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Q. Is it safe to take iron supplements for fatigue or can it become toxic?


 

Hello doctor,

I began presenting last fall with some chronic fatigue. The initial blood work showed low iron saturation without anemia. I have attached reports of the same. There were other endocrine-related findings as well. In the course of various endocrine-related treatments and corresponding blood work, I began iron supplementation in the form of ferrous sulfate 143 mg daily. I began this before the blood work was done. So, you can see that that the levels have increased. Subsequent testing, a month later, showed a decline despite continuing treatment. Most recently, you can see that the levels are back up. Note that the ferritin levels began a bit low around 27 ng/mL and had increased to 30 ng/mL.

I have received a wide range of conflicting advice about whether low iron levels in the absence of anemia can cause fatigue. I have also received a range of conflicting advice about whether to continue iron supplementation. One doctor told me to continue taking the iron until the ferritin is up around 50 or so. Another said that would be unnecessary and to discontinue it and wait for three months to re-measure the blood work. It is all quite puzzling. Please help me to understand iron's role, if any, in fatigue in the absence of anemia. And help me to then understand the rationale for treatment or lack thereof. And finally, please give me some sense of when iron toxicity emerges in terms of blood work measurements and at what frequency one needs to check the iron levels during any supplementation.


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Dr. Parth R Goswami
M.B.B.S., M.D
Hematology, Pathology

Hello,

Welcome to icliniq.com.

  • In my opinion, iron supplementation can be stopped because serum iron, TIBC (total iron binding capacity) and hemoglobin levels are within the range.
  • Fatigue can occur in hypothyroidism, or due to anxiety, lack of sleep, exhaustion, stress or lack of exercise.
  • Repeat CBC (complete blood count) after few weeks and upload the results.
  • The following investigations, if done, will reveal the exact cause of your fatigue:
  1. Thyroid profile.
  2. Serum Potassium, Calcium and Sodium levels.
  3. Liver and kidney profile.
  4. Nerve conduction velocity.
  5. Electromyography.
  6. FSH and LH levels.

You can consult an endocrinologist or a neurologist based on your reports, but iron medication need not be continued as per my opinion.

For more information consult a hematologist online --> https://icliniq.com./ask-a-doctor-online/hematologist

 

Hello doctor,

Thank you for your answer. My endocrinologist and primary care physician both want me to continue taking the iron and resample the blood in three months. The idea is to raise the ferritin to about 50, so that I will have more iron reserves. I realize that this conflicts with your advice, but I want to understand this from a hematologist. Is continuing the iron safe? When does iron become toxic? Is toxicity going to occur right away or is it more of a long-term possibility? Is a 3-month waiting period sufficient for blood testing if I do continue the iron? They want me to take 143 mg ferrous sulfate per day during this time. These doctors seem very convinced that this is safe. Please help me feel the same way.

 

Dr. Parth R Goswami
M.B.B.S., M.D
Hematology, Pathology

Hello,

Welcome back to icliniq.com.

Our body uses up the iron reserve whenever required, especially when the iron intake is low.

  • Serum ferritin level reflects the iron store. Your serum ferritin is not low. So, I advised you to stop taking the iron medication intake.
  • But, as such iron tablets are safe. It will not lead to toxicity if you take iron because iron gets accumulated in organs like liver, heart, thyroid etc when the serum ferritin is above 1000. So, iron toxicity issues occur in thalassemia patient commonly.
  • If your doctors are sure, you can continue it as they advise. It will definitely not harm you. You can check the serum ferritin again after iron 3 months.

For more information consult a hematologist online --> https://icliniq.com./ask-a-doctor-online/hematologist

 
 
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