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As many as 40-50% of Hypothyroid patients have a B12 deficiency (2)

Persistent fatigue, cognitive dysfunction, dizziness, pain, sleep disturbance, or autonomic symptoms may reflect several different mechanisms, including delayed diagnosis, neurologic Lyme disease, untreated co-infections, autonomic dysfunction, persistent infection in selected patients, or unrelated medical conditions

Some neurological symptoms may continue improving for up to 1218 months, though permanent damage can occur if deficiency was severe and prolonged

Because the body cannot produce B12 independently, deficiency develops when dietary intake is inadequate or absorption is impaired