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In the UK, hydroxocobalamin is the preferred injectable form, with cyanocobalamin rarely used in NHS practice

Studies have shown that hydroxocobalamin reaches a higher peak concentration in the liver than cyanocobalamin 28 days after treatment

The key safety step is ensuring your endocrinologist or primary care provider knows you are considering tirzepatide, so your thyroid panel (TSH, free T4) can be checked before starting and re-evaluated every 3-6 months during treatment

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