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While these medications do not directly cause hypothyroidism, significant weight loss can sometimes unmask subclinical thyroid disease or necessitate adjustment of thyroid hormone replacement in patients with pre-existing hypothyroidism

And that's sort of defined by the endocrine society, looking at a lot of different aggregate studies and all-cause mortality, for example

Chronic stress similarly undermines results through cortisol elevation

All patients reported at least one of the above-mentioned symptoms

Bensignor MO, Bramante CT, Bomberg EM, Fox CK, Hale PM, Kelly AS et al