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In the presence of such conditions, it should be understood that significant intracellular hypothyroidism may remain undiagnosed by standard blood tests

This works because L-carnitine L-tartrate undergoes transamination in the liver

(PubMed) Contempre B, Duale NL, Dumont JE, Ngo B, Diplock AT, Vanderpas J

The pyrophosphate, formed from the hydrolysis of the two high-energy bonds in ATP, is immediately hydrolyzed to two molecules of P i by inorganic pyrophosphatase

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Children with various forms of organic acidaemia have carnitine requirements that exceed their dietary intake and biosynthetic capability, in order to permit excretion of accumulating organic acids