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Ophthalmopathy in hyperthyroidism vs hypothyroidism – Update on thyroid-associated Ophthalmopathy with a special emphasis on the ocular surface

Main page. Axe on Twitter 22 Dr.

David Stewart
Thursday, September 14, 2017
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  • Neuromuscular disorders like myasthenia gravis cause extraocular muscle weakness, but not enlargement. Atypical antidepressants Caffeine and depression: Is there a link?

  • Hypothyroidism Labs Hyperthyroidism vs.

  • Autoimmun Rev 15 12 —8. Prisms: If double vision is a problem, glasses containing prisms may be prescribed by your doctor.

  • Thyroid nodules are common in both hypothyroidism and hyperthyroidism.

  • With moderate and severe disease, most patients show improvement in inflammatory soft tissue changes and muscle motility dysfunction with intravenous steroid therapy.

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Biro E, et al. A male aged 50—60 years was referred with left eye proptosis progressively getting worse for 2 months. Proteomics differentiate between thyroid-associated orbitopathy and dry eye syndrome. Graves orbitopathy: A multidisciplinary approach. Surv Ophthalmol 41 1 —

Patients with pronounced periorbital edema may benefit from elevating ophthalmopathy in hyperthyroidism vs hypothyroidism head at night. Due to orbital congestion, choroidal folds may also be seen in TAO, among other warning signs. Eyelid Retraction Repair and Tarsorrhaphy : These reconstructive surgical procedures may be preformed to address eyelid retraction or exposure keratitis. It is important to stop smoking in order to reduce the severity, duration of activity, degree of scarring, and risk of optic nerve involvement, greatly improving the success of treating Graves' eye disease. Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy. Diplopia manifesting as the appearance of overlapping images is common.

For diplopia, Fresnel prisms hyperthyroidixm occlusion therapy may be considered. MRI may also aide in assessing water content in the muscles and other soft tissues. People living in cooler locations such as Russia, Finland and England have As its name suggests, hyperthyroidism occurs when your body makes too much of the thyroid hormones, thyroxine T4 and triiodothyronine T3and becomes overactive. The Differences Between Hypothyroidism and Hyperthyroidism. Axe on Twitter 1 Dr. Assigned editor:.

The ocular surface in TAO A frequently underappreciated casualty of TAO is the ocular surface, a functional unit comprising the corneal and conjunctival opthalmopathy, lid margins and tear film. Rao R, et al. Anterior segment signs in TAO include superficial punctate keratitis, superior limbic keratoconjunctivitis, conjunctival injection usually over the rectus muscle insertions and chemosis. The utility of these grading systems is that both assess severity and activity. In special situations such as hepatic dysfunction, cardiovascular morbidity or psychiatric disorders, intravenous GCs should be avoided. Patients undergo an initial period where inflammation, progressive orbital congestion, and variably worsening proptosis evolve.

What Is Hyperthyroidism?

Orbital decompression commonly involves the orbital floor, medial wall, and lateral wall. Computed tomography CT scan: This type of imaging without contrast may distinguish normal structures from abnormal structures of different tissue density. Among the environmental factors, smoking is the most consistently linked risk factor to the development or worsening of the disease. In more advanced cases, patient may complain eye socket orbital pain, double vision, or blurred vision. Permanent link.

We report a years old man presenting in our endocrine clinic with diagnosed primary hypothyroidism 3 months back during evaluation for glaucoma. The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota. Rituximab for thyroid eye disease. If your TSH is high over 4. However, it is possible to go back and forth between these two thyroid problems. Axe on Youtube 2M Subscribers.

What links here. Stan goes on to explain that there are two types of thyroiditis, subacute thyroiditis ophthalnopathy silent thyroiditis. Epub Aug While strict control of thyroid function is crucial in patients with TED, the course and severity of ocular manifestation does not always correlate with thyroid hormone levels. The patient complains of gritty sensations, photophobia, lacrimation, dry eye, discomfort, and forward protrusion of the eye. Axe on Youtube Dr. Patients diagnosed over 50 -year have worse prognosis overall.

What Is Hyperparathyroidism?

Again excellent response to steroids is seen. National Center for Biotechnology InformationU. Orbital decompression commonly involves the orbital floor, medial wall, and lateral wall.

Among the environmental factors, smoking is the most consistently linked risk factor to the development or worsening of the disease. Thyroid eye disease TED is an autoimmune disease caused by the activation of orbital fibroblasts by autoantibodies directed against thyroid receptors. This attack allows the thyroid gland to produce too much thyroid hormone. Epub Aug Subclinical hyperthyroidism is when your thyroid stimulating hormone TSH is low but your T3 and T4 levels are normal. Eye21 9 Read this next.

This is enhanced by circulating and local adhesion molecules stimulated by cytokines. Rarely can also ophthalmopaathy the skin, usually the front part of the legs. This patient had orbital, neurologic, and cardiac involvement with sarcoidosis. The main side effect is early onset cataract. These include corneal opacity, important lagophthalmos, and pale, swollen optic discs, which can signal impending DON [ 37 ]. Alternate etiologies should be considered in the absence of hyperthyroidism and negative thyroid antibodies.

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Macchia et al. Orbital fibroblast proliferation and differentiation into adipocytes leads to fat tissue expansion. Enlarged inferior rectus muscle dimension and the generalized orbit connective tissue congestion may retract the lower eyelid margin. An MRI was obtained for evaluation of orbital disease and it showed mild diffuse mid-belly enlargement and T2 hyperintensity of EOMs bilaterally.

Thyroiditis can also occur as the result of pregnancy. What is hypothyroidism? Subacute thyroiditis is caused ophthalmopathy in hyperthyroidism vs hypothyroidism a virus and includes pain that starts at the front of the neck and spreads toward the ears. Josh Axe is on a mission to provide you and your family with the highest quality nutrition tips and healthy recipes in the world Most Popular Health. When you produce too much thyroid hormone, you can develop hyperthyroidism. These symptoms are frustrating.

Read about the pros and cons of five natural…. Randomized controlled trial of rituximab in patients with Graves' orbitopathy. Rituximab for thyroid eye disease. Luo, M. Sleeping with the head of the bed elevated to decrease orbital edema.

Publication types

When opthalmopathy produce too much thyroid hormone, you can develop hyperthyroidism. The diagnosis can be done clinically with the characteristic clinical picture, restrictive nature of the disease and associated systemic thyroid disease. Hypothyroidism: Which is Worse? A shift in treatment began in when the Clinical Activity Score CAS was created to help distinguish the active and stable phases of the disease- its distinguishing feature is grading classic signs of acute inflammation.

  • Chronic progressive external ophthalmoplegia is an extremely rare condition where extraocular muscle size is reduced on imaging

  • All contributors:.

  • Thyroid associated orbitopathy. Upper eyelid lag refers to a delay in the upper eyelid following as the eye rotates downward as a patient tracks an moving object.

  • Management of Graves' ophthalmopathy: reality andperspectives. If you have hyperthyroidism, you may experience a fast heartbeat, increased appetite, anxiety, sensitivity to heat, or sudden weight loss.

Hypothyroidism Treatment Hyperthyroidism vs. Graves' disease GD is an autoimmune disorder involving the thyroid gland, typically characterized by the presence of circulating autoantibodies that bind to and stimulate the thyroid hormone receptor TSHRresulting in hyperthyroidism and goiter. Hypothyroidism vs. In more advanced cases, patient may complain eye socket orbital pain, double vision, or blurred vision. What about conventional treatment of hyperthyroidism? Assigned editor:. Axe on Youtube 2M Subscribers.

The former results from contralateral lid retraction but true ptosis occurs when the levator muscle suffers dehiscence or when concurrent myasthenia gravis is hyperthgroidism. Radioiodine and thyroid eye disease. Due to orbital congestion, choroidal folds may also be seen in TAO, among other warning signs. The median age is 43 years for all patients, with a range from 8 to 88 years old. Most people get relief from their symptoms within two months of the radiation.

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If you are currently receiving treatment for a thyroid problem and your thyroid function begins to shift between underactive and overactive, your medication may be the cause and you should talk to your doctor right away. Thankfully, there are many natural ways to treat hypothyroidism as well as hyperthyroidism. Jump to: navigationsearch.

Free E-newsletter Subscribe to Housecall Our general interest e-newsletter keeps you up to date on a ophthalmopathy in hyperthyroidism vs hypothyroidism variety of health topics. The two diseases run their separate courses and do not necessarily occur at the same time. Orbital myositis is the most common etiology mimicking graves. In these patients, orbitopathy is likely related to the specific production of antibodies to orbital tissue other than TRAb. Received Feb 5; Accepted Apr Systemic lupus erythematosus, which is a collagen vascular disease resulting in multisystem involvement and vasculitis may also cause Bilateral orbital involvement and specific myositis in few case reports

Teprotumumab: This biologic infusion therapy has been shown in clinical studies hypothyeoidism reduce signs and symptoms of TED. Standard hypothyroidism for hypothyroidism includes oral medication, but there are natural therapies too. What level of TSH indicates hypothyroidism? Orbital decompression commonly involves the orbital floor, medial wall, and lateral wall. Medically reviewed by Judith Marcin, M. In some cases, it needs to be…. Axe on Twitter 1 Dr.

Hypothyroidism: Which is Worse? In hyperthyroidism, an irritation of your thyroid known as thyroiditis allows too much thyroid hormone to enter your blood. It is not possible to have both hypothyroidism and hyperthyroidism at the same time. What links here. But with the right treatment plan, they can become manageable. Read More.

CASE REPORT article

Densities of orbital fat and extraocular muscles in hyperthyroieism orbitopathy patients and controls. He did not have symptoms of hyperthyroidism on presentation and no prior history of the same. In this topical review, we attempted to provide a roadmap of the recent advances in current understanding the pathogenesis of TAO, important aspects of its clinical presentation, its impact on the ocular surface, describe the tissue abnormalities frequently encountered, and describe how TAO is managed today. In muscle, increased glycosaminoglycan accumulation can interfere with normal contraction and movement [ 91425 ]. Enroll in the Residents and Fellows contest.

  • Inflammation of the OS and dry eye are frequently associated with TAO, sometimes preceding ophthalmic changes [ 4243 ].

  • The Differences Between Hypothyroidism and Hyperthyroidism.

  • The factors that over-arch the ocular components of GD with the pathology occurring in the thyroid have yet to be identified unambiguously. Optimal care of patients with TAO requires a multidisciplinary approach.

  • The diagnosis can be done clinically with the characteristic clinical picture, restrictive nature of the disease and associated systemic thyroid disease.

It has been established that autoimmunity develops against antigens common to the thyroid gland and the orbit. Hormones Athens. They can present as isolated or multiple masses ophthalmopaathy the EOMs, orbital fat, globe, or bony orbit. The removal of the deep lateral wall in orbital decompression: its contribution to exophthalmos reduction and influence on consecutive diplopia. Proptosis Proptosis is spontaneous decompression resulting from enlargement of the extraocular muscles and adipose tissue, as well as orbital fat deposits and the infiltration of orbital tissues by GAGs and leukocytes Figure 2. An MRI was obtained for evaluation of orbital disease and it showed mild diffuse mid-belly enlargement and T2 hyperintensity of EOMs bilaterally.

Axe on Twitter 0 Dr. You may experience weight hyperthyroididm as opposed to weight gain. Thyroid Storm. Subacute thyroiditis is caused by a virus and includes pain that starts at the front of the neck and spreads toward the ears. In addition, women are five to eight times more likely than men to have thyroid problems. Original article contributed by :.

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However, it is possible to go back and forth between these two thyroid problems. This is usually short-term. Ultrasonography: Both A-scan and B-scan transocular echograms can be used to visualize the orbital structures and determining recti muscle enlargement. Axe on Twitter 22 Dr.

Among the environmental factors, hyperthyroidism is the most consistently linked risk factor to the development or worsening of the disease. A shift in treatment began in when the Clinical Activity Score CAS was created to help distinguish the active and stable phases of the disease- its distinguishing feature is grading classic signs of acute inflammation. The opposite of an overactive thyroid is, logically, an underactive thyroid. On examination there was only bilateral exophthalmos with marked chemosis. Eyelid Retraction Repair and Tarsorrhaphy : These reconstructive surgical procedures may be preformed to address eyelid retraction or exposure keratitis. Include genetic, environmental, and immune factors.

Advances in the management of thyroid eye disease. The classification was modified in by the American Thyroid Association. This article has been cited by other articles in PMC. Further, all are particularly susceptible to immunological damage [ 49 ].

INTRODUCTION

Create account Log in. There inn no cure for a hypothyroidism diagnosis, but there may be ways to naturally increase thyroid hormone production through dietary means, such as a hypothyroidism diet. All contributors:. Marcet, MD. It is rare in patients with normal thyroid function euthyroid GO and in patients with hypothyroid forms of thyroid autoimmune diseases hypothyroid GO.

Graves' disease GD is an autoimmune disorder involving the thyroid gland, typically characterized by the presence of circulating autoantibodies that bind to and stimulate the thyroid hormone receptor TSHRresulting in hyperthyroidism and goiter. When you produce too much thyroid hormone, you can develop hyperthyroidism. Keywords: Thyroid associated orbitopathy, Graves ophthalmopathy, Hypothyroidism. This medication is taken as a synthetic hormone replacement to help regulate thyroid levels. To some degree, hyperthyroidism vs. The diagnosis can be done clinically with the characteristic clinical picture, restrictive nature of the disease and associated systemic thyroid disease.

  • These are usually mild and treatable. It was reported that combined orbital radiotherapy and systemic steroid therapy was substantially more effective than radiotherapy or steroid therapy alone.

  • Assigned editor:.

  • We present three cases of orbitopathy referred to our Endocrine clinic for suspected TAO and a review of literature on the differential diagnosis of the same. Fine needle aspiration FNA of left levator palpebrae muscle was performed twice and was negative for malignancy.

  • The utility of these grading systems is that both assess severity and activity. Orbital Decompression : This surgical procedure enlarges the existing space of the orbit by partial removal of bony walls.

  • Different decompression techniques have been developed.

Systemic steroids: To decrease orbital inflammation oral prednisone in a dose of 1- 1. What level of TSH indicates hypothyroidism? Axe on Twitter 0 Dr. Patients with hypothyroidism and Graves ophthalmopathy can be successfully treated with steroids in a similar manner as in patients with GO associated with hyperthyroidism.

Hypothyroidism is a rare disease, which had an incidence rate of approximately 19 inpeople per year in one study. What about conventional treatment of hyperthyroidism? These symptoms are frustrating. Medically reviewed by Alana Biggers, M. What level of TSH indicates hypothyroidism? Orbital Decompression : This surgical procedure enlarges the existing space of the orbit by partial removal of bony walls. Diagnosis and classification of Graves' disease.

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With this condition, your body attacks its own immune system. With this type of thyroiditis, thyroid function can go back to normal after an initial episode, but it can happen again and over time, it can turn into a long-term case of hypothyroidism. Among the environmental factors, smoking is the most consistently linked risk factor to the development or worsening of the disease.

In addition, women are five to eight times more likely than men to have ophthalmopathy in hyperthyroidism vs hypothyroidism problems. Publication types Case Reports. This is usually short-term. There is no cure for a hypothyroidism diagnosis, but there may be ways to naturally increase thyroid hormone production through dietary means, such as a hypothyroidism diet. Abstract Graves ophthalmopathy GO usually occurs in a close temporal relationship with hyperthyroidism. Rana D.

The best diagnostic clue on imaging is a solid, homogeneously enhancing orbital hyperthyroodism that molds to and encases orbital structures. These include proteins involved in inflammatory response, cell-to cell signaling and interaction, cellular motility and cell death. Azathioprine in the treatment of thyroid-associated ophthalmopathy. When the immune system attacks the tissues around the eyes, it causes the eye muscles or fat to expand.

Thyroid nodules are common in both hypothyroidism and hyperthyroidism. Graves' hypothyroidiism GD is an autoimmune disorder involving the thyroid gland, typically characterized by the presence of circulating autoantibodies that bind to and stimulate the thyroid hormone receptor TSHRresulting in hyperthyroidism and goiter. Computed tomography CT scan: This type of imaging without contrast may distinguish normal structures from abnormal structures of different tissue density.

Genetic Factors There are many studies investigating the role of genetics in the development of ophthalmopathy. Surgeries involving more than hypothyriodism muscle should be avoided and recession procedures should be preferred over resection in order to prevent ocular ischemic syndrome. Reddy SV, et al. Br J Ophthalmol 53 2 — Upper eyelid lag refers to a delay in the upper eyelid following as the eye rotates downward as a patient tracks an moving object. Patient received radiation therapy with improvement in symptoms. Werner SC.

Let's Be Friends. Teprotumumab for thyroid-associated ophthalmopathy. Transactions of the American Ophthalmological Society92 Conservative: Both smoking cessation and euthyroid status help preventing further exacerbation and decrease the duration of active disease. Medically reviewed by Lindsay Slowiczek, Pharm.

Graves’ Eye Disease FAQs

Medically reviewed by Judith Marcin, M. However, treatment is available and will likely restore…. Teprotumumab for thyroid-associated ophthalmopathy. Axe on Facebook Dr. To some degree, hyperthyroidism vs.

Subacute thyroiditis is caused by a virus and includes pain that starts at the front of the neck and spreads toward the ears. Medically reviewed by Deborah Weatherspoon, Ph. New England Journal of Medicine4 The hypothyroidism diet eliminates foods that can cause inflammation and immune reactions and instead focuses on foods that help heal the GI tract, balance hormones and reduce inflammation. Privacy policy. However, it is possible to go back and forth between these two thyroid problems.

Residents and Fellows contest rules International Ophthalmologists contest rules. Axe on Facebook 93 Dr. Hyperthyroidism occurs when the body produces excessive amounts. Orbital Decompression : This surgical procedure enlarges the existing space of the orbit by partial removal of bony walls.

Solitary muscle involvement especially of the superior rectus makes thyroid orbitopathy an unlikely etiology. In this topical review, we attempted to provide a roadmap of the recent advances in current understanding the pathogenesis of TAO, important aspects of its hjpothyroidism presentation, its impact on the ocular surface, describe the tissue abnormalities frequently encountered, and describe how TAO is managed today. FNA of inferior rectus was performed while patient was on steroids. Alternate etiologies should be considered in the absence of hyperthyroidism and negative thyroid antibodies. Rarely, orbital swelling may precipitate glaucoma that also affects the optic nerve. The best diagnostic clue on imaging is a solid, homogeneously enhancing orbital tumor that molds to and encases orbital structures.

The diagnosis can be done clinically with the characteristic clinical hyperthyridism, restrictive nature of the disease and associated systemic thyroid disease. This, in turn, slows your metabolism, which can lead to weight gain. Both men and women demonstrate a bimodal pattern of age of diagnosis. The opposite of an overactive thyroid is, logically, an underactive thyroid.

Medically reviewed by Deborah Weatherspoon, Ph. Intravenous IV corticosteroids pulse methyl prednisolone can be considered as an alternative. PMID: It is not possible to have both hypothyroidism and hyperthyroidism at the same time.

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It also may present as mass effect. Second hand exposure to smoke has the hyperthyroidiwm effect as active smoking and should be avoided. These procedures are performed by an eye specialist called an ophthalmologist. Retrobulbar and subconjunctival application of steroids is not commonly performed due to side effects and lack of efficacy. Biochemical evaluation for thyroid and pituitary was within normal range.

Axe on Facebook 2. Cigarette smoking and thyroid eye disease: a systematic review. Rituximab for thyroid eye disease. Orbital Radiation: Can be used alone or in conjunction with corticosteroids The radiation therapy works on the similar mechanism of decreasing inflammation. Josh Axe is on a mission to provide you and your family with the highest quality nutrition tips and healthy recipes in the world

Computed tomography CT scan: This type of imaging without contrast may distinguish normal structures from abnormal structures of different tissue density. Hypothyroidism Treatment Hyperthyroidism vs. J Ophthalmol.

Hyperthyroidism vs. Surgery may be another conventional recommendation as a last resort to remove all or part of the thyroid if anti-thyroid medications do not work. For diplopia, Fresnel prisms or occlusion therapy may be considered. Orbital Radiation: Can be used alone or in conjunction with corticosteroids The radiation therapy works on the similar mechanism of decreasing inflammation.

Wang Y, Smith TJ. Gulati S, et al. Graves Lower Eyelid Retraction. N Engl J Med. Reddy SV, et al. Article Google Scholar Eye Lond.

Eye involvement must be evaluated on a continuing basis by an ophthalmologist during the active phase of the disease and, if necessary, treated. The concept of anterior globe displacement as a mechanism for eyelid retraction resulting from proptosis is demonstrated by improvement of eyelid retraction following surgical correction of proptosis [ 243031 ]. About this article. In more advanced cases, patient may complain eye socket orbital pain, double vision, or blurred vision.

MJ hgperthyroidism responsible for writing Case 2 and part of the discussion as well as editing of ophthalmopathy in hyperthyroidism vs hypothyroidism. Cholesterol concerns? Products and services. This causes activation of T lymphocytes with subsequent release of inflammatory mediators 9. Full size image. These complications are not common when the dose is properly divided and the eyes are closed. One study reported a positive effect in mild disease after a 6-month exposure to mcg daily dosage [ 67 ].

  • Upper eyelid retraction is the most common clinical sign in TAO.

  • What are the signs and symptoms of hyperthyroidism and hypothyroidism?

  • Clin Endocrinol Oxf ; 67 — Immunosuppressive Therapies Due to the autoimmune mechanism of TAO, various immunosuppressive drugs such as cyclosporin, azathioprine, and cyclophosphamide, as well as immunomodulatory agents like ciamexon have been used in treatment.

  • Radiation therapy RT has been reassessed recently in combination with GCs and was found to improve symptoms more than GCs alone [ 75 ].

Inflammation of the OS and dry eye are frequently associated with TAO, sometimes preceding hypothyriidism changes crp high sensitivity and hypothyroidism 4243 ]. Moreover, smoking leads to delayed and reduced response to ophthalmopathy treatment. Conclusion: Our cases and discussion describe some other conditions that clinically mimic TAO and the importance of pursuing further work-up for accurate diagnosis when presentation of orbitopathy is atypical. Show more related content.

So once the hormone stores are depleted, hypothyroidism develops. Having an underactive hypothyroidism can decrease or slow down your bodily functions. Stan goes on to explain that there are two types of thyroiditis, subacute thyroiditis and silent thyroiditis. There are clear differences in hypothyroidism vs. Were you recently diagnosed with hypothyroidism? PMID: In rare cases the roof of the orbit may also be decompressed surgically.

Botulinum A toxin injection for restrictive myopathy of thyroid-related orbitopathy: effects on intraocular pressure. Hypothyroidiem orbitopathy: correlation of CT and clinical findings. External link. Factors which may lead to surgical failure are tightness and hemorrhagic tendency of the extraocular muscles, potential postoperative scarring, and restricted access to the surgical area due to lid edema. Cyclosporin acts by inhibiting cytotoxic T lymphocyte activation and antigen presentation by monocyte and macrophages, which in turn activates suppressor T lymphocytes and inhibits cytokine production.

  • Eye movements are restricted due to edema that occurs in the extraocular muscles during the infiltrative stage and the subsequent fibrosis.

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  • Axe on Twitter 22 Dr. This is according to Marius Stan, M.

Medically reviewed by Alana Biggers, M. Medically reviewed by Deborah Weatherspoon, Ph. Page information. Magnetic resonance imaging MRI : Fusiform rectus enlargement and orbital fat expansion may be identified. Enroll in the Residents and Fellows contest. Jirawuthiworavong, M.

It is an immune disorder causing inflammation and expansion of orbital fat and muscle. Pract Radiat Oncol. Rehabilitative surgeries are often needed after treatment. Strabismus after balanced medial plus lateral wall versus lateral wall only orbital decompression for dysthyroid orbitopathy.

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