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L-Carnitine: Boosting Energy Metabolism in Hypothyroidism and Beyond

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Our specialists regularly review advancements in health and wellness, ensuring our articles are updated with the newest information as it becomes accessible.
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Updated On
October 1, 2024

Energy metabolism stands at the core of overall health and is pivotal in sustaining vital physiological functions. Its significance becomes even more pronounced in conditions such as hypothyroidism, where the body's energy production is compromised. L-carnitine has garnered attention for its role in optimizing energy production. As we delve into the discussion surrounding L-carnitine, it becomes apparent that its involvement in energy metabolism holds promise for individuals grappling with conditions that impact their metabolic well-being, offering a potential avenue for support and optimization.

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Understanding Hypothyroidism and Energy Metabolism

Hypothyroidism is a medical condition characterized by an underactive thyroid gland, leading to insufficient production of thyroid hormones. These hormones regulate growth, development, metabolism, and energy production.

The intricate connection between thyroid function and energy metabolism is pivotal for maintaining overall physiological balance in the body. The thyroid gland, located in the neck, plays a central role in regulating metabolism by producing thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3). These hormones influence the metabolic rate (the speed at which the body converts food into energy) and thermogenesis (heat generation). By increasing basal metabolic rate, thyroid hormones modulate the metabolism of fats, carbohydrates, and proteins; influence blood glucose levels; and contribute to maintaining lean body mass. (19)

Thyroid hormones affect nearly every cell in the body, influencing the utilization of nutrients and the production of ATP, the primary energy currency of cells. In a hypothyroid state, the metabolic rate slows down. This can result in the classic symptoms of hypothyroidism, including fatigue, weight gain, sensitivity to cold, muscle weakness, constipation, and hair loss, as the body struggles to convert nutrients into energy efficiently. 

The primary cause of hypothyroidism is an autoimmune disorder known as Hashimoto's thyroiditis, where the immune system attacks the thyroid gland. Other potential causes include iodine deficiency, certain medications, hypothalamic or pituitary disorders, and thyroid radiation treatment. Understanding the root cause is essential for effective management.

Traditional treatment for hypothyroidism typically involves hormone replacement therapy with synthetic thyroid hormones, such as levothyroxine. This medication aims to supplement the deficient thyroid hormones and restore normal bodily functions. Regularly monitoring thyroid hormone levels through blood tests is essential to adjust medication dosage as needed. While thyroid replacement therapy is a crucial aspect of maintaining optimal thyroid balance and preventing unwanted consequences of hypothyroidism, functional medicine approaches may also be considered. Functional medicine encourages using nutrition, lifestyle modifications, dietary and herbal supplements, and stress management techniques to correct suboptimal nutrient levels, dampen inflammation, and support other body systems influencing thyroid hormone production. (3)

The Role of L-Carnitine in the Body

L-carnitine (levocarnitine) is one form of carnitine, a derivative of amino acids, which are the building blocks of proteins. It plays a vital biological role in facilitating the transport of fatty acids into the mitochondria, where they undergo oxidation to generate energy. Mitochondria are responsible for producing adenosine triphosphate (ATP), the energy currency of cells. L-carnitine is a carrier molecule that transports long-chain fatty acids across the mitochondrial membrane. This process is essential for the beta-oxidation of fatty acids, a metabolic pathway that breaks down fats into acetyl-CoA, a precursor for ATP synthesis. 

L-carnitine is a conditionally essential nutrient, meaning that while the body can generally make enough of it to support metabolism, there are certain instances (such as during intense physical exertion) in which the body will require exogenous sources of carnitine through foods or supplements. The liver and kidneys create L-carnitine from the amino acids lysine and methionine. The kidneys can store L-carnitine and eliminate the excess through urine. Dietary sources of L-carnitine include red meat, poultry, fish, dairy, avocados, tempeh, seeds, and nuts. (2, 8)

L-Carnitine and Hypothyroidism

Studies suggest that despite adequate thyroid hormone replacement and normalization of TSH levels, many hypothyroid patients will continue to experience persistent fatigue. In a recent study published in 2023, researchers used fatigue severity scale (FSS) scores and clinical and biochemical characteristics of 92 patients with primary hypothyroid to evaluate the effects of levothyroxine on hypothyroid-associated fatigue. Researchers noted a decrease in the frequency of fatigue in participants after six months of levothyroxine therapy compared to before treatment (45.7% at the beginning of the trial versus 26.1% at the end). However, these results show that nearly half of the participants were still experiencing fatigue despite adequate thyroid replacement. (17

Carnitine deficiency in hypothyroid patients may be a causative factor for persistent fatigue. In a 2016 study, 60 patients experiencing hypothyroid-related fatigue were given L-carnitine (990 mg twice daily) or a placebo for 12 weeks. After 12 weeks, researchers noted that the experimental group receiving L-carnitine experienced improvements in fatigue. Patients younger than 50 and those who had a history of thyroidectomy experienced the most significant results. (1

Hypothyroid myopathy, characterized by muscle weakness, cramps, stiffness, and pain, is present in 79% of hypothyroid patients. The metabolic effects of inadequate thyroid hormone can, in part, be linked to this high prevalence of muscle complaints. Deficiencies in T4 and T3 impair muscle energy metabolism, leading to selective atrophy of type 2 muscle fibers and slowed muscle contraction. However, research also indicates a trend for lower muscle carnitine content in hypothyroid patients, with levels improving upon thyroid hormone treatment. (7)

Dosage and Administration of L-Carnitine

L-carnitine is most commonly used at a dose of 2 grams daily. Doses ranging from 1-4 grams daily, most often in divided doses, have been used safely for up to one year. L-carnitine can be safely administered to children in doses of 50-100 mg/kg by mouth. (11

The bioavailability of dietary carnitine can vary depending on dietary composition. According to one study, the bioavailability of L-carnitine in individuals with vegetarian diets was higher (66-86%) than in those with high-carnitine diets (54-72%). The bioavailability of supplemental L-carnitine is considerably lower than that of the diet, ranging between 5-25% of the total dose. This means that the body will absorb and utilize no more than one-quarter of the dose. (10)

Beyond Hypothyroidism: Broader Applications of L-Carnitine

Because of its ability to support mitochondrial function and energy production, the implications of using carnitine as adjunctive support in treating other conditions associated with metabolic dysfunction have been explored.

In cardiovascular health, L-carnitine has demonstrated the potential to improve lipid profiles and positively affect blood vessel function. Its ability to facilitate the transport of fatty acids into mitochondria may contribute to the metabolism of fats, potentially aiding individuals with conditions related to lipid metabolism. Carnitine also acts as an antioxidant, preventing oxidative damage, which is implicated as a strong risk factor for cardiovascular disease. L-carnitine has been used successfully to assist recovery from heart attack, treat symptoms of congestive heart failure, and improve insulin resistance.

L-carnitine has gained attention for its role in optimizing energy production in the setting of athletic performance. L-carnitine may assist athletes in exercise recovery, increasing oxygen supply to the muscles, improving stamina by delaying muscle discomfort and fatigue, increasing the production of red blood cells (13, 14), and improving high-intensity athletic performance. (22, 23)

‍Weight management is another area where L-carnitine has been studied. Its involvement in fatty acid metabolism suggests a potential role in supporting weight loss efforts by aiding the utilization of fat stores for energy. However, it's important to note that while some studies suggest positive outcomes, results can vary. L-carnitine should be considered as part of a comprehensive approach to weight management, including a healthy diet and regular exercise.

Potential Interactions and Side Effects

In one review of L-carnitine's safety profile, doses of 2 grams daily were deemed safe for long-term use. The authors did note reports of mild side effects, including heartburn and indigestion, at this dose. (18) Other side effects that have been reported with carnitine supplementation include diarrhea and fishy body odor (5). 

L-carnitine supplements can also raise blood levels of trimethylamine-N-oxide (TMAO). TMAO is a gut microbe-derived metabolite of carnitine suggested to be pro-atherogenic. High levels of TAMO are linked to an increased risk of atherosclerotic cardiovascular disease and future cardiac events. (12)

Integrating L-Carnitine with Other Therapeutic Approaches

Managing hypothyroidism and enhancing energy metabolism necessitates a holistic approach encompassing various aspects of lifestyle, nutrition, and targeted supplementation. While L-carnitine plays a role in supporting energy metabolism, its integration into a broader therapeutic plan enhances overall effectiveness. Working with a functional and integrative healthcare provider can help you to identify specific triggers for thyroid dysfunction. Using specialty labs and a comprehensive patient intake, a personalized treatment approach that removes obstacles to achieving a euthyroid state and restores a healthy thyroid signaling cascade can be implemented. This may include modifying diet to emphasize nutrient-dense, anti-inflammatory foods while removing potential thyroid dietary triggers; managing stress and optimizing sleep; reducing exposure to endocrine-disrupting chemicals; balancing other endocrine systems; addressing gut dysbiosis and intestinal permeability; treating infections; and using additional supplements to reduce inflammation, support thyroid hormone production, and manage symptoms of hypothyroidism. (28

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L-Carnitine for Energy Metabolism in Hypothyroidism: Final Thoughts

The benefits of L-carnitine in metabolic health underscore its potential to enhance energy metabolism. L-carnitine's role in facilitating the transport of fatty acids into mitochondria positions it as a valuable component in optimizing energy production. In individuals with hypothyroidism, where reduced thyroid hormone levels impact energy metabolism, L-carnitine supplementation may offer support. However, recognizing the importance of personalized approaches is crucial, as responses can vary. Consulting with healthcare professionals becomes essential to tailor L-carnitine use effectively, considering individual needs and potential interactions. This emphasizes the need for a comprehensive and personalized strategy, integrating L-carnitine into broader health applications for optimal metabolic well-being.

Energy metabolism is important for overall health and helps keep the body's functions working well. It becomes even more important in situations like hypothyroidism, where the body's energy production might not be as strong. L-carnitine is being looked at for its role in helping energy production. As we explore L-carnitine, it seems that its role in energy metabolism could be helpful for people dealing with conditions that affect their metabolic health, offering a possible way to support and improve it.

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Understanding Hypothyroidism and Energy Metabolism

Hypothyroidism is a medical condition where the thyroid gland doesn't make enough thyroid hormones. These hormones are important for growth, development, metabolism, and energy production.

The connection between thyroid function and energy metabolism is important for keeping the body's balance. The thyroid gland, located in the neck, helps control metabolism by making thyroid hormones, mainly thyroxine (T4) and triiodothyronine (T3). These hormones affect how fast the body turns food into energy and generates heat. By increasing the basal metabolic rate, thyroid hormones help manage the metabolism of fats, carbohydrates, and proteins; influence blood glucose levels; and help maintain lean body mass. (19)

Thyroid hormones affect almost every cell in the body, helping use nutrients and produce ATP, the main energy source for cells. In a hypothyroid state, the metabolic rate slows down. This can lead to common symptoms of hypothyroidism, like feeling tired, gaining weight, being sensitive to cold, having weak muscles, constipation, and hair loss, as the body has trouble turning nutrients into energy efficiently.Β 

The main cause of hypothyroidism is an autoimmune disorder called Hashimoto's thyroiditis, where the immune system attacks the thyroid gland. Other possible causes include not getting enough iodine, certain medications, problems with the hypothalamus or pituitary gland, and thyroid radiation treatment. Understanding the root cause is important for effective management.

Traditional treatment for hypothyroidism usually involves hormone replacement therapy with synthetic thyroid hormones, like levothyroxine. This medication aims to add the missing thyroid hormones and help the body work normally. Regularly checking thyroid hormone levels with blood tests is important to adjust medication dosage as needed. While thyroid replacement therapy is a key part of keeping thyroid balance and preventing unwanted effects of hypothyroidism, functional medicine approaches may also be considered. Functional medicine encourages using nutrition, lifestyle changes, dietary and herbal supplements, and stress management techniques to help correct nutrient levels, reduce inflammation, and support other body systems that affect thyroid hormone production. (3)

The Role of L-Carnitine in the Body

L-carnitine (levocarnitine) is a form of carnitine, which comes from amino acids, the building blocks of proteins. It helps transport fatty acids into the mitochondria, where they are used to make energy. Mitochondria are responsible for producing adenosine triphosphate (ATP), the energy currency of cells. L-carnitine helps move long-chain fatty acids across the mitochondrial membrane. This process is important for breaking down fats into acetyl-CoA, which is used to make ATP.Β 

L-carnitine is a conditionally essential nutrient, meaning that while the body can usually make enough of it to support metabolism, there are times (like during intense physical activity) when the body needs more carnitine from foods or supplements. The liver and kidneys make L-carnitine from the amino acids lysine and methionine. The kidneys can store L-carnitine and get rid of the extra through urine. Foods that have L-carnitine include red meat, poultry, fish, dairy, avocados, tempeh, seeds, and nuts. (2, 8)

L-Carnitine and Hypothyroidism

Studies suggest that even with enough thyroid hormone replacement and normal TSH levels, many people with hypothyroidism still feel tired. In a recent study published in 2023, researchers used fatigue severity scale (FSS) scores and clinical and biochemical characteristics of 92 patients with primary hypothyroid to evaluate the effects of levothyroxine on hypothyroid-associated fatigue. Researchers noted a decrease in the frequency of fatigue in participants after six months of levothyroxine therapy compared to before treatment (45.7% at the beginning of the trial versus 26.1% at the end). However, these results show that nearly half of the participants were still experiencing fatigue despite adequate thyroid replacement. (17)Β 

Carnitine levels in hypothyroid patients may be linked to ongoing fatigue. In a 2016 study, 60 patients experiencing hypothyroid-related fatigue were given L-carnitine (990 mg twice daily) or a placebo for 12 weeks. After 12 weeks, researchers noted that the experimental group receiving L-carnitine experienced improvements in fatigue. Patients younger than 50 and those who had a history of thyroidectomy experienced the most significant results. (1)Β 

Hypothyroid myopathy, which includes muscle weakness, cramps, stiffness, and pain, is present in 79% of hypothyroid patients. The effects of low thyroid hormone can partly explain this high rate of muscle issues. Low levels of T4 and T3 can affect muscle energy metabolism, leading to changes in muscle fibers and slower muscle contraction. However, research also indicates a trend for lower muscle carnitine content in hypothyroid patients, with levels improving upon thyroid hormone treatment. (7)

Dosage and Administration of L-Carnitine

L-carnitine is most commonly used at a dose of 2 grams daily. Doses ranging from 1-4 grams daily, most often in divided doses, have been used safely for up to one year. L-carnitine can be safely administered to children in doses of 50-100 mg/kg by mouth. (11)Β 

The bioavailability of dietary carnitine can vary depending on dietary composition. According to one study, the bioavailability of L-carnitine in individuals with vegetarian diets was higher (66-86%) than in those with high-carnitine diets (54-72%). The bioavailability of supplemental L-carnitine is considerably lower than that of the diet, ranging between 5-25% of the total dose. This means that the body will absorb and utilize no more than one-quarter of the dose. (10)

Beyond Hypothyroidism: Broader Applications of L-Carnitine

Because of its ability to support mitochondrial function and energy production, the implications of using carnitine as adjunctive support in treating other conditions associated with metabolic function have been explored.

In cardiovascular health, L-carnitine has shown potential to help maintain healthy lipid profiles and support blood vessel function. Its ability to help transport fatty acids into mitochondria may contribute to the metabolism of fats, potentially aiding individuals with conditions related to lipid metabolism. Carnitine also acts as an antioxidant, which may help protect against oxidative damage, a factor in cardiovascular health. L-carnitine has been used to assist recovery from heart attack, support symptoms of congestive heart failure, and help with insulin resistance.

L-carnitine has gained attention for its role in supporting energy production in the setting of athletic performance. L-carnitine may assist athletes in exercise recovery, increasing oxygen supply to the muscles, improving stamina by delaying muscle discomfort and fatigue, increasing the production of red blood cells (13, 14), and supporting high-intensity athletic performance. (22, 23)

‍Weight management is another area where L-carnitine has been studied. Its involvement in fatty acid metabolism suggests a potential role in supporting weight management efforts by aiding the utilization of fat stores for energy. However, it's important to note that while some studies suggest positive outcomes, results can vary. L-carnitine should be considered as part of a comprehensive approach to weight management, including a healthy diet and regular exercise.

Potential Interactions and Side Effects

In one review of L-carnitine's safety profile, doses of 2 grams daily were deemed safe for long-term use. The authors did note reports of mild side effects, including heartburn and indigestion, at this dose. (18) Other side effects that have been reported with carnitine supplementation include diarrhea and fishy body odor (5).Β 

L-carnitine supplements can also raise blood levels of trimethylamine-N-oxide (TMAO). TMAO is a gut microbe-derived metabolite of carnitine suggested to be pro-atherogenic. High levels of TAMO are linked to an increased risk of atherosclerotic cardiovascular disease and future cardiac events. (12)

Integrating L-Carnitine with Other Therapeutic Approaches

Managing hypothyroidism and enhancing energy metabolism requires a holistic approach that includes various aspects of lifestyle, nutrition, and targeted supplementation. While L-carnitine plays a role in supporting energy metabolism, its integration into a broader therapeutic plan enhances overall effectiveness. Working with a functional and integrative healthcare provider can help you to identify specific triggers for thyroid function. Using specialty labs and a comprehensive patient intake, a personalized treatment approach that removes obstacles to achieving a euthyroid state and restores a healthy thyroid signaling cascade can be implemented. This may include modifying diet to emphasize nutrient-dense, anti-inflammatory foods while removing potential thyroid dietary triggers; managing stress and optimizing sleep; reducing exposure to endocrine-disrupting chemicals; balancing other endocrine systems; addressing gut dysbiosis and intestinal permeability; treating infections; and using additional supplements to reduce inflammation, support thyroid hormone production, and manage symptoms of hypothyroidism. (28)Β 

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L-Carnitine for Energy Metabolism in Hypothyroidism: Final Thoughts

The benefits of L-carnitine in metabolic health highlight its potential to support energy metabolism. L-carnitine's role in helping transport fatty acids into mitochondria makes it a valuable component in supporting energy production. In individuals with hypothyroidism, where reduced thyroid hormone levels impact energy metabolism, L-carnitine supplementation may offer support. However, recognizing the importance of personalized approaches is crucial, as responses can vary. Consulting with healthcare professionals becomes essential to tailor L-carnitine use effectively, considering individual needs and potential interactions. This emphasizes the need for a comprehensive and personalized strategy, integrating L-carnitine into broader health applications for optimal metabolic well-being.

The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.
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  2. ‍Carnitine. (2017). National Institutes of Health; Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Carnitine-HealthProfessional/
  3. ‍Cloyd, J. (2022, October 19). 11 Medications That Can Cause Drug-Induced Hypothyroidism. Rupa Health. https://www.rupahealth.com/post/drug-induced-hypothyroidism
  4. ‍Cloyd, J. (2023, May 24). A Functional Medicine Hypothyroidism Protocol: Comprehensive Testing, Supplements, and Integrative Nutrition. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-hypothyroidism-protocol-comprehensive-testing-supplements-and-integrative-nutrition
  5. ‍Cloyd, J. (2023, November 9). The Top 5 Reasons Your Holistic Practitioner May Recommend Carnitine. Rupa Health. https://www.rupahealth.com/post/the-top-5-reasons-your-holistic-practitioner-may-recommend-carnitine
  6. ‍Cloyd, J. (2023, December 5). The Impact of Gut Health on Cardiovascular Disease: Insights from Functional Medicine. Rupa Health. https://www.rupahealth.com/post/the-impact-of-gut-health-on-cardiovascular-disease-insights-from-functional-medicine
  7. ‍Fariduddin, M. M., & Bansal, N. (2020). Hypothyroid Myopathy. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519513/
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  9. ‍Ko, J., Wong, E. Y., Tran, H. N., et al. (2023). The glycemic, cholesterol, and weight effects of L-carnitine in diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Epidemiology and Management, 10, 100122. https://doi.org/10.1016/j.deman.2022.100122
  10. ‍L-Carnitine. (2014, April 23). Oregon State University; Linus Pauling Institute. https://lpi.oregonstate.edu/mic/dietary-factors/L-carnitine#metabolism-bioavailability
  11. ‍L-Carnitine - Uses, Side Effects, and More. (2012). WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-1026/l-carnitine
  12. ‍Lee, Y., Nemet, I., Wang, Z., et al. (2021). Longitudinal Plasma Measures of Trimethylamine N‐Oxide and Risk of Atherosclerotic Cardiovascular Disease Events in Community‐Based Older Adults. Journal of the American Heart Association, 10(17). https://doi.org/10.1161/jaha.120.020646
  13. ‍MairbΓ€url, H. (2013). Red blood cells in sports: effects of exercise and training on oxygen supply by red blood cells. Frontiers in Physiology, 4(332), 332. https://doi.org/10.3389/fphys.2013.00332
  14. ‍Matsumoto, Y., Amano, I., Hirose, S., et al. (2001). Effects of L-carnitine supplementation on renal anemia in poor responders to erythropoietin. Blood Purification, 19(1), 24–32. https://doi.org/10.1159/000014474
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  16. ‍Mielgo-Ayuso, J., Pietrantonio, L., Viribay, A., et al. (2021). Effect of Acute and Chronic Oral l-Carnitine Supplementation on Exercise Performance Based on the Exercise Intensity: A Systematic Review. Nutrients, 13(12), 4359. https://doi.org/10.3390/nu13124359
  17. ‍RuΓ­z-Pacheco, M. G., HernΓ‘ndez, I., HernΓ‘ndez-Estrella, G., et al. (2023). Severity of Fatigue and Its Relationship with TSH before and after Levothyroxine Replacement Therapy in Patients with Primary Hypothyroidism. Biomedicines, 11(3), 811. https://doi.org/10.3390/biomedicines11030811
  18. ‍Sawicka, A. K., Renzi, G., & Olek, R. A. (2020). The bright and the dark sides of L-carnitine supplementation: a systematic review. Journal of the International Society of Sports Nutrition, 17(1). https://doi.org/10.1186/s12970-020-00377-2
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  22. ‍Spiering, B. A., Kraemer, W. J., Hatfield, D. L., et al. (2008). Effects of L-Carnitine L-Tartrate Supplementation on Muscle Oxygenation Responses to Resistance Exercise. Journal of Strength and Conditioning Research, 22(4), 1130–1135. https://doi.org/10.1519/jsc.0b013e31817d48d9
  23. ‍Stefan, M., Sharp, M., Gheith, R., et al. (2021). L-Carnitine Tartrate Supplementation for 5 Weeks Improves Exercise Recovery in Men and Women: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients, 13(10), 3432. https://doi.org/10.3390/nu13103432
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  27. ‍Weinberg, J. L. (2022, March 18). Fatigue, Weight Gain, Depression, And Brain Fog Are Common Signs Of This Autoimmune Disease. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-hashimotos-disease
  28. ‍Weinberg, J. L. (2022, September 7). An Integrative Medicine Approach to Hypothyroidism. Rupa Health. https://www.rupahealth.com/post/understanding-hypothyroidism-and-how-to-treat-it-naturally
  29. ‍Weinberg, J. L. (2023, May 3). Complementary and Integrative Medicine Testing and Treatment Options for Infants with Hypothyroidism. Rupa Health. https://www.rupahealth.com/post/complementary-and-integrative-medicine-treatment-for-infants-with-hypothyroidism
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