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Hypothyroidism is often a cause of Vitamin B12 deficiency, arising from the reduced absorption of B12, poor utilisation of the liver, and general organ disfunction associated with hypothyroidism, and sometimes by dietary insufficiency of B12 (particularly in the case of a vegetarian diet)

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Pain originates from the liver's outer capsule stretching when the organ swells, not from the liver tissue itself which lacks nerve endingsthis is why the sensation feels deep and diffuse rather than sharp and localized