Time-Domain Heart Rate Variability in Coronary Artery Disease Patients Affected by Thyroid Dysfunction
Subclinical hypothyroidism and hyperthyroidism have been recognized as clinical entities with negative effects on the cardiovascular system. Moreover, the effect of treated thyroid dysfunction on parameters associated with the cardiovascular control system has been poorly investigated. In the presen...
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| Published in | International Heart Journal Vol. 55; no. 1; pp. 33 - 38 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Japan
International Heart Journal Association
2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1349-2365 1349-3299 1349-3299 |
| DOI | 10.1536/ihj.13-198 |
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| Abstract | Subclinical hypothyroidism and hyperthyroidism have been recognized as clinical entities with negative effects on the cardiovascular system. Moreover, the effect of treated thyroid dysfunction on parameters associated with the cardiovascular control system has been poorly investigated. In the present study we analyzed time-domain heart rate variability in coronary artery disease (CAD) patients with known thyroid diseases. Twenty-four hour ECG monitoring was performed in 344 patients with coronary artery disease (174 with thyroid dysfunction and 170 without thyroid dysfunction used as a control group), using a 3-channel tape recorder. Time domain parameters of heart rate variability (HRV) were definitely lower both in patients with subclinical hypothyroidism and subclinical hyperthyroidism than in the control group, with statistically significant differences in SDNN, RMSSD, TINN, and mean RR for both subgroups. Furthermore, patients on L-thyroxine treatment and restored euthyroidism had generally higher HRV values than patients with subclinical hypothyroidism, nevertheless SDNN, RMSSD, SDNN index, TINN, and mean RR were signifi cantly lower when compared to those of the control group. Significant differences in HRV were also found between hyperthyroid patients under treatment and control group subjects with respect to RMSSD, TINN, and mean RR values. In conclusion, patients with cardiac disease and known thyroid disease, even when the disease is in the subclinical range or despite treatment, should be regarded as patients at additional risk conveyed by thyroid hormone disturbances. |
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| AbstractList | Subclinical hypothyroidism and hyperthyroidism have been recognized as clinical entities with negative effects on the cardiovascular system. Moreover, the effect of treated thyroid dysfunction on parameters associated with the cardiovascular control system has been poorly investigated. In the present study we analyzed time-domain heart rate variability in coronary artery disease (CAD) patients with known thyroid diseases. Twenty-four hour ECG monitoring was performed in 344 patients with coronary artery disease (174 with thyroid dysfunction and 170 without thyroid dysfunction used as a control group), using a 3-channel tape recorder. Time domain parameters of heart rate variability (HRV) were definitely lower both in patients with subclinical hypothyroidism and subclinical hyperthyroidism than in the control group, with statistically significant differences in SDNN, RMSSD, TINN, and mean RR for both subgroups. Furthermore, patients on L-thyroxine treatment and restored euthyroidism had generally higher HRV values than patients with subclinical hypothyroidism, nevertheless SDNN, RMSSD, SDNN index, TINN, and mean RR were signifi cantly lower when compared to those of the control group. Significant differences in HRV were also found between hyperthyroid patients under treatment and control group subjects with respect to RMSSD, TINN, and mean RR values. In conclusion, patients with cardiac disease and known thyroid disease, even when the disease is in the subclinical range or despite treatment, should be regarded as patients at additional risk conveyed by thyroid hormone disturbances. Subclinical hypothyroidism and hyperthyroidism have been recognized as clinical entities with negative effects on the cardiovascular system. Moreover, the effect of treated thyroid dysfunction on parameters associated with the cardiovascular control system has been poorly investigated. In the present study we analyzed time-domain heart rate variability in coronary artery disease (CAD) patients with known thyroid diseases. Twenty-four hour ECG monitoring was performed in 344 patients with coronary artery disease (174 with thyroid dysfunction and 170 without thyroid dysfunction used as a control group), using a 3-channel tape recorder. Time domain parameters of heart rate variability (HRV) were definitely lower both in patients with subclinical hypothyroidism and subclinical hyperthyroidism than in the control group, with statistically significant differences in SDNN, RMSSD, TINN, and mean RR for both subgroups. Furthermore, patients on L-thyroxine treatment and restored euthyroidism had generally higher HRV values than patients with subclinical hypothyroidism, nevertheless SDNN, RMSSD, SDNN index, TINN, and mean RR were significantly lower when compared to those of the control group. Significant differences in HRV were also found between hyperthyroid patients under treatment and control group subjects with respect to RMSSD, TINN, and mean RR values. In conclusion, patients with cardiac disease and known thyroid disease, even when the disease is in the subclinical range or despite treatment, should be regarded as patients at additional risk conveyed by thyroid hormone disturbances. |
| Author | Guasti, Luigina Savulescu, Ioana Pelissero, Gabriele Bozzini, Sara Vailati, Alberto Falcone, Colomba Matrone, Benedetta Colonna, Anna Falcone, Rossana Benzi, Alberto |
| Author_xml | – sequence: 1 fullname: Guasti, Luigina organization: Department of Clinical and Experimental Medicine, University of Insubria – sequence: 1 fullname: Vailati, Alberto organization: Department of Endocrinology, Istituti Clinici di Pavia e Vigevano, University Hospital – sequence: 1 fullname: Falcone, Colomba organization: IRCCS San Donato Hospital – sequence: 1 fullname: Colonna, Anna organization: Department of Cardiology, Istituti Clinici di Pavia e Vigevano, University Hospital – sequence: 1 fullname: Bozzini, Sara organization: Interdepartmental Center of Research in Molecular Medicine (CIRMC), University of Pavia – sequence: 1 fullname: Pelissero, Gabriele organization: IRCCS San Donato Hospital – sequence: 1 fullname: Falcone, Rossana organization: Interdepartmental Center of Research in Molecular Medicine (CIRMC), University of Pavia – sequence: 1 fullname: Benzi, Alberto organization: Department of Cardiology, Istituti Clinici di Pavia e Vigevano, University Hospital – sequence: 1 fullname: Savulescu, Ioana organization: Department of Endocrinology, Istituti Clinici di Pavia e Vigevano, University Hospital – sequence: 1 fullname: Matrone, Benedetta organization: Department of Cardiology, Istituti Clinici di Pavia e Vigevano, University Hospital |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24463923$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_3390_ijerph20021542 crossref_primary_10_4103_jfmpc_jfmpc_845_23 crossref_primary_10_1371_journal_pone_0269277 crossref_primary_10_1590_1414_431x20187704 crossref_primary_10_3389_fphys_2023_1212775 crossref_primary_10_3390_ijerph19063606 crossref_primary_10_23736_S0026_4725_20_05153_1 crossref_primary_10_1016_j_eprac_2024_05_010 crossref_primary_10_3389_fcvm_2025_1508805 crossref_primary_10_1007_s00380_016_0826_x crossref_primary_10_1186_s13104_018_3224_x crossref_primary_10_7759_cureus_24378 crossref_primary_10_1590_1414_431x20198417 crossref_primary_10_1016_j_resp_2014_10_003 crossref_primary_10_1111_jch_13536 crossref_primary_10_3390_biomedicines10081982 crossref_primary_10_3390_diagnostics14121261 crossref_primary_10_1186_s13104_018_3922_4 |
| Cites_doi | 10.1152/ajpheart.1994.267.2.H821 10.2147/vhrm.2006.2.4.499 10.1159/000097013 10.1016/0026-0495(76)90126-8 10.1111/j.1365-2265.2006.02514.x 10.1093/oxfordjournals.eurheartj.a014868 10.1016/S0002-9149(97)00350-0 10.1530/eje.0.1430327 10.1089/thy.1997.7.411 10.1055/s-2007-978927 10.1038/sj.jhh.1002091 10.1530/eje.0.1450691 10.1210/jc.2008-0080 10.1016/j.biopha.2006.07.009 10.1111/j.1475-097X.1987.tb00172.x 10.1016/j.amjcard.2004.04.061 10.1001/jama.2010.1361 10.1046/j.1540-8167.2003.03078.x 10.1161/01.CIR.102.11.1239 10.1016/j.jacc.2012.03.047 10.1093/ajh/2.3.112S 10.1210/jc.2006-0414 10.1210/jc.2004-1554 10.1007/BF03347648 |
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| References | 17. Iqbal A, Figenschau Y, Jorde R. Blood pressure in relation to serum thyrotropin: The Tromsø study. J Hum Hypertens 2006; 20: 932-6. 22. Inukai T, Takanashi K, Kobayashi H, et al. Power spectral analysis of variations in heart rate in patients with hyperthyroidism or hypothyroidism. Horm Metab Res 1998; 30: 531-5. 27. Osman F, Franklyn JA, Daykin J, et al. Heart rate variability and turbulence in hyperthyroidism before, during, and after treatment. Am J Cardiol 2004; 94: 465-9. 4. Manhem P, Bramnert M, Hallengren B, Lecerof H, Werner R. Increased arterial and venous plasma noradrenaline levels in patients with primary hypothyroidism during hypothyroid as compared to euthyroid state. J Endocrinol Invest 1992; 15: 763-5. 30. Dörr M, Wolff B, Robinson DM, et al. The association of thyroid function with cardiac mass and left ventricular hypertrophy. J Clin Endocrinol Metab 2005; 90: 673-7. 28. Chen JL, Chiu HW, Tseng YJ, Chu WC. Hyperthyroidism is characterized by both increased sympathetic and decreased vagal modulation of heart rate: evidence from spectral analysis of heart rate variability. Clin Endocrinol 2006; 64: 611-6. 8. La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet 1998; 351: 478-84. 1. Coulombe P, Dussault JH, Walker P. Plasma catecholamine concentrations in hyperthyroidism and hypothyroidism. Metabolism 1976; 25: 973-9. 18. Rodondi N, den Elzen WP, Bauer DC, et al; Thyroid Studies Collaboration. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 2010; 304: 1365-74. 16. Lekakis J, Papamichael C, Alevizaki M, et al. Flow-mediated, endothelium-dependent vasodilation is impaired in subjects with hypothyroidism, borderline hypothyroidism, and high-normal serum thyrotropin (TSH) values. Thyroid 1997; 7: 411-4. 11. Cacciatori V, Gemma ML, Bellavere F, et al. Power spectral analysis of heart rate in hypothyroidism. Eur J Endocrinol 2000; 143: 327-33. 3. Guasti L, Marino F, Cosentino M, et al. Changes in autonomic modulation to the heart and intracellular catecholamines. A longitudinal study in differentiated thyroid carcinoma during short-term hypothyroidism and thyroid hormone replacement. Horm Res 2007; 67: 171-8. 25. Stein PK, Kleiger RE, Rottman JN. Differing effect of age on heart rate variability in men and women. Am J Cardiol 1997; 80: 302-5. 20. Mayer O Jr, Simon J, Filipovský J, Plásková M, Pikner R. Hypothyroidism in coronary heart disease and its relation to selected risk factors. Vas Health Risk Manag 2006; 2: 499-506. 29. Eustatia-Rutten CF, Corssmit EP, Heemstra KA, et al. Autonomic nervous system function in chronic exogenous subclinical thyrotoxicosis and the effect of restoring euthyroidism. J Clin Endocrinol Metab 2008; 93: 2835-41. 2. Insel PA. Adrenergic receptors. Evolving concepts on structure and function. Am J Hypertens 1989; 2: 112S-8S. (Review) 23. Xing H, Shen Y, Chen H, Wang Y, Shen W. Heart rate variability and its response to thyroxine replacement therapy in patients with hypothyroidism. Chin Med J 2001; 114: 906-8. 5. Matsukawa K, Wall PT, Wilson LB, Mitchell JH. Reflex stimulation of cardiac sympathetic nerve activity during static muscle contraction in cats. Am J Physiol 1994; 267: H821-7. 24. Bonnemeier H, Richardt G, Potratz J, et al. Circadian profile of cardiac autonomic nervous modulation in healthy subjects: differing effects of aging and gender on heart rate variability. J Cardiovasc Electrophysiol 2003; 14: 791-9. 12. Tseng FY, Lin WY, Lin CC, et al. Subclinical hypothyroidism is associated with increased risk for all-cause and cardiovascular mortality in adults. J Am Coll Cardiol 2012; 60: 730-7. 10. Petretta M, Bonaduce D, Spinelli L, et al. Cardiovascular haemodynamics and cardiac autonomic control in patients with subclinical and overt hyperthyroidism. Eur J Endocrinol 2001; 145: 691-6. 15. Saravanan P, Visser TJ, Dayan CM. Psychological well-being correlates with free thyroxine but not free 3,5,3’-triiodothyronine levels in patients on thyroid hormone replacement. J Clin Endocrine Metab 2006; 91: 3389-93. 6. Vagn Nielsen H, Hasselström K, Feldt-Rasmussen U, et al. Increased sympathetic tone in forearm subcutaneous tissue in primary hypothyroidism. Clinical Physiology 1987; 7: 297-302. 26. Guasti L, Grimoldi P, Mainardi LT, et al. Autonomic function and baroreflex sensitivity during a normal ovulatory cycle in humans. Acta Cardiol 1999; 54: 209-13. 19. Galetta F, Franzoni F, Fallahi P, et al. Heart rate variability and QT dispersion in patients with subclinical hypothyroidism. Biomed Pharmacother 2006; 60: 425-30. 21. Földes J, Istvánfy M, Halmágyi M, Váradi A, Gara A, Pártos O. Hypothyroidism and the heart. Examination of left ventricular function in subclinical hypothyroidism. Acta Med Hung 1978; 44: 337-47. 7. Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 1996; 17: 354-81. 9. Dekker JM, Crow RS, Folsom AR, et al. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis Risk In Communities. Circulation 2000; 102: 1239-44. 14. Asvold BO, Vatten LJ, Nilsen TI, Bjøro T. The association between TSH within the reference range and serum lipid concentration in a populationbased study. The HUNT Study. Eur J Endocrinol 2007; 156: 181-6. 13. Collet TH, Gussekloo J, Bauer DC, et al; Thyroid Studies Collaboration. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med 2012; 172: 799-809. (Review) 22 23 24 25 26 27 28 29 30 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 20 21 |
| References_xml | – reference: 20. Mayer O Jr, Simon J, Filipovský J, Plásková M, Pikner R. Hypothyroidism in coronary heart disease and its relation to selected risk factors. Vas Health Risk Manag 2006; 2: 499-506. – reference: 14. Asvold BO, Vatten LJ, Nilsen TI, Bjøro T. The association between TSH within the reference range and serum lipid concentration in a populationbased study. The HUNT Study. Eur J Endocrinol 2007; 156: 181-6. – reference: 18. Rodondi N, den Elzen WP, Bauer DC, et al; Thyroid Studies Collaboration. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 2010; 304: 1365-74. – reference: 28. Chen JL, Chiu HW, Tseng YJ, Chu WC. Hyperthyroidism is characterized by both increased sympathetic and decreased vagal modulation of heart rate: evidence from spectral analysis of heart rate variability. Clin Endocrinol 2006; 64: 611-6. – reference: 21. Földes J, Istvánfy M, Halmágyi M, Váradi A, Gara A, Pártos O. Hypothyroidism and the heart. Examination of left ventricular function in subclinical hypothyroidism. Acta Med Hung 1978; 44: 337-47. – reference: 9. Dekker JM, Crow RS, Folsom AR, et al. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis Risk In Communities. Circulation 2000; 102: 1239-44. – reference: 24. Bonnemeier H, Richardt G, Potratz J, et al. Circadian profile of cardiac autonomic nervous modulation in healthy subjects: differing effects of aging and gender on heart rate variability. J Cardiovasc Electrophysiol 2003; 14: 791-9. – reference: 5. Matsukawa K, Wall PT, Wilson LB, Mitchell JH. Reflex stimulation of cardiac sympathetic nerve activity during static muscle contraction in cats. Am J Physiol 1994; 267: H821-7. – reference: 12. Tseng FY, Lin WY, Lin CC, et al. Subclinical hypothyroidism is associated with increased risk for all-cause and cardiovascular mortality in adults. J Am Coll Cardiol 2012; 60: 730-7. – reference: 25. Stein PK, Kleiger RE, Rottman JN. Differing effect of age on heart rate variability in men and women. Am J Cardiol 1997; 80: 302-5. – reference: 30. Dörr M, Wolff B, Robinson DM, et al. The association of thyroid function with cardiac mass and left ventricular hypertrophy. J Clin Endocrinol Metab 2005; 90: 673-7. – reference: 6. Vagn Nielsen H, Hasselström K, Feldt-Rasmussen U, et al. Increased sympathetic tone in forearm subcutaneous tissue in primary hypothyroidism. Clinical Physiology 1987; 7: 297-302. – reference: 3. Guasti L, Marino F, Cosentino M, et al. Changes in autonomic modulation to the heart and intracellular catecholamines. A longitudinal study in differentiated thyroid carcinoma during short-term hypothyroidism and thyroid hormone replacement. Horm Res 2007; 67: 171-8. – reference: 27. Osman F, Franklyn JA, Daykin J, et al. Heart rate variability and turbulence in hyperthyroidism before, during, and after treatment. Am J Cardiol 2004; 94: 465-9. – reference: 8. La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet 1998; 351: 478-84. – reference: 15. Saravanan P, Visser TJ, Dayan CM. Psychological well-being correlates with free thyroxine but not free 3,5,3’-triiodothyronine levels in patients on thyroid hormone replacement. J Clin Endocrine Metab 2006; 91: 3389-93. – reference: 23. Xing H, Shen Y, Chen H, Wang Y, Shen W. Heart rate variability and its response to thyroxine replacement therapy in patients with hypothyroidism. Chin Med J 2001; 114: 906-8. – reference: 11. Cacciatori V, Gemma ML, Bellavere F, et al. Power spectral analysis of heart rate in hypothyroidism. Eur J Endocrinol 2000; 143: 327-33. – reference: 7. Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 1996; 17: 354-81. – reference: 1. Coulombe P, Dussault JH, Walker P. Plasma catecholamine concentrations in hyperthyroidism and hypothyroidism. Metabolism 1976; 25: 973-9. – reference: 22. Inukai T, Takanashi K, Kobayashi H, et al. Power spectral analysis of variations in heart rate in patients with hyperthyroidism or hypothyroidism. Horm Metab Res 1998; 30: 531-5. – reference: 10. Petretta M, Bonaduce D, Spinelli L, et al. Cardiovascular haemodynamics and cardiac autonomic control in patients with subclinical and overt hyperthyroidism. Eur J Endocrinol 2001; 145: 691-6. – reference: 29. Eustatia-Rutten CF, Corssmit EP, Heemstra KA, et al. Autonomic nervous system function in chronic exogenous subclinical thyrotoxicosis and the effect of restoring euthyroidism. J Clin Endocrinol Metab 2008; 93: 2835-41. – reference: 26. Guasti L, Grimoldi P, Mainardi LT, et al. Autonomic function and baroreflex sensitivity during a normal ovulatory cycle in humans. Acta Cardiol 1999; 54: 209-13. – reference: 19. Galetta F, Franzoni F, Fallahi P, et al. Heart rate variability and QT dispersion in patients with subclinical hypothyroidism. Biomed Pharmacother 2006; 60: 425-30. – reference: 16. Lekakis J, Papamichael C, Alevizaki M, et al. Flow-mediated, endothelium-dependent vasodilation is impaired in subjects with hypothyroidism, borderline hypothyroidism, and high-normal serum thyrotropin (TSH) values. Thyroid 1997; 7: 411-4. – reference: 2. Insel PA. Adrenergic receptors. Evolving concepts on structure and function. Am J Hypertens 1989; 2: 112S-8S. (Review) – reference: 13. Collet TH, Gussekloo J, Bauer DC, et al; Thyroid Studies Collaboration. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med 2012; 172: 799-809. (Review) – reference: 4. Manhem P, Bramnert M, Hallengren B, Lecerof H, Werner R. Increased arterial and venous plasma noradrenaline levels in patients with primary hypothyroidism during hypothyroid as compared to euthyroid state. J Endocrinol Invest 1992; 15: 763-5. – reference: 17. Iqbal A, Figenschau Y, Jorde R. Blood pressure in relation to serum thyrotropin: The Tromsø study. J Hum Hypertens 2006; 20: 932-6. – ident: 5 doi: 10.1152/ajpheart.1994.267.2.H821 – ident: 20 doi: 10.2147/vhrm.2006.2.4.499 – ident: 3 doi: 10.1159/000097013 – ident: 1 doi: 10.1016/0026-0495(76)90126-8 – ident: 28 doi: 10.1111/j.1365-2265.2006.02514.x – ident: 7 doi: 10.1093/oxfordjournals.eurheartj.a014868 – ident: 25 doi: 10.1016/S0002-9149(97)00350-0 – ident: 11 doi: 10.1530/eje.0.1430327 – ident: 16 doi: 10.1089/thy.1997.7.411 – ident: 22 doi: 10.1055/s-2007-978927 – ident: 14 – ident: 17 doi: 10.1038/sj.jhh.1002091 – ident: 10 doi: 10.1530/eje.0.1450691 – ident: 29 doi: 10.1210/jc.2008-0080 – ident: 19 doi: 10.1016/j.biopha.2006.07.009 – ident: 6 doi: 10.1111/j.1475-097X.1987.tb00172.x – ident: 27 doi: 10.1016/j.amjcard.2004.04.061 – ident: 26 – ident: 18 doi: 10.1001/jama.2010.1361 – ident: 24 doi: 10.1046/j.1540-8167.2003.03078.x – ident: 9 doi: 10.1161/01.CIR.102.11.1239 – ident: 12 doi: 10.1016/j.jacc.2012.03.047 – ident: 13 – ident: 2 doi: 10.1093/ajh/2.3.112S – ident: 15 doi: 10.1210/jc.2006-0414 – ident: 30 doi: 10.1210/jc.2004-1554 – ident: 4 doi: 10.1007/BF03347648 – ident: 8 – ident: 21 – ident: 23 |
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| SubjectTerms | Aged Aged, 80 and over Autonomic Autonomic Nervous System - physiopathology Cardiovascular risk Case-Control Studies Coronary Artery Disease - complications Female Heart Rate Humans Hyperthyroidism Hypothyroidism Male Middle Aged Regulation Thyroid Diseases - complications Thyroid Diseases - physiopathology |
| Title | Time-Domain Heart Rate Variability in Coronary Artery Disease Patients Affected by Thyroid Dysfunction |
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