Treatment Protocol

High consumption of fruits, vegetables, dried fruits, nuts, and muesli-style eating patterns is associated with lower TPO and thyroglobulin antibodies. Non-pharmacological strategies are presented as having evidence for delaying cognitive deterioration. The sham device appears identical but uses customized lead wires without internal conductors to prevent actual current output. The sham procedure uses superficial needling at non-acupoint locations about 20 mm from true acupoints. The placebo group receives 30 mL of 5% dextrose without verteporfin followed by identical laser application. The placebo arm matches the levosimendan arm in route, volume, and infusion rate. Soluvit N is used as placebo because its diluted yellow appearance matches levosimendan and supports blinding. Needles are retained for 30 minutes during each active electroacupuncture session. The intervention arm receives enteral midodrine 10 mg every 8 hours, three times daily. Midodrine is stopped after sustained vasopressor independence, one week of IV vasopressors, ICU discharge, or death. The study drug is held if systolic blood pressure exceeds 130 mm Hg without IV vasopressor support. Active electroacupunctur…