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[5] The most common initial symptoms are feeling tired and weak

Requirements of vitamin B12 in excess of normal (due to pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, malignancy, hepatic and renal disease) can usually be met with oral supplementation

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the clinical relevance of this finding in humans is unknown, and in UK and EU prescribing information this is noted as a precaution rather than a formal contraindication but individuals with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 (MEN2) should discuss this with their doctor

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