u/GrapefruitOk1363

I thought it might be anemia of chronic inflammation, but my crp markers are within reference range and I also got tested for lupus and that was fine as well.

I’ve been dealing with progressively worsening fatigue for years, especially since late high school/university. At this point it’s affecting concentration, stamina, studying, exercise tolerance, and daily functioning pretty heavily. I sleep 12 hours a day and I’m still tired. Every physician I’ve been to either waves me off or says they don’t know what to do with my case. I’ve even tried pharmacists and same thing lol.

Main symptoms:
\- constant fatigue/exhaustion even after sleeping
\- dizziness/lightheadedness when standing
\- poor exercise tolerance
\- brain fog and cognitive fatigue
\- sometimes feel physically “drained” very quickly
\- caffeine helps temporarily but not consistently

Recent labs:
Hemoglobin: \~111 g/L
Iron: 9 µmol/L (low)
Transferrin saturation: \~17%
TIBC: normal
Ferritin historically around \~223
B12: 493 pmol/L
Folate: 14.1 nmol/L
Vitamin D: 60 nmol/L
ACTH at baseline: 1.4pmol/L
CRP: 5.5mg/L
I’m also a SILENT thalassemia carrier

What confuses me is the combination of low iron saturation/low hemoglobin with previously high ferritin. I know ferritin can sometimes be elevated from inflammation, but I’m struggling to understand what pattern this actually fits. My inflammation markers are fine. I’ve already gotten tested for lupus and it came back negative. Also got ACTH stimulation test and free t3 and free t4 checked and they were fine.

I’ve also wondered whether autonomic issues (like mild dysautonomia/POTS-type symptoms), chronic stress physiology, sleep problems, or something else could be contributing because the fatigue feels disproportionate to “just being tired.”