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Unfortunately, I have found people with Hashimotos may have impairments in their bodys ability to synthesize carnitine due to: Multiple nutrient deficiencies (beyond carnitine) : Other cofactors (additional nutrients needed to support our body in making carnitine) can also be lacking in those with Hashimotos, including having adequate amounts of iron ( iron deficiency with or without anemia is a common issue for people with Hashimotos, and it is thought that low iron may contribute to the low levels of carnitine found in most pregnant women), vitamin B3 (niacin), vitamin B6, and vitamin C

18 The gut microbiota is crucial for the maintenance of intestinal barrier integrity, regulation of gut homeostasis, and stimulation of the host immune response

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Interestingly, a similar alteration of AdA and AA has been reported in NAFLD and AdA has been reported to promote liver inflammation ( ELOVL5 , which transformed AA into AdA ( ELOV2 , which was responsible for the biosynthesis of DPAn-6 from AdA ( Peroxidation of PUFAs could mediate inflammatory responses and enhance tissue injury, and was involved in the etiology of various liver diseases (56)