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Because most T3 is primarily produced from peripheral 5-deiodinasemediated conversion of T4, decreased conversion and increased production of reverse T3 further lowers free T4 and T3 levels [32, 34,35,36] Elevated inflammatory cytokines including IL-1, IL-6, TNF- also suppress the release of thyroid-releasing hormone (TRH) and thyroid-stimulating hormone (TSH), and inhibit type 1 deiodinase activity, compounding the reduction in active T3 [35, 37]

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Duke Analytics Core pipeline Raw reads were processed using Trim Galore, which employs Cutadapt to remove low-quality bases and Illumina adapter sequences, retaining reads 20 nucleotides in length

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