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Int J Cardiol 1992;34(2):167-172

Some users add the upper arm as a fifth site

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Specifically, TSH induces hepatic steatosis by activating sterol regulatory element-binding protein (SREBP) pathways, inhibits bile acid synthesis by suppressing the SREBP2hepatocyte nuclear factor 4 (HNF4)CYP7A1 axis, and attenuates cholesterol biosynthesis via AMP-activated protein kinase (AMPK)dependent phosphorylation of 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) (42)

Everything below describes a documented research protocol , not a prescription or a personal recommendation