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The most detrimental clinical presentation is fulminant liver failure, where patients without a history of liver disease present with hepatic encephalopathy and coagulopathy preceding jaundice

This compounds the dose calculation problem: a vial that should provide 25 doses at 200mcg + 200mcg daily might provide only 10 usable doses if reconstituted improperly, effectively tripling your per-dose cost without any indication that half the vial is contaminated

This does not mean the risk is zeroit means the trials were not specifically designed to detect OCD patterns or evaluate patients with pre-existing OCD vulnerabilities

Consistent reports of smaller portions or steadier cravings lifted a products score, while repeated did nothing notes dragged it down