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aggressive iron repletion is now first-line therapy when ferritin is below 75 ng/mL Cold hands and feet poor peripheral circulation and impaired thyroid hormone conversion Dizziness or lightheadedness on standing Headaches , especially in the morning Brain fog and difficulty concentrating Shortness of breath with mild exertion Exercise intolerance slower recovery, higher heart rate at submaximal effort Pica unusual cravings for ice (pagophagia), starch, dirt, or paper

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