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A note on thyroid hormones: Carnitine has traditionally been used by individuals with hyperthyroidism to help with symptoms resulting from hyperthyroid-induced carnitine depletion (such as muscle wasting), so scientists initially believed that carnitine acted like an antagonist or a thyroid hormone receptor blocker, and cautioned against using carnitine in hypothyroidism

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When mitochondria fail, the body cannot generate enough energy to meet even basic metabolic demands, directly causing the severe physical exhaustion and post-exertional malaise (PEM) that leaves patients bedbound after minor exertion