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This pain can be attributed to inflammation and the impact of thyroid dysfunction on the musculoskeletal system

Toxicol Appl Pharmacol 222:235242

Mercaptopyruvate pathway: cysteine aminotransferase catalyzes the transamination of cysteine with -ketoglutarate to form 3-mercaptopyruvate which can be further converted by 3-mercaptopyruvate sulfurtransferase (MPST) to pyruvate and H 2 S

A more recent hypothesis postulates that high-dose folic acid redirects the active form of vitamin B12 in serum, i.e., holotranscobalamin, either toward the bone marrow to support reticulocyte synthesis that is induced by folic acid in B12-deficient patients, or into the urine in which it is excreted instead of being taken up and recycled into circulation through the kidneys (84)