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Do not attempt to adjust the dose on your own

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Other factors which can cause Pernicious Anemia and/or low B12 besides hypothyroidism Pancreatic insufficiency (when the pancreas is making le ss digestive enzymes) Gastritis (bacterial-caused inflammation which weakens the stomach lining) Stomach Removal (whether partial from Bariatric Surgery, or complete removal) Stomach cancer Active mutation of the Q5R intrinsic factor gene, plus other genes Low levels of folate aka B9 Symptoms of Pernicious Anemia From : The symptoms of pernicious anemia may include weakness, fatigue, an upset stomach, an abnormally rapid heartbeat (tachycardia), and/or chest pains

Alcohol Dilution : Another factor to consider is the volume of alcohol consumed relative to the volume of food in your stomach

and (2) certain additional clinically related Medicare Part B medication costs that were not initially included in the measure