), 10 Natural Treatments for Alzheimer’s Disease & Dementia, How to Prevent Alzheimer’s: Strategies for Early Prevention, 14 Risk Factors for Alzheimer’s [2021 Research Update], Alzheimer’s Medications: Drugs to Slow Memory Loss, What Causes Alzheimer’s? This topic will review diagnosis of and screening for hypothyroidism in nonpregnant adults. Secondary hypothyroidism is caused by a failure in the hypothalamus, or failure of the pituitary gland to release thyroid stimulating hormone. . Levothyroxine is the most commonly used medication. : The evidence is suggestive—and raises interesting possibilities for treatment. Aging, Genetics, and Other Causes, Personal or family history of pituitary dysfunction, Anti-thyroid peroxidase (TPO) antibody and anti-thyroglobulin antibody (Hashimoto’s antibodies), High quality protein like grass-fed meat and wild-caught fish, Small amounts of honey, maple syrup, and fruits, Don’t exercise within two hours of bedtime, Take a hot epsom salt bath or shower before bed. Secondary adrenal insufficiency is adrenal hypofunction due to a lack of adrenocorticotropic hormone (ACTH). Doctors and healthcare professionals will need to do blood tests to diagnose secondary hypothyroidism — and any thyroid disorder, really. Their treatment plans are always personalized to reflect that. Diagnosis,…, Diagnosis, Reversal & Outlook of Primary Hypothyroidism, Hypothyroidism & Pregnancy: Testing, Management, Causes & More, https://academic.oup.com/jcem/article/97/9/3068/2536827, https://academic.oup.com/jcem/article/98/9/3802/2833494, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205405/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115436/, https://www.ncbi.nlm.nih.gov/pubmed/21903114, https://www.sciencedirect.com/science/article/pii/S0169204611003665, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688585/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473809/, https://www.ncbi.nlm.nih.gov/books/NBK539808/, Hypothyroidism Diet Plan: Reverse Symptoms & Heal Your Thyroid, How To Lose Weight with Hypothyroidism Naturally: 6 Steps, Symptoms, Treatment & Outlook for Subclinical Hypothyroidism, The Bredesen Protocol: 6 Strategies (Plus, does it work? However, TSH levels may also be normal or even slightly elevated. Central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges. Two common antibodies are thyroid peroxidase antibody and thyroglobulin antibody. Symptoms and signs of myxedema coma include: Calling your health care provider: Call your health care provider if signs of hypothyroidism are present, or if chest pain or rapid heartbeat occur. In secondary hypothyroidism, your pituitary gland does not release enough TSH — also called thyrotropin — to stimulate your thyroid to produce its thyroid hormones. Generally, secondary hypothyroidism is associated with low TSH and low T3 and T4. Some simple lifestyle changes can bring about noticeable improvements to your quality of life when you live with secondary hypothyroidism. Also, going outside and breathing fresh air often can combat daily stress. Less known aspects of central hypothyroidism: Part 1–Acquired etiologies. It’s important to consider these other options when trying to optimize thyroid medication and function. Join our online Prime Gut Course, which is filled with immediate action steps to help you optimize your thyroid for life. Thyroid disorders caused by overproduction of thyroid hormones are called hyperthyroidism, and underproduction of these hormones is known as hypothyroidism. However, symptoms of thyroid dysfunction are often vague and nonspecific, which can lead to delayed or missed diagnosis. Affiliated: Hypothyroid | Hypothyroidism | Hypothyroidism Primary | Hypothyroidism Secondary | Hypothyroidism Illustration. Call your provider if restlessness, rapid weight loss, sweating, or other symptoms occur after beginning treatment for this disorder. A popular thyroid hormone replacement drug is levothyroxine. After replacement therapy has begun, report any symptoms of increased thyroid activity (hyperthyroidism), such as restlessness, rapid weight loss, and sweating. We break up treatment of hypothyroidism secondary into several parts: diet, lifestyle, and medication. Below, we will talk about what secondary hypothyroidism is, how it’s different from other thyroid diseases, and how to permanently reverse hypothyroidism. Measuring levels of thyroid antibodies may help diagnose the cause of the thyroid problem. Secondary (or central) hypothyroidism is caused by disorders of the pituitary gland or hypothalamus. These endocrine conditions occur primarily in patients who have undergone intracranial irradiation or … In primary hypothyroidism, your thyroid is being stimulated properly. Much of the time, people referring to hypothyroidism are talking about primary hypothyroidism, or a disorder of the thyroid gland. The rare diagnosis of central or secondary hypothyroidism is a bit trickier. This section covers recommendations regarding managing comorbid diseases, patient subpopulations, treatment nonadherence, secondary hypothyroidism, management of symptoms when thyroid function is normal, and ethical considerations. Secondary amenorrhea is defined as the absence of menstrual flow in women with previously normal menstruation. However, TSH levels may also be normal or even slightly elevated. Symptoms are the same as for Addison disease and include fatigue, weakness, weight loss, nausea, vomiting, and diarrhea, but there is usually less hypovolemia. These more detailed data points allow us to truly personalize medical treatment. Klose, M., Marina, D., Hartoft-Nielsen, M. L., Klefter, O., Gavan, V., Hilsted, L., … & Feldt-Rasmussen, U. Alleviating that stress can be paramount to pituitary and thyroid health. The thyroid itself is regulated by another gland that is … The … Aetiology. Though side effects can be severe for hormone therapy in the long run, hormone replacement therapy may be necessary to get your body the thyroid hormones it requires. StatPearls Publishing. The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. Excessive production of this hormone caused by increased activity of these glands is known as hyperparathyroidism. There are several signs and symptoms of hypothyroidism. Persani, L. (2012). Secondary (central) hypothyroidism is characterized by a low serum T4 concentration and a serum TSH concentration that is not appropriately elevated. However, surgery may not cure the hypothyroidism, and thyroid replacement will still be needed. Here are some tips on how to get the best sleep: Though pharmaceuticals are a last resort, there are several medications that possess few side effects and can be individualized for unique patient cases. The recommendation to check serum lipids is based on the fact hypothyroidism is a known secondary cause of increased heart disease risk and dyslipidaemia, as outlined in the NICE clinical guideline on cardiovascular disease and lipid modification [ NICE, 2016 ]. Vital signs (temperature, pulse, rate of breathing, blood pressure) reveal a slow heart rate, low blood pressure, and low temperature. Also called “hypothyroidism secondary,” secondary hypothyroidism is when the pituitary gland is underactive. Soyona Rafatjah, MD is a board-certified Family Physician who practices Integrative and Functional concierge medicine at Prime Health in Denver, CO. PrimeHealth is a Functional Medicine practice that offers evidence-based, and personalized programs for reversing IBS & Hypothyroidism, and focuses on Health Optimization & Prevention, © 2021 PrimeHealth Denver | Site by Yakadanda, If you enjoyed this article, we invite you to join our newsletter for news and media updates, new events and free recipes, Prime Health Denver invite you to join our newsletter for the latest news and media updates and upcoming events, Doctor Visits & Comprehensive Yearly Physical, Online Access & Safekeeping of Medical Records, Book 1st Follow Up Appointment (In-Person), What is secondary hypothyroidism? Central hypothyroidism suggests a pituitary gland or hypothalamus problem. 22 Biochemically, central hypothyroidism is defined by low or low-to-normal TSH concentrations and a disproportionately low concentration of free thyroxine. Generally affecting the pituitary, hypothalamus, or hypothalamic-pituitary portal circulation, causing reduced thyroid-stimulating hormone (TSH), thyrotropin-releasing hormone (TRH), or possibly both. It is the most common pharmaceutical prescribed for hypothyroidism of any kind. The thyroid secretes the hormones thyroxine (T4), triiodothyronine (T3), and calcitonin, which control body metabolism and regulate calcium balance. Clinical scenario, if associated with secondary and tertiary hypothyroidism, may present other coexisting endocrine deficiencies such as hypogonadism and adrenal insufficiency that may mask the manifestations of hypothyroidism. Symptoms vary from mild to severe. If you may have secondary hypothyroidism, sign up here for a free phone consultation with our team! Symptoms, signs, and more critically, blood tests—are taken into consideration when evaluating the possibility of an underactive thyroid gland—all of which help identify the cause and severity of the disease. This TSH deficiency leads to adverse symptoms similar to primary hypothyroidism, but treatment for this disorder is very different. Secondary hypothyroidism There may be clinical features of primary hypothyroidism together with clinical features of possible hypothalamic-pituitary disease such … Eghtedari, B., & Correa, R. (2019). Two common antibodies are thyroid peroxidase antibody and thyroglobulin antibody. Primary hypothyroidism (the more common of the two) is a result of low thyroid hormone (TH) produced by the thyroid gland while Secondary hypothyroidism is due to the pituitary’s inability to produce enough thyroid stimulating hormone (TSH) or thyrotropin releasing hormone (TRH). However, relapses will occur if the medication is not continued. Thyroid. Hypothyroidism is evaluated and diagnosed by a physician, usually an endocrinologist or your primary care doctor. Other risk factors include being older than 50, being female, and having a history of pituitary dysfunction. This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism. Although secondary hypothyroidism is uncommon, its causes often affect other endocrine organs controlled by the hypothalamic-pituitary axis. This helps keep levels appropriately balanced. However, normal or even high values may be seen. The typical findings that would indicate a diagnosis of secondary hypothyroidism are as follows: Normal/low TSH: due to a lack of production. Central hypothyroidism (CH) is a disease characterized by a defect of thyroid hormone production due to insufficient stimulation by TSH of an otherwise normal thyroid gland (1– 4).This condition is the consequence of an anatomic or functional disorder of the pituitary gland or the hypothalamus, resulting in variable alterations of TSH secretion. In general, optimal TSH levels should be between 0.5 mIU/L and 2.5 mIU/L. Generally, secondary hypothyroidism is associated with low TSH and low T3 and T4. An elevated serum TSH level with a normal range serum free T 4 level is consistent with subclinical hypothyroidism. The finding of an elevated TSH and low FT 4 or FTI indicates primary hypothyroidism due to disease in the thyroid itself. Your pituitary gland is supposed to secrete a hormone that stimulates your thyroid gland, but sometimes your pituitary gland doesn’t function perfectly. Although secondary hypothyroidism is uncommon, its causes often affect other endocrine organs controlled by the hypothalamic-pituitary axis. This is sometimes referred to as Hashimoto's thyroiditis and can be present along with other autoimmune disorders such as Fibromyalgia. The pituitary gland produces thyroid-stimulating hormone, also called thyrotropin. Untreated hypothyroidism increases morbidity and mortality. Causes of Secondary Hypothyroidism. Laboratory tests to determine thyroid function include: Additional laboratory abnormalities may include: The purpose of treatment is to replace the deficient thyroid hormone. Hypothyroidism is a common endocrine disorder resulting from deficiency of thyroid hormone. It’s important to get seven to eight hours of sleep. The cause of secondary hypothyroidism is failure of the pituitary gland to secrete thyroid stimulating hormone (TSH). In a woman with hypothyroidism, indications of secondary hypothyroidism are a history of amenorrhea rather than menorrhagia and some suggestive differences on physical examination. Screening, ... American Thyroid Association. Signs on physical exam may indicate hypothyroidism, including skin changes, hair loss, and bradycardia. Adrenal crisis, if thyroid replacement is begun prior to steroids in hypoadrenal patients. UCLA Endocrine Surgery Research & Education, Referring Physicians - Surgical Unit Focus, For Referring Physicians - Parathyroid disease Treatment, Cushing's Disease (pituitary Cushing's syndrome), Multiple Endocrine Neoplasia (MEN) Type 1, Multiple Endocrine Neoplasia (MEN) Type 2, Thyroid Nodule Fine Needle Aspiration (FNA) Biopsy, Parathyroidectomy Minimally Invasive FAQs, Parathyroidectomy Minimally Invasive (focused), Scar Photo Album - Surgery for Benign Thyroid Disease, Scar Gallery Benign Thyroid Disease Surgery, Scar Gallery Laparoscopic Adrenal Surgery, Scar Gallery Minimally Invasive Parathyroid Surgery. Rarely the cause is an infiltration of the pituitary by inflammatory cells from the immune system or foreign substances (such as iron in hemochromotosis). Hypothyroidism results from low levels of thyroid hormone with varied etiology and manifestations. Diagnosis is clinical and by laboratory findings, including low plasma ACTH with low plasma cortisol. Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. This condition may not be preventable. Other healthcare providers might use a thyroid function test to diagnose thyroid disease. Life-long therapy may be necessary. ETIOLOGY. The causes of central hypothyroidism are the same as the causes of hypopituitarism ( table 1) [ 2,3 ]. In secondary hypothyroidism, not only is the thyroid involved, but also other endocrine system glands. Myxedema coma is treated by intravenous (IV) thyroid replacement and steroid therapy. Secondary hypothyroidism is a rare disorder that describes an underactive pituitary gland causing an underactive thyroid. In rare instances, hypothyroidism secondary may occur when inflammatory cells infiltrate the pituitary gland. Hypothyroidism is a clinical state of thyroid hormone deficiency that may have a primary or secondary (central) cause. Hypothyroidism affects millions of people every year, and many doctors claim it is usually irreversible. Hirotsu, C., Tufik, S., & Andersen, M. L. (2015). The body's normal rate of functioning slows, causing mental and physical sluggishness. Untreated hypothyroidism increases morbidity and mortality. More green space is linked to less stress in deprived communities: Evidence from salivary cortisol patterns. Here are some unique situations which will affect our approach to diagnosing thyroid problems: Though diagnosis may take hours of medical investigation, we believe plans should be tailored to each individual patient. The reverse is also true -- when levels of the thyroid hormones rise, pituitary and hypothalamic hormones fall back. Thyroid disorders caused by overproduction of thyroid hormones are called hyperthyroidism, and underproduction of these hormones is known as hypothyroidism. E03.8 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Symptoms of central hypothyroidism include those of primary hypothyroidism (fatigability, cold intolerance, weight gain), with or without other symptoms of hypopituitarism, including hypogonadism and secondary adrenal insufficiency. 3. A high-fiber, low-calorie diet and moderate activity will help relieve constipation and promote weight loss if weight was gained during the time when thyroid activity was low. Hence, when secondary or tertiary hypothyroidism is suspected, measurement of serum TSH alone is inadequate; free T4 should also be measured. Meditation is a great way to relieve stress. If you think you have hypothyroidism, sign up here for a free phone consultation with our team! Full text. As you can tell from the name, this pituitary hormone is needed for normal thyroid function. For example, positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies in a patient with hypothyroidism result in a diagnosis of Hashimoto’s thyroiditis. Imaging will include an MRI of the pituitary to look for a tumor. Benvenga, S., Klose, M., Vita, R., & Feldt-Rasmussen, U. Symptoms of central hypothyroidism include those of primary hypothyroidism (fatigability, cold intolerance, weight gain), with or without other symptoms of hypopituitarism, including hypogonadism and secondary adrenal insufficiency. You'll likely start to … Alternative Names: Pituitary hypothyroidism. Screening for hypothyroidism during pregnancy and in neonates is reviewed separately. Thompson, C. W., Roe, J., Aspinall, P., Mitchell, R., Clow, A., & Miller, D. (2012). Myxedema coma can result in death. Secondary hypothyroidism Secondary hypothyroidism occurs when the hypothalamus produces insufficient thyrotropin -releasing hormone (TRH) or the pituitary produces insufficient TSH. Occasionally, … However, levothyroxine can come with a whole host of side effects in certain people: If we feel medication is safe and necessary, we might suggest a compounded synthetic combination of T3 and T4 hormones, levothyroxine, or dessicated thyroid medication, depending on the situation. A major cause of hypothyroidism is known as autoimmune thyroid disorder. Full text: Olivares, E. L., Silva-Almeida, C., Pestana, F. M., Sonoda-Côrtes, R., Araujo, I. G., Rodrigues, N. C., … & Rocha, F. F. (2012). Patients with secondary hypothyroidism Routine T4 measurements Patients with type 1 diabetes Routine TSH measurements. Fortunately, newborn screenings for congenital hypothyroidism are mandated in the United States, so it’s almost always caught early. The lowest dose effective in normalizing thyroid function is used. Hypothyroidism is almost always treatable and often reversible. These brain structures control the thyroid gland and may be damaged from tumors, infections, radiation, and infiltrative diseases like sarcoidosis, among other causes. There are four basic variations of hypothyroidism: primary hypothyroidism, secondary hypothyroidism, tertiary hypothyroidism, and subclinical hypothyroidism. Global rise of potential health hazards caused by blue light-induced circadian disruption in modern aging societies. Medication must be continued even when symptoms subside. However, secondary hypothyroidism is a much rarer disorder. Many of our patients are euthyroid (healthy thyroid) by the end of our treatment plan. For most cases of hypothyroidism, we recommend an Autoimmune Paleo Diet for a period of 1-6 months. Sometimes, deficient TSH secretion due to deficient TRH secretion is termed tertiary hypothyroidism. 2016:26(10):1343-1423. It may take a year, but the future outlook is much brighter than conventional medicine would have you believe. In StatPearls [Internet]. The cause of secondary hypothyroidism is failure of the pituitary gland to secrete thyroid stimulating hormone (TSH). Social stress-induced hypothyroidism is attenuated by antidepressant treatment in rats. Your pituitary gland is supposed to secrete a hormone that stimulates your thyroid gland, but sometimes your pituitary gland doesn’t function perfectly. Our patients are our evidence. However, it isn’t able to produce enough thyroid hormones for your body to function properly. (2013). Risk factors for secondary hypothyroidism include being over 50 years old, being female, and having a history of pituitary or hypothalamic dysfunction. With blood tests, we will assess: The normal range of TSH levels should stay in between 0.4 mIU/L and 4.0 mIU/L (milli-international units per liter). Do dietary lectins cause disease? With early treatment, return to the normal state is usual. Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levo-T, Synthroid, others). (NICHD) Definition (NCI_NCI-GLOSS) Too little thyroid hormone. It may be precipitated by an infection, illness, exposure to cold, or certain medications. Secondary (central) hypothyroidism is characterized by a low serum T4 concentration and a serum TSH concentration that is not appropriately elevated. Call your provider if headache, visual loss, or breast discharge occur. Central hypothyroidism. Hypothyroidism is one of the most common endocrine disorders, with a greater burden of disease in women and the elderly.1 A 20 year follow up survey in the United Kingdom found the annual incidence of primary hypothyroidism to be 3.5 per 1000 in women and 0.6 per 1000 in men.2 A cross sectional Australian survey found the prevalence of overt hypothyroidism to be 5.4 per 1000.3 | RACGP This is usually caused by a tumor in the region of the pituitary. Figure 22.10. Hypothyroidism is a common clinical disorder that psychiatrists frequently encounter. However, we at PrimeHealth take a more comprehensive approach to diagnosis. Diagnosing secondary hypothyroidism should include comprehensive blood testing. Whereas many conventional endocrinologists say that hypothyroidism is often irreversible, our patients have responded to PrimeHealth’s treatment plans very well. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions. A physical exam usually reveals a small thyroid gland. Low T4: due to the absence of any positive feedback from TSH. Central hypothyroidism is rare and affects both sexes equally. The terms “thyroid storm” or “thyrotoxic crisis” describe an acute, life-threatening, hypermetabolic state that affects multiple systems and results from excessive release of thyroid hormones in people with hyperthyroidism. Central hypothyroidism includes secondary and tertiary hypothyroidism. Central hypothyroidism and its replacement have a significant influence on cardiovascular risk factors in adult hypopituitary patients. However, symptoms of thyroid dysfunction are often vague and nonspecific, which can lead to delayed or missed diagnosis. Other conditions may exhibit similar symptoms. Central hypothyroidism (CH) is a disease characterized by a defect of thyroid hormone production due to insufficient stimulation by TSH of an otherwise normal thyroid gland (1– 4).This condition is the consequence of an anatomic or functional disorder of the pituitary gland or the hypothalamus, resulting in variable alterations of TSH secretion. The patient … A chest x-ray may reveal an enlarged heart. Ontology: Hypothyroidism (C0020676) Definition (NCI_CTCAE) A disorder characterized by a decrease in production of thyroid hormone by the thyroid gland. This is the American ICD-10-CM version of E03.8 - other international versions of ICD-10 E03.8 may differ. Measuring levels of thyroid antibodies may help diagnose the cause of the thyroid problem. Here at PrimeHealth in Denver, CO, we believe that you can permanently reverse hypothyroidism. Serum TSH -- Results are generally low in secondary hypothyroidism because the pituitary is damaged. Checking serum thyroid peroxidase antibodies (TPOAbs) This topic will review diagnosis of and screening for hypothyroidism in nonpregnant adults. Levothyroxine. The 2021 edition of ICD-10-CM E03.8 became effective on October 1, 2020. Since the end result is the same as primary hypothyroidism — thyroid hormone deficiency — the symptoms of secondary hypothyroidism are basically the same: If allowed to progress, severe hypothyroidism causes more serious symptoms to develop: What causes secondary hypothyroidism? Secondary hypothyroidism due to underactivity of the pituitary gland (or hypothalamus) thyroid-stimulating hormone 1 in 1000 hypothyroid cases — it’s quite rare. Screening for hypothyroidism during pregnancy and in neonates is reviewed separately. Hypothyroidism results from low levels of thyroid hormone with varied etiology and manifestations. In the United States, autoimmune thyroid disease (Hashimoto thyroiditis) is the most common cause of hypothyroidism, but globally lack of iodine in the diet is the most common cause. Awareness of risk may allow early diagnosis and treatment. For this reason, TSH is often an unreliable measure of secondary hypothyroidism and should not be used to assess the adequacy of thyroid replacement in these patients. Some conventional endocrinologists may only test for TSH levels and free T4 levels. Supportive therapy of oxygen, assisted ventilation, fluid replacement, and intensive care nursing may be indicated. What is Secondary Hyperparathyroidism? Stress can trigger a thyroid disorder. Risk factors for secondary hypothyroidism include: Congenital hypothyroidism secondary can also occur in newborns. Or continue reading to learn more about this rare but dangerous disease. In a woman with hypothyroidism, indications of secondary hypothyroidism are a history of amenorrhea rather than menorrhagia and some suggestive differences on physical examination. Since the thyroid gland is regulated by the pituitary gland and the hypothalamus, thyroid disorders may result not only from defects in the thyroid itself but also from the disruption of the control system in these other organs. Central hypothyroidism is a rare cause of hypothyroidism, estimated to occur in 1:20,000 to 1:80,000 in the general population [ 1 ]. The parathyroids are four glands in the neck that produce parathyroid hormone to help control calcium metabolism. Myxedema coma, the most severe form of hypothyroidism, is rare. The term “central hypothyroidism” refers to thyroid disorders that are caused outside the thyroid gland. Patients with central hypothyroidism frequently have other pituitary hormone deficiencies. The patient presentation can vary from … For example, positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies in a patient with hypothyroidism result in a diagnosis of Hashimoto’s thyroiditis. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Hypothyroidism is a clinical state of thyroid hormone deficiency that may have a primary or secondary (central) cause. Unlike primary hypothyroidism, which is most often caused by an autoimmune disease called Hashimoto’s disease (also known as lymphocytic thyroiditis), secondary hypothyroidism’s most common cause is a pituitary tumor (such as a pituitary adenoma). Your pituitary gland produces and secretes hormones like prolactin (the milk hormone), growth hormone, and thyroid-stimulating hormone (TSH). Secondary hypothyroidism involves decreased activity of the thyroid caused by failure of the pituitary gland. This occurs when a person's immune system malfunctions and begins to attack the thyroid gland. In individuals with accompanying hypoadrenalism, steroid replacement must be instituted before thyroid replacement is begun. The secretion of T3 and T4 by the thyroid is controlled by an endocrine feedback system involving the pituitary gland and the hypothalamus (structures in the brain).
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