High ferritin: causes, and when it means iron overload

• Male, age 18+: 24.0 – 336 ng/mL
• Female, age 18+: 11.0 – 307 ng/mL

Often reflects inflammation, infection, or excess iron stores. Less commonly, liver disease.

Full reference table, citations and testing options: Ferritin biomarker page.

1. Fatty liver disease and metabolic syndrome (insulin resistance, central weight, high triglycerides, high blood pressure) — the most common cause of a moderately high ferritin in the US, sometimes called dysmetabolic hyperferritinemia
2. Alcohol — raises ferritin directly and through liver injury; often falls substantially after four to six weeks without alcohol
3. Inflammation or infection — a recent cold, flu, COVID-19, a flare of arthritis or inflammatory bowel disease; ferritin can double for weeks
4. Chronic liver disease — hepatitis B or C, cirrhosis of any cause; injured liver cells release stored ferritin
5. Hereditary hemochromatosis — most often the HFE C282Y mutation; iron is absorbed excessively for decades, and ferritin rises with a transferrin saturation above 45%
6. Transfusions, intravenous iron infusions, long-term high-dose iron supplements, and conditions with ineffective red cell production such as thalassemia
7. Cancer — lymphoma, leukemia, liver, kidney, breast and other tumors can raise ferritin as part of inflammation
8. Hyperthyroidism, chronic kidney disease, and very high values (often above 5,000–10,000 ng/mL) in adult-onset Still's disease and hemophagocytic syndromes

• Usually none — the ferritin itself causes no symptoms
• In true iron overload: fatigue, joint pain (classically the second and third knuckles), loss of libido or erectile dysfunction, bronze or gray skin, new diabetes, liver enlargement, heart rhythm problems
• Symptoms of the underlying cause — right-upper abdominal discomfort with liver disease, fever with infection

• Fasting iron, TIBC and transferrin saturation: saturation above 45% sends the workup down the iron-overload path; below 45% it is inflammation, liver or metabolic
• CRP (or ESR) to see whether inflammation explains it, and a CBC
• Liver enzymes (ALT, AST, GGT), bilirubin and albumin; hepatitis B and C screening if not already done
• Metabolic screen — A1c or fasting glucose, lipids, blood pressure and waist measurement; weight loss and alcohol reduction lower this kind of ferritin
• HFE gene testing (C282Y, H63D) when transferrin saturation is above 45%, when ferritin is above 1,000 ng/mL, or when a first-degree relative has hemochromatosis
• Repeat in 6–12 weeks after an infection has cleared or after four to six weeks without alcohol before drawing conclusions from one value
• Liver ultrasound, elastography or MRI iron quantification when ferritin stays above 1,000 ng/mL, when liver tests are abnormal, or when hemochromatosis is confirmed

Follow-up tests available at TestWell: CBC with Differential Test ($17.99), Body Inflammation Test (ESR) ($18.99), Transferrin Test ($23.99), ALT Test (Alanine Aminotransferase) ($16.99), GGT Test (Gamma-Glutamyl Transferase) ($19.99), C-Reactive Protein Test (CRP) ($26.99).

Ferritin refills slowly. When treating iron deficiency, hemoglobin usually improves within a few weeks, but ferritin needs roughly 3 months of consistent iron before a recheck can confirm stores have recovered (British Society of Gastroenterology guidance). Because ferritin also rises with inflammation, a result drawn during or just after an illness can read falsely reassuring — retest once you're well.