fluctuating tsh levels without medication

Pregnancy can affect thyroid hormones in many ways. This is felt to be a protective mechanism to conserve energy when your body is under extreme stress. Depending on the results of the blood tests, you may need other tests too. However, this test can often time be misleading, as levels of circulating hormones may fluctuate at different times, such as in Hashimoto's, the person affected may fluctuate between highs and lows. Hypothyroidism can affect the heart by slowing the heart rate. And patients who are in this situation feel frustrated because they are symptomatic with abnormal labs, but still arent getting treatment. And this process is controlled by these very important enzymes. A previously abnormal TSH level should be rechecked in, at minimum, 7 weeks or 2 month intervals until levels stabilize. Hashimoto's Disease and Blood Sugar Imbalance How Oxalates Impact Your Thyroid Health Hashimoto's Flare-Up: One Day Meal Plan As of last year, a brand new liquid formulation, Tirosint-SOL, became available in the U.S. It can affect the gastrointestinal system, too, causing less frequent bowel movements and constipation. If your thyroid isn't or cannot respond because it's compromised in some way, you'll produce more and more TSH. Total T4 and Total T3 levels measure bound and free thyroid hormone in the blood. In hypothyroidism, the thyroid gland doesn't respond fully to TSH, so not enough T3 and T4 reach the body's organs, and functions begin to slow. Signs and symptoms will be expected to progress without thyroid supplementation such as with. Hyperthyroidism may be treated with antithyroid meds (Methimazole, Propylthiouracil), radioactive iodine or surgery. TSH can actually be very helpful in initially diagnosing hypothyroidism and (sometimes) in helping to determine the ideal dose of thyroid hormone medication. But as I mentioned above it is important to consider that your pituitary is the MOST sensitive tissue to thyroid hormone in your body. level is far too high, indicating your thyroid is not sending out enough thyroid, to support your body. Assessment ofthyroidfunction duringpregnancy: the advantage of self-sequential longitudinal reference intervals. The amount of thyroid hormones your body makes is regulated by another hormone called thyroid stimulating hormone, or TSH, that's produced by the pituitary gland. 1 Since the case patient weighs 84 kg, the expected LT4 dosage would be around 125 to 150 g/d. This guide will walk you through everything you need to know about TSH including why it isnt always the best marker of thyroid function in the body and which conditions make the interpretation of TSH less accurate. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Thank you! But unless you check the reverse T3 level your free T4 may appear falsely normal despite the fact that your body is lacking thyroid hormone at the cellular level. Their effects are different from what's known as "Hashitoxicosis." #1. https://www.ncbi.nlm.nih.gov/books/NBK499850/, #2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578364/, #3. https://www.ncbi.nlm.nih.gov/pubmed/21415143, #4. https://www.ncbi.nlm.nih.gov/pubmed/21139124, #5. https://www.ncbi.nlm.nih.gov/pubmed/3051835, #6. https://www.ncbi.nlm.nih.gov/pubmed/16148345, #7. https://www.ncbi.nlm.nih.gov/pubmed/27051079, #8. https://www.ncbi.nlm.nih.gov/pubmed/2333963, #9. https://www.ncbi.nlm.nih.gov/pubmed/17991805, #10. https://www.ncbi.nlm.nih.gov/pubmed/21104580, #11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608008/, #12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC377492/, #13. https://www.ncbi.nlm.nih.gov/pubmed/19941233, #14. https://www.ncbi.nlm.nih.gov/pubmed/402379. She was a non-smoker and mother of two (last childbirth 2 years previously). Therefore, they may not raise the issue with their doctor or seek treatment., Your thyroid levels may also vary due to medication type, potency, and dosage. You start titration with Natural desiccated thyroid and after 2 months your TSH drops to 1.0 on 2 grains (130-135mg) of NDT. often is recommended. Is it normal for TSH levels to drop from 19 to 8 without Levothyroxine? What causes tsh level to go up and down without medication? So lab tests in this instance would look something like this: This pattern is seen very frequently in patients who are treated based on the TSH alone but have insulin/leptin resistance and/or a history of calorie-restricted dieting. Your TSH could be fluctuating because of anitbodies. Many women attribute their fatigue, weight gain, and brittle hair and nails to menopause instead of a thyroid issue. Get my free thyroid downloads, resources, and PDFs here. This can only be corrected by taking a daily pill of. It produces hormones that regulate your body's energy use, along with many other critical functions. It has a different set of deiodinases(3)(these are the enzymes that either activate or inactivate thyroid hormone). I have a tsh level of .31 T3 T4 are good I had unintentional weight loss of 80 lbs in 6 months have diabetes 2 and My A1C is 5.3 no medication for it is this part of the cause for my extreme weight loss my doctor just srugged it off help? Why do my TSH levels keep fluctuating? The first blood test is done six to eight This hormone is at the center of your digestive and . In your level of thyroid hormone. DEAR MAYO CLINIC: I recently was diagnosed with mild hypothyroidism that isn't causing symptoms. Some prescription meds that can influence thyroid hormones: We suggest regular monitoring of your thyroid function during the long-term use of any of the therapies listed above. Hyperthyroidism is diagnosed with a medical history, physical exam and blood tests. So why is it that this patient was obviously hypothyroid, but she was still able to produce somewhat normal thyroid lab tests? The second set of tests in February 2020 were: TSH = 18 / T4 = 1.0 . In this post, we will discuss why TSH levels are not the best way to evaluate your thyroid function, but more importantly, we are going to talk about how to actually assess thyroid function and which lab tests you need. 2022 Dr. Westin Childs | Thyroid & Health Supplements That Work Built withGeneratePress and powered by Kinsta. Reverse T3 may also be measured, however it is inactivated T3. The pituitary is a gland in your brain that attempts to tell your thyroid how much thyroid hormone to produce. To find the right dosage of levothyroxine for you, your health care provider checks your level of TSH about 6 to 8 weeks after you start taking the medicine. body. 1) TSH increased because of low T3 T3 is the active thyroid hormone. 1. Thirty-five years ago, fluctuating TSH levels were demonstrated and found to be at their highest in the middle of the night. Thyroid hormone doesnt do anything if its in your bloodstream. Due to the natural course of the condition, As a response to significant changes triggered by the treatment (such as, Competing with the body's thyroid hormone activity, Increasing the effects of thyroid hormones, Altering medication absorption and activity. Most conventional physicians use the TSH test to determine if one has a thyroid disorder and to dose thyroid medications. Are you having your thyroid tested at approx the same trime of day. Some herbal supplements and medications can have an impact on thyroid hormone levels. Learn which foods you should avoid if you have thyroid disease of any type. Patients have low T3 but the problem is that they have a relatively preserved TSH (in the normal or even optimal range), but free T3 levels that are either at the low end of the reference range or barely below it. Another subset of patients have what would be considered subclinical hypothyroidism where their TSH is absolutely elevated (even the conventionally trained physician would agree) but their free T4 is relatively preserved. In many instances, even when your treatment is at the correct dose, you may notice the following effects of disease progression: With Graves' disease, the opposite can happen, too. T4 ~ 1.0. Mary Shomon is a writer and hormonal health and thyroid advocate. So lets say you are convinced that your thyroid is suboptimal and youd like to prove it. Increased appetite. If your TSH is suppressed it will come back as < 0.005 or < 0.001 or something similar. #4. Foods to Avoid if you Have Thyroid Problems: Ive found that these 10 foods cause the most problems for thyroid patients. Hypothyroidism can affect the brain and lead to difficulty with concentration and memory. Need better symptom control? results. #2. What Do Herpes Sores Look Like at Different Stages. Welcome to my website! Something went wrong while submitting the form. Ask him to test TPO ab and Tg ab. Both rT3 and T3 can be used as sensitive markers for assessing thyroid disease severity because they become abnormal earlier than other thyroid lab tests. But other factors, such as hormonal changes and medication variations, or significant weight gain or loss, can alter your thyroid hormone levels as well; in some cases progression of a thyroid condition (such as a nodule) may be responsible. Newer studies have shown that the healthy TSH reference range should be between 0.3 and 2.5 mU/l (13). This leads to an adaptive state which reduces metabolic energy expenditure. T3 and T4 continues (referred to as overt hypothyroidism), it can affect many Other laboratory . This is where things can get a little more complicated. For several reasons (including pituitary sensitivity to thyroid hormone, hormone changes, and differences in thyroid medication) measuring the TSH isnt the most accurate thyroid lab test. One particular enzyme, known as D2, plays a major role in converting T4 into the active T3 hormone (8), especially at the cellular level. Do I take it or stop it? Standard treatment for hypothyroidism involves taking a daily oral medication called levothyroxine, a synthetic form of thyroid hormone. Remember that T4 is simply a reservoir hormone for T3. TRAb antibody levels can fluctuate widely and unexpectedly, and when they do, they can immediately begin to affect thyroid biochemistry. Hyperthyroidism is when an overactive gland produces too much thyroid hormone. Some people developthyroiditis after pregnancy. If hypothyroidism doesn't go away on its own within several months, then treatment is necessary. for several years, monitoring usually can switch to once a year. Yes, TSH can go back to normal. The big problem is that this condition is relatively new and our understanding is limited. Subclinical Hyperthyroidism: a mild form of hyperthyroidism where the only abnormal hormone level is a decreased TSH. Increasing doses of Synthroid or Levothyroxine will certainly drop the TSH (remember there is no competition for reverse T3 in the pituitary) but may actually make thyroid function in the peripheral tissues worse due to T4 to reverse T3 conversion. Its like the pituitary gland has one switch and its the on switch. For potential or actual medical emergencies, immediately call 911 or your local emergency service. And in case you are wondering here are other conditions that can cause Low T3 syndrome and put the brakes on your thyroid function: If so, then there is a good chance you may have low T3 syndrome which is causing hypothyroidism but NOT altering your TSH. After you receive a diagnosis and treatment plan, thyroid antibodies may continue to attack the thyroid gland. This liquid solution containing just three hypoallergenic ingredients (levothyroxine, glycerol, and water), is sold in single-dose ampules. However, medications can vary from one manufacturer to another. Often, people can decrease or discontinue these medications if and when the condition improves. Endocr Pract. 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. Data mining: seasonal and temperature fluctuations in thyroid-stimulating hormone. To Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. In order to find out if it is normal, we have to first understand what this test is actually testing for. Can cause variable TSH results. Keep your follow up appointment an As of february 2010, at most laboratories in the U.S., the official "normal" reference range for the thyroid stimulating hormone (TSH) blood test runs What causes tsh level to go up and down without medication? Variances such as a change in health plans, change in primary care physician, or change in thyroid medication formulations may lead to an adjustment in your thyroid medication dosage or potency. P.S. The last rsc 5month was 0.275. My TSH and Thyroglobulin numbers were way different from 4 months ago and I am wondering what they mean. Finding the right treatment and the proper dosage is a step-by-step process that takes time and requires monitoring. TSH levels change inversely with how much thyroid hormone is in your body. are checked every six months. What would cause TSH at 8 go down to a normal level a week and a half later withouth meds. Unfortunately, patients who fall into any of these categories tend to get misdiagnosed and/or mismanaged by providers who rely solely on TSH levels for diagnosis. This is what will happen to your thyroid gland over time assuming you dont treat the autoimmunity or inflammation, and it just doesnt make sense to wait until the damage is greater than 50% to prove it. Once you start thyroid medication several changes take place that alters these numbers and makes interpretation difficult unless you understand the physiology. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Suppression of thyroid-stimulating hormone (TSH) after thyroidectomy for low-risk cancer can increase the risk of osteoporosis in women without cutting back on cancer recurrence, according to. Also, keep in mind that prescription errors can occur. Generally, this means you will have to look outside of the insurance model (I know its not what you want to hear but its just the truth right now) because most Doctors practice what is known as the standard of care and that standard is to test only the TSH. To start with I have never seen a healthy individual with a TSH > 1.0. If you are on generic medication, work with your pharmacist to ensure that you always get medicines from the same generic manufacturer. Shakiness. Taking a closer look, you can clearly see that her other lab tests were indeed abnormal. Furthermore, elevated TSH levels have been observed with ageing. Why was the test ordered? It can also lead to irregular or missed periods. My white blood cells are whacked out at 2.5 (4.0-11.0) Doctor told me to get my thyroid tested once a year but another doctor said that would be crazy, I still need to keep getting it re-checked? So low levels of this hormone in your blood mean you will have low levels of active thyroid hormone despite whatever your TSH may be. Hereditary factors, gender, radiation exposure and pregnancy all influence a person's likelihood of getting Hashimoto's . My Dr. said it could be that the RAI treatment that I had several months ago is working or that she needed to reduce my medication, which she did by 1/2 a tablet. Assessment ofthyroidfunction duringpregnancy: the advantage of self-sequential longitudinal reference intervals. Check out my thyroid supplements. Thyroid disease can remain stable or worsen as the years go on. That blood test is repeated at regular intervals to monitor thyroid Treatment. This illustration helps explain (in addition to the differences in deiodinases, tissue level demands, etc.) Thyroid Hormone Preparation. and as you travel right on the X-axis, you can see how the lab tests change over time. In an attempt to oversimplify thyroid function and management, doctors have become reliant upon TSH testing. Some women have high prolactin levels without any symptoms. However, in some women, the increase can be too drastic, leading to hyperthyroidism. That means it is entirely possible to have a normal but less than optimal TSH. Since it's a signaling hormone, high TSH indicates that your body detects low hormone, so it's turning up the volume on the signal to make more. My wife is on thyroid medication, we are planning on starting a family. FT3 and FT4 are much more important than TSH. In women, during the menstruation cycle, pregnancy, or after menopause, TSH levels may fall slightly outside the normal range, because of fluctuating levels of estrogen. A partial thyroidectomy is a surgical operation in which only half of your thyroid gland is removed and should be compared to a complete thyroidectomy in which the entire thyroid gland is removed. They can produce a significant change in thyroid status within weeks or months. Read More We offer this Site AS IS and without any warranties. Want to know why I'm so passionate about these topics? Tests like free T3 and total T3? Why your TSH is fluxuating is another matter. I love to write and share what I've learned over the years. In general, normal TSH levels during pregnancy include: First trimester (9 to 12 weeks): 0.18 - 2.99 (uIU/mL). The TSH level is far too high, indicating your thyroid is not sending out enough thyroid hormone to support your body. Will the adjustment in medication cause the weight to drop off? Rapid or irregular pulse. The thyroid gland is a small butterfly-shaped gland in the front of the neck that makes the hormones triiodothyronine, or T3, and thyroxine, or T4. Alpha Lipoic Acid (ALA) and Thyroid Health: Is it Safe to Use? Without TSH, the system would fail. Do Not Sell or Share My Personal Information. In men, high prolactin levels can cause . TSH is a sensitive hormone that will respond to low thyroid hormone levels, it is important. I am a 57 year old female who has had hypothyroidism for 20 years. How likely would you say I am positive for hashi's I've never been tested yet. Patients with little or no residual thyroid function require replacement doses of LT4 at approximately 1.6 g/kg/d, based on lean body weight. During the exam, your health care provider may check for: Slight tremor in your fingers and hands. In addition to some types of drug-induced thyroid dysfunction, the differential diagnoses for a low TSH are: Graves' disease Toxic multinodular goiter Toxic adenoma Thyroiditis (silent, painful, de Quervain) Exogenous sources of thyroid hormone ingestion Non-thyroidal illness (euthyroid sick syndrome) Central hypothyroidism Food and exercise change would not help with this. Tsh is secreted in spurts and may vary depending upon when it's drawn. The following medications can cause your thyroid hormone levels to fluctuate: Oral contraceptives Iron, calcium or biotin supplements Anti-depressants Corticosteroids Cholesterol-lowering drugs It is important that you inform your doctor if you're taking any of these. Paloma Health helps to make that process easy and personalized. In the case of standard hyperthyroidism, your TSH decreases. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. At that point, For example, a 29-year-old woman may have normal TSH around 4.2 mU/L, while an 88-year-old man may reach 8.9 mU/L at their upper limits. The following table provides. But, as a result, its not well recognized by many providers or physicians who arent trained to identify or look for it despite the fact that it is highlighted in the medical literature. For people with thyroid disease, certain things can cause fluctuations in thyroid hormone levels. If the TSH level is elevated due to a thyroid related issue, you may need treatment. Hyperthyroidism and pregnancy. What causes blood pressure to go down while the heart rate goes up with exercise. Instead, each of the cells in your body has a different demand for thyroid hormone depending on the situation, time of day, stress you are under, etc. Thyroid disease can progress or stabilize as the year's pass due to any number of reasons: One of the most common contributing factors of fluctuation in your thyroid levels is your age. Without making it too complex the pituitary gland has only the enzyme which activates thyroid hormone. This can include whether or not you ate before your test, what time of day you take the test, and things like stress, diet, and sleep. She is the founder of the Center for Hormonal Health and Well-Being in San Diego, California. In cases of low T3, subclinical hypothyroidism, partial thyroidectomy, and autoimmune thyroiditis the TSH may NOT accurately reflect the thyroid status of your body. This is a big problem because T3 is the active thyroid hormone. Normal TSH Level in Adults. Alternations in thyroid hormone levels following growth hormone replacement exert complex biological effects. By these new standards, you can consider a TSH which is greater than 2.0 to be an early indicator of some thyroid dysfunction in the body. Understanding the way that these enzymes work is essential to understanding why treating TSH doesnt work for all people. I am 23 years old and My TSH level is 5.52 , if I donot take any medication , will that increase ? If the body is able to preserve thyroid function after a partial thyroidectomy (as evidenced above) then it is certainly able to preserve function if 10-50% of the thyroid gland is destroyed. To better understand what is happening in your body its best to visualize the thyroid lab tests over time on a chart. It restores the body's hormone levels to normal, which reverses the signs and symptoms of hypothyroidism. TSH can fluctuate when HypoT is developing - I can understand your doctor's point. and will that comes to control again ? Hypothyroidism They can be very helpful for the initial diagnosis and sometimes for management, but once you introduce thyroid hormone into the system exogenously (from the mouth) you have changed the dynamics of the system. determine the right dosage for you, your health care provider will regularly By using our website, you consent to our use of cookies. Alternating hyperthyroidism and hypothyroidism in Graves' disease. Her free T3 was at the low end of normal and her reverse T3 was greater than 15. T3, or triiodothyronine, is a thyroid hormone produced in small amounts by the thyroid gland. Does this mean I don't have Hashimotos anymore? HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. A 30-year-old woman presented for the first time in August 1990 with signs and symptoms of hypothyroidism: weight gain, fatigue, and muscle aches. That would explain a lot. Not only does it help you establish a habit and make it less likely for you to miss a dose, but it also ensures that you always take it in the same way. Taking your medication at the same time every day is essential. Leptin resistance and hypothyroidism both appear to be caused and sustained by calorie-restricted diets (chronic yo-yo dieting) which cause high reverse T3 and low free T3 levels leading to clinical hypothyroidism. She is the author of "The Thyroid Diet Revolution.". It's important to receive the correct amount of this This content is strictly the opinion of Dr. Westin Childs and is for educational and information purposes only. This can change or stop ovulation (the release of an egg from the ovary). If you are incredibly sick in the ICU of a hospital, does it make sense for your body to put energy into growing your hair follicles or making your nails strong? These hormonal drops cause your thyroid-stimulating hormone (TSH) to rise in response. metabolism slows down. It's the TSH levels that are the source of all the squabble among doctors. Often, over time, the thyroid hormones and TSH eventually return to normal. These fluctuations can occur as your thyroid disease progresses. Have you gone through the HCG diet or some other medically assisted weight loss program? As this enzyme increases in activity, it can do a lot with a little and it can make what little thyroid hormone you have more effective by keeping it active inside the cell. is the level too low? Some known interactions occur between thyroid medication and corticosteroids, cholesterol-lowering drugs, corticosteroids, amiodarone, and lithium. I would insist on antibody tests from your doc. The exact mechanism by which leptin and thyroid hormone are connected is not completely understood (you can read more about it here(12)), but one thing is certain: Leptin levels and thyroid function are connected. Hypothyroidism can affect many different systems in your body. Levels vary by time of day. All rights reserved. So one crucial tip is always to double-check your medication. Several factors can affect your TSH level, such as stress, lifestyle choices, medication, age, and thyroid function. That can lead to a rise in blood cholesterol, increasing the risk of heart disease and cardiovascular events, such as heart attack and stroke. However, many organizations agree that a reading of 2.5 or less is truly ideal for normal thyroid levels, with anything 2.5 - 4.0 mIU/L considered "at risk". Occasionally, the condition may resolve without treatment. However, during the period of thyroiditis, your doctor may prescribe thyroid hormone replacement or antithyroid medications. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. check your level of thyroid hormone. However, according to the American Thyroid Association, doctors generally consider levels are within a normal range between 0.4-4.0 milliunits per liter (mU/l). indicates that your Thyroid is not producing enough, ). Her tsh levels are 8, is it ok to start or wait till the tsh levels come down? Find inspiration for a healthy way to support your thyroid. In some cases, after months or years of taking antithyroid medications, your condition cango into remission. the condition may not produce any noticeable symptoms. That means if thyroid hormone is floating around in your body it will eventually make it to the thyroid gland which will cause your TSH to drop. The seasons - spring, summer, fall, winter - can affect your thyroid. It could becuased by a gland that is slowly eroding and functioning less and less each month or year, requiring small increases in meds every so often. If you have questions regarding your health you should seek qualified information from a medical professional or your doctor. But while some studies suggest that adding T3 to T4 may help weight loss, "it is not a skinny pill," says Dr . Step 1 Consult your doctor if you believe your TSH levels are high. DEFINITION: WHAT DO THE FOLLOWING PATIENTS OVER THE AGE OF 60 YEARS HAVE IN COMMON? This can occur if a person's TSH level is significantly elevated. Does a child with tsh level of 6.0 need medication? Potency tends to be reasonably stable within a particular brand name or generic manufacturer. Low T3 syndrome is exactly as it sounds. Arch Med Sci. There are several conditions where the TSH can be decidedly normal in fact it can even be sometimes < 1.0 but the patient can still be hypothyroid. A TSH measurement at 09.00 has been shown to strongly correlate with the total 24-hour TSH secretion, sampled at 10-minute intervals. And we are going to talk about it in detail below. Postpartum Thyroiditis and Related Issues After Pregnancy, Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement, Alternating hyperthyroidism and hypothyroidism in Graves' disease, Postpartum thyroiditis: management and treatment, Drugs that interact with thyroid medication, Data mining: seasonal and temperature fluctuations in thyroid-stimulating hormone, Alternations in thyroid hormone levels following growth hormone replacement exert complex biological effects. Too much levothyroxine can cause side effects, such as: Tiredness. If you plan to change how you take your thyroid medication, make sure you clear it with your healthcare provider first. If you are pregnant, it's normal for TSH levels to become slightly elevated. Fortunately, it is relatively easy to check for and just requires the complete thyroid panel which we will be going over below. The hypothalamus signals the pituitary gland, which sends thyroid-stimulating hormone (TSH) to the thyroid to trigger the release of thyroid hormones. However, when that happens, your T3 and T4 levels may decrease (while your TSH rises). Around this time is when the free T4 level also begins to drop as well below the normal range. These small, almond-shaped glands are located in the neck, near or behind the thyroid gland. weeks after you start taking the medication. Tshis 1.5 it can fluctuate 1.0 - 4.0. Your current TSH actually isn't "perfect" although in the middle of your reference range - around 1-1.5 (or at least below 2) would be. Around 10 years ago I was diagnosed with Hashimotos Diease and my TSH level was 13. So how does this fit in with the pituitary gland? The situation where patients have hypothyroid symptoms, normal lab tests but elevated antibodies to either Thyroglobulin or thyroid peroxidase. I like to think of it as the gas pedal to the car. Avoid the usual suspects like refined flour and processed foods. How your hormones respond over time depends on which type of thyroid disease you have. Have you gone through a calorie-restricted diet in your life? As part of the endocrine system, the thyroid gland makes and stores hormones that help regulate the body's metabolism in the form of blood pressure, blood temperature and heart rate.

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