Decreased activity of deiodinase enzyme, lower inorganic iodide renal elimination, aberrant TSH response to thyrotropin-releasing hormone (TRH), uremic substance, metabolic acidosis, malnutrition, increased age, infected by HCV, chronic inflammation, and medications such as beta-blockers, amiodarone, and steroids could be potential explanations for impaired thyroid function in these patients [3]. Here, TRH is linked to metabolic acidosis.