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10.1038/s41398-019-0456-z Transl

"Wellness isn't just about what you takeit's about what your body can actually use

Cold exposure can stress the cardiovascular system, particularly in individuals with coronary artery disease

Because any T4 given will contribute to more reverse T3, T4-only preparations should not be considered optimal thyroid replacement in the presence of high or high-normal reverse T3 levels while T3 can be significantly beneficial