Ferritin and Hypothyroidism

In this post I'll cover everything you need to know about ferritin and hypothyroidism.  The ferritin test is a simple blood test and it is one of the most important tests you should have if you have Hashimoto’s disease, Graves’ disease, and hypothyroidism. Ferritin is a storage form of iron and the ferritin level test can tell you if your iron stores are low and need to be increased. The ferritin test is rarely ordered by conventional doctors so many patients are left with the signs and symptoms of hypothyroidism when it is actually their low ferritin levels that are causing their health problems.  The first issue with iron is that iron deficiency may be quite severe but blood markers such as hemoglobin and the red blood cell count may be normal. This leaves many patients, especially women, misdiagnosed as not having anemia.

What are the symptoms of low ferritin?

Weakness
Fatigue
Difficulty concentrating
Poor work productivity
Cold hands and feet
Poor short-term memory
Difficulty remembering names
Dizziness
Pounding in the ears
Shortness of breath
Brittle nails
Headaches
Restless legs

The above symptoms overlap with Hashimoto’s disease and hypothyroidism so it can be difficult to ascertain what is causing the symptoms.
What causes iron deficiency and low ferritin?
A lifelong history of blood loss due to heavy menstrual bleeding, blood donations, pregnancies, surgeries, accidents, atrophic gastritis, antacid medications, and celiac disease. If you have gut problems that are causing malabsorption of nutrients then your ferritin levels may be low. Additionally, if someone is a high-level athlete or vegan/vegetarian, they are also at risk for low iron. These lead to excessive loss of iron or poor absorption of iron leading to low ferritin levels.
What are optimal ferritin levels for thyroid health?
Once ferritin gets below 30, this is considered iron deficiency despite the fact that the lower end of the laboratory cut-off range is usually 10-20. However, even the ferritin level can be normal, around 50-100, and the patient may still actually be iron deficient. This makes the diagnosis somewhat tricky in certain cases.

According to Dr. Esa Soppi of the Eira Hospital in Helsinki, Finland, optimal ferritin levels for hypothyroidism are >100 and iron therapy should be continued until symptoms have resolved. He also recommends that the ferritin level should be checked regularly to be sure the levels stay normal.

He also states that if someone has restless leg syndrome and their ferritin is <75, then they should be considered iron deficient.

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

According to Dr. Soppi, 10-20% of menstruating females are iron deficient. If we think about the reasons why this could be prominent in those with Hashimoto’s disease and hypothyroidism, we can see what a big problem this may be.

Hashimoto’s disease is very common in those who have celiac disease and celiac disease often leads to iron deficiency due to malabsorption in the intestine from the damage that gluten has inflicted on the intestinal barrier. Not only that, but hypothyroidism can lead to low stomach acid which would also impair absorption of iron. Thyroid hormone is also very important for the utilization of iron so you can see what a vicious cycle this could be for someone with Hashimoto’s disease and hypothyroidism.

“Hypothyroidism based on symptoms is indistinguishable from iron deficiency,” stated Soppi.

Dr. Soppi has a special interest in thyroid disease and hematology and he points out that many patients come in with the following symptoms:

Fatigue
Brain fog
Muscle and joint pain
Weight gain
Headache
Difficulty breathing
Heart palpitations and arrhythmias