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Hello, I’m A 20 Year Old Female. For Several Months
Question: Hello, I’m a 20 year old female. For several months I was struggling with what I believed to be anemia, although when I had blood work done a couple months ago my iron levels and hemoglobin were normal. However, during those months whenever I stopped taking my iron supplements, I would get a terrible rash on my face and my lips would peel, almost like an allergic reaction, and it would only get better once I started taking iron again. Certain areas of my skin were also turning blue and I was having fatigue.
In the past month, I started having chronic headaches every day and very dry eyes, so I started eliminating things to find the issue. Once I eliminated the iron supplements, the headaches went away. Since being off the iron I haven’t been having the usual rash reaction on my face or lip peeling, but I’ve been having extreme fatigue, hair loss, dry patches on my hands, and sometimes swollen feet. But whenever I take iron again the headaches come back.
I have hypothyroidism and take levothyroxine for it. I thought these issues may be due to my hypothyroidism, but I had bloodwork done for that as well a couple months ago and my thyroid levels were normal. I’m not sure if levels can change drastically enough over the course of a couple months to cause these issues.
I am currently living abroad and it’s very difficult for me to go to a doctor or find a place to get blood tests, so I wanted to try this first. If you can give me any ideas of what you think may be wrong I would greatly appreciate it.
Even if you can just suggest specific blood tests you think I should get done that would be great. I thought maybe a thyroid panel, and possibly various vitamins. I have had vitamin d deficiency in the past, but I am taking a high dosage of d3 per day for that.
In the past month, I started having chronic headaches every day and very dry eyes, so I started eliminating things to find the issue. Once I eliminated the iron supplements, the headaches went away. Since being off the iron I haven’t been having the usual rash reaction on my face or lip peeling, but I’ve been having extreme fatigue, hair loss, dry patches on my hands, and sometimes swollen feet. But whenever I take iron again the headaches come back.
I have hypothyroidism and take levothyroxine for it. I thought these issues may be due to my hypothyroidism, but I had bloodwork done for that as well a couple months ago and my thyroid levels were normal. I’m not sure if levels can change drastically enough over the course of a couple months to cause these issues.
I am currently living abroad and it’s very difficult for me to go to a doctor or find a place to get blood tests, so I wanted to try this first. If you can give me any ideas of what you think may be wrong I would greatly appreciate it.
Even if you can just suggest specific blood tests you think I should get done that would be great. I thought maybe a thyroid panel, and possibly various vitamins. I have had vitamin d deficiency in the past, but I am taking a high dosage of d3 per day for that.
Brief Answer:
Try a different formulation of iron like ferrous ascorbate.
Detailed Answer:
Hello Ms XXXXXXX
Welcome to Ask A Doctor service, this is Dr. Yogesh here, I will try to help you to the best of my ability.
I appreciate your detailed description of the ongoing issue.
Iron deficiency does cause dry and scaly skin, angular chelitis (peeling of skin over the lips and sores at the angle of the mouth) along with geographic tongue (stomatitis), hair loss and fatigue.
However, you have mentioned that the iron levels and haemoglobin levels were normal when you last checked. This part is the most confusing part.
I would like to know how long it takes for all these symptoms of anaemia to appear from the day of stopping taking the iron supplements.
Another confounding factor in your case is hypothyroidism, most of the symptoms of iron deficiency anaemia are also common with hypothyroidism and sometimes supplemental thyroid hormone you take may not be sufficient even though the lab tests show it to be normal.
In my opinion, you can get a few tests repeated and a few new tests done.
1. Peripheral smear study to see the type of anaemia if any, and to see any deformities in the red blood cells.
2. Complete blood counts (CBC).
3. ESR
4. T3, T4, TSH (Thyroid profile)
5. Vitamin B12, B1, B6, Folic acid and Vitamin C (ascoribic acid) levels to be done.
6. Serum electrolyte levels.
7. Liver function tests to look for any increased turnover of RBCs.
8. Test for intrinsic factor (this is produced in the stomach and essential for absorption of iron).
9. Serum Iron, and transferrin levels.
10. Abdominal ultrasound scan to look for any enlargement of the liver or spleen.
Meanwhile, I would suggest you to increase the intake of foods rich in iron and vitamins such as liver from chicken, fish, green leafs.
You can also try changing the specific iron formulation from the current one to one these, ferrous fumerate, or ferrous ascorbate, ferrous succinate, or ferrous gluconate.
You can also try injectable iron formulations.
I hope this information will be useful to you, you are most welcome to ask me for any clarifications if needed.
Wishing you a very good health.
Warm regards.
Try a different formulation of iron like ferrous ascorbate.
Detailed Answer:
Hello Ms XXXXXXX
Welcome to Ask A Doctor service, this is Dr. Yogesh here, I will try to help you to the best of my ability.
I appreciate your detailed description of the ongoing issue.
Iron deficiency does cause dry and scaly skin, angular chelitis (peeling of skin over the lips and sores at the angle of the mouth) along with geographic tongue (stomatitis), hair loss and fatigue.
However, you have mentioned that the iron levels and haemoglobin levels were normal when you last checked. This part is the most confusing part.
I would like to know how long it takes for all these symptoms of anaemia to appear from the day of stopping taking the iron supplements.
Another confounding factor in your case is hypothyroidism, most of the symptoms of iron deficiency anaemia are also common with hypothyroidism and sometimes supplemental thyroid hormone you take may not be sufficient even though the lab tests show it to be normal.
In my opinion, you can get a few tests repeated and a few new tests done.
1. Peripheral smear study to see the type of anaemia if any, and to see any deformities in the red blood cells.
2. Complete blood counts (CBC).
3. ESR
4. T3, T4, TSH (Thyroid profile)
5. Vitamin B12, B1, B6, Folic acid and Vitamin C (ascoribic acid) levels to be done.
6. Serum electrolyte levels.
7. Liver function tests to look for any increased turnover of RBCs.
8. Test for intrinsic factor (this is produced in the stomach and essential for absorption of iron).
9. Serum Iron, and transferrin levels.
10. Abdominal ultrasound scan to look for any enlargement of the liver or spleen.
Meanwhile, I would suggest you to increase the intake of foods rich in iron and vitamins such as liver from chicken, fish, green leafs.
You can also try changing the specific iron formulation from the current one to one these, ferrous fumerate, or ferrous ascorbate, ferrous succinate, or ferrous gluconate.
You can also try injectable iron formulations.
I hope this information will be useful to you, you are most welcome to ask me for any clarifications if needed.
Wishing you a very good health.
Warm regards.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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