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If you believe you may produce a lower amount of intrinsic factor, using it sublingually is a reasonable approach

Human users have reported occasional headaches, mild GI discomfort, and transient fatigue

This deficiency is so common that I recommend using B12 for almost all hypothyroid patients regardless of what your labs show

If left untreated, it can lead to Heart palpitations and shortness of breath Weakness, tiredness, or lightheadedness Pale skin Vision loss Constipation, diarrhea, loss of appetite, or gas A smooth tongue Depression Memory loss Behavioral changes Numbness or tingling Muscle weakness Problems walking not trying to give you the wobbles here!), low levels of B12 can be linked to the development of pernicious anemia, dementia, or osteoporosis