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due to lack of cofactors such as selenium and zinc) Secondary hypothyroidism - low T4 and TSH, poor pituitary release Tertiary hypothyroidism low production of THRH from hypothalamus Autoimmune - production of antibodies against the thyroid gland Wilsons syndrome normal levels of T4 and T3 but high levels of rT3 It is quite common to have subclinical hypothyroidism, where no diagnosis will be made based on blood tests as results are within the normal range