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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

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26 Through mediating the post-translational modification dependent on NAD + , sirtuins modulate the adaptation to the altered cellular energetic status, especially the activation of oxidative metabolism and stress resistance in mitochondria in various physiological or pathological conditions