TPO and Iron deficiency anemia: Iron is involved in the synthesis of thyroid hormones, and its deficiency can alter thyroid hormone levels in several ways: (1) iron deficiency can reduce TPO activity [221]; (2) iron deficiency can increase rT3 deiodination, leading to thyroid hormone metabolism by inactivating pathway [222]; and (3) iron deficiency can lead to inefficient erythropoiesis, consequently causing a decrease in oxygen transport to tissues.