of neurotic, in that when I found out I had low ferritin (after 12 conventional doctors couldnโt figure it out) I learned everything I could about iron and ferritin. I found that I became drastically better with a ferritin above 50, but really I needed to be above an 80. Once I supplemented enough and got above 80/90 I felt better and better. My hair grew like crazy and itโs like a lionโs mane now down to the bottom of my back.
I then went the functional route because the ordeal terrified me. They found I had subclinical hypothyroidism when this occurred. I forget what stage of hashimotos- 3??? (I didnโt know it at the time- learned it later from your video). I also ordered labs (ordered by my doctor or myself) almost every month for 3 years and correlated it. I studied and studied and used old thyroid meds (broke in half) to add to the ones I have to become optimal. Iโm finally optimal in both the thyroid and ferritin and feeling soooooo much better.
It blew my mind how in sync my thyroid was with my ferritin labs. When my thyroid labs tanked my ferritin labs did too.
Now it has me thinking- did I ever need to supplement that heavily to begin with? All I needed was for someone to optimize my thyroid correctly! But how would that have happened with a TSH of 2.35 and slightly low T3? It was always missed by doctors. Then when I was given thyroid meds they never got my T3 right. The Dr freaked when my TSH was a 0.3 even though my T3 was low. Then my Dr moved away.
Thanks to you and Dr. Amieโs podcasts I was able to test and optimize myself and my ferritin is sitting nice at around 100, TSH is low and T3 is 3.9. ๐ ๐ best of all I feel better.
Thank you for helping people like me. I know you donโt give medical advice because you canโt but you definitely provide the tools for us to figure it out.
Hi Robin,
Glad to hear you are figuring this out and it definitely sounds like you are doing great! Thanks for sharing your story and I’m glad you find the information helpful.
Hi! Very interesting article with helpful information. I’m trying currently to get to the bottom of some of my health-related issues. I’m struggling with my doctors either not really listening/taking my symptoms or tests seriously, or not ‘talking’ to one another. I’m struggling to understand my most recent test results. Iron panel shows saturation at 17, TIBC 323, Iron 56, but Ferritin only 11. My endocrinologist referred me to my PCP to discuss these results for either further testing or iron supplementation. I had also had a thyroid testing done, and while my TSH is 1.8 my free T4 is just .64, which I know is low and marker for Hypothyroidism. My doctor said she is not concerned because this low T4 would only be a concern if my TSH was high. I’ve read otherwise, so do not know what to think or if I should get a second opinion. I also do have a confirmed Pituitary microadenoma (4mm)that has not grown in 3 years and has been determined to be non-functioning, though I am awaiting a new cortisol test. I’ve just been unable to reconcile any of this with my symptoms. I know I’m not well but can’t determine if this all truly could be only the iron stores or if there is also something going on with my thyroid, or who to try and go to at this time, another endocrinologist or my pcp or someone else? thanks for any thoughts!
Hi, you put two ranges for optimal ferritin 70 to 100 and 40 to 50. What one is it? Thanks!
yes I saw this as well. 40-50 does not sound optimal. I didn’t feel optimal with a ferritin of 47.
I have hypothyroidism and hashimotos. I’m very tired all the time and have been having more joint and muscle pain than the usual for the past month. Here is my most recent lab work. What does this mean? Could the high inflammation be causing a false higher ferritin? And what about the lower saturation%?
Labs 4-13-26
IRON, TOTAL 94 {40-190 (mcg/dL)
IRON BINDING CAPACITY {332 250-450 (mcg/dL (calc))
% SATURATION 28 (16-45 % (calc))
FERRITIN 97 (16-232 ng/mL)
MCHC 32.2 (32.0-36.0 g/dL) tested on 6-3-25
ANA SCREEN, IFA POSITIVE
C-REACTIVE PROTEIN 14.1 H (<8.0 mg/L)
SED RATE BY MODIFIED WESTERGREN 22 H (< OR = 20 (mm/h)
RHEUMATOID FACTOR <10 (<14 IU/mL)
TSH 5.16 (mIU/L)
T4, FREE 1.3 (0.8-1.8 ng/dL)
T3, FREE 2.8 (2.3-4.2 pg/mL)
THYROID PEROXIDASE ANTIBODIES 93 H (<9 IU/mL)
VITAMIN D,25-OH,TOTAL,IA 49 (30-100 ng/mL)