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Theres one final population that this situation fails to protect - the socially vulnerable

They are contraindicated for anyone with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2

10.1016/j.jdiacomp.2015.08.006 150

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This is generally reversible and not harmful, but it requires baseline measurement and periodic monitoring to distinguish normal metabolic adjustment from true thyroid dysfunction