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Patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 should not use these medications, as studies in rodents have shown an increased risk of thyroid C-cell tumours (though the relevance to humans remains uncertain)

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In the short term, insufficient B-12 levels can trigger deep fatigue, mood fluctuations, and cognitive changes resembling dementia, hindering your vitality and optimal performance