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The 2024 NICE Guideline NG239 from the United Kingdoms National Institute for Health and Care Excellence similarly distinguishes between patients who can be managed with oral therapy and those who require intramuscular treatment

[7] Multiple studies have examined patients with coexisting iron-deficiency anemia and subclinical hypothyroidism, and found that the combination of iron and levothyroxine produced a larger increase in serum iron and blood count variables, than control groups who only received monotherapy of either iron or levothyroxine alone

One of their effects is to lower the firing threshold of motor neurons, meaning the nerves that would normally remain silent begin to fire spontaneously

Most protocols recommend administration in a fasted state, typically first thing in the morning before breakfast