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One surgeon might recommend immediate fusion
205 Shortterm Response to Deep Brain Stimulation Surgery for Opisthotonus in a Patient with PKAN: A Clinical Case Report H

Thyroid medications (e.g., levothyroxine) Some evidence suggests that ALA may interfere with thyroid hormone activity, potentially reducing the effectiveness of these medications when taken together

The human body's inability to extract energy from carbohydrates prompts it to use alternative sources of energy (93)
