Iron-test results cause worry

Dear Dr. Roach: I’m a 59year-old white woman. Results of an iron-level test showed that both my iron and iron saturation were high. My doctor ordered a ferritin level and a hereditary hemochromatosis DNA test. The ferritin came back normal, but the hereditary hemochromatosis DNA test came back indicating that “two copies of H63D mutation were identified.”

My doctor was uncertain about these results, so he consulted with my gastroenterologist, who said: “If her ferritin is normal, she does not have hemochromatosis.”

This still left me with no action plan as to what to do about having too much iron. So, I decided to see a liver specialist just to be certain about whether I have an issue that needs to be addressed. In the meantime, I gave blood, and the next day I felt like a million bucks.

A. Hereditary hemochromatosis is a genetic condition in which iron is absorbed at too high a rate, even when iron levels are normal. Based on the genetic test, you have two abnormal copies of the gene, but because you don’t have iron overload (the ferritin is the best test for iron overload), you are unlikely to develop any problems. The abnormal gene mutation you have two copies of, the H63D, confers a lower risk than the more severe genetic abnormality C282Y. Only about one per cent of women with your genes will have iron overload, versus 50 per cent of women (and 85 per cent of men) with two copies of C282Y. Women tend to develop symptoms of iron overload later in life than men, since they are partially protected by menstrual blood loss. However, premenopausal women can develop iron overload, especially those with the C282Y mutations.

Dear Dr. Roach: I had papillary thyroid cancer diagnosed. After surgery, my doctor wants me to take a higher dose of replacement thyroid hormone. I am confused, because all the lab tests are normal. Why a higher dose?

M.V. After thyroid cancer surgery, the entire thyroid usually is removed, so the body needs replacement hormones. However, we like to slightly suppress the hormone TSH, which is the pituitary hormone that stimulates the thyroid gland (“TSH” stands for stimulating hormone).

The hope is that with less TSH, there will be fewer stimuli for growth, just in case there are any cancer cells left after surgery. The thyroid replacement dose needs to be only very slightly adjusted and should not cause noticeable symptoms of excess thyroid levels.

Dear Dr. Roach: What is the problem if a person eats ice regularly?

J.T. Ice eating, a specific form of pica (a condition where people crave and eat substances of no nutritional value), is associated with several nutritional deficiencies, but the most common is iron deficiency.

One study showed that eating ice improves alertness in those with iron deficiency anemia.

However, ice eating is not good at all for your teeth. Also, any iron deficiency should prompt a search for where the iron is being lost.