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The combination of all four pathways should theoretically produce earlier onset of appetite suppression, more sustained fullness between meals, increased resting energy expenditure from the glucagon component, and a reduced tendency toward the metabolic adaptation that commonly causes weight loss plateaus on single-agent therapy

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Diagnosis is typically based on Thyroid-Stimulating Hormone (TSH) levels: subclinical hypothyroidism is characterized by elevated TSH with normal triiodothyronine (T3) and thyroxine (T4), and overt cases showed elevated TSH levels with low T3 and T4