Ferritin "normal" and now thyroid is "normal" - but still pale?

[Sunny537]

Hi I have Hashimoto's and my doctor did some blood tests for ferritin and Vitamin D, both of which have come back normal. However the doctor said when ordering these blood tests that I look unwell and if the results are normal she wanted me to come back so that she can look at other things that are causing my paleness. I am on 50mcg T4.

Recent blood tests

(October)

Ferritin - normal (no result given, will post this and the ranges when I get them)
Vitamin D - normal (no result given, will post this and the ranges when I get them)

(September)

Ferritin - 15 (30-400) - I was still debating on what iron supplement to take and because I changed practices as well as looking unwell to my new doctor the ferritin was rechecked and I was on supplementation.

TSH - 0.30 (0.2-4.2)
Free T3 - 4 (3.9-6.8)
Free T4 - 15 (12-22)

Anti-TPO antibodies were done in August, they are 141 (>34)

Symptoms:

- Difficulty swallowing
- Fizzy feeling in throat
- Lumpy feelings in neck/throat although I could be mistaking them for lymph nodes.
- Fatigue
- Dark circles under eyes
- Pale skin (people have told me I look anemic and this is the first time a doctor has said I look unwell. Most have put in their notes that I "look well"!)
- Cramps in legs/feet
- Headache
- Heavy feeling in eyelids
- Feeling the cold
- Dry skin

So if the doctor now says everything is normal what else is it they think I have if my ferritin and thyroid results are, according to them, normal? Does that mean they are now looking at arranging other investigations? If so, what could they be? I have been getting frustrated with my other 3 practices and I feel as though this is all in my head again. There is no magic information I know but when the receptionist told me over the desk my ferritin and thyroid results were both normal I couldn't help but feel a bit silly when I feel so unwell and especially since the doctor has said herself I didn't look well at all.

Thanks :)

[Sunny537]

Thanks. I'll continue with the B12 I have for now then. :)

[Sunny537]

Ok, thanks.

[Sunny537]

Thanks :)

I don't smoke or have liver problems. The only thing that came back abnormal for the liver function test was urea but I was told by my doctor that a low urea is fine. It's a high and out of range urea that's more of a concern.

I have two iron supplements, both contain the cyano form of B12. It's better than none. :)

[Red_Star]

Your vitamin D isn't even high enough to optimally absorb calcium just to add "...optimal calcium absorption occurs with a 25(OH)D level greater than 32 ng/mL" which is a level greater than 79.8 nmol/L. I take cyanocobalamin personally but I have read if you have liver issues or smoke you are going to have problems converting cyanocobalamin to methylcobalamin.

[Red_Star]

With that low a ferritin level you are iron deficient.

"Serum ferritin is the single best laboratory test for the diagnosis of iron deficiency. In patients with bleeding colorectal adenomas ≥1 cm, serum ferritin may decrease before a decrease in the serum iron level is detected [35]. Every 1 μg/l of serum ferritin corresponds to 8–10 mg storage of iron [13]." - Evaluation and Treatment of Iron Deficiency Anemia: A Gastroenterological Perspective - Dig Dis Sci. Mar 2010; 55(3): 548–559.

For cancer prevention vitamin D is recommended between 100 - 150 nmol/L (40 to 60 ng/mL). My slam dunk diagnosis for calcium deficiency is the chvostek sign (demo on youtube). I pushed for an ionized calcium test due to chvostek sign (calcium serum was "normal") and to no surprise showed I was deficient.  Vitamin B12 can be in optimal range with symptoms (I know this well) but anyway B12 below 400 pmol/L (550 pg/mL) is too low.

[gimel]

I would continue on the B12 and see what the new test shows.  Don't know about the cyano form of B12.  Some recommended forms of iron for supplementation are ferrous fumarate, bisglycinate, and gluconate.

[Sunny537]

Thanks. :)

Should I continue on the B12 for now? When do I need to be retested for this?
I have been on it since the start of October.

I have been struggling to find an ideal iron supplement but the liquid ones I find (I have difficulty swallowing tablets/pills/capsules) all contain B12 but cyanocobalamin and not the methylcobalamin. Would taking one of these containing the cyano- form of B12 affect me very much?

[gimel]

For women the recommended level is more like 70-80.  B12 should be in the upper end of its range.  Your D3 is good.

[Sunny537]

Hi my doctor has said I am not iron deficient. My ferritin is 28 (30-400) but it was 15 (30-400) 2 months ago.

Full blood count was completely normal as was calcium, liver function and electrolytes.

[Sunny537]

Thanks for reply.

My thyroid is being retested at the beginning of November.

I have the results of Vitamin D and ferritin, they were done last week.

Vitamin D3 - 73 (suboptimal 50-75)

Ferritin - 28 (30-400) Doctor has put normal no action so I take it my result is normal?

Vitamin B12 was done a few weeks ago through another doctor

Vitamin B12 - 362 (180-900) I have been taking B12 1000mcg recently.

[Red_Star]

I look pale due to hypothyroidism due to not enough oxygen and and my lips are sometimes so pale they look white. This symptom changes depending on my thyroid levels. Right now I'm not breathing too well. :(  Another reason I have looked pale in the past was due to iron deficiency anaemia.  

[gimel]

That 50 mcg is a typical starting dose.  You should expect to be re-tested in about 4-6 weeks after starting on that dose, and will need to continue to increase the dose to adequately raise your Free T4 and Free T3 levels as necessary to relieve those hypo symptoms you mentioned.  

Be aware that many hypo patients taking T4 only type meds find that their body does not adequately convert the T4 to T3.  If that appears and your Free T3 level lags behind your Free T4 level, then you will have to go to work on your doctor to get T3 added to your meds.  Also, don't forget the importance of adequate levels of Vitamin D, B12 and ferritin.  You can supplement those on your own, without the doctor having to prescribe anything.  

[Sunny537]

50mcg Levothyroxine.

[Sunny537]

Sorry, I am on T4-only therapy.

[gimel]

Unfortunately just being in the low end of the range for Free T3 and Free T4 as well You definitely need another doctor.  as Vitamin D  and ferritin does not work for many people.  Both your Free T4 and especially your Free T3 are much too low in the range.  Many members here say that symptom relief required Free T3 in the upper part of its range and Free T4 around the middle of its range.  Also, Vitamin D should be around the middle of its range and ferritin should be around 70-80 for women.  So you need to supplement as necessary to reach those levels, and also get your doctor to prescribe thyroid medication as necessary to relieve symptoms.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

I realize that in the UK it is sometimes difficult to get adequate treatment for hypothyroidism, but a fellow member that was ultimately successful told us this.  Otherwise you may have to go private to get the necessary treatment.

"What I have learned from my experience is that you have to go to the Dr's office and TELL THEM WHAT YOU WANT and to go backed up with knowledge.  You have to tell them that you have done your reading and looked into your condition and care about the long-term treatment of your health and thyroid.  If you fight for what you want, you will eventually find someone that is happy to go along with your wishes.  But we all have to take charge of our own health, right?"