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I would have a thyroid panel run, which includes the free T4 and the TgAA.

I would try some joint supplements if she isn't already on a good one at full dose.

If both of those didn't help, I would probably have a blood panel run, and look for indications of tick diseases - might do a trial of doxy is nothing else could be found.

I would also evaulate current diet and ingredients.
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