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All statistical tests were conducted on a two-sided basis (unless otherwise specified), and a P value of less than 0.05 was considered statistically significant

When Se deficiency occurs in the context of already existing hypothyroidism, the symptoms of myxedema (such as puffiness of the skin, a hoarse voice, and slowness of mental function) may become more pronounced [73]

Stagnaro-Green, A., Dong, A