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Pernicious anemia occurs more commonly in people who already have diseases that are linked to immune-system abnormalities, such as Graves disease, hypothyroidism (under-functioning thyroid gland), thyroiditis (inflammation of the thyroid), vitiligo, and Addison's disease (adrenocortical insufficiency)

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Most clinicians would recommend maximizing results with a single agent before adding complexity, particularly given that tirzepatide already produces substantial fat loss on its own