Latest Update: April 21, 2005
Iron, Anemia and Hypothyroidism
A double-edged sword for thyroid patients who may be slightly anemic
by Kim Carmichael-Cox
Iron plays a crucial role in helping to regulate several major systems within the body, including the transportation of oxygen in the blood to the lungs as well as helping to regulate the immune system. Having an iron deficiency can create an array of symptoms, none of which are very pleasant.
As a thyroid patient suffering from Hashimoto's, I discovered that too much iron in the diet can wreak havoc on the way your medication is absorbed. Surprisingly, I found iron in large quantities in some foods you might never suspect.
While in for a routine check of my thyroid levels, I found I was borderline deficient in my iron stores, i.e. anemic. As a result, my endocrinologist prescribed me an over-the-counter iron supplement. It upset my stomach, so after about two days I quit taking it. While in to see my gynecologist later that month I mentioned my low iron stores to him and what happened with the iron supplement. He then gave me a prescription iron supplement called Chromagen of 250 mg to be taken twice daily. The body can absorb this iron supplement more easily and it causes less gastric upset. After about five days of taking this supplement I began to have problems. I started to feel lethargic and had what I recognized as "reduced" thyroid function symptoms. I became teary-eyed and just generally felt out of sorts. Even my friends noticed a change in my behavior.
What I didn't know at the time was that a four hour gap was needed between taking synthroid and the iron supplement, with the synthroid to be taken first. After being off the supplement for about 10 days I decided to try it again. Suspecting that my previous problems were due to the timing of the medications, I began the supplement again following the guidelines of separating the thyroid medication from my iron.
Again after about five days the same problems arose. I decided that perhaps an iron supplement wasn't going to work for my problem. After the second episode I decided to give up the iron supplement altogether for a while. I also began to read about iron and discovered that I was not obtaining iron in my diet in either the most efficient manner or in the most natural ways. I found out that large quantities of iron in the diet could interfere with the binding of the thyroid medication and prevent it from being absorbed properly. I found that even separating my iron supplements by more than four hours from my thyroid medication didn't work for me.
Still, the issue of iron in my diet was a double-edged sword. I needed the iron, but had to be careful with my thyroid condition. I began to incorporate more lean meats into my diet including red meat, after eating foods in iron from mostly vegetarian sources such as dried beans. I assumed I could absorb most of the iron needed from plant sources, such as beans, and dark green leafy vegetables, such as spinach, I found this was not the case. In fact, there needs to be a balance between the two sources of plant and animal protein. While I am not advocating a diet rich in red meats, I am merely suggesting that people who may have problems with iron interacting with their medications may have to eat red meats more often.
I also found that in the morning when I take my medication of 100 mcg of synthryoid I had to be careful of hidden sources of iron that were also probably contributing to my symptoms. I found that some of my favorite breakfast foods were loaded with iron. Some of these foods were quite a surprise, such as cream of wheat. To my dismay I discovered it contained 50 percent of the daily requirement of iron in one serving. I also found a lot of breakfast cereals contain large quanties of iron, such as Post Raisin Bran; it contains 60 percent of the recommend daily value of iron in a one-cup serving. Certain breakfast bars and drinks are also high in iron. I began to scrutinize what I was eating and to read food labels more carefully to see how much iron was in the product. In general, I found if a food product is fortified with vitamins and minerals, it usually has iron. It is crucial to read labels carefully, especially with what you are eating within a few hours taking your medication. Look and see just how much iron the product contains.
As women, iron is a very important part of our healthy diets and critical to good health, but as a thyroid patient when and how much iron is consumed is equally important. I since learned that it is not uncommon for women who are menstruating to be borderline anemic. People who suffer from various autoimmune diseases can be prone to anemia as well. There is a definite trade-off in feeling a little tired from not having enough iron or from consuming large quantities of iron that can affect your thyroid regulation. I have since given up supplements and by incorporating the things I have learned about iron absorption and I have been able to increase my iron stores without supplements. After a year and a half of trial and error I have learned to manage some of the dietary triggers that can cause these episodes. It wasn't easy, though, and I found there are a lot of dietary triggers and medications that can exacerbate thyroid disease and interfere with thyroid medications. Even just taking something as simple as aspirin can affect thyroid patients in different ways. These are things some doctors may not tell you.
Perhaps the vast majority of people who take iron supplements will never experience what happened to me. Each person's body is different and different supplements or medications effect each person differently, but iron supplements definitely caused me some problems. My internal medicine doctor told me medicine is "part art and part science." I think that was very insightful. We are all individually unique beings, having essentially the same construction, but the way we react to substances may be completely different. There will always be those individuals who experience reactions above and below the average norm. I have come to the conclusion I have a highly sensitive system. All thyroid patients need to strive to create a medication and supplement plan that works for them, and to pay attention to what their bodies are saying.
http://thyroid.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=thyroid&zu=http%3A%2F%2Fwww.thyroid-info.com%2Farticles%2Firon.htm 
Iron, Anemia and Hypothyroidism 
