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Description
It turns out that this can cause relative carnitine deficiency, which can result in lingering fatigue (even after thyroid hormone therapy )

It is well-recognized that indoxyl sulfate damages various cell types, including vascular endothelial cells (109112)
58(3): 2014 Brooks DE, Mclntosh JE

Sources BUM-CHUN L

Ho XL, Tsen SY, Ng MY, Lee WN, Low A, Loke WM
It is extremely safe