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The rest is produced in the tissues by converting T4 to T3 This is why when we replace thyroid hormone we only need to give T4 as T3 is subsequently produced by the metabolism of T4 to T3 These thyroid hormones circulate in the blood, and act on the peripheral tissue to cause a wide variety of effects mainly related to metabolism They also act as a feedback loop to the hypothalamus which can then adjust the amount of TSH that is produced in response to this Under normal control, the thyroid gland responds to the signal of the TSH, to alter its production of T3 and T4 relative to the bodies needs In thyroid disease, the production of T3 and T4 becomes uncoupled from the production of TSH In primary hypothyroidism The thyroid gland is unable to produce sufficient amounts of T4 and T3, despite a strong signal (high TSH) from the pituitary gland

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The tetracycline was the culprit. It took a long time for this womans problem to be diagnosed