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Low Thyroid? Or Low Iron?

When you hear these symptoms: fatigue, hair loss, dry skin, brittle nails, cold intolerance, is your first thought low thyroid? These symptoms certainly do coincide with having a low functioning thyroid, but they can also be a result of low iron. If only your thyroid is tested, a big piece to the puzzle may be overlooked.

You may be told your thyroid is normal and there is no explanation for your symptoms. Or you may be told you have low thyroid hormone and are then started on thyroid medication. But if you have undetected low iron, symptoms will not resolve because the low iron has not been corrected.

Not to mention, Iron is one of the nutrients needed to make a main thyroid hormone - Thyroxine (T4). So if you are low in iron, that could be a big reason why you have low thyroid function. If iron levels are addressed and brought into optimal range, you may not even need thyroid medication because now your thyroid has one of the main building blocks it needs to make Thyroxine. (Other building blocks for thyroid hormone production: Vitamin D, C, E, Tyrosine, Iodione, B2, B3, B6, Selenium and Zinc).

There is a difference between iron anemia (seen on a CBC which is extremely low iron levels), an iron panel, and ferritin (iron storage). Your CBC may not show anemia, but digging deeper by having a ferritin level drawn - we can see if your iron storage is being depleted. If your ferritin levels are below 50, you may be experiencing all of the symptoms listed above as well as: exercise intolerance/feeling winded easily, light headedness, dizziness and restless legs. Optimal levels to aim for are between 80 and 150.

I recommend increasing iron in your diet, especially plant foods high in iron: Leafy greens, beans, lentils, nuts and potatoes to name a few. Red meat is high in iron, but it's heme-iron which contributes to inflammation and should be consumed sparingly.

Often times prescription iron causes stomach upset and constipation. Over-the-counter supplement iron glycinate, is a highly absorbable form of iron and tends to not cause stomach troubles. Taking iron with vitamin C makes it even more absorbable. Prior to starting iron supplementation, I recommend having your ferritin levels checked and evaluated by your practitioner. Iron levels can become too high and should be monitored. High levels of iron are inflammatory and can be deposited in various organs and joints causing liver issues, joint aches and stiffness as well as fatigue.

While increasing iron will help resolve symptoms, the most important thing to figure out is why your iron levels are being depleted. It is either an absorption issue (low iron intake in your diet/ low stomach acid/ Celiac or other disease pathway in the gut) or it's an iron loss problem (heavy menstrual bleeding, stomach ulcer or bleeding in the intestines, hemorrhoids?) Depending on the underlying issue, there are likely other disruptions as a result. For example, if the reason your iron is low is because of low stomach acid which is contributing to poor digestion and poor nutrient absorption - what other nutrients are being depleted? Taking a iron supplement and not addressing the underlying issue is a short term approach.

Alyssa Vest FNP-C

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