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Many individuals cycle through active treatment and maintenance phases over extended periods

Realistic expectations matter though

Contraindicated for: Individuals with hypercalcemia, severe kidney disease, or vitamin D hypersensitivity

Treatment with triiodothyronine (T3) has been used in combination with levothyroxine previously but has not been shown to be of benefit It may be considered in specialist cases Usually treatment is lifelong except in cases where transient disease is caused by severe illness or drugs

Instead, it functions as a bacteriostatic agent

Monitoring and follow-up Monitor clinically and repeat tests as indicated by the underlying condition Ongoing monitoring of liver function, renal function, and FBC as clinically indicated Regular review in primary care or specialist clinics for underlying conditions Patient advice: Patients should understand that elevated B12 is a marker requiring investigation rather than a condition requiring direct treatment