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Patients should be instructed to rotate injection sites systematically among the abdomen, thigh, and upper arm, avoiding repeated injections in the same location

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Over time, this chronic immune attack results in a gradual loss of functional thyroid tissue, with the clinical course typically progressing from an initial euthyroid state to subclinical hypothyroidism and, in a subset of patients, overt hypothyroidism requiring lifelong thyroid hormone replacement [13,14]

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