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Central tolerance versus peripheral tolerance Central tolerance occurs in the thymus, where self-reactive T cells are eliminated before they enter circulation

Given the patients long-standing history of Hashimotos thyroiditis, it is important to consider the possibility of coexisting autoimmune conditions

When B12 levels are insufficient, abnormal red cell production can render HbA1c results unreliable, potentially in either direction

While there is no definitively established direct mechanism by which GLP-1 receptor agonists cause fatigue, several biological pathways warrant consideration

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