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Anemia with Hashimotos?

Has anyone had experience with anemia with hashimotos?  Did you take iron supplements to resolve, or should I be looking at something else to resolve?

My total Iron is normal (95), but my Ferritin is low (15, where the range is 38-380 for normal), and my TIBC is 430's (with range of 250-425 for normal).

3 Responses
649848 tn?1534633700
COMMUNITY LEADER
Low Ferritin isn't uncommon with Hashimoto's.  Ferritin is the iron storage hormone and should be at least 50 - some say it should be higher than that.  Without adequate iron, your body can't produce or metabolize thyroid hormones properly.

Have you also had vitamin B-12 tested?  It's also not uncommon for those of us with Hashimoto's to be deficient in Vitamin B-12, as well as vitamin D.  

Vitamin B-12 deficiency causes a different type of anemia, but has many of the same symptoms as those caused by low iron.  You may need to supplement them both.   I have Pernicious Anemia (inability to absorb Vitamin B-12 via the stomach) and have to haveinjections to keep my levels up.  That makes a huge difference in the way I feel.  I had blood work for a recent surgery that indicated a mild anemia so I'm getting ready to follow up and possibly start an iron supplement as well.

Do you have current thyroid hormone test results?  It would be helpful if you could post those, along with their reference ranges so we can see your actual thyroid status.  

Do you take replacement thyroid hormone medication(s)?  If so, what medication(s), dosage(s) and how long have you been taking it/them?
6 Comments
Thanks!  My B12 was tested as well at the time and was 570 (range 200-1100).  My Levo just got increased because I asked for it, but my Dr tested for other things as well (which is why I'm seeing this iron test results) to see if anything else is causing it.  I'm only about a little over a week with the new Levo increase, so not sure on that yet.  TSH was 4.3 (ref 0.10-4.50) last blood draw (w/FT4 at 1.3 ref 0.1-1.8, and FT3 at 3 ref 2.3-4.2).
I just got in touch with my Dr today and they said "just a little low" and nothing else.  But I'm reading (just like you are mentioning) that the Ferritin and TIBC values indicate anemia.  
Any recommendations on what worked for you...was B12 enough, or did you take iron as well?  Thank you!
Sorry you asked about dosage.  I'm not at 88mcg, up from 75mcg prior to that.  
Most of us find that we have to keep B-12 at/near the top of the range in order to keep symptoms from creeping in.  In some countries, anything under 500 is considered deficient, so your 570 is barely high enough.  Personally, with a level that low, I'd be dragging.  You might want to consider supplementing to bring that up a little bit and see it helps.

That said, your thyroid  hormones are off a bit, as well.  Your Free T4 is mid range, which is what we recommend, but your Free T3 is only at 37% of range.  Most of us feel best with Free T3 in the upper half to upper third of its range.  Your increase from 75 mcg to 88 mcg might be helpful, but I'm guessing all that's going to do is increase your Free T4, but not do much for the Free T3.  Free T4 is considered a storage hormone and must be converted to Free T3 prior to being used.  Free T3 is the hormone used by nearly every cell in the body.

There's a good possibility you aren't converting the Free T4 to Free T3 adequately.  

To answer your question, B-12 has done quite well for me because I have Pernicious Anemia, but it's no longer adequate.  My thyroid hormone levels are beginning to look very similar to yours and I'm seriously considering adding an iron supplement to my daily regimen but have not yet been able to get the iron panel to determine if that's what I need.   I did have a recent surgery and pre-op blood work indicated low RBC and borderline Hemoglobin, which is an indication of anemia, but I just did regular blood work for my doctor and everything was well within the different, "very wide" ranges...  :-)  

Your low Ferritin indicates that you have little/no iron stores so you may need to supplement.  

You may also need to add a separate source of T3 in the form of Cytomel or its generic counterpart, Liothyronine.  You could also ask your doctor to prescribe a desiccated medication such as Armour Thyroid, NP, NatureThyroid, etc.  These medications are produced from pig thyroid.  Some people do better on them as they have much more T3 than humans produce.  Many people on desiccated hormones have to add a separate source of T4, so since you already have adequate levels of Free T4 it might be easier to simply add Cytomel or Liothyronine if your doctor is willing to do that.  Of course, you need to wait and see if your Free T3 level increases adequately following the increase in your Levothyroxine.  You can also try changing your Levo - some people do better on brand name drugs than generics... for instance, I do better on Levoxyl brand than on generic Levo or on Synthroid.

"I just got in touch with my Dr today and they said "just a little low" and nothing else."  Are you saying that your doctor's office indicated that you aren't anemic and don't really need to supplement iron?  For some of us "just a little low" can make a world of difference, considering how important iron is in relation to thyroid hormones.  
Thank you!  I appreciate all the feedback.  Yes, they said my bloodwork is "unremarkable" and just a "little low" re: ferritin, and seemed unconcerned.  It's close to impossible getting to a Endo Dr (it's always a "no" for referral, because they say they are told that primary care should handle it)...so I highly doubt they will even give me T3 supplement, or even a NDT supplement (they live and breathe within those wide TSH ranges and that's it...it was a challenge even to get this bump with Levo.).  
Have you considered trying a different doctor?  We've had members who have had to try several (or more) different doctors before being able to get adequate treatment.

It doesn't necessarily take an endo to manage a thyroid condition because many endos aren't any better (some are actually worse) than primary care doctors, but it does take a doctor that really understands that TSH isn't the end all, be all of thyroid testing and T4 only medication isn't adequate for many of us.
Agreed.  I have tried numerous primary care doctors.  They believe 100% in TSH range alone.  Getting my meds bumped up took going through four doctors, and even then I got a skeptical look.  I'm still looking though!
Avatar universal
As Barb mentioned, there are sources that recommend ferritin should be at least 100.  The following link is to a review of available information on ferritin levels.  They concluded that ferritin should be at least 100.  

https://www.ncbi.nlm.nih.gov/pubmed/26561626

For supplementation, Vitron C is a good source.  Each pill contains 65 mg of iron.  At your level you may end up needing 2 pills, but I would start with one and see how that increases your level.  

Unfortunately most doctors have the "Immaculate TSH Belief" by which they only pay attention to TSH, which is totally wrong.   If you want more info, click on my name and then scroll down to my Journal and read at least the Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.    You can readily  see what should be done for you.   You can also give the doctor a copy and ask to be treated clinically, rather than based on TSH.   Everything suggested in the Overview is supported with  extensive scientific evidence.  

If you cannot get your doctor to treat clinically, as needed to relieve hypo symptoms, then let us know your location and perhaps we can give you the name of a doctor in your area that is recommended by other thyroid patients.  
2 Comments
Thank you!  This is great :)
Follow-up question.  So my "iron" level is "normal" in the labs (90), but it's really my Ferittin and TIBC that's off.   Would iron supplementation like Vitron C (just looked it up, looks great!) raise my Iron level also, or just help correct my Ferittin/TIBC?
Avatar universal
Ferritin is considered as a precursor to iron levels.  It goes down before  serum iron confirms a deficiency.     Vitron C  will affect both ferritin and serum iron.
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