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Samuels, a professor at the Oregon Clinical and Translational Research Institute, stated: It is a common clinical observation that some otherwise healthy patients with hypothyroidism continue to complain of fatigue, poor mood, inability to concentrate, and vague cognitive difficulties (often described as brain fog) despite normal TSH levels. [5] 2

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Some doctors now consider adding the active hormone T3 (liothyronine) to T4 if patients feel better with that combination ( Clinical Endocrinology , July 2025)

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Alternative translational initiation of ATP sulfurylase underlying dual localization of sulfate assimilation pathways in plastids and cytosol in Arabidopsis thaliana