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The lack of a difference in thyroid indices is consistent with previous findings, which suggest that L-carnitine has a peripheral action, rather than directly inhibiting the thyroid gland or influencing hypothalamicpituitary feedback

Meta-regression analyses were conducted with STATA statistical software package, version 18.1 (Stata Corp, College Station, TX, USA)

Even when a medication is technically on formulary, the prior authorization process can delay treatment by weeks or result in denial if documentation is incomplete

Targeted short-term interventions: peptides, low-dose GLP1s, or hormone support to quell inflammation and stabilize the patient