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For instance, it has been reported that hypothyroidism-induced dysfunction of the mitochondrial respiratory chain is associated with increased production of free radicals (59) Thus, excess TSH in hypothyroidism may modulate oxidative stress processes (60) by augmenting the accumulation of ROS that result from both increased generation of free radicals and diminished capacity of the antioxidative defense systems

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Injections are normally administered as cyanocobalamin or hydroxocobalamin

Starting at the lowest dose and slowly increasing your dose may help minimize side effects