This is a podcast episode from JJ Virgin titled “How Is Ferritin Related to T4 Thyroid Levels?” (episode includes ads and promos). The core content is a listener question answered by Dr. Michael Ruscio: ferritin is a sensitive marker of iron status and in people with hypothyroidism a ferritin below ~100 ng/mL may be associated with fatigue even if standard lab cutoffs (around 20 ng/mL) call it 'normal.' Hypothyroid patients have a 20–30% chance of low stomach acid, which can impair iron absorption; raising ferritin above 100 via iron supplementation (and addressing digestive health/HCl) can sometimes improve fatigue. The transcript also contains multiple ad reads (home decor, laundry detergent, budgeting app, car dealer) and podcast subscription prompts.
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How is ferritin related to T4 thyroid levels?
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This is JJ Virgin, four time New York Times bestselling author, celebrity nutrition expert, and fitness hall of famer. I've been on a lifelong quest for answers to the toughest health questions and now I'm sharing what I found with you. Welcome to Ask the Health Expert. Stephania from Instagram asks, how is ferritin related to T4 levels? Hey, it's JJ and I've got Dr. Michael Ruscio. You may know him as the best selling author of Healthy Gut, Healthy youy. I know him as the guy who's a little bit of an adventure junkie, a musician in his spare time, and he's got a secret dream to paraglide. We'll be right back to answer this question.
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Great question. Ferritin is something that more patients are becoming aware of. Why it's important just to define it really quickly. Ferritin is a marker of iron status and it may be the most sensitive marker for iron status, meaning this will be the first thing that goes low and shows that someone has iron deficiency anemia. What's tricky here is that many patients will come in and let's say their endocrinologist had tested their ferritin if they're lucky. This is not often done in a conventional panel, but if they're a more forward thinking endocrinologist and they're keeping an eye on some of this literature, they've run a ferritin and the patient says, well, my ferritin is normal. Well, this is one instance where we actually have to be a bit more discerning in what that level of ferritin should be. The evidence is showing that if someone who's hypothyroid has ferritin below 100, that may actually lead to fatigue, even though the lab will signify that as normal. And the lab cutoff for ferritin I believe is around 20. So there's a big discrepancy between the lab telling you you're low and potentially being suboptimal. And this is a area where, especially if, let's say a given person comes in and they are hypothyroid, but they also have digestive symptoms, then what may be happening in this situation is their thyroid hormones are now normal because they're on a medication. But the digestive symptoms are a byproduct of inflammation, potentially leaky gut, and they're not absorbing their iron effectively. And what can happen in these cases is someone pursues further and further down the rabbit hole of well, let's look at my T3, let's look at my reverse T3, let's look at the ratios and they try different medications and they never quite feel it may be that they're pursuing the wrong endpoint. This to the listener's question is where ferritin can come in and there is published evidence and you also see this sometimes in clinical practice when you get someone's ferritin to above 100 vis a vis supplementing with iron. Now, their fatigue improves. And sometimes this also ties into this kind of fatigue, brain fog. Because some people don't have true brain fog or difficulty thinking or depression. It's rather just a derivative of them being low energy. And then it just feels like, oh, you know, I have to take the kids here, I have to do this, and they get kind of overwhelmed and they feel like they have a hard time doing things and they might get a little bit depressed, more so because of the lack of energy rather than there being actual depression or brain fog. So ferritin is definitely something to keep one's eye on. Now, there's something else here important to understand, which is those who have hypothyroid have about a 20 to 30% chance that their secretion of hydrochloric acid is low or insufficient. And why does that matter? Well, we need hydrochloric acid to absorb minerals like iron. So there is a predisposition in those who have hypothyroid to have low ferritin. And low ferritin can lead to certain symptoms, namely fatigue. Using iron to rectify and get that ferritin above 100 can improve the fatigue. Now to the question. There's also an impact on conversion of T4 to T3, and then we get kind of into a chicken or the egg, and I think that's less relevant. What's more relevant is understanding who you are and what you have. So in this case, if you have hypothyroid, you're at increased risk for low stomach acid, therefore low ferritin and the fatigue that ensues as a byproduct of that iron deficiency anemia. So have your ferritin tested, and if you're below 100, consider supplementing with iron to get it above 100. Also, don't forget to tend to your digestive health and consider a supplement that a hydrochloric acid supplement to get your levels a little bit higher and to better absorb the iron going forward.
This is JJ with Ask the Health Expert. I do this five times a week, so make sure you never miss a show by going to subscribetojay.com.
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