Friday, January 22, 2010

Anemia and Hypothyroidism

So, at the same appointment where I learned that my TSH was up but my access to Armour thyroid meds was gone, I also learned that I'm borderline anemic again. In particular, I'm very iron-deficient. My ferritin levels are down the tubes.

Ferritin is a protein that binds with iron and keeps it available for use, if I understand it correctly. It's one measure of stored iron in your body, basically.

Online, ferritin levels considered "normal" vary from source to source. The lab I used listed 11-307 as "normal." Medline Plus lists normal ferritin levels as:
Male: 12-300 ng/mL
Female: 12-150 ng/mL

"The lower the ferritin level, even within the "normal" range, the more likely it is that the patient does not have enough iron."
Most online sources I've read state that while "normal" may be as low as 12, people should start getting concerned with levels below about 50.

Guess what my level was? 7.2. Definitely below any measure of "normal" and basically in the toilet. Great.

Now, my hemoglobin and hematocrit are in the "normal" range.....but only just barely. My hemoglobin was 11.6 and the cutoff is 11.5; my hematocrit was 35.4 and the cutoff is 34.7 at my lab. So not "officially" anemic, but barely above the cutoffs. And the ferritin is definitely abnormally low (7.2 when it should be at least 11).

The good news is that we had other levels tested last year to figure out which kind of anemia I had. My folate levels are good (I have aggressively supplemented these over the years because of pregnancy and breastfeeding) and my B12 levels are also good. So with the really low ferritin levels, it looks like it's iron deficiency anemia.

I've been struggling with this for a while. I've often been a bit borderline anemic over the years, but not enough to cause big problems. In pregnancy, I used "Floradix" - an herbal over-the-counter preparation - and that helped immensely without causing constipation, the way that iron pills can. It's great stuff, much better than OTC iron. It's what got my hemotocrit and hemoglobin levels up this past year.....but apparently it doesn't have as much effect on ferritin levels. Bummer.

As I've gotten older, I've had more issues with anemia, enough so that I was no longer able to donate blood to the Red Cross anymore. I'm a fairly rare blood type so they love me, but I haven't been able to donate now in several years because of the anemia. In fact, my donations probably exacerbated my low iron issues.....but I haven't donated in several years now, and my ferritin levels are still down to 7.2, so obviously it's much more than just blood donation going on.

Part of the problem is being perimenopausal. One symptom of impending menopause you don't hear a lot about is extremely heavy periods, called "menorrhagia." Colloquially, it's called the "blood flood" and sadly, it's very aptly named.

My periods were always reasonably normal, not usually too heavy or too painful. I skipped months periodically because of the PCOS, but once my hypothyroidism was finally diagnosed and treated, I never skipped a period again. (Still have other PCOS symptoms but as long as they hypothyroidism is treated, they stay relatively mild. Now, with my TSH going up, they're starting to act up more again. Ugh.)

As I've become perimenopausal, the periods became heavier and heavier. So this is quite likely a big cause of the low ferritin levels too. But I'm happy to report that as I move closer to menopause (and with the help of acupuncture), the heavy periods have eased up, thank goodness! And yet, despite this, my ferritin levels are still at an all-time low. So obviously, menorrhagia is not the only cause for my low ferritin levels.

I eat plenty of iron foods, I cook in iron skillets, I regularly take vitamin C with my iron, I avoid calcium etc. with the iron, I eat plenty of red meat (a more easily absorbed source of iron), and basically do all the things that are supposed to "fix" this problem. And none of them are working.

What I learned recently, though, is that hypothyroidism and anemia tend to go hand in hand. When you have one, you often have the other, especially if there are any other challenges to your system (like pregnancy, birth, blood donation, heavy periods, etc.).

And apparently, undertreated hypothyroidism in particular tends to result in low ferritin levels.

So it will be interesting to see whether getting my TSH levels back to where they feel better to me will also coincide with an improvement in my ferritin levels. I am also taking supplemental iron and Floradix. Hopefully all of that will be enough to get things back to normal. Keep your fingers crossed!

[Anyone else with hypothyroidism had problems with anemia and low ferritin in particular? I'd love to hear about other people's experiences and what helped you.]


Bonnie said...

Here is a link to the site where I get my natural thyroid. Hope it helps.

Unknown said...

I am also hypothyroid with low ferrtin. I started feeling better once my ferritin hit 20, which I suspect also got my thyroid levels to shape up. I have now reached a ferritin of 45, but since I started to exercise my levels have not increased (rather decreased somewhat).

Last week I found out my DD 9 was also hypothyroid with low ferritin.

After letting the news sink in, I convinced my very reluctant DD 12 to go for a test.

Yesterday we received the news, hypo and low ferritin.

Our doctor liked to call them subclinical, but no way did I agree! With THS for both at about 20 (0.35 - 6.0) and Free T4 at 11 and 8.5 (8.0 - 22.0), I requested to see a pediatric endo.

My youngest has started on medication, and I am sure my eldest will as soon as she get to see the endo.

I will give them both liquid iron for 2 - 3 months, hopefully it will make them perk up.

I curse myself for not catching on to it sooner, but it never occured to me until my youngest displayed a goiter.

Do keep an eye on your children, and have them tested if you suspect something.

All the best,


Anonymous said...

On the subject of iron supplements, for people who don't have ferritin problems and just need more iron: the constipation is caused by ferrous sulphate. That's the cheapest and commonest form of iron in supplements. But if you can find supplements containing ferrous gluconate or ferrous fumerate, those won't cause constipation.

Anonymous said...

I have two more weeks left in a 6-week course of Ferlicet (I think that's the spelling) to get my iron levels up. My ferritin was at a 4. Yikes! No hypothyroidism for me, however. I've also had weight loss surgery (the duodenal switch) and gave birth via C-section to twin boys this summer. My iron levels, already low, but a stable low, crashed immediately thereafter. When you're that low, no amount of supplementing is going to get you up when you add in a malabsorption factor. So, it was infusion city for me.

In addition, I'm also choking down a tablespoon of blackstrap molasses every day. You get 40% of your RDA of iron from that. Utterly incredible, if you can stand getting it down.

If all else fails, go with the infusions. They're the quickest way to resolve at least part of your problem. Good luck!


Well-Rounded Mama said...

Thanks for the comments folks.

The type of iron I am taking is mostly ferrous gluconate so it's easier on my system. And of course, Floradix, which is really helpful too overall, just not as helpful with the ferritin.

Cya, thanks for the heads-up on watching the kids' levels. I did start having my teenage daughter tested for hypothyroidism recently because mine first presented in my late teens and I wanted a baseline for her. So far so good...but we'll watch the ferritin too.

Sarah, the combo of WLS and the blood loss you can have with childbirth (esp c/s) is a tough combo. I'm sorry you had to go through that. I know that nearly all the WLSers I have known have ended up on IV iron sooner or later. It's just too hard to keep those levels up without it because of the malabsorption.

Interesting how you ended up with a level of 4 with the WLS, and I'm at 7----without WLS. Yipes. Scary what it might be with WLS!! Well, hopefully I can start getting it back up again pronto! If not, thanks for the hint about the IV iron protocol. Here's hoping I won't need it....but thanks for sharing.

Congrats on your twins, btw!

Anonymous said...,0,3227448.story

Just read that, and ran right over here to share it.

BBBW (big beautiful breastfeeding woman) right here. Nursed my 4yo til she was 3.

Anonymous said...

I used a product called Ferrasorb when my iron levels were low.

Hazelnut said...

Do you know what your red cells actually look like? I'm a veterinarian, not a doctor, and employed in a research lab rather than in practice, but what I was taught is that true iron deficiency anemia will typically cause a hypochromic microcytic anemia (cells are pale and smaller than normal). I never hear about this in human medicine, and I always wonder.

Anonymous said...

Glad to see this post. I too have been dealing with low ferritin and life without a thyroid. Ferrous Gluconate is also my choice of supplement. I take synthroid.

So what have I learned? Low ferritin, hypothyroidism and perimenopause symptoms mimic one another. I feel best when my ferritin is over 70. As I approach menopause and my ferritin levels come up, I became hyperthyroid and need less synthroid. I feel best when my TSH is between 1-2.

Oh yes, iron supplements and calcium interfere with synthroid (and each other) - give them a 4 hour window from each other.

Thanks for the opportunity to share!

Sick of being tired! said...

Hey! Who stole my body? We share so many common symptoms it was kinda weird reading your comment!-Perimenopause, Hypothyroid, Low iron, & Low Vit D!?! I just found out about the last 2 this week. The way the symptoms mimic each other is crazy and confusing at times- I wonder if it amplifies the symptoms? I appreciate the comments from everyone and look forward to walking down the road to health because I have too many things to do in life beginning with keeping up with and enjoying my 3 teenagers! I am looking for a healthy way to jumpstart my health in addition to my supplements. If anyone has advice..."sick of being tired"

Anonymous said...

Skin Bright says I am also hypothyroid with low ferrtin. I started feeling better after I got my ferritin into the mid twenties. Through exercise I have now been able to get my ferrtin level up into the forties.

Home Remedies said...

There are also different types of anemia: iron deficiency anemia, vitamin deficiency anemia, and anemia of chronic disease, as well as aplastic anemia, anemia associated with bone marrow disease, hemplytic anemia and sickle cell anemia.

Anonymous said...

I'm 4 years post-menopausal, and the blood lab turned me away in April after 30 loyal years of donating due to low iron -- turned out I was anemic, leading to thyroid check, and Hashimoto's diagnosis... Also low in calcium, Vit. D, globulin, etc. Like "sick of being tired," I wonder whether all these conditions' symptoms amplify one another, and what more is recommended aside from religiously taking iron supps, thyroid meds, and the low-dose anti-depressants the docs have prescribed. It's tough enough keeping up with teenagers, work, and home, without all this...

Anonymous said...

Joe said,,,
I have got rock bottom ferritin levels. Below 4 at its lowest & I felt wrecked. Even managed to crash the car I was so spaced out! Fortuneately no serious injuries but I blame my low ferritin for that.
I am also hypothyroid. Spent most of last year on iron supplements & my ferritin was hardly raised off the floor. I got it up to about 20. I was sent for various investigations including an upper & lower endoscopy to no avail.
Just found this website & feel some hope.
I am off to my gp with a print out ASAP. Thanks to the well rounded mama.

Anonymous said...


Iam recenlty diagnosed with hypothyroidism and anemia.. Im afraid that i might pregnant this month as we did not use any protective measures and i also assume Im ovulating as i have lots of discharge..Should i use any contraceptive pills or is it okay if im pregnant?.. I wanted to have a baby but before that i wanted to get back to normal.. But Im worried that if i get preg this month what will happen to the baby..

Please advise.

Well-Rounded Mama said...

Anonymous, I'm not a health care provider and I don't give medical advice. Besides, there is no way for me to know what your iron and thyroid levels are, which is important. My suggestion is to consult a midwife or your GP as soon as you can.

To answer on a basic level, I think a lot depends on how bad your anemia and hypothyroidism is and whether you are on meds. People do have generally healthy pregnancies with mild hypothyroidism and mild anemia; if you were pregnant and your condition was mild, you could start getting those labs improved via meds and diet and go from there. It doesn't have to be a disaster. But more severe deficiencies might mean more problems.

Really, you need to see a healthcare professional who is familiar with your details and ask them these questions. Sorry I can't help you more.

Anonymous said...

Happy to have found this. I have had hypothyroid for about 8 years and they just keep raising my dose. I have always been anemic and know I'm bad when I start chewing ice. Anyway - had them test my ferritin at the advice of a relative and it was <3.4 - didn't even know that was possible. No doctor has ever told me about the link between anemia and hypothyroid. I have an appointment with a hematologist next week after these last labs so I am going to mention this. Thanks!

Anonymous said...

I had a Ferritin of Zero. Chest pain, racing heart, short of breath, calf pains, tingling feet, feeling cold. Mirena IUD and Tranexamic Acid are helping me. Prometrium might be next...

Well-Rounded Mama said...

Recently read somewhere that one reason that people with hypothyroidism tend to have low ferritin levels is because their stomach acid levels tend to be low. So some more "alternative" practitioners prescribe taking some apple cider vinegar in warm water every morning to increase acidity in the GI system, which should help increase the absorption of iron from foods. If that doesn't work, then there are some supplements you can take (Betaine? or something like that) that will also help increase acidity a bit.

Have no idea whether this is valid or not, but thought I should pass the info along as a follow-up to this post. If you are interested, I suggest further research on it before trying it.

Well-Rounded Mama said...

Yikes, Anonymous, a ferritin of zero? I've never heard of that before. How is that even possible? Why isn't your care provider having you get a transfusion? I'm not a healthcare provider by any means, but it seems to me like job one is to get your levels normalized to protect your heart, and THEN address what's causing it.

How will Prometrium help? That usually brings ON a period by flushing out the endometrial lining. Seems like that might make things worse, but perhaps there's something I'm missing here. Can you explain?

Have they scoped you internally to see if you are losing blood chronically somewhere (besides just periods)?

Honestly, I think you should see a hematologist, if you haven't already. Something weird is going on and I think it deserves more investigation.

Bardea said...

Ha. I love this. 38yo mom of 2, ages 5 and 3, doc just upped my levothyroxine to 200mcg because TsH crept back up to 1.95, and checked some other things as a follow up to my continued tiredness. I have been more rested since 4 months on a cpap machine, I did have moderate sleep apnea, but the new labs also showed iron has only gone up to 19 from 12 in 4 months, b12 is still on the low end, and vitamin D is finally up to 70 from 20 after 6 months of 150,000ui per week. Reading these other posts encourages me that sticking diligently to iron supplements for 3months will either greatly improve my body functioning, or reveal some blood thing that is blocking the iron absorption. I feel so happy knowing the correlations are out there in other people too. Ps, I was also PCOS pre babies and got on thyroid meds between kid one and kid two, and conceived naturally with kid two. ... Thanks well rounded mama for your site!

Unknown said...

I believe you mentioned you started noticing symptoms of your hypothyroidism as a teenager... I am wondering what made you decide to get tested initially/how ou were diagnosed. Thanks!

Well-Rounded Mama said...

Blair, I had a huge weight gain in my late teens/early 20s, despite doing lots of things to lose weight. We looked for a physical cause so they tested my thyroid levels. The results always came back "normal" or "borderline" (depending on who was explaining the results), and they told me they just needed to be watched.

NOW I know that different organizations disagree on the cutoffs for thyroid labs, and that some have lowered their cutoffs. By those new standards, I was probably abnormal....but I'd probably still be considered normal by other standards. I was treated with suspicion and condescension by doctors the whole time. One endocrinologist told me I was looking for an excuse for being fat. It took me 10 years to find a doctor who took my concerns seriously based on my symptoms and "borderline" readings. We did a trial of meds and it changed how I felt immensely. I also think it prevented a lot of further weight gain.

I now know I also have lipedema, which is a rare adipose disorder that can cause huge weight gains. For me, the thyroid is the trigger for lipedemic flares. If I keep it well in range, then my weight is pretty stable. If the thyroid gets out of whack, I can gain weight really fast via the lipedema flares.

If you are considering getting tested, do some research about thyroid symptoms and the various tests and cutoff controversies. Find a thyroid-knowledgeable doctor; you might need to find a bit more "alternative" doctor to get one who will really take your symptoms seriously. Then get the blood tests...TSH, free T4, free T3, and possibly others. Get a copy of your exact lab results, rather than just accept "normal" from the dr. Then you can decide what to do from there, based on the results. But you really need to be well-educated about the issue and able to advocate for yourself.

Best wishes to you. Hope you find some answers!

Unknown said...

Thanks so much for your reply!

Anonymous said...

I have hypothyroidism too. Was diagnosed anemic a couple months ago and have had iron infusions. They are saying its my diet but I dont believe that. I think its the hypothyroidism or medication induced.