Oral thyroid hormone replacement therapy is thought to decrease the absorption of dietary iron, which may, in turn, lead to iron deficiency anemia (and, by definition, decreased serum ferritin levels). Additionally, oral calcium intake, and especially the use of oral calcium supplements, will further reduce dietary iron absorption. If you are still menstruating, then you may have additional iron losses that can further add to low ferritin levels.
Your Endocrinologist may be able to help you to set up a "schedule" for taking your oral thyroxine, as well as iron and/or calcium supplements, to decrease adverse absorption interactions among these medications. (I cannot, of course, ethically give specific medical advice to patients who are not directly under my care.)
Sincerely/ Robert A. Wascher, MD, FACS
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