low serum iron, recommended next steps?

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I have had muscle pains for almost 3 years.  Started very lightly in March 2014, escalated slowly until April 2016, then escalated rapidly after a thyroidectomy.  The most intense pain is in my legs, but also have shoulder/neck/back pain.

My thyroid numbers are good.  I did a rheumatology workup that found nothing.  Ran some iron numbers in mid December 2016 and my serum iron was in the bottom 5% of the normal range (57 with a reference range of 50-180).  Ferritin was 81 (20-380)  and TIBC was 330 (250-425) which were comfortably normal.  I took a 5mg liquid iron supplement and my leg pain which had been constant from June 2016 to December 2016 disappeared after 4 days.  The leg pain returns after minor exercise (ex walk 1 mile on a treadmill), but thankfully does go away after 4-5 days of rest.

Notably, I tried an 18mg iron pill because it was cheaper than the liquid iron, but the pills provided much less relief than the lower dosage liquid iron supplement.

Also, my vitamin D and testosterone numbers are low and I am on supplements for those.  I started the vitamin D in October 2016 and the testosterone in very early December 2016.  The muscle pain was very intense before I started those treatments and the treatments provided no noticable relief, for leg pain or fatigue.  So I do not think that the low Vitamin D and testosterone are the cause of the muscle pain, but maybe they are also syptoms of a single underlying root cause.

Any recommendation on blood tests (or other) to move this effort along?  I have an appointment with my primary care doctor in about a week and plan to ask for a consultation with a hematologist.  I do not mind paying for blood tests out of pocket to speed up the solution.

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14 Replies

  • Posted

    Was your vitamin B12 checked? Please see pernicious anaemia society for full details on this.
    • Posted

      B12 was normal (526 with a reference range of 200-1100).  It was also done with a folate test which was 17.4 (>5.4 defined as normal).

    • Posted

      Too low according to values in the US and Japan e al. If you log onto pernicious anaemia society you will find tons of info to confirm that B12 values are grossly understimated in the UK.
    • Posted

      Interesting Jane.  Would the next step be one or both of the following?

      1.  Trial B12 injections

      2.  Homocysteine and Methylmalonic blood tests

      Anything else?

      I tried B12 pills before the thyroidectomy, but did not get symptom relief.

    • Posted

      Brian The problem is that if you do have trial of vit B12 injections or tablets then it gives a false reading.

      Methlaminic and homocysteine tests should really be done tocheck all the vit B vitamins.

      VIT B12 values. Should be at least 750.

       Homocysteine and Methylmalonic blood tests should be done really to get a full picture.

      Also the signs and symptoms should be taken into consideration rather than blood results and treatment started based on the signs and symptoms.

      B12 is under diagnosed in the UK.

      B12 tablets prior to thyroidectomy.

      Not everyone can absorb B12 via the gut hence injections. There is sub lingul B12 but I would have the bloods re checked in their entireity first in order to obtain accurate results.

      Please look at the Pernicious anaemia society website. They will look at your blood results and give their skilled opinions.

      Was your Haemaglobin checked Brian?


    • Posted

      The B12 test was done in December 2016.  I took the B12 sublingual tablets in 2015 just to see if they relieved my symptoms.

      My last hemoglobin was 14.5 with a reference range of 13.2 - 17.1.

      At my next doctors appointment, I will ask for the methlaminic and homocysteine tests.

  • Posted

    Other tests that might be of interest

    B12: 526 (200-1100)

    Folate:  17.4 (>5.4)

    Reverse T3: 12 (8-25)

    C-Reactive Protein: 0.26 (<0.80)

    Complement Component C3C: 124 (90-180)

    Complement Component C4C: 28 (16-47)

    RBC Count: 4.76 (4.20-5.80)

    Hematocrit: 41.7 (38.5-50.0)

    MCV: 87.6 (80.0-100.0)

    • Posted

      I had the thyroidectomy in April 2016 for papillary thyroid cancer.  The thyroglobulin tests that they've run this far have been really low (0.1 with a pre-thyroid reference range of 2.8-40.9) indicating no metastasis.

      My T4 numbers went slightly high in early June 2016, but have been good since then.  The TSH and T3 numbers have consistently been in range.  Here are the most recent results

      TSH: 0.07 (very low is desirable since I had cancer)

      fT4:  1.6 (0.8-1.8)

      fT3:  3.7 (2.3-4.2)

      I tried ArmourThyroid in September-November.  It helped about 20% with the leg pain, but raised my blood pressure.  The liquid iron supplements I started in late December have gotten about 4 times better improvement than the ArmourThyroid.

    • Posted

      Sorry to hear this about the thyroid cancer. However I believe  it has a very good prognosis. I  had ovarian  cancer many  years ao I was lucky as it was discovered by  accident on what was thought  to be  a fibroid.

      ​I am unsyure what is causing  the leg pains but the B12 is low so possibly pernicious anaemia. In the xcircumstances it may be well worthwhile pressing your \GP to prescribe it in injection form to see if the leg pains improve. In the meantime magnesium is good for leg pains. 


    • Posted


      Thank you for the kind words and advice.  In the cancer universe, I believe that papillary cancer is one of the easiest to beat.  Most treatment plans do not incorporate chemotherapy because it does not metastasize aggressively.

      My magnesium blood test in August 2016 was 2.1 with a reference range of 1.5 - 2.5.  I will keep the magnesium on the list of things to try.  I'm reluctant to change too many things at once.

      My initial post was hoping for guidance on blood tests to distinguish iron deficiency anemia (IDA) from functional iron deficiency (FID) from iron anemia from chronic disease (ACD).  I should have been more direct.  Since the iron supplements produced such a pronounced and quick improvement, I think that is the path with the most potential.  But since I've been unwell for 3 years and have seen 19 health professionals so far who all shrug their shoulders, I'm very receptive to any and all advice.  It was an alternative medicine internet site that recommended the serum iron test, which was a major breakthrough.

    • Posted

      Brian You are more than welcome. I had a dysgerminoma with NO follow up. I had a prophylactic removalof the remaining ovary several years ago. I was very lucky .

      If you wish to PM please feel free to do so.


  • Posted

    Look up magnesium. Magnesium deals with a lot of functions in your body. Magnesium relaxes the muscles. Calcium tightens. Too much calcium and not enough magnesium could cause tightening of the muscles causing pain. Check magnesium levels or just eat foods with magnesium and see if pain improves. Just don't get too much magnesium either. It shouldn't be a problem unless you take magnesium pills in which you need the right dose for your body. Your body will usually filter out too much magnesium unless problems with kidneys. It is better to get through food though. Hope you feel better soon!


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