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Chronic inflammation caused by Hashimotos thyroiditis, in particular, has a wide-ranging effect not only reducing thyroid hormone output but also increasing overall susceptibility to other autoimmune diseases

Unfortunately, the test proved to be too complicated and unwieldly for many patients and their clinicians as it required "an overnight fast, ingestion of (modestly) radioactive cobalamin, a 24-hour collection of urine, a cobalamin injection, two trips to the laboratory, and, if the result [was] abnormal, repetition of the entire procedure with a dose of [intrinsic factor]" (45)

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Anyone taking this drug should be monitored very carefully and supplementation may be necessary