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Obesity represents itself as a challenge for hypothalamus-pituitary-thyroid axis since it has been hypothesized that hyperleptinemia, that often characterizes these patients, may increase the expression of TRH gene and thus TSH secretion [194]

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Do I need lab testing

In terms of monitoring, it is advisable to conduct monthly tests for B12, Hcy and MMA during the initial 6 months, followed by tests every 36 months in LCIG patients (Jia et al