Iron and hypothyroidism
(Important note: STTM is an information-only site based on what many patients have reported or learned in their treatment. Please work with your doctor. This is not meant to replace that relationship or guidance, and you agree to that by reading this website. See the Disclaimer.)
ALL ABOUT THE IRON PROBLEM
Why do we, as thyroid patients, often have low iron levels?
Here are six reasons, with #1 being the most common, but it doesn’t exclude that any of the others can be contributing…
- Being hypothyroid can result in a lowered production of stomach acid which in turn leads to the malabsorption of iron. This is probably the most common reason which covers the most people.
- Being hypo can result in heavier periods for women, which causes more iron loss on top of having low stomach acid. http://www.ncbi.nlm.nih.gov/pubmed/12754530
- Chronic inflammation can lower our serum iron levels because it pushes iron into storage, i.e into ferritin. And too many thyroid patients have inflammation. To see if you have inflammation, go here.
- Gluten sensitivity or intolerance can also cause inflammation, we’ve noticed, which might lower iron.
- An allergy to what we eat can cause inflammation for some, as happened to thyroid patient Deb who discovered she was allergic to eggs. That inflammation can lower iron because it pushes iron into storage. Once she removed eggs, her iron went up!
- Having an active MTHFR mutation, which can result in the body being unable to break down iron for use, placing some of us in a “low iron state”, even if iron in our blood looks high. Even other methylation snps can contribute to high iron.
And here are seven reasons having low iron can be a problem for hypothyroid patients
- Becomes the precursor to being anemic, revealed by the other iron labs–saturation and serum iron.
- Can lead to symptoms which mimic hypothyroidism–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.
- Can make it difficult to continue raising your desiccated thyroid (or T3), patients have reported, causing either pooling of one’s T3 levels (T3 going high and not getting to the cells) or rising RT3 (the inactive hormone). RT3 going up is very common with low iron!
- Can decrease deiodinase activity, i.e. it may be slowing down the conversion of T4 to T3. http://www.ncbi.nlm.nih.gov/pubmed/2498473
- 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. http://www.ncbi.nlm.nih.gov/pubmed/12097675 Thyroid peroxidase 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).
- Can negatively effect 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.
- Can have a negative effect on your body’s ability to produce/break down for use thyroid hormones (in addition to iodine, selenium and zinc) http://www.biomedcentral.com/1472-6823/8/2
Which iron labs do I need? How do I prepare for them? How do I understand the results?
In summary: it’s four iron labs we need: serum iron, % saturation, TIBC and Ferritin…NOT just ferritin. We stay off iron for 24 hours, or even better, 5 days to see what we are hanging onto. To see where patients fall when iron is optimal, this page will help: //www.stopthethyroidmadness.com/lab-values
Can I ONLY measure ferritin, aka storage iron, and/or treat based on ferritin alone?
Big mistake! Yes, low ferritin can go hand-in-hand with low iron. But low ferritin can also occur with high iron due to the MTHFR mutation, patients have reported discovering i.e. because of the MTHFR mutation, our bodies don’t break down the iron for use, so it goes higher than it should, and storage iron goes down. We might also see a high TIBC with this scenario–another clue that our bodies aren’t breaking iron down for use and thus, putting us in a low iron state. Not everyone gets the high TIBC, but many do.
So by treating that low ferritin alone, we can push our iron and % saturation levels even higher! Not a good thing.
POTENTIAL SYMPTOMS OF HAVING LOW IRON
Summary: symptoms of having low iron include heart palps or fast heartrate, easy fatigue (similar to hypothyroid), short of breath or air hunger, burning in legs when climbing stairs, achiness, poor recovery after exercise, weakness, brain fog, hot flashes or feeing hot, pressure behind eyes, diarrhea, stressed, irritable, cramps, numbness, pale after walking, etc.
HOW TO DO IT ALL
How have patients reported bringing their low iron up (when labs show it is too low)?
a) Focusing on high iron foods in one’s diet
Now granted, this won’t be as effective as being on supplementation. But if serum iron is only low in a minor way (see the Lab Values page to know), it might work, report patients. Foods rich in iron include lean meats, liver, eggs, green leafy vegetables (spinach, collard greens, kale), wheat germ, whole grain breads and cereals (though not for those with gluten problems), raisins, and molasses. Some cook their foods in a cast iron skillet. Remember that to be effective, we as patients discovered we need an acidic environment in our stomach to properly absorb the iron. If in doubt, we make sure to put lemon juice or ACV (apple cider vinegar) in water and drink while eating iron rich foods.
This has been the most effective if iron is quite low, we’ve observed in each other. There are all sorts of iron out there: Ferrous Sulfate, Ferrous Glutamate, Ferrous Fumerate and others. One favorite is Ferrous Bisglycinate because it seems to cause less constipation that some of the others cause, plus the milligrams on the bottle equal the amount of elemental iron in the tablets, whereas the other may not. See below on how much. Or there are whole food versions of iron which can be made from beet root or liver. Or there are some liquid varieties. If we find ourselves with constipation, patients add magnesium to tolerance to help soften stools. 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.
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.
How much iron supplementation is needed to raise low iron levels, and how long do patients report taking it?
It’s NOT about taking one or two tablets, a mistake many patients make who aren’t informed. Patients have discovered they usually need 150 to 200 mg of “elemental iron” daily, spread out with meals (i.e. 3 times a day), in order to adequately raise their iron levels. Always check your labels or call the company to see how much “elemental iron” is in each tablet. We’ve noticed it can take a minimum of 6-8 weeks to improve our levels to the desirable goal. Keep track of labwork with your doctor to see where your levels are, because you want to lower 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. But it’s hard to know how much will raise your iron. Labs will help.
Please work with your doctor on this.
WARNING: literature states that if you have cancer, taking iron can promote cancer growth. Talk to your doctor before deciding this information is right for you.
Do thyroid patients report taking anything with the iron to help absorption?
Yes, say patients, two things: an acid in the drink (lemon juice or apple cider vinegar, such as one tablespoon or more) and Vitamin C in supplement form to tolerance each time, or high Vitamin C foods.
Also taking a mineral supplement can assist the absorption, as can B12. http://www.irondisorders.org/iron-deficiency-anemia One important B-vitamin is Folate (not Folic acid), which promotes red blood cell formation. Adding it to your iron supplementation can be key, some patients have reported. But if you have MTHFR, be careful going too high–in helps increase the breakdown and release of toxins or metals, and you have symptoms of that, or excess fatigue.
What should I avoid in my stomach at the same time as iron?
Literature says to avoid calcium, coffee, tea or wine (tannins interfere with absorption to some degree), the fiber of bran, and chocolate at the same time we take iron. Also avoid mixing iron with your thyroid pills. Keep them all apart from each other where possible, we’ve found.
Can I take iron at the same time I swallow my desiccated thyroid?
Patients report avoiding swallowing iron at the same time as thyroid pills, since the iron will bind to some of the thyroid hormones as they mix in your stomach and bind some thyroid hormones. They might take their T3 or desiccated thyroid one hour before iron is taken, or several hours later…or try their 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.)
PROBLEMS WITH IRON SUPPLEMENTATION
What about the constipation I get from taking particular iron supplements?
Patients report adding Magnesium Citrate or other kinds of magnesium as a supplement, taken twice a day, until they find the amount that softens their stool. They know within a few days if the amount being taken is enough….or even too much (i.e. too much will cause diarrhea).
What if I can’t tolerate oral iron?
For one, if you have low stomach acid, it can cause that iron tablet to sit around too long in your stomach, causing problems. So it can be important to drink it down with an acid in your drink, like lemon juice or ACV. Some report they start on less than others, then slowly built up. Or if there are 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 about this, though. See below.
What about iron injections or IV?
If 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. Patients will often follow that up in a few weeks by staying in lower doses of oral iron tablets.
POST IRON SUPPLEMENTATION
How soon do I re-test my iron labs when I’m supplementing iron?
Every 4-6 weeks minimum 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! Or you could have hemochromatosis and not know it! Also, you could have what’s called the MTHFR genetic defect, which means your body doesn’t do a good job breaking metals down. Thus, your iron could get too high. ALWAYS retest, we have learned!
Once I get my 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 iron levels may stay where they need to…but they may not! Work with your doctor.
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. Others focused on consuming high iron foods. You can see where optimal iron results should be, here.
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, we’re noticed on labs. It’s common to see healthy men with a ferritin slightly over 100. See the lab values page.
QUESTIONS PERTAINING TO IRON LAB RESULTS:
My TIBC is low as is my iron. What does that mean for me? TIBC stands for Total Iron Binding Capacity, and it’s basically telling you how much protein your liver is making in order to envelope and carry that iron around. Typically, if iron is low, TIBC will be higher in the range. So if your TIBC is low, it might mean three things, say literature 1) Your liver needs support! Milk Thistle and Dandelion Root are two supportive supplements. 2) You can’t take the high amounts of iron that others do with low TIBC, since it will be problematic without that protein 3) You’ll need to consider taking lactoferrin with each dose of iron to supply the needed carrying iron. Because of lactoferrin, you might be able to take the higher amounts.
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. Testing is needed, though, to confirm it. Then 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. (NOTE: Another cause of high levels of iron is having a defect in the MTHFR gene, meaning the body isn’t breaking down iron for use, but it will usually mean low ferritin, unlike hemochromatosis).
What causes low ferritin when other labs look great or are even too high? That usually points to an MTHFR mutation and having high heavy metals. You can also see high levels of homocysteine with this defect, as well as higher levels of copper and other metals.
DIDN’T DO YOUR PERCENT SATURATION LAB?? If you did both TIBC and Serum iron, you can figure out your percent saturation right here.
• Need a good doctor to work with in all this? Go here. Remember this is all about information and shouldn’t replace that relationship.
• Get your own iron labs ordered and done via the Recommended Labwork page
• AS FAR AS THE 70-90 RANGE FOR FERRITIN: there were five scholarly articles on the net referring to this 70-90 range from 2004 to 2012…but they have all disappeared i.e. the websites disappeared from the net. So most of what you will see on the internet are websites which saw this range on Stop the Thyroid Madness (and fail to give STTM credit–sadly common), and we at least had studies or articles to prove it. Now we don’t.
• 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
• 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.
• A good article explaining supplements to take with iron found here.