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Carnitine deficiency results in a reduced oxidation (breakdown) of fatty acids and therefore, reduced energy (ATP) production

In humans, the HTMLA activity is partially compensated by serine hydroxymethyl transferase (SHMT) 1 and 2, while in mice, threonine aldolase (Tha1) is the primary source of HTMLA activity, but this gene is absent in humans [159].The liver and kidney are considered the primary organs involved in carnitine synthesis because of their considerable BBD activity

Creatine forms a compound inside cells that provides the power required to recycle ATP

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They will also likely look at underlying (and common thyroid) issues, such as nutrient depletion and absorption issues that a conventional medicine doctor might not look at, and whether you have the MTHFR gene variation (which can impair thyroid hormone levels and energy metabolism)

Why go through the trouble of shuttling citrate and pyruvate back and forth