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28 However, oral therapy does not improve serum methylmalonic acid levels as well as intramuscular therapy, although the clinical relevance is unclear

Alternatively, Medivitan iV can be administered via infusion

If a persons hormones are not well-controlled with medications, if they have an enlarged thyroid gland, out-of-control antibodies, Graves disease, thyroid nodules , or thyroid cancer , or are not able to have balanced thyroid hormones as they swing from hyper/hypothyroidism, some doctors may recommend surgical removal of the thyroid gland

The right option depends on the patients goals, health history, eligibility, and provider review