Question: Hello Doctor,
I am a 39 year old female. I was diagnosed with Hypothyroidism and PCOD in 2008. I was suffering from the usual Hypothyroidism symptoms like chill, fatigue, hairfall, weight gain of 20 kgs almost overnight and puffiness of face. Also, infertility as I had not conceived till then, almost 8 years into my marriage. My family friend (Doctor) suspected Hypothyroidism and asked me to take a thyroid blood test which confirmed that I was suffering from Hypothyroidism. I was advised Thyronorm 100 mg 6 days a week. After the medication my symptoms somewhat gradually subsided and I started feeling normal again. My Doctor advised me to take the T4 and TSH tests every 3 months to see if my medicine was working fine. I used to take the test and my medicine regularly. My medication used to be adjusted as the blood work showed some fluctuation in T4 and TSH values or if there was some symptoms like not getting lung full of air. Sometimes the medication would be adjusted to 150 Mg and 100 mg on alternate days basis my values of T4 and TSH and breathing symptoms. If there was some breathing problem my medication would be reduced to 100mg per day. Things were fine and gradually I also got complacent and started to neglect the 3 monthly blood test and visit to the Doctor though I continued with my medication i.e. 100 mg 6 days a week. I would take the test randomly at 6 months or a year and the values would appear normal (Read between the range) and I would continue with the 100 mg medication.
In the meantime, I conceived twice once in 2009 and again in 2010, for the first time, but both pregnancies resulted in miscarriage. They were termed as Pregnancies of Unknown Location by the doctors at Fortis, and I was treated with Methotrexate. Post 2010, I have not tried at all, since I was very depressed and the entire experience in 2009-10 was emotionally and financially draining too.
Off late for the last 2 years my hair fall has become severe, so much so that I think I will get bald in few years. Also I am getting frequent and severe throat infections (3 to 4 times in last 2 years). Everytime, my voice becomes hoarse like you have during laryngitis. I consulted a physician, an ENT specialist and a chest specialist. They ran a battery of tests like chest x-ray, pulmonary function test, blood tests. Everything came normal except hemoglobin and hematocrit which were low and RDW which was high (I have read that elevated RDW is symptom of iron deficiency). They concluded that it is allergy/chronic sinus and have asked me to take steam inhalation twice a day to unclog the sinuses. Temporarily I was also advised steroids early last year, and I was off it after 2 months post the symptoms of wheezing subsided. The throat infections still continue every 2-3 months.
I recently took an Iron profile test along with complete thyroid profile on my own. I am attaching this report along with the last two thyroid tests which I had taken in Aug 2014 and XXXXXXX 2015 for your reference. All these blood tests were taken on empty stomach first thing in the morning.
My last 3 tests appeared normal to me, (I know that I am not a Doctor but I am basing my observation basis the values within range) but I would like to have an expert opinion on this as I have realized that these values(T3,T4,TSH) are relative to each other and only an expert can understand the report. I am particularly worried by my Iron profile test where the Transferrin Saturation level is 14.5% even though other values appear to be in range. Please advise me if
1.     I am suffering from anemia.
2.     Does my Thyroid medication needs to be adjusted? (Currently I am taking 100 mg of Thyronorm 6 days a week).
3.     Also please advise me if the thyroid medication I am taking is getting converted into T3. My T4 value is on the higher side whereas T3 is on the lower side.
4.     If T4 is not adequately getting converted to T3, would you recommend T3 medication like liothyronine provided it is available in XXXXXXX
5.     I would like to increase my Ferritin level. Currently it is on the lower side 24.40 ng/ml (Range 10-120).
Warm Regards XXXXXXX

Thank you Doctor for your prompt response. As suggested by you I am going to increase my Thyroid medication to 7 days a week. You have suggested that I have mild anemia and I need to be on iron supplements. Can you please prescribe me a good iron supplement and how much micrograms should I be taking in order to raise my low levels. I have read that the iron supplements are available in various forms such as Ferrous Sulfate, Ferrous Glutamate, Ferrous Fumerate, Ferrous Bisglycinate, etc. I would request you to prescribe me a form which does not give constipation.

I have also read about that iron supplements come in two forms i.e heme and nonheme, and that heme form of iron is the best absorbable form of iron. Will you prescribe me heme form of iron supplement? If so, preferably in liquid form so that I can mix it with orange juice for better absorption. Please let me know the gap between the intake time of Thyroid medication and iron supplement to avoid miss absorption of thyroid medicine.

Guess you missed my question around the severity of hair fall, is there anything I can do to control it as its the most visible form of ailment at the moment and most disturbing too :)

Thanks and warm regards XXXXXXX