Table of ContentsView AllTable of ContentsHypothyroidismHyperthyroidismSymptomsDiagnosisTreatmentFAQ
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Table of Contents
Hypothyroidism
Hyperthyroidism
Symptoms
Diagnosis
Treatment
FAQ
If you havethyroid diseaseandfatigue,iron deficiencycould be to blame. Low iron levels can cause fatigue and hair loss in thyroid patients. This is especially true withhypothyroidism(underactive thyroid), but it can also occur withhyperthyroidism(overactive thyroid).
You might see the terms “iron deficiency,” “anemia,” and “iron-deficiency anemia” used to mean the same thing. But they are different:
This article looks at iron deficiency and anemia in hypothyroidism and hyperthyroidism, symptoms to watch for, and how it’s diagnosed and treated.
Anemia in Hypothyroidism
The low thyroid hormone levels of hypothyroidism suppress the activity of bone marrow, the tissue that makes red blood cells. That lowers the production of red blood cells and triggers anemia.
Research shows anemia is diagnosed in up to 60% of people with hypothyroidism.That’s compared to about 7% in the general U.S. population.Persistent fatigue is a main feature of the condition.
Iron Deficiency Alone
Research suggests between 30% and 50% of people on levothyroxine (a thyroid hormone replacement medication) have chronic fatigue with no evidence of anemia.
Anemia in Hyperthyroidism
If you have hyperthyroidism, you likely have high levels offerritin, a protein that helps your body store iron. An overactive thyroid gland produces high amounts of ferritin.
It seems logical that increasing iron storage would prevent anemia. The opposite is often true, though. High ferritin appears to trigger an inflammatory response that prevents the body from using iron normally.
This is seen most often inGraves' disease(autoimmune hyperthyroidism). Graves' is associated with IDA and low levels of several kinds of blood cells.
Verywell / Elise Degarmo
What Are the Symptoms of Iron Deficiency?
Symptoms of iron deficiency and thyroid disease are similar, making it hard to spot iron deficiency or IDA. They include:
If your symptoms continue despite treatment for your thyroid disease, ask your doctor to check for iron deficiency or IDA.
How Is Iron Deficiency With Thyroid Disease Diagnosed?
Iron deficiency is diagnosed with aserum ferritintest. It measures the amount of iron storage in your body.
If results are low, you’ll be diagnosed with iron deficiency. If they’re high, it can help confirm a hyperthyroidism diagnosis.
Normal Range - Serum Ferritin TestSexLowHighMen40 ng/mL300 ng/mLWomen20 ng/mL200 ng/mLng/mL = nanograms per milliliterSerum ferritin is not a routine part of yourcomplete blood count(CBC). Your healthcare provider will need to order it separately.If you’re paying out of pocket, the test will likely cost between $25 and $50. Results are usually back within two days (depending on your lab).How Is Iron Deficiency With Thyroid Disease Treated?Iron deficiency alongside hyperthyroidism usually doesn’t require treatment. It typically goes away with hyperthyroidism treatment.In other cases,treatments for iron deficiencyand IDA are based on the severity of symptoms and serum ferritin test results. It may involve iron supplements and/oran iron-rich diet.Iron SupplementationAn iron supplement is typically prescribed to treat iron deficiency in people with thyroid disease. A typical initial dose is 65 mg of elemental iron (325 mg of ferrous sulfate) given once a day.Your healthcare provider will likely re-test your serum ferritin after 30 to 60 days of treatment. You can stay on the supplement for up to four months. The dosage is gradually decreased as levels get back to normal.If you’re takinglevothyroxine, take your iron supplement three to four hours before or after your thyroid medication. Taking them together interferes with how your body absorbs the thyroid drug.Especially if you have a largely plant-based diet, you may want to take your iron supplement with vitamin C. Many plant foods contain substances calledphytatesthat reduce iron absorption in the intestines.Vitamin C may enhance iron absorption, so consuming vitamin C-rich foods, such as citrus fruits, strawberries, tomatoes, bell peppers,broccoli,brussels sprouts, and potatoes may increase iron absorption.Other nutrients that can help iron absorption include:Vitamin B12 (found in meat, fish, dairy products, and eggs)Folic acid (found in spinach, fortified breakfast cereals, rice, asparagus, and Brussels sprouts)Copper (found in potatoes, mushrooms, cashews, sunflower seeds, and tofu)Side EffectsIron supplements can cause side effects such as:ConstipationVomitingDiarrheaBlack stoolsA liquid form of iron called Floradix may be easier to tolerate.Don’t take larger doses of iron than your healthcare provider prescribes. That can lead to iron toxicity, especially at dosages above 20 milligrams per kilogram of body weight per day (mg/kg/day).What Foods Are High in Iron for Thyroid Patients?Adding iron-rich foods to your diet can also help you get enough iron into your blood. For mild iron deficiency, it may be all the treatment you need. For more extreme cases, it may be recommended along with supplements.Iron-rich foods include:Red meatOrgan meatPorkPoultryMollusks (oysters, mussels, clams)EggsChickpeasPumpkin seeds and sesame seedsLentilsDried fruit (raisins, apricots, prunes)Iron-fortified bread, pasta, and cerealCaffeine and calcium can interfere with iron absorption and are best avoided.In Depth: Your Diet and IDASummaryIDA and iron deficiency are common in thyroid disease and can lead to fatigue. Both hypothyroidism and hyperthyroidism can cause iron deficiency and anemia. In turn, iron deficiency can also trigger hypothyroidism.Iron deficiency/IDA symptoms are similar to those of thyroid disease, making them hard to spot. Your healthcare provider can order a blood test, called serum ferritin, to check your iron levels.Treatment for iron deficiency includes thyroid replacement medication, iron supplements, and/or a high-iron diet. Consuming vitamin C-rich foods when taking iron may improve iron absorption.What Is Chelated Iron?Frequently Asked QuestionsTry eating more iron-rich foods, and have them alongside foods high in vitamin C, which will help you absorb the iron (and other nutrients) in your meal.For instance, beef, liver, tuna, poultry, sardines, pork, lentils, oysters, and other good source of iron should be paired with foods such as oranges, bell peppers, strawberries, and broccoli.You might. Hyperthyroidism and hypothyroidism can both cause anemia.If you notice fatigue, pale skin, dry skin, or other anemia symptoms, talk to your healthcare provider about having a blood test to check for anemia.
Serum ferritin is not a routine part of yourcomplete blood count(CBC). Your healthcare provider will need to order it separately.
If you’re paying out of pocket, the test will likely cost between $25 and $50. Results are usually back within two days (depending on your lab).
How Is Iron Deficiency With Thyroid Disease Treated?
Iron deficiency alongside hyperthyroidism usually doesn’t require treatment. It typically goes away with hyperthyroidism treatment.
In other cases,treatments for iron deficiencyand IDA are based on the severity of symptoms and serum ferritin test results. It may involve iron supplements and/oran iron-rich diet.
Iron Supplementation
An iron supplement is typically prescribed to treat iron deficiency in people with thyroid disease. A typical initial dose is 65 mg of elemental iron (325 mg of ferrous sulfate) given once a day.
Your healthcare provider will likely re-test your serum ferritin after 30 to 60 days of treatment. You can stay on the supplement for up to four months. The dosage is gradually decreased as levels get back to normal.
If you’re takinglevothyroxine, take your iron supplement three to four hours before or after your thyroid medication. Taking them together interferes with how your body absorbs the thyroid drug.
Especially if you have a largely plant-based diet, you may want to take your iron supplement with vitamin C. Many plant foods contain substances calledphytatesthat reduce iron absorption in the intestines.
Vitamin C may enhance iron absorption, so consuming vitamin C-rich foods, such as citrus fruits, strawberries, tomatoes, bell peppers,broccoli,brussels sprouts, and potatoes may increase iron absorption.
Other nutrients that can help iron absorption include:
Side Effects
Iron supplements can cause side effects such as:
A liquid form of iron called Floradix may be easier to tolerate.
Don’t take larger doses of iron than your healthcare provider prescribes. That can lead to iron toxicity, especially at dosages above 20 milligrams per kilogram of body weight per day (mg/kg/day).
What Foods Are High in Iron for Thyroid Patients?
Adding iron-rich foods to your diet can also help you get enough iron into your blood. For mild iron deficiency, it may be all the treatment you need. For more extreme cases, it may be recommended along with supplements.
Iron-rich foods include:
Caffeine and calcium can interfere with iron absorption and are best avoided.
In Depth: Your Diet and IDA
Summary
IDA and iron deficiency are common in thyroid disease and can lead to fatigue. Both hypothyroidism and hyperthyroidism can cause iron deficiency and anemia. In turn, iron deficiency can also trigger hypothyroidism.
Iron deficiency/IDA symptoms are similar to those of thyroid disease, making them hard to spot. Your healthcare provider can order a blood test, called serum ferritin, to check your iron levels.
Treatment for iron deficiency includes thyroid replacement medication, iron supplements, and/or a high-iron diet. Consuming vitamin C-rich foods when taking iron may improve iron absorption.
What Is Chelated Iron?
Frequently Asked QuestionsTry eating more iron-rich foods, and have them alongside foods high in vitamin C, which will help you absorb the iron (and other nutrients) in your meal.For instance, beef, liver, tuna, poultry, sardines, pork, lentils, oysters, and other good source of iron should be paired with foods such as oranges, bell peppers, strawberries, and broccoli.You might. Hyperthyroidism and hypothyroidism can both cause anemia.If you notice fatigue, pale skin, dry skin, or other anemia symptoms, talk to your healthcare provider about having a blood test to check for anemia.
Frequently Asked Questions
Try eating more iron-rich foods, and have them alongside foods high in vitamin C, which will help you absorb the iron (and other nutrients) in your meal.For instance, beef, liver, tuna, poultry, sardines, pork, lentils, oysters, and other good source of iron should be paired with foods such as oranges, bell peppers, strawberries, and broccoli.
You might. Hyperthyroidism and hypothyroidism can both cause anemia.If you notice fatigue, pale skin, dry skin, or other anemia symptoms, talk to your healthcare provider about having a blood test to check for anemia.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Banday T, Bhat S, Bhat S, et al.Incipient iron deficiency in primary hypothyroidism.Thyroid Res Pract. 2018;15(3):138. doi: 10.4103/0973-0354.245563Le CH.The Prevalence of Anemia and Moderate-Severe Anemia in the US Population (NHANES 2003-2012).PLoS One. 2016 Nov 15;11(11):e0166635. doi:10.1371/journal.pone.016663515th International Thyroid Congress program and meeting abstracts.Thyroid.2015;25 Suppl 1:P1-A337. doi:10.1089/thy.2015.29004.abstractsFischli S, Von Wyl V, Trummler M, et al.Iron metabolism in patients with Graves' hyperthyroidism.Clin Endocrinol (Oxf). 2017;87(5):609-616. doi:10.1111/cen.13450NIH. National Heart, Lung, and Blood Institute.Iron-deficiency anemia.Merck Manual Professional Version.Iron deficiency anemia.Harvard T.H. Chan School of Public Health.Vitamin C.Mount Sinai.Vitamin B12 (cobalamin).Mount Sinai.Copper.Tolkien Z, Stecher L, Mander AP, Pereira DI, Powell JJ.Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis.PLoS One. 2015;10(2):e0117383. doi:10.1371/journal.pone.0117383Academy of Nutrition and Dietetics.Foods to fight iron deficiency.Soliman AT, De Sanctis V, Yassin M, Wagdy M, Soliman N.Chronic anemia and thyroid function.Acta Biomed. 2017;88(1):119–127. doi:10.23750/abm.v88i1.6048
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Banday T, Bhat S, Bhat S, et al.Incipient iron deficiency in primary hypothyroidism.Thyroid Res Pract. 2018;15(3):138. doi: 10.4103/0973-0354.245563Le CH.The Prevalence of Anemia and Moderate-Severe Anemia in the US Population (NHANES 2003-2012).PLoS One. 2016 Nov 15;11(11):e0166635. doi:10.1371/journal.pone.016663515th International Thyroid Congress program and meeting abstracts.Thyroid.2015;25 Suppl 1:P1-A337. doi:10.1089/thy.2015.29004.abstractsFischli S, Von Wyl V, Trummler M, et al.Iron metabolism in patients with Graves' hyperthyroidism.Clin Endocrinol (Oxf). 2017;87(5):609-616. doi:10.1111/cen.13450NIH. National Heart, Lung, and Blood Institute.Iron-deficiency anemia.Merck Manual Professional Version.Iron deficiency anemia.Harvard T.H. Chan School of Public Health.Vitamin C.Mount Sinai.Vitamin B12 (cobalamin).Mount Sinai.Copper.Tolkien Z, Stecher L, Mander AP, Pereira DI, Powell JJ.Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis.PLoS One. 2015;10(2):e0117383. doi:10.1371/journal.pone.0117383Academy of Nutrition and Dietetics.Foods to fight iron deficiency.Soliman AT, De Sanctis V, Yassin M, Wagdy M, Soliman N.Chronic anemia and thyroid function.Acta Biomed. 2017;88(1):119–127. doi:10.23750/abm.v88i1.6048
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Banday T, Bhat S, Bhat S, et al.Incipient iron deficiency in primary hypothyroidism.Thyroid Res Pract. 2018;15(3):138. doi: 10.4103/0973-0354.245563Le CH.The Prevalence of Anemia and Moderate-Severe Anemia in the US Population (NHANES 2003-2012).PLoS One. 2016 Nov 15;11(11):e0166635. doi:10.1371/journal.pone.016663515th International Thyroid Congress program and meeting abstracts.Thyroid.2015;25 Suppl 1:P1-A337. doi:10.1089/thy.2015.29004.abstractsFischli S, Von Wyl V, Trummler M, et al.Iron metabolism in patients with Graves' hyperthyroidism.Clin Endocrinol (Oxf). 2017;87(5):609-616. doi:10.1111/cen.13450NIH. National Heart, Lung, and Blood Institute.Iron-deficiency anemia.Merck Manual Professional Version.Iron deficiency anemia.Harvard T.H. Chan School of Public Health.Vitamin C.Mount Sinai.Vitamin B12 (cobalamin).Mount Sinai.Copper.Tolkien Z, Stecher L, Mander AP, Pereira DI, Powell JJ.Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis.PLoS One. 2015;10(2):e0117383. doi:10.1371/journal.pone.0117383Academy of Nutrition and Dietetics.Foods to fight iron deficiency.Soliman AT, De Sanctis V, Yassin M, Wagdy M, Soliman N.Chronic anemia and thyroid function.Acta Biomed. 2017;88(1):119–127. doi:10.23750/abm.v88i1.6048
Banday T, Bhat S, Bhat S, et al.Incipient iron deficiency in primary hypothyroidism.Thyroid Res Pract. 2018;15(3):138. doi: 10.4103/0973-0354.245563
Le CH.The Prevalence of Anemia and Moderate-Severe Anemia in the US Population (NHANES 2003-2012).PLoS One. 2016 Nov 15;11(11):e0166635. doi:10.1371/journal.pone.0166635
15th International Thyroid Congress program and meeting abstracts.Thyroid.2015;25 Suppl 1:P1-A337. doi:10.1089/thy.2015.29004.abstracts
Fischli S, Von Wyl V, Trummler M, et al.Iron metabolism in patients with Graves' hyperthyroidism.Clin Endocrinol (Oxf). 2017;87(5):609-616. doi:10.1111/cen.13450
NIH. National Heart, Lung, and Blood Institute.Iron-deficiency anemia.
Merck Manual Professional Version.Iron deficiency anemia.
Harvard T.H. Chan School of Public Health.Vitamin C.
Mount Sinai.Vitamin B12 (cobalamin).
Mount Sinai.Copper.
Tolkien Z, Stecher L, Mander AP, Pereira DI, Powell JJ.Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis.PLoS One. 2015;10(2):e0117383. doi:10.1371/journal.pone.0117383
Academy of Nutrition and Dietetics.Foods to fight iron deficiency.
Soliman AT, De Sanctis V, Yassin M, Wagdy M, Soliman N.Chronic anemia and thyroid function.Acta Biomed. 2017;88(1):119–127. doi:10.23750/abm.v88i1.6048
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