text: Thyroid hormone transporters During NTIS,  alterations arise in the concentrations of thyroid hormone transporters such as MCT8 and MCT10, although whether the levels are increased or decreased depends on the study. The altered concentrations are thought to be a result of NTIS, rather than a cause; a study in rabbits showed that administering thyroid hormones normalized transporter expression.
  Binding proteins
  Decreased thyroxine-binding globulin (TBG) occurs following bypass surgery, and in chronic illness, a less effective form of TBG with lower affinity for thyroxine is synthesized. Reduced quantities of bound thyroid result, leading to decreased total thyroid measurements. Decreases in total thyroid may be more severe than alternations in free hormone levels.
  Drugs
  Dopamine and corticosteroids, commonly given in the hospital setting, can suppress TSH and suppress conversion of T4 to T3. Other drugs such as estrogen, contraceptives, salicylates, and phenytoin can alter the binding of TBG to TH, resulting in different TH concentrations. Additionally, lithium disrupts thyroid function, and thyromimetic endocrine disrupters may downregulate the HPT axis.
  Fasting
  Fasting is a common response in inflammation and critical illness. Originally, selenium deficiency as a result of malnutrition was thought to reduce D1 catalytic activity, but this theory has not been supported as a cause of NTIS.
  NTIS as a result of fasting may be regarded as a healthy and adaptive mechanism that reduces energy expenditure. Fasting in healthy, euthyroid people causes reduced T3 and elevated rT3, although TSH is usually unchanged. Even moderate weight loss can lower T3.