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Clinical evidence for five of the seven possible explanatory mechanisms of an SSRI in PCS were found in this study

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Importantly, sustained cortisol elevation can suppress the HPT axis by inhibiting TRH expression, reducing TSH secretion, and impairing deiodinase activity, which not only blunts thyroid hormone production but may also raise rT3 levels and exacerbate functional hypothyroidism in susceptible individuals

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