**3.4 Augmentation of cellular responses to thyroid hormone**

In patients with condition of hypoxemia, ketoacidosis, lactic acidosis, and infection, there is augmentation of cellular response to thyroid hormone [25]. There is uncoupling of oxidative phosphorylation leading to generation of ATP, which results in excess utilization of substrate, increased oxygen consumption, thermogenesis, and hyperthermia [26]. Excess heat is dissipated by increased sweating and cutaneous vasodilation, the most common symptoms of thyroid storm.
