TSH and FT4 are what tell us about the actual thyroid function or levels. A high TSH is seen after thyroid removal if thyroxine replacement is not adequate or from injection of biosynthetic TSH. The range is usually somewhere between 0 and 34 IU/mL (6). A TPO test detects antibodies against TPO in the blood. Tg is included in this brochure of thyroid function tests to communicate that, although measured frequently in certain scenarios and individuals, Tg is not a primary measure of thyroid hormone function. A diagnosis of subclinical hypothyroidism is suspected positive TPOAb can predict progression to overt hypothyroidism. Unexplained weight loss. Dr. John Berryman and 6 doctors agree. Thyroid surgery for patients with Hashimotos disease. a TSH level between 10 and 20 mlU/litre on 2 separate occasions 3 months apart, or. Tests measuring free T4 either a free T4 (FT4) or free T4 index (FTI) more accurately reflect how the thyroid gland is functioning when checked with a TSH. TPO antibodies (TPOAb): these are antibodies that attack the thyroid instead of bacteria and viruses, they are a marker for autoimmune thyroid disease, which is the main underlying cause for hypothyroidism and hyperthyroidism in the United States. The outcome of the study was a patient-reported health score on the generic Short Form-36 Health Survey (SF-36) after 18 months. Thus, the thyroid and the pituitary, like a heater and thermostat, turn on and off. Takasu N, Matsushita M. Changes of TSH-stimulation block - ing antibody (TSBAb) and thyroid stimulating antibody (TSAb) over 10 years in 34 TSBAb-positive patients with hy - pothyroidism and in 98 TSAb-positive Graves' patients with I have TPO levels in the 300 range, but all other thyroid test levels are mid range normal. just because the thyroid is no longer present you still have sick autoimmune antibodies that can cause issues. By measuring the amount of radioactivity that is taken up by the thyroid gland (radioactive iodine uptake, RAIU), doctors may determine whether the gland is functioning normally. Do not arrange repeat testing of TPOAb. TPO helps with the conversion of T4 to T3. The best way to initially test thyroid function is to measure the TSH level in a blood sample. Regression analysis of patients with antibody resolution yielded an average decline of -11% IU/mL per month 2.2%. Epub 2017 Nov 8. information is beneficial, we may combine your email and website usage information with The site is secure. However, many patients may be overtreated with futile surgery for benign ITN. Fourth, the physician should attempt to differentiate between Graves disease and other forms of thyroiditis, because patients with Graves disease are candidates for thionamide therapy. While detecting antibodies is helpful in the initial diagnosis of hypothyroidism due to autoimmune thyroiditis, following their levels over time is not helpful in detecting the . Fam Med. These non-self proteins are called antigens. After screening about 150 subjects were assigned to two groups. There is a problem with Please enable it to take advantage of the complete set of features! 2010;42(2):111-5. https://www.thyroid.org/thyroid-function-tests/. Thyroid tests. Mayo Clinic does not endorse any of the third party products and services advertised. Our purpose was to describe the TgAb resolution time course and the significance of persistent antibody elevation after thyroidectomy. Typically, the hyperthyroid phase occurs one to six months postpartum and persists for one to two months.17. If you are a Mayo Clinic patient, this could After five to seven days of high-dose prednisone, the dose is then tapered over the next 30 days. The gland produces too much thyroid hormone, a condition known as hyperthyroidism. FREE T3 THYROGLOBULIN Patients who are hyperthyroid will have an elevated T3 level. This is an autoimmune disease and the most common cause of hypothyroidism. Heat intolerance. If no thyroid hormone is administered, patients should be monitored annually for the development of overt hypothyroidism.12 Guidelines exist to direct the family physician in the treatment of women with detectable TPO antibodies who are pregnant or who desire fertility.14,15, Postpartum thyroiditis is transient or persistent thyroid dysfunction that occurs within one year of parturition, miscarriage, or medical abortion. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. It is not a measure of thyroid function and it does not diagnose thyroid cancer when the thyroid gland is still present. In the United States, the prevalence ranges from 1.1% to 9%.16, Postpartum thyroiditis is now considered an unmasking or acute presentation of underlying chronic thyroid autoimmune disease. Persistently elevated levels after thyroidectomy were not associated with disease recurrence in our series. Maggie0652 in reply to Clutter 6 years ago. The mere presence of detectable TPO antibodies does not, however, necessitate empiric treatment with thyroid hormone. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. My recent antibody levels came back 421 last week (May 30, 2013). Thyroid gland physiology and testing. Background: Advertising and sponsorship opportunities. Antibodies that attack the thyroid gland cause swelling, rarely tenderness and reduced function of the thyroid. A family or personal history of autoimmune thyroid disease confers increased risk, and there is a strong female predominance in this disorder. Since then I've done two whole body scans, two PET scans, and three ultrasounds. Men and women who had chronic widespread musculoskeletal pain (often diagnosed as "fibromyalgia . Postpartum thyroiditis. An overactive thyroid causes problems with organs like the heart, as well as bones and muscles. But the presence of TPO antibodies may increase the risk of future thyroid disorders. The opposite situation, in which the TSH level is low, usually indicates that the thyroid is producing too much thyroid hormone (hyperthyroidism). https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/thyroid-disorders/overview-of-thyroid-function?query=overview thyroid function. Clinical implications of anti-thyroglobulin antibody measurement before surgery in thyroid cancer. Methods: Data of 2,352 patients who committed thyroidectomy from January 2018 to December 2018 at our institution were retrospectively reviewed.Of which, 806 patients diagnosed with thyroid . 2008 Jan;158(1):77-83. doi: 10.1530/EJE-07-0399. 6 months later the LN was still elevated but the Tg was detectable at 0.7. Thyroid peroxidase (TPO) is an enzyme found in the thyroid gland that plays a vital role in producing thyroid hormones. Thyroglobulin Antibodies (TgAb) Although thyroglobulin antibodies interfere with the measure of Patients and Methods: This is a retrospective work of 112 cases managed with total thyroidectomy with positive antithyroid peroxidase antibodies (TPO-Ab), anti-thyroglobulin . However, if the thyroid antibodies remain elevated after following a natural treatment protocol, this means that either the autoimmune trigger hasn't been removed, the autoimmune response hasn't been suppressed, and/or other compromised areas of the body need to be healed. Autoimmune thyroid disease is the most common etiology of hypothyroidism in the United States. It is not a measure of thyroid function and it does not diagnose thyroid cancer when the thyroid gland is still present. I had RAI Nov 1, 2012. Merck Manual Professional Version. Patients typically present with a nontender goiter, symptoms of hypothyroidism, and elevated thyroid peroxidase (TPO) antibody level. Once the T4 in the bloodstream goes above a certain level, the pituitarys production of TSH is shut off. This raises the possibility that some symptoms may be related to the autoimmune condition itself. Search dates: June 6, 2011, through February 29, 2012, and March 30, 2014. Surveillance and clinical follow-up are necessary in all forms of thyroiditis because of the potential for change in thyroid status. Third, the degree of hyperthyroidism and the severity of symptoms should be considered. Cautions: The test is most sensitive for detection of thyroid cancer recurrence when patients are off thyroid replacement long enough to have an elevated thyroid-stimulating hormone (TSH) prior to drawing the specimen. Occasionally, a low TSH may result from an abnormality in the pituitary gland, which prevents it from making enough TSH to stimulate the thyroid (secondary hypothyroidism). Your thyroid is a small, butterfly-shaped gland in the front of your neck. We tapped the CDC for information on what you need to know about radiation exposure, Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them. This antibody causes the thyroid to be overactive in. In the first study, 100 people were recruited to receive nigella or a placebo for 8 weeks. the unsubscribe link in the e-mail. What are the actual levels, with reference ranges, for the Free T3 and Free T4? In many patients with hypothyroidism or hyperthyroidism, lymphocytes react against the thyroid (thyroid autoimmunity) and make antibodies against thyroid cell proteins. FT4 and FT3 levels did not differ in patients with a mild lymphocytic infiltration compared to those with a severe lymphocytic infiltration (21.1 vs 32 ng/L, P = 0.5 for FT4 and 8.1 vs 13.2, P = 0.18 for FT3). Subacute thyroiditis is a transient thyrotoxic state characterized by anterior neck pain, suppressed TSH, and low uptake of iodine 123 on thyroid scanning. WHAT ARE THE IMPLICATIONS OF THIS STUDY? FOIA Clinical aggressiveness and long-term outcome in patients with papillary thyroid cancer and circulating anti-thyroglobulin autoantibodies. Some people with TPO antibodies may not have thyroid disease. I don't believe it was a TPOab. TPO is an antibody produced by the body that can indicate thyroid issues if present in abnormally high levels. This would indicate that the antibodies have not yet destroyed enough of your thyroid, to keep . A week later the test was done again along Redheadaussie hasn't been active on the forum for quite some time, so it's unlikely she will respond. Answer From Todd B. Nippoldt, M.D. A low TSH with an elevated FT4 or FTI is found in individuals who have hyperthyroidism. Permanent hypothyroidism is uncommon but is reported to develop in up to 15% of patients with subacute thyroiditis, and can develop more than one year following presentation.20 It should be noted that the use of corticosteroids is not associated with a lower incidence of permanent hypothyroidism.20 Rarely, patients may experience recurrent episodes of subacute thyroiditis. There are several natural approaches to balancing your immune system and addressing leaky gut. Postpartum thyroiditis is transient or persistent thyroid dysfunction that occurs within one year of childbirth, miscarriage, or medical abortion. Treatment with levothyroxine is generally initiated at 50 mcg per day and titrated to achieve a TSH level between 1 and 2.5 mIU per L. Given the natural course of postpartum thyroiditis, tapering of levothyroxine may be considered after 12 months of therapy.17 This may be accomplished by reducing the dose by 50% and repeating thyroid function testing at four- to eight-week intervals.17 Alternatively, it is reasonable to continue levothyroxine therapy during a woman's reproductive years, given the potential adverse effects of maternal hypothyroidism and the high likelihood of recurrence of postpartum thyroiditis, which approaches 70% with subsequent pregnancies.17 Hypothyroidism that occurs beyond one year postpartum should not be classified as postpartum thyroiditis. If the neck pain is not improved after four days, or if the patient presents with severe neck pain, then corticosteroids can be considered.25 In one study, the mean starting dosage was 40 mg of prednisone per day.20 Pain should rapidly improve within two days with use of prednisone. Thyroid peroxidase (TPO) Antibodies. Even though the results of this study indicate that surgical management of Hashimotos thyroiditis may be beneficial, it is not clear whether undergoing surgery for this relatively common disease is necessary to treat symptoms in all patients. The aim of this systematic review is to examine all the data currently available in the literature on the effects of nutritional intervention on biochemical parameters (anti-thyroid antibody . American Thyroid Association. 2 Many cases of subacute thyroiditis follow an upper respiratory viral illness, which is thought to trigger an inflammatory destruction of thyroid follicles. To avoid unnecessary surgery, PET/CT scan is a possible alternative to help differentiate between benign and malignant ITN. Thyroid ultrasonography in subacute thyroiditis shows a nonuniform echotexture, hypoechoic areas, and decreased vascularity throughout the gland. A 2019 study found that anti-TG antibodies are elevated in 60-80% of patients with . KL2 TR000428/TR/NCATS NIH HHS/United States, R01 CA176911/CA/NCI NIH HHS/United States, T35 DK062709/DK/NIDDK NIH HHS/United States, UL1 TR000427/TR/NCATS NIH HHS/United States. Additionally, TgAb+ positive patients were also stratified into those with persistent TgAb elevation and those without. An abnormally high level of TSI in your body is highly predictive of a condition known as Graves' disease (2). Thyroid hormone therapy: patients with hypothyroidism are most often treated with Levothyroxine in order to return their thyroid hormone levels to normal. The symptoms of hyperthyroidism overlap with those of Graves disease, but tend to be milder. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. In this narrative review, the major results and limitations of the . While detecting antibodies is helpful in the initial diagnosis of hypothyroidism due to autoimmune thyroiditis, following their levels over time is not helpful in detecting the development of hypothyroidism or response to therapy. Patients typically present with a nontender goiter, hypothyroidism, and an elevated TPO antibody level. Results: Herpes sores blister, then burst, scab and heal. Selenite supplementation in euthyroid subjects with thyroid peroxidase antibodies. If you've been diagnosed with thyroid disease, your doctor may suggest a TPO antibody test and other thyroid tests to help find the cause. Antibodies attack and even thyroid antibodies can be present with no gland. The cancerous LNs might not even absorb the RAI. Approximately 50% of women who are TPOAb positive early in pregnancy go on to develop some form of post-partum thyroid dysfunction, usually of a transient nature. Because T4 contains iodine, the thyroid gland must pull a large amount of iodine from the bloodstream in order to make an appropriate amount of T4. The range resembles what we normally see for TPOab; it means that anything < 30 is negative for antibodies. 7. This content does not have an Arabic version. Your doctor may also order a TPO antibody test if you are pregnant and have an autoimmune disease that involves the thyroid, such as Hashimoto's disease or Graves' disease. T3 testing rarely is helpful in the hypothyroid patient, since it is the last test to become abnormal. A 41-year-old female asked: Anti thyroid peroxidase antibody - <28 U/ml (range <60) Rubella . The natural history of postpartum, silent, or subacute thyroiditis may include a hyperthyroid or toxic phase of short duration, followed by transient or permanent hypothyroidism. In some individuals with a low TSH, only the T3 is elevated and the FT4 or FTI is normal. Thyroid hormone therapy should resolve hypothyroid symptoms and may result in a reduction in goiter size. We offer this Site AS IS and without any warranties. The lab's "in range" is not "normal" for everyone. Data Sources: A search was completed using the following sources: American Thyroid Association, American Association of Clinical Endocrinologists, PubMed, U.S. Preventive Services Task Force, UpToDate, and The Endocrine Society. Feeling shaky 4. I shouldn't have thyroid left, so why am I now getting high anti thyroid peroxidase antibodies? Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. This frequently happens during pregnancy and with the use of birth control pills. Often, even when these are "in range", the patient does not feel well. Release of preformed thyroid hormone into the bloodstream may result in hyperthyroidism. If we combine this information with your protected Currently, total thyroidectomy (TT) is widely used to treat benign thyroid diseases and thyroid carcinoma. Most of these patients will have recovery of euthyroidism, but some may benefit from treatment aimed at relieving symptoms of hyperthyroidism or hypothyroidism, provided they are monitored for anticipated changes in thyroid function. Subacute thyroiditis is self-limited, and in most cases the thyroid gland spontaneously resumes normal thyroid hormone production after several months. Symptoms may include an enlarged thyroid gland (goiter), tiredness, weight gain, and muscle weakness. The neck pain may be bilateral or unilateral, and may radiate to the jaw.20,21,25 Dysphagia is also reported by patients, with increased sweating, tremor, and weight loss. Thyroid function tests. You didn't mention how long ago you had the RAI, if only recently then that would explain your situation. Second, the laboratory test result should be interpreted within the context of the medical status of the patient. Hypothyroidism is treated by thyroid hormone and returning thyroid hormone levels to the normal range usually resolves symptoms in most patients. Disease-free survival was equivalent between TgAb-positive and TgAb-negative groups (P = 0.8). A high Thyroid Peroxidase Antibody (TPO) level is defined as a level higher than 35 IU/mL, as documented in research conducted by the Mayo Clinic. In healthy, non-hospitalized people, measurement of reverse T3 does not help determine whether hypothyroidism exists or not, and is not clinically useful. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. All of my numbers are normal except for Free T3 Uptake A month and a half ago I had my annual physical and routine blood draw. As such, antithyroid medications (thioureas) are ineffective for postpartum thyroiditis. Methods: This week, researchers have added another to the listthe thyroid. 2014 Jul;24(7):1139-45. doi: 10.1089/thy.2013.0698. Not per se: Antibodies to thyroglobulin are not an issue if you had a thyroidectomy. To exert its effects, T4 is converted to triiodothyronine (T3) by the removal of an iodine atom. In these patients structural recurrence is rare, more frequently diagnosed in the first 5 years from initial treatment and almost invariably localized in neck lymph . Epub 2014 May 21. In the thyroidectomy and thyroid hormone replacement group, the health survey results improved 26 points and the average fatigue score decreased by 9 points. Home Patients Portal Clinical Thyroidology for the Public July 2019 Vol 12 Issue 7 p.8-9, CLINICAL THYROIDOLOGY FOR THE PUBLIC The family physician will most commonly diagnose thyroiditis because of abnormal results on thyroid function testing in a patient with symptoms of thyroid dysfunction or anterior neck pain. Log-Rank analysis showed. Thyroid peroxidase (TPO) is an enzyme normally found in the thyroid gland. Surgery. See permissionsforcopyrightquestions and/or permission requests. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Follow up visits were done every 3 months for 18 months and the thyroid hormone therapy was adjusted as needed. A prospective study of hospitalised COVID-19 patients conducted in Hong Kong showed that the majority of those with abnormal thyroid function (13.1% of the group) had low TSH concentrations, but only one of 191 participants (0.5%) had a high TSH concentration and a high thyroid peroxidase antibody titre. TPO plays an important role in the production of thyroid hormones. The titers usually are significantly elevated in the most common type of hyperthyroidism, Graves thyrotoxicosis, and usually are low or absent in toxic multinodular goiter and . Indeed, some patients with high TPOAb levels and normal thyroid hormone levels (without medication) will present with symptoms similar to those of patients with hypothyroidism. I had a total thyroidectomy and RAI 131 for thyroid cancer. If the patient presents beyond the thyrotoxic phase, which typically lasts four to eight weeks, TSH and free T4 levels may be low. There are many medications that can affect thyroid function testing. Thyroglobulin (Tg) is a protein produced by normal thyroid cells and thyroid cancer cells. They found that the number of CD45 + cells infiltrating the thyroid and the elevated level of serum interleukin-6 is associated with the severity of thyroiditis . All Rights Reserved. We live in a rural area of Arizona and the doctors don't seem to understand Autoimmune issues. When chronic autoimmune thyroiditis is suspected, the family physician should perform a careful thyroid examination and measure serum TSH and TPO antibody levels. PMC Mayo Clinic; 2020. Graves disease may be differentiated from postpartum thyroiditis by the presence of exophthalmos, thyroid bruit, and positive TSH receptor antibody. Hashimotos thyroiditis: the most common cause of hypothyroidism in the United States. This study suggests that thyroidectomy in patients with Hashimotos thyroiditis who had persistent thyroid-related symptoms on thyroid hormone replacement resulted in significantly higher health-related quality-of-life scores and lower fatigue scores as compared with continued thyroid hormone therapy alone. 2015;198(2):366-370. doi:10.1016/j. Yamada O, Miyauchi A, Ito Y, Nakayama A, Yabuta T, Masuoka H, Fukushima M, Higashiyama T, Kihara M, Kobayashi K, Miya A. Endocr J. If you've been diagnosed with thyroid disease, your doctor may suggest a TPO antibody test and other thyroid . Overview of thyroid function. All rights reserved. Is early recurrence of papillary thyroid cancer really just persistent disease? 1.50 - 38.5 ng/mL for women. 2018 Nov;33(6):1050-1057. doi: 10.3904/kjim.2018.289. When the heat rises to an appropriate level, the thermostat senses this and turns off the heater. Do not routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland. The amount of TSH that the pituitary sends into the bloodstream depends on the amount of T4 that the pituitary sees. . SUMMARY OF THE STUDY During that time, the only intervention was the use of nigella extract. Accessed Aug. 5, 2020. When the heater is off and it becomes cold, the thermostat reads the temperature and turns on the heater. Patients recovering from recent illness or those taking drugs such as glucocorticoids or opiates may have suppressed TSH, but free thyroid hormone levels will be normal or low. Practice Essentials. The synthetic hormone works like the T-4 hormone naturally produced by the thyroid. The amount of T4 produced by the thyroid gland is controlled by another hormone, which is made in the pituitary gland located at the base of the brain, called thyroid stimulating hormone (abbreviated TSH). Epub 2014 Jul 17. Other signs of thyrotoxicosis such as fever, tachycardia, tremor, and increased skin warmth may be present. However, the same conclusion has not been confirmed in humans. Lab results indicating Hashimoto's thyroiditis include elevated thyroid-stimulating hormone (TSH), low levels of free thyroxine (FT4), and increased anti-thyroid peroxidase (anti-TPO) antibodies. This generally occurs within six months after achievement of euthyroidism. There is no role for antibiotics in the treatment of subacute thyroiditis, and referral for thyroidectomy is not warranted.25 The differential diagnosis for thyroid bed pain includes hemorrhage into a thyroid cyst and acute infectious or suppurative thyroiditis. Thyroiditis is a general term that refers to inflammation of the thyroid gland and encompasses several clinical disorders. Even in euthyroid women, elevated TPO antibodies (anti-TPO) are strongly associated with a higher prevalence of infertility, gestational anemia, miscarriage and preterm delivery. In autoimmune forms of thyroid diseaseespecially Hashimoto disease and Graves' diseaseantibodies may be formed to thyroid peroxidase. information submitted for this request. Learn how we can help. It makes hormones that control the way the body uses energy. If the pituitary sees very little T4, then it produces more TSH to tell the thyroid gland to produce more T4. Keywords: Feeling weak. Women tend to have slightly higher thyroglobulin levels than men [ 8 ]. Because T4 contains iodine, the thyroid gland must pull a large amount of iodine from the bloodstream in order to make an appropriate amount of T4. While TPO-antibodies are more indicative of Hashimotos thyroiditis, elevated anti-TG antibodies are often reported on lab results, creating concern for patients. Thyroid. The thyroid examination will commonly reveal a firm, bumpy gland with symmetric enlargement. In most cases, the thyroid gland spontaneously resumes normal thyroid hormone production after several months. Elevated levels may also indicate a high risk of thyroid cancer recurrence after treatment [ 4. TPO plays an important role in the production of thyroid hormones. Thyroid stimulating immunoglobulin or TSI for short (1) is the name of a blood test that is used to identify the presence of autoimmune disease in those with hyperthyroidism. http://www.thyroid.org/postpartum-thyroiditis/. Eur J Endocrinol. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. Like Hashimoto thyroiditis, post-partum thyroiditis is characterized by an elevated TPO antibody level, but the clinical presentation is more variable. If your thyroid peroxidase antibodies fall within the 0 to 34 range they will be considered "normal" and they won't flag as high on your lab tests. A high TSH level indicates that the thyroid gland is not making enough thyroid hormone (primary hypothyroidism). We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. The major thyroid hormone secreted by the thyroid gland is thyroxine, also called T4 because it contains four iodine atoms. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. In contrast with postpartum thyroiditis, silent thyroiditis is less likely to result in permanent hypothyroidism (up to 11% of patients), and recurrence is less common.19 The considerations for initiation of therapy and the treatment approach are the same as for postpartum thyroiditis. THE FULL ARTICLE TITLE: Background: Thyroglobulin antibodies (TgAb) are produced by 10%-25% of thyroid cancer patients and interfere with thyroglobulin measurement, a marker of residual or recurrent cancer after surgery. There are few large epidemiologic studies on subacute thyroiditis; however, one large community-based study performed in Olmstead County, Minn., between 1960 and 1997 reported an incidence of 4.9 cases per 100,000 persons per year.20 Women are significantly more likely to be affected than men, and the peak incidence in both sexes occurs at 40 to 50 years of age.20,21 Cases of subacute thyroiditis generally cluster in the late summer and fall.20,21 An increased association of subacute thyroiditis in persons with HLA-B35 is well established.2224.
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