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We hypothesize that reduced CPT-I activity may contribute to persistent fatigue in these congenital hypothyroid patients, even after levothyroxine therapy, which alone may be insufficient to fully address the downstream metabolic consequences of TPO and TSHR gene mutations present in this cohort

*Correspondence: Mohamed Ashraf Virmani, [email protected] Disclaimer All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers

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Do not apply it in sensitive areas

When uncertain, document your symptoms and discuss with a healthcare provider, especially if effects persist beyond 48-72 hours