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Without adequate carnitine, long-chain fatty acids cannot enter mitochondria for oxidation, leading to impaired energy production and metabolic dysfunction

The authors also found there was tissue variability in the level of suppression in different tissues, resulting in a significant variation when comparing the T4 and T3 levels in different tissues

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Impaired L-carnitine synthesis by the kidneys may also contribute to the potential for carnitine deficiency in patients with end-stage renal disease undergoing hemodialysis