Possible Iron Deficiency?

I am about 1 year post-thyroidectomy due to papillary carcinoma.  For many, many months I've felt quite fatigued, yet my numbers are exactly where they want them to be. Getting myself on the treadmill is a chore and so is just getting the energy to move around after a day of work.  

I have to wait until March for my next blood test which will finally check my red blood cell count (my doctor is leaving the practice and didn't seem to check things other than thyroid-related numbers unless I asked, so I'm happy I will have someone new).  I guess my question is, "Has anyone experienced iron deficiency post-thyroid cancer?"  I've always been borderline in that area (I only know from trying to donate blood a few times).  Could thyroid cancer/treatment possibly have pushed me over the edge into iron-deficiency?  Anyone have any opinions/experiences?

[goolarra]

It does help!

Your FT4 looks really good.  It's just a little over midrange, and midrange is the "target" for FT4.  On the other hand, your FT3 really doesn't look so good.  It's a little below midrange, and many of us find that FT3 has to be upper half to upper third of range to not feel hypo.  Also, FT3 should be higher in it's range than FT4 is in its.  Your FT4 is at 60%, and your FT3 is at 47%.  This usually indicates slow conversion and the need to add a direct source of T3 to your meds...either synthetic (Cytomel) or desiccated (Armour, NatureThroid, ERFA, etc.).  Many endos don't like prescribing T3 meds...you might have to do some convincing.

Just a couple of other observations...vitamin D often has to be near top of range before it's adequate for those of us that are hypo.  Perhaps you should ask your doctor about increasing that?  B-12 deficiency caused by pernicious anemia will not improve with oral B-12 due to a lack of a substance in the gut that allows it to be absorbed.  I'm not saying you have PA, but if your B-12 has been low and it hasn't improved, you might explore that further.  

I'm willing to bet that if your doctor would agree to add a very small dose of T3 to your meds, it might make a world of difference in how you feel.  

[blsdnsvd]

Depending on your Thyroid labs (even if they are in range), you may still be hypothyroid. It's helpful to post your recent labs so that others who are knowledgable can help. I had a TT and i am still hypo. Most docs look at the TSH levels and use that as the main tool to determine how a patient should feel, however i have learned from others on this site that FT3 and FT4 are the most important numbers to look at. I am anemic and have been long before my surgery and i can tell you that i've never felt like this before. Tired to the point that i cannot do anything but lay down.

[goolarra]

Iron deficiency often accompanies hypothyroidism.  By all means have iron and ferritin levels checked.  You might also consider checking B-12 and D levels as these seem to suffer in hypo patients as well.  All of those can produce fatigue.  

Please post your most recent thyroid labs so members can assess adequacy of testing and levels.  Often "...exactly where THEY want them to be"  is not where WE feel comfortable.  Please include reference ranges as they vary lab to lab.

[michelleee71]

Okay.  My most recent labs in November showed the following:
TSH = .38 mIU/L         >or= .40-4.50
T4, Free = 1.4             0.8-1.8 ng/dL
T3, Free = 3.1             2.3-4.2 pg/mL
Thyroglobulin = <0.2    2.0-35.0 ng/mL
Vitamin D (from September) = 29   30-100 ng/mL (I'm almost there/have been raising it ever since they found it at 17 after the surgery).

So they told me that the T3 looks fine too. I've been taking a Super B Complex tablet each day for a few months in hopes that the B12 might help a bit, but it really doesn't seem to make a difference.

My Vitamin D will be checked in my next blood test, along with a total cortisol level, a comprehensive metabolic panel, ACTH, and CBC (DIFF/PLT), but I don't know what any of those mean.

Thanks for any advice you may have.  I hope providing my most recent levels help!

[goolarra]

It does help!

Your FT4 looks really good.  It's just a little over midrange, and midrange is the "target" for FT4.  On the other hand, your FT3 really doesn't look so good.  It's a little below midrange, and many of us find that FT3 has to be upper half to upper third of range to not feel hypo.  Also, FT3 should be higher in it's range than FT4 is in its.  Your FT4 is at 60%, and your FT3 is at 47%.  This usually indicates slow conversion and the need to add a direct source of T3 to your meds...either synthetic (Cytomel) or desiccated (Armour, NatureThroid, ERFA, etc.).  Many endos don't like prescribing T3 meds...you might have to do some convincing.

Just a couple of other observations...vitamin D often has to be near top of range before it's adequate for those of us that are hypo.  Perhaps you should ask your doctor about increasing that?  B-12 deficiency caused by pernicious anemia will not improve with oral B-12 due to a lack of a substance in the gut that allows it to be absorbed.  I'm not saying you have PA, but if your B-12 has been low and it hasn't improved, you might explore that further.  

I'm willing to bet that if your doctor would agree to add a very small dose of T3 to your meds, it might make a world of difference in how you feel.  

[flyingfool]

Ditto what Goolarra said.  EXCELLENT advice.

[michelleee71]

Thank you so much for all of that great information.  I had been hoping for a dose of Cytomel last time, but since she said it was "fine," I gave up.  Maybe my new doctor will agree to try it out.  I'm actually already armed with a study to bring with me to my next appointment that shows how it helped for people who are in the normal range!

Do you happen to know if B-12 levels are covered in any of those above tests that I happened to mention?  If not, I may have to request a specific test for that as well.  Taking the B-complex was my own idea, and yes, I've read about pernicious anemia, but my understanding is that is quite rare?

I've been taking 2000 IU of the Vitamin D.  Thank you for letting me know that we want to see it near the top of the range.  I can ask about an increase in that as well if necessary after we see what the next blood test indicates.  My guess is that it hasn't gone up really far -- it's been a steady and slow increase since I began taking the supplement.  

I would just love to have Cytomel (it sounds like it would really help - plus, I've gained about 13 pounds since my surgery and I can't get it off).  I hope I can convince this doctor (as you said, I know many endos don't like to prescribe it - let's hope this one is open to trying it out).  Do you think that if I begin Cytomel, I should request a bone density test for a baseline (I've read that it can affect the bones)?

[goolarra]

I don't think B-12 is covered in any of the test you mentioned.  I think you should specifically request it.  PA is an autoimmune disease, and since so many of us have autoimmune thyroid disease, it's a little more "popular" around here than it is in the general population, since once you have one autoimmune, you're more likely to get another.

I know some people on this forum take 50,000 to 100,000 IU of vitamin D per week.  Sounds like a lot, but apparently once hypo, some people need that much to get their levels up.

I, personally, don't think you need a baseline bone density test...I'm just a fellow patient, you understand.  T3 meds don't affect the bones; it's being hyperthyroid that affects the bones.  If you're taking T3 to correct a deficiency, you're T3 levels shouldn't be in hyper range unless you are overmedicated.  For a short period of time, even that won't affect your bones.

Best of luck with that new doctor...