Iron

So often hypo patients do not have Iron levels that are optimal.  Please note that “levels” was plural because we need more than just Ferritin tested.

We need to test (if supplementing Iron, you would want 5-7 days off the Iron supplements):

  • Serum Iron (sometimes called Total Iron)
  • TIBC
  • % Saturation
  • Ferritin

​​For women in the USA:

FERRITIN should be about 70-90.
% SATURATION of IRON: this should be close to 35% PERCENT (or .35 for Canadian ranges)
SERUM IRON this should be 110 some are optimal there or 109 or 108 or 107 etc.
TIBC (Total iron binding capacity) this test will be low in the range—about 1/4 above the bottom number or slightly higher.

Please note we have found that iron testing is not as accurate during menstruation due to loss of iron in blood, so we have found it best to wait to test at least a week past your cycle. 

For men in the USA:
FERRITIN men tend to be slightly above 100 and optimally close to the 130’s.
% SATURATION of IRON: this should be about 45% for men
SERUM IRON this should be in the upper 130’s for men
TIBC (Total iron binding capacity) this test will be low in the range—about 1/4 above the bottom number or slightly higher.

Canadian and European ranges:
Ferritin: range is often about 15-200, and optimal for most women is about 70-90, for men it’s 110-120.
Percent Saturation: same as US observations about .35/35% for women is the ideal; .38/38% or higher for men.
Serum Iron (range 9-30) Optimal results are usually in the mid-20’s for women, upper 20’s and higher for men)
TIBC: when range is umol/L 45-77, low 60’s is noted when iron is looking good. If range is 50-70 umol/L, usually 1/4 above bottom of range.

How to figure out Percent Saturation:

Percent Saturation can by figured using your iron and TIBC values. It’s a math equation that the laboratory does and is not a specific test — you just need your iron and TIBC values.

The formula:
Iron divided by TIBC multiplied by 100.

Your iron 152 divided by your TIBC 270 = .56296
Multiplied by 100 = 56% (rounded)

Some reasons our Iron levels may not be optimal:

We cannot simply test Ferritin and treat based on that.  As mentioned above, one can have very high Ferritin in inflammation, and very low Ferritin with heavy metal issues  (specifically high Copper).   

Having non-optimal Iron levels can cause many problems for hypothyroid patients:

When serum Iron and % Saturation are low, it is the beginnings of becoming anemic if not addressed.

Some of the symptoms of low iron (this includes those who are not able to utilize their iron), can imitate symptoms of being hypo.  This can have you thinking you may need more NDT and raising it too high.  (ALWAYS test to see if you do or do NOT need more NDT!)  Some may think their NDT is not working, when in fact, it is the lack of Iron. 

Non-optimal iron very often can cause high Reverse T3 levels, leaving you still hypo. 

Non-optimal iron can slow down the conversion of T4 to T3.   Non-optimal iron can affect the first two steps of three in the thyroid hormone synthesis.  It can reduce the Thyroid Peroxidase enzyme (TPO), which depends on iron.  Thyroid Peroxidase is responsible for the oxidation of iodide on the amino acid tyrosine residues in thyroglobulin which then produces T4 and T3.

Non-optimal Iron can bind T3 so that it is not available for you to use.

Non-optimal Iron can increase TSH due to high Reverse T3 levels and bound T3.

Non-optimal Iron can affect production of cortisol in the adrenal cortex.  There is a large amount of iron-containing protein in the adrenal cortex that is involved in the forming of corticosterone.  Having low Iron can potentially affect your cortisol levels.

Non-optimal Iron can affect your body from being able to produce or break down for use, the following: Thyroid hormones, Iodine, Selenium and Zinc.   

Some symptoms of low iron, or of iron not being utilized:

  • A Fast heart rate
  • Feeling out of breath
  • Feeling very hot
  • Being easily fatigued
  • Numbness
  • Burning in legs (an increase in lactic acid)
  • Irritability
  • Muscle cramps
  • Diarrhea
  • Body aches
  • Feeling weak

Bringing low iron up to optimal:
Foods can be of some help if one is addressing low stomach acid and avoiding any grains, legumes, seeds and nuts near meals with iron in them. They contain phytates that block the absorption of iron.

Average iron absorption with adequate stomach acid, is about 8-10% of intake.  All vegetable sources contain the non-heme form of iron which is poorly absorbed and utilized.  Meat forms of Iron are all heme in form.  Heme forms are absorbed between 10-30%.  Combining non-heme and heme forms of foods improves the absorption of iron from the non-heme foods.

Organ meats are the richest in iron, like Liver, heart etc.

Other foods rich in iron are:

  • Blackstrap Molasses
  • Beef
  • Lamb
  • Ham
  • Turkey
  • Chicken
  • Veal
  • Pork
  • Dried beef
  • Liver
  • Liverwurst
  • Eggs (any style)
  • Shrimp
  • Clams
  • Scallops
  • Oysters
  • Tuna
  • Sardines
  • Haddock
  • Mackerel
  • Spirulina
  • Spinach
  • Dried Beans
  • Green Peas
  • Sesame Seeds
  • Dried Fruit
  • Dark Chocolate
  • Pumpkin Seeds
  • Quinoa
  • Whole Grains
  • Dandelion Greens
  • Coconut

Supplementing iron:
There are many forms of iron available in supplement form available:

  • Ferrous Fumerate
  • Ferrous Sulfate
  • Ferrous Glutamate
  • Ferrous Bisglyciante


Liquid animal-based iron (Heme) can stain teeth, so using a straw to keep it off your teeth is suggested. Liquid vegetable based (non-Heme) is less absorbable than the Heme but does not stain teeth.  Because these absorb so much better, less is needed than when taking tablets or capsules.

Ferrous Bisglcinate appears to cause less constipation than the other pill forms. The milligrams listed on the bottle actually equal the amount of elemental iron in the pills, which the other forms do not.

There are fabulous forms of iron supplements made form food sources, such as Desiccated Liver and Beet root.

If you do find that you have constipation taking iron supplements, you can take Magnesium Citrate to bowel tolerance, in order to loosen stools.​

How much iron is needed to raise levels?
Patient experience has shown that taking 150-200 mg of elemental iron spread out throughout each day, 3-4 times day, can raise low iron levels.  It seems to take 6-8 weeks to raise levels.  It is important that you test off the Iron supplements for 5-7 days 4-6 weeks after beginning it.  High levels of iron cause issues too!  Once you achieve optimal Iron levels you will want to reduce and hopefully be able to stop the iron supplements.  Iron can promote free radicals, so the goal is to be off it as soon as we can be safely.  Please make sure you read labels carefully to know how much elemental iron is in your supplement.

WARNING: There is some information out there that states if you have Cancer, taking iron can promote the Cancers growth.  It is extremely important you work with your Dr. if you have Cancer and need to take iron supplements.


What can I take with my iron supplements to help them absorb better?

Vitamin C to bowel tolerance and vitamin C rich foods can help iron absorb.  Acidic drinks are also helpful.  You can add 1 Tablespoon or more of Apple Cider Vinegar with the Mother in it, or 1 Tablespoon or more of lemon juice to a glass of water.  These should be taken at the same time as taking Iron supplements or iron rich foods.

Having optimal B-12 and folate levels is also helpful in iron absorption.  If you have low or high irons, be sure to check your B-12 and Folate levels too!


Do I need to avoid anything when taking iron?

Black Tea, Coffee (the caffeine and Tannic acid can interfere with iron absorption) Calcium, Bran fiber, chocolate, antacids and wine should be avoided at the same time we take our iron supplements.  Iron must be taken 4 hours away from NDT and T3 if you swallow them whole.  If you take them sublingually (under your tongue to dissolve), then 2 hours away from NDT and T3.  Iron blocks absorption of the NDT and T3. Avoid any grains, legumes, seeds and nuts near supplementing iron. They contain phytates that block the absorption of iron.


IV Iron infusions are used by some Dr.’s for those with severely low Iron labs.
Iron infusions can be used to raise Iron significantly in just a few weeks instead of a few months.  Most still need to take lower doses of iron supplements after a few weeks of having the infusions to maintain levels.



After getting Iron optimal with supplements:

Females who still menstruate may need to continue taking iron supplements in lower doses to remain optimal.  It is always a good idea to test regularly so you know how much you need.

For more detailed medical reading:

– Details on iron:     http://www.fao.org/docrep/004/Y2809E/y2809e0j.htm

– How low iron affects cortisol:       https://www.ncbi.nlm.nih.gov/pubmed/1651678

– Impaired conversion of T4 to T3:       http://ajpregu.physiology.org/content/239/5/R377

– Low iron and sympathetic system:       https://www.ncbi.nlm.nih.gov/pubmed/17660705

– Iron and selenium deficiencies on iodine and thyroid metabolism 
     https://www.ncbi.nlm.nih.gov/pubmed/12487769?dopt=Abstract

– Iron Deficiency in Goitrous Children       https://academic.oup.com/ajcn/article/75/4/743/4689380

– Iron Supplementation for Unexplained Fatigue in Non-Anaemic women
     https://www.bmj.com/content/326/7399/1124.abstract?etoc=

– Article about Floridex:    https://healthfully.com/side-effects-floradix-5780217.html