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Also, since you need stomach acid to absorb B12, long-term use of acid-suppressing proton pump inhibitors (such as Nexium, etc.) can lead to B12 deficiency, as can chronic intestinal conditions such as Crohns disease, celiac disease, and intestinal parasites
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Under normal circumstances, the TSH levels will remain adequate, (between 0.4 and 2.0 mIU/L for most people) and your thyroid will produce just the right amount of its powerful hormones needed to maintain health
Derek Lowe, writing on science.org, summarized the conundrum eloquently