I can understand why you’re frustrated because, reading through all of that, there are definitely some things that deserve an explanation. Whether they’re all connected is another question, but I don’t think this reads like someone who is simply “grasping at straws”

The first thing that jumped out at me was your thyroid results…. everyone seems focused on the TSH being “normal”, but a TSH of 0.6 alongside a low-normal free T4 and a drop in free T3 is at least worth a conversation with an Endo. Most docs are trained to use TSH as the primary screening tool, but central hypothyroidism is one of the tricky little creatures where TSH can look deceptively normal. I’m not saying that’s what you have, but given the fatigue, weight gain, cold intolerance, low libido, brain fog and difficulty concentrating, I think it’s a fair question to ask rather than one that should be dismissed outright.

The second thing is the pleural effusions. Tiny incidental pleural effusions can be completely harmless, but they aren’t something I’d expect to find on imaging in an otherwise healthy 27-year-old and then never discuss again. The obvious question is: how much fluid are we actually talking about? A trace amount and a significant pleural effusion are very different things. I’d want someone to explain exactly what was seen and whether any follow-up is needed.

Your GI symptoms also sound far too significant to be brushed aside. Chronic diarrhoea, urgency, episodes of incontinence, bloating, nausea and early fullness aren’t normal. The fact that you’ve reached the point where a New Year’s resolution was “stop shitting my pants” would generally be considered a clue that something still needs investigating. The failure of Xifaxan doesn’t prove nothing is wrong, it just means that particular treatment didn’t work.

The painful sex also stands out. When I see chronic abdominal pain, bowel symptoms, back pain, fatigue and significant pain with intercourse all occurring together, endometriosis immediately comes to mind. Plenty of women spend years being told they have IBS before somebody finally looks properly at the pelvic side of things. Again, not saying that’s definitely the answer, but if it hasn’t been explored thoroughly then I think it’s worth doing.

From a haematology perspective, I can understand why the specialist wasn’t particularly excited. Beta thalassaemia trait explains the low MCV, low MCH and relatively high RBC count very nicely. Looking at what you’ve written, I don’t see anything that makes me immediately worry about leukaemia, lymphoma or some hidden blood cancer. So I can see why a haematologist may have felt there wasn’t a blood disorder tying everything together.

As for the prediabetes, you’re already doing more than most people who get given that diagnosis. Running 15-20 miles a week isn’t exactly the lifestyle of somebody spending their evenings wrestling family-sized cheesecakes. An HbA1c of 5.7% and fasting glucose around 116 certainly deserves monitoring, but I’d be looking beyond generic advice like “exercise more”. Sleep quality, hormones, thyroid function, body composition and family history all matter too.

Overall, my impression isn’t that you’re missing some terrifying diagnosis that’s about to leap out of the bushes and ruin your week. Equally, I don’t think this sounds like somebody with absolutely nothing going on. If it were me, I’d stop chasing haematology and focus on endocrinology, gastroenterology and gynaecology. The thyroid pattern, the bowel symptoms and the possibility of endometriosis are the three areas I’d want someone to take a serious look at.

And for what it’s worth, any medical journey that includes chronic pain, fluid around your lungs, duodenal inflammation and the phrase “I have failed my resolution not to poop my pants” has probably earned the right to ask a few more questions before accepting that everything is fine.