Is pernicious anemia affecting my daughter’s health?

Question

Hello doctor,

I hope you will be able to help me with my daughter's health. The summary of her health is as follows: She was born prematurely at 25 weeks. She had to undergo PDA surgery soon after. She had Hashimoto's hypothyroidism when she was 8 years of age. She had urticaria and angioedema for many years. She took a double dose of antihistamines for at least five years. She had her tonsils and adenoids removed at age 10. She had pernicious anemia since the age of 11. Three years ago, she was bedridden for a month, as she was diagnosed with post-viral fatigue.

So, as you see, she has never felt well. She has put on a large amount of weight, in spite of being on a strict diet. She has chronic constipation, severe fatigue, breathlessness, cold hands and feet, and dry and thin hair. My daughter has phases where her eyes are swollen, and she feels pressure behind the eyeballs. Sometimes, her fatigue is so bad that she struggles to go about her daily routine.

During these episodes, she feels very weak, like her body is shutting down. Last year, she had a similar episode, but that time it was due to stomach acid issues. It lasted for around six months. Her stool test confirmed very high levels of the indicator for Crohn's. The surgeon carried out an endoscopy and a pill camera. But nothing showed up, much to his surprise. I am attaching a copy of her latest blood reports, the abnormal values of which are HbA1c (IFCC) 33 mmol/mol, Insulin (fasting) 27.4 pg/mL, and CRP 7.00. She is currently on Thyroxine, B12, and birth control pills.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I just read your query and the medical history of your daughter. I have seen the detailed reports (attachment removed to protect patient identity) as well. Let me answer each one of your questions.

Her raised cortisol is likely to be due to exogenous steroid use, like oral contraceptives, or any other ointment containing steroids. The Dexamethasone suppression test with a cortisol level of 26 indicates that she does not have Cushing's syndrome; as a result, a level of less than 875.6 mcg/L makes Cushing’s unlikely.
Iron deficiency has already been managed quite well. Unfortunately, she must continue to take the iron tablets in spite of her constipation. But it would cause less discomfort if taken after a heavy meal. Regarding pernicious anemia, she must continue to take those vitamin B12 shots.
Regarding thyroid issues, there is no necessity to increase her thyroxine dosage because her TSH is within the normal range, and that is the single indicator for adequate thyroxine replacement because the others are variable components.
Her CRP values are slightly high because of the chronic conditions she is having. She must continue her contraceptives as recommended, as they are not causing much of a problem.

I suggest the following:

Ask her to watch her diet, restrict the intake to 1200 to 1500 kcal per day, and also make a note of whatever she eats.
It is recommended she exercises for 60 minutes every day, five days a week. She can start with 10 minutes a day and gradually increase it by five minutes every week until she is able to do 60 minutes.
She can practice yoga, as it helps with the flexibility of her muscles and joints.
It is good to get seven to eight hours of sleep every day.
Try to cut down on her salt.
Try a gluten-free diet.
She must also take multivitamin supplements, as they will help with her hair loss.
Take Calcium and Vitamin D supplements daily, as thyroxine can weaken the bones over time.

I hope this helps.

Thank you.