As discussed before, the liver converts vitamin D3 to 25-hy-droxy vitamin D3, an essential step before conversion to the active hormone 1,25-hydroxy vitamin D3 in the kidneys. The liver is also a major site of conversion of the thyroid hormone thyroxine (T4) to the biologically more potent hormone triiodothyronine (T3). The regulation of the hepatic T4 to T3 conversion occurs at both the uptake step and the conversion step. Due to the liver's relatively large reserve in converting T4 to T3, hypothyroidism is uncommon in patients with liver disease. In advanced chronic liver disease, however, signs of hypothyroidism may be evident.
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