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The provider can also order relevant laboratory investigations, including thyroid function tests (TSH, free T4), comprehensive metabolic panel, hemoglobin A1c, lipid profile, and pregnancy testing when appropriate to identify metabolic barriers to continued weight loss

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If levels are inadequate, the use of fats as an energy source can be affected and fatigue , reduced exercise tolerance or slower recovery may occur

In the presence of diabetes this feedback system is completely out of balance