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NICE Clinical Knowledge Summaries advise oral cyanocobalamin for dietary deficiency, while intramuscular hydroxocobalamin is recommended for pernicious anaemia or malabsorption syndromes

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One does need to increase the dosage slowly, titrating it, under monitoring TSH levels and most importantly, monitoring the patients well-being. Thyroid hormones in excess carry the risk of tachycardia and arrhythmia that is why usually the prohormone T4 and not the active hormone T3 is prescribed and supplemented