The specific reasons identified include intensive insulin therapy, decreased renal function, severe liver disease, alcohol ingestion, defective counter regulatory hormone release, missing meals/fasting, and gastroparesis
10.1016/j.tcb.2014.11.002 278 SchieberM.ChandelN
So, if you have Hashimotos and are still struggling to get your symptoms under control, you should get checked for B12 deficiency and pernicious anemia.
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This relationship, however, is not linear and depends on the stage of the human life cycle
High homocysteine accumulation is linked to various diseases and complications in pregnancy