Did you know that even when taking thyroid medication to correct hypothyroidism, an iron deficiency could be contributing factor to your uncontrollable thyroid symptoms? In fact, there are times low or under-active thyroid conditions can be caused by a deficiency of iron in the blood stream.
Thyroid health and proper thyroid function is vital for everyone’s quality of life because thyroid hormones are our metabolic control center. Thyroid health is responsible for our metabolism, weight management, mood, cholesterol, maintaining other hormone pathways, even our hair, skin and nail health.
One of the most frequent nutritional deficiencies observed in hypothyroid patients is iron deficiency. It ranks up there with deficiencies in magnesium, vitamin D, and B12. It is not only common, but doctors often miss it or misdiagnose it. But why?
For years, the majority of conventional medical professionals are taught to screen for iron deficiency anemia, not iron deficiency. Rarely do conventional primary care providers diagnose this condition. Yet what is the precursor condition to iron deficiency anemia? Iron deficiency. So why not screen for this condition before it snowballs into full anemia? Well, that would be treating the cause and being preventative — concepts that conventional medicine does not often embrace.
In order to diagnose iron deficiency, the provider needs to measure a lab called an iron panel, and specifically, an iron panel that includes a marker called ferritin. Ferritin can be a marker of iron storage in the body. Furthermore, ferritin reference ranges given by a laboratory in the lab report often give a reference range value of “normal” that is not the same as ideal. A laboratory’s given reference range is not thinking about the context of what the patient’s gender, and what stage of life they are in. For example, a 65 year old male should have a different reference range than a menstruating 35 year old female, yet they do not account for this in the given reference range. This means you need an informed and experienced clinician to read your results and understand what the optimal, not just bare minimum, values should be in the context of the patient sitting in front of them.
Suboptimal ferritin-measured iron levels, the measurement of your iron stores — rather than just serum iron levels — is more significant when it comes to thyroid function. Given the critical role iron plays in thyroid hormone formation and function, patients who have low iron stores should receive specific and early treatment to prevent other health conditions and worsening of existing ones.
Thyroid health and iron levels
For the thyroid to function properly, iron is needed. Studies and basic physiology textbooks on the subject are clear. Not only is iron necessary for the production of thyroid hormone, but low levels of iron in the body are also linked to low levels of free T3, the active form of thyroid hormone in the body.
If you have hypothyroidism, you are likely aware that T3 is the most significant and potent thyroid hormone in your body, and your functional medicine provider should be helping you improve this value to improve your quality of life. However, if you have hypothyroidism and your provider is not regularly measuring T3 hormone, you need to find a different provider to manage your care.
This means that hypothyroidism patients, even after taking a regular thyroid medication, can continue to have hypothyroidism symptoms because they are still fighting an iron deficiency.
If you have only been seen by conventional medical providers in the past, you likely know that the only thyroid lab marker that gets measured often is TSH. TSH stands for thyroid stimulating hormone and is produced in the brain to tell the thyroid to output thyroid hormones. This hormone is responding to a feedback loop, so it works opposite of how you would expect: low TSH levels indicate thyroid health; whereas high TSH indicates hyperthyroidism. TSH values still help functional medicine practitioners see the whole picture, when they measure important functional bloodwork.
This is another reason it is important to measure an iron panel in conjunction with thyroid labs. Transferrin saturation and TSH have an inverse relationship. The TSH value rises in response to a decrease in transferrin saturation which suggests hypothyroidism. Transferrin saturation can determine how much of your body’s serum iron is bound and unbound. Low serum iron levels in the body are indicated by a low transferrin saturation.
As referenced earlier in this article, iron deficiency can be the root cause of hypothyroidism conditions. This is because iron affects heme-dependent thyroid peroxidase, a hormone necessary for the production of thyroid hormones. “Heme-dependent” means iron-dependent. Put differently, iron is necessary for this vital enzyme to work to create thyroid hormones in the first place.
Remember, conventional medicine will only often check a “CBC”, or a complete blood count, to rule out anemia, but will often not check an iron panel to see if there is iron deficiency, which is why iron deficiency can be commonly missed in medicine. This is why an iron panel is a vital part of Virasoap Natural Medicine’s functional annual lab panel. Many patients with and without hypothyroidism are living with suboptimal iron levels, which can be harming their thyroid levels and thus, quality of life.
Signs of hypothyroidism and low iron levels
So you might ask yourself: “how do I know if I’m iron deficient?” Symptomatically there are clues even before running labs and blood work. Iron deficiency, even before anemia is present, can cause many known symptoms. However, because iron deficiency and hypothyroidism are unfortunately correlated, meaning that if you have one, you could be experiencing the other condition as well.
This further muddies the picture because you might have a mix of symptoms that are related to both iron deficiency and hypothyroidism, which do share some characteristics. While symptoms are good place to start giving clues to what is going on in your body, lab work can help further determine, which or both are occurring and give your functional medicine provider values to guide your individual treatment plan.
Symptoms of iron deficiency
- Fatigue
- Weakness
- Shortness of breath (especially upon standing or exertion)
- Brain Fog
- Skin pallor (pale skin)
- Lightheadedness (especially upon standing or exertion)
- Ice cravings or chewing
- Cold extremities
- Hair loss
- Dry skin
- Thinning nails
- Headaches
- Low mood
- Restless legs
Symptoms of hypothyroidism
- Fatigue
- Weakness
- Brain Fog
- Cold extremities
- Hair loss
- Dry skin
- Thinning nails
- Headaches
- Low mood
- Muscle pains
- Weight gain
Many of the iron deficiency symptoms, as you can see, closely resemble the hypothyroidism symptoms and have a lot of cross over. For example, you may experience weakness, fatigue, and cold hands and feet from both conditions. How can you tell if the symptoms are brought on by your iron levels or your thyroid? If you are not tested for both in the lab work, you will never know for certain. As described before, it can even be both conditions simultaneously as they impact each other physiologically.
Hashimoto’s thyroiditis and iron deficiency
Do individuals with Hashimoto’s disease also experience iron deficiency? Yes, without a doubt.
Although Hashimoto’s autoimmune thyroiditis patients are not typical hypothyroid patients, they still frequently encounter many of the same problems as Hashimoto’s is one type of hypothyroidism. For both unspecified hypothyroid and Hashimoto’s patients, optimal thyroid function still requires appropriate iron levels. It could even be argued that it is more important to run complete thyroid and iron panels in Hashimoto thyroid patients as iron is a metal based mineral, and has implications in inflammation. Hashimoto’s is an autoimmune condition and thus inflammation levels are also important to track for optimal health.
Important takeaways
Iron deficiency and suboptimal iron levels are common in patients with Hashimoto’s disease and hypothyroidism conditions. Iron deficiency can cause symptoms that resemble those of hypothyroidism since iron is essential for thyroid function in the body. This is why it’s important for iron levels to be assessed with optimal ranges in mind because of these changes. Remember that you need both a complete iron panel lab test and thyroid panel lab test to get the full picture.
Sometimes, the root cause of a hypothyroid condition is iron deficiency, and is an important reminder that nutrition matters! Micronutrient deficiencies can have a large impact on hormones and overall health as we see described here just about iron. There are other vitamins and minerals not covered here (such as vitamin B12, vitamin B9/folate, vitamin D, magnesium, etc.) that can also impact thyroid health and other health conditions, so these are important to have measure directly or indirectly for a complete health picture. Patients with hypothyroidism frequently have these nutrient deficiencies as well.
Want to know EXACTLY what mineral, vitamin and thyroid lab tests your doctor should be ordering? Book a free discovery call with our functional medicine provider.
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