Differential Diagnosis for Chronic Fatigue with Laboratory Results

Single Most Likely Diagnosis

• Hypothyroidism: The patient's TSH level is elevated at 7.49, which is a strong indicator of hypothyroidism. This condition is known to cause chronic fatigue among other symptoms. The elevated TSH level is the most direct indicator of a specific diagnosis from the provided laboratory results.

Other Likely Diagnoses

• Anemia of Chronic Disease: Despite the ferritin being elevated (481), which might suggest iron overload or inflammation, the patient's iron level is low (10), and the transferrin saturation is very low (4.7%). This pattern, along with an elevated WBC count, could suggest anemia of chronic disease, where chronic inflammation leads to increased ferritin and decreased iron availability.
• Chronic Infection or Inflammation: The elevated WBC count (15) suggests an infectious or inflammatory process. Chronic fatigue can be a symptom of ongoing infection or inflammation.
• Iron Deficiency Anemia: Although the ferritin is high, which usually indicates sufficient iron stores, the low iron level and low transferrin saturation suggest that the patient may not have enough iron available for erythropoiesis, potentially contributing to fatigue.

Do Not Miss Diagnoses

• Hemochromatosis: Although the current iron and transferrin saturation levels are low, the very high ferritin level could be indicative of hemochromatosis, especially if the patient has a history of elevated iron levels. This condition can lead to significant morbidity if not addressed.
• Malignancy: Elevated ferritin can also be seen in various malignancies. The combination of chronic fatigue, elevated WBC, and abnormal iron studies warrants consideration of an underlying malignancy.
• Sepsis or Severe Infection: The elevated WBC count could indicate a severe infection. Although the patient's primary complaint is chronic fatigue, the possibility of an underlying severe infection should not be overlooked, especially if there are other symptoms such as fever or localized signs of infection.

Rare Diagnoses

• Porphyria: Some types of porphyria can present with chronic fatigue and abnormal iron studies, although this would be a less common diagnosis.
• Gaucher's Disease: This is a rare genetic disorder that can cause an elevation in ferritin levels among other symptoms, including fatigue, due to the accumulation of glucocerebroside in cells and certain organs.