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November 4, 1983, Vol 250, No. 17 >
ARTICLE | November 4, 1983

The Value of Serum Thyroglobulin Measurement in Clinical Practice FREE

Samuel Refetoff, MD; Eric G. Lever, MD
[+] Author Affiliations

Reprint requests to University of Chicago, 950 E 59th St, Chicago, IL 60637 (Dr Refetoff).


JAMA. 1983;250(17):2352-2357. doi:10.1001/jama.1983.03340170078037
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Published online
Article
References

Thyroglobulin (TG) is a normal constituent of serum detectable by radioimmunoassay in 75% to 90% of healthy adults. Levels are altered in a number of physiological and pathological conditions. Although the indications for serum TG measurements have not been clearly established, it is simple, inexpensive, and presents no risk of radiation exposure. Problems include variable sensitivity and reproducibility of assays, interference by TG autoantibodies, and changes induced by certain diagnostic or therapeutic interventions. Serum TG measurement is primarily used as a tumor marker in thyroid carcinoma. Values are almost invariably high with disseminated metastases. After total ablation of thyroid tissue, serum TG determination is useful in separating patients in remission from those with residual metastatic disease. Serial measurements in the same patients are useful in monitoring the effect of treatment of nonfunctioning thyroid metastases. It is of no proved value in the initial diagnosis of thyroid carcinoma. Controversy still exists regarding the advantages of measuring TG during hormonal therapy. The assay may aid in the diagnosis of thyrotoxicosis factitia, painless subacute thyroiditis, and neonatal hypothyroidism.

(JAMA 1983;250:2352-2357)

REFERENCES

1 +
Van Herle AJ, Uller RP, Matthews NL, et al:  Radioimmunoassay for measurement of thyroglobulin in human serum . J Clin Invest 1973;; 52:1320-1327.
2 +
Ochi Y, Hachiya T, Yoshimura M, et al:  Radioimmunoassay for estimation of thyroglobulin in human serum . Endocrinol Jpn 1975;; 22:351-356.
3 +
Bodlaender P, Arjonilla JR, Sweat R, et al:  A practical radioimmunoassay of thyroglobulin . Clin Chem 1978;;24:267-271.
4 +
Vassart G, Refetoff S, Brocas H, et al:  Translation of thyroglobulin 33S messenger RNA as a means of determining thyroglobulin quaternary structure . Proc Natl Acad Sci USA 1975;;72:3839-3843.
5 +
Vassart G:  Specific synthesis of thyroglobulin membrane bound thyroid ribosomes . FEBS Lett 1972;;22:53-56.
6 +
Ekholm R, Engstrom G, Ericson LE, et al:  Exocytosis of protein into the thyroid follicle lumen: An early effect of TSH . Endocrinology 1975;;97:337-346.
7 +
Daniel PM, Pratt OE, Roitt IM, et al:  Thyroglobulin in the lymph draining from the thyroid gland and in the peripheral blood of rats . Q J Exp Physiol 1967;;52:184-199.
8 +
Lo Gerfo P, Colaccho T, Colaccho D, et al:  Serum clearance rates of immunologically reactive thyroglobulin . Cancer 1978;;42:164-166.
9 +
Feldt-Rasmussen U, Petersen PH, Nielsen H, et al:  Thyroglobulin of varying molecular sizes with different disappearance rates in plasma following subtotal thyroidectomy . Clin Endocrinol 1978;;9:205-214.
10 +
Scherberg N, Vassart G, Lecocq R, et al:  Modulation of thyroglobulin messenger RNA accumulation in the rat thyroid . Endocrinology 1981;;109:1650-1656.
11 +
Davies E, Dumont JE, Vassart G:  Thyrotropin-stimulated recruitment of free monoribosome on to membrane-bound thyroglobulin synthesizing polyribosomes . Biochem J 1978;; 172:227-231.
12 +
Hashizume K, Fenzi G, DeGroot LJ:  Thyroglobulin inhibition of thyrotropin binding to thyroid plasma membrane . J Clin Endocrinol Metabol 1978;;46:679-685.
13 +
Schneider AB, Pervos R:  Radioimmunoassay of human thyroglobulin: Effect of antithyroglobulin antibodies . J Clin Endocrinol Metabol 1978;;47:126-137.
14 +
Ng Tang Fui SC, Hoffenberg R, Maisey M, et al:  Serum thyroglobulin concentrations and whole-body radioiodine scan in follow-up of differentiated thyroid cancer after thyroid ablation . Br Med J 1979;;2:298-300.
15 +
Castagnoli A, Cappelli G, D'Agata A, et al:  Can thyroglobulin assay really supplant radioiodine scans in patients with differentiated thyroid cancer? Lancet 1982;;1:573-574.
16 +
Roitt IM, Torrigiani G:  Identification and estimation of undegraded thyroglobulin in human serum . Endocrinology 1967;;81:421-429.
17 +
Black EG, Cassoni A, Gimlette TMD, et al:  Serum thyroglobulin in thyroid cancer . Br Med J 1981;;3:443-445.
18 +
Pacini F, Pinchera A, Giani F, et al:  Serum thyroglobulin in thyroid carcinoma and other thyroid disorders . J Endocrinol Invest 1980;; 3:283-292.
19 +
Pezzino V, Vigneri R, Squatrito S, et al:  Increased serum thyroglobulin levels in patients with nontoxic goiter . J Clin Endocrinol Metabol 1978;;46:653-657.
20 +
Schneider AB, Favus MJ, Stachura ME, et al:  Plasma thyroglobulin in detecting thyroid carcinoma after childhood head and neck irradiation . Ann Intern Med 1977;;86:29-34.
21 +
Osotomehin B, Black EG, Hoffenberg R:  Thyroglobulin concentration in neonatal blood: A possible test for neonatal hypothyroidism . Br Med J 1978;;2:1467-1468.
22 +
Torrigiani G, Doniach D, Roitt IM:  Serum thyroglobulin levels in healthy subjects and in patients with thyroid disease . J Clin Endocrinol Metabol 1969;;29:305-314.
23 +
Pezzino V, Filetti S, Belfiore A, et al:  Serum thyroglobulin levels in the newborn . J Clin Endocrinol Metabol . 1981;;52:364-366.
24 +
Ket JL, de Vijlder JJM, Bikker H, et al:  Serum thyroglobulin levels: The physiological decrease in infancy and the absence in athyroidism . J Clin Endocrinol Metabol 1981;;58:1301-1303.
25 +
Shlossberg AH, Jacobson JC, Ibbertson HK:  Serum thyroglobulin in the diagnosis and management of thyroid carcinoma . Clin Endocrinol 1979;;10:17-27.
26 +
Greenspan FS, Lew W, Okerlund MD, et al:  Falsely positive bovine TSH radioimmunoassay responses in sera from patients with thyroid cancer . J Clin Endocrinol Metabol 1974;;38:1121-1122.
27 +
Van Herle AJ, Uller RP:  Elevated serum thyroglobulin: A marker of metastases in differentiated thyroid carcinoma . J Clin Invest 1975;; 56:272-277.
28 +
LoGerfo P, Collacchio T, Colacchio D, et al:  Thyroglobulin in benign and malignant thyroid disease . JAMA 1979;;241:923-925.
29 +
Shah DH, Dandekar SR, Jeevanram RK, et al:  Serum thyroglobulin in differentiated thyroid carcinoma: Histological and metastatic classification . Acta Endocrinol 1981;;98:222-226.
30 +
Schlumberger M, Charbord P, Fragu P, et al:  Circulating thyroglobulin and thyroid hormones in patients with metastases of differentiated thyroid carcinoma: Relationship to serum thyrotropin levels . J Clin Endocrinol Metabol 1980;;51:513-519.
31 +
Lever EG, Refetoff S, Scherberg NH, et al:  The influence of percutaneous fine needle aspiration on serum thyroglobulin . J Clin Endocrinol Metabol 1983;;56:26-29.
32 +
Bech K, Feldt-Rasmussen U, Bliddal H, et al:  The acute changes in thyroid stimulating immunoglobulins, thyroglobulin and thyroglobulin antibodies following subtotal thyroidectomy . Clin Endocrinol 1982;;16:235-242.
33 +
Schlumberger M, Fragu P, Parmentier C, et al:  Thyroglobulin assay in the follow-up of patients with differentiated thyroid carcinomas: Comparison of its value in patients with or without normal residual tissue . Acta Endocrinol 1981;;98:215-221.
34 +
Schneider AB, Line BR, Goldman JM, et al:  Sequential serum thyroglobulin determinations, 131I scans, and 131I uptakes after triiodothyronine withdrawal in patients with thyroid cancer . J Clin Endocrinol Metabol 1981;;53:1199-1206.
35 +
Colacchio TA, LoGerfo P, Colacchio DA, et al:  Radioiodine total body scan versus serum thyroglobulin levels in follow-up of patients with thyroid cancer . Surgery 1982;;91:42-45.
36 +
Barsano CP, Skosey C, DeGroot LJ, et al:  Serum thyroglobulin in the management of patients with thyroid cancer . Arch Intern Med 1982;;142:763-767.
37 +
Ashcraft MW, Van Herle AJ:  The comparative value of serum thyroglobulin measurements and iodine 131 total body scans in the follow-up study of patients with treated differentiated thyroid cancer . Am J Med 1981;;71:806-814.
38 +
Pacini F, Pinchera A, Giani C, et al:  Serum thyroglobulin concentrations and 131I whole body scans in the diagnosis of metastases from differentiated thyroid carcinoma (after thyroidectomy) . Clin Endocrinol 1980;;13:107-110.
39 +
Mariotti S, Martino E, Cupini C, et al:  Low serum thyroglobulin as a clue to the diagnosis of thyrotoxicosis factitia . N Engl J Med 1982;; 307:410-412.
40 +
Glinoer D, Puttemans N, Van Herle AJ:  Sequential study of the impairment of thyroid function in the early stages of subacute thyroiditis . Acta Endocrinol 1974;;77:26-34.
41 +
Izumi M, Larsen PR:  Correlation of sequential changes in serum thyroglobulin, triiodothyronine and thyroxine in patients with Graves' disease and subacute thyroiditis . Metabolism 1978;;27:449-460.
42 +
Fragu P, Rougier P, Schlumberger M, et al:  Evolution of thyroid 127I stores measured by x-ray fluorescence in subacute thyroiditis . J Clin Endocrinol Metabol 1982;;54:162-166.
43 +
Uller RP, Van Herle AJ:  Effect of therapy on serum thyroglobulin levels in patients with Graves' disease . J Clin Endocrinol Metabol 1978;; 46:747-755.
44 +
Gardner DF, Rothman J, Utiger RD:  Serum thyroglobulin in normal subjects and patients with hyperthyroidism due to Graves' disease: Effects of T3, iodide, 131I and antithyroid drugs . Clin Endocrinol 1979;;11:585-594.
45 +
Amino N, Hagen SR, Yamada N, et al:  Measurement of circulating thyroid microsomal antibodies by the tanned red cell hemagglutination technique: Its usefulness in the diagnosis of autoimmune thyroid diseases . Clin Endocrinol 1976;;5:115-125.
46 +
Van Herle AJ, Chopra IJ, Hershman JM, et al:  Serum thyroglobulin in inhabitants of an endemic goiter region of New Guinea . J Clin Endocrinol Metabol 1976;;43:512-516.
47 +
Van Voorthuizen WF, Dinsart C, Flavell RA, et al:  Abnormal cellular localization of thyroglobulin mRNA associated with hereditary congenital goiter and thyroglobulin deficiency . Proc Natl Acad Sci USA 1978;;75:74-78.
48 +
Lissitsky S, Torresani J, Burrow GN, et al:  Defective thyroglobulin export as a cause of congenital goiter . Clin Endocrinol 1975;;4:363-392.
49 +
Black EG, Bodden SJ, Hulse JA, et al:  Serum thyroglobulin in normal and hypothyroid neonates . Clin Endocrinol 1982;;16:267-274.
50 +
Uller RP, Van Herle AJ, Chopra IJ:  Comparison of alterations in circulating thyroglobulin, triiodothyronine and thyroxine in response to exogenous (bovine) and endogenous (human) thyrotropin . J Clin Endocrinol Metabol 1973;; 37:741-745.
51 +
Unger J, Van Heuverswyn B, Decoster C, et al:  Thyroglobulin and thyroid hormone release after intravenous administration of bovine thyrotropin in man . J Clin Endocrinol Metabol 1980;;51:590-593.
52 +
Van Herle AJ, Klandorf H, Uller RP:  A radioimmunoassay for serum rat thyroglobulin: Physiologic and pharmacological studies . J Clin Invest 1975;;56:1073-1081.
53 +
Sarne D, Bavokas K, Scherberg NH, et al:  Elevated serum thyroglobulin level in congenital thyroxine-binding globulin (TBG) deficiency . J Clin Endocrinol Metabol , in press.
54 +
Refetoff S, Salazar A, Smith TJ, et al:  The consequences of inappropriate treatment due to failure to recognize the syndrome of pituitary and peripheral tissue resistance to thyroid hormone . Metabolism , in press.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Van Herle AJ, Uller RP, Matthews NL, et al:  Radioimmunoassay for measurement of thyroglobulin in human serum . J Clin Invest 1973;; 52:1320-1327.
2 +
Ochi Y, Hachiya T, Yoshimura M, et al:  Radioimmunoassay for estimation of thyroglobulin in human serum . Endocrinol Jpn 1975;; 22:351-356.
3 +
Bodlaender P, Arjonilla JR, Sweat R, et al:  A practical radioimmunoassay of thyroglobulin . Clin Chem 1978;;24:267-271.
4 +
Vassart G, Refetoff S, Brocas H, et al:  Translation of thyroglobulin 33S messenger RNA as a means of determining thyroglobulin quaternary structure . Proc Natl Acad Sci USA 1975;;72:3839-3843.
5 +
Vassart G:  Specific synthesis of thyroglobulin membrane bound thyroid ribosomes . FEBS Lett 1972;;22:53-56.
6 +
Ekholm R, Engstrom G, Ericson LE, et al:  Exocytosis of protein into the thyroid follicle lumen: An early effect of TSH . Endocrinology 1975;;97:337-346.
7 +
Daniel PM, Pratt OE, Roitt IM, et al:  Thyroglobulin in the lymph draining from the thyroid gland and in the peripheral blood of rats . Q J Exp Physiol 1967;;52:184-199.
8 +
Lo Gerfo P, Colaccho T, Colaccho D, et al:  Serum clearance rates of immunologically reactive thyroglobulin . Cancer 1978;;42:164-166.
9 +
Feldt-Rasmussen U, Petersen PH, Nielsen H, et al:  Thyroglobulin of varying molecular sizes with different disappearance rates in plasma following subtotal thyroidectomy . Clin Endocrinol 1978;;9:205-214.
10 +
Scherberg N, Vassart G, Lecocq R, et al:  Modulation of thyroglobulin messenger RNA accumulation in the rat thyroid . Endocrinology 1981;;109:1650-1656.
11 +
Davies E, Dumont JE, Vassart G:  Thyrotropin-stimulated recruitment of free monoribosome on to membrane-bound thyroglobulin synthesizing polyribosomes . Biochem J 1978;; 172:227-231.
12 +
Hashizume K, Fenzi G, DeGroot LJ:  Thyroglobulin inhibition of thyrotropin binding to thyroid plasma membrane . J Clin Endocrinol Metabol 1978;;46:679-685.
13 +
Schneider AB, Pervos R:  Radioimmunoassay of human thyroglobulin: Effect of antithyroglobulin antibodies . J Clin Endocrinol Metabol 1978;;47:126-137.
14 +
Ng Tang Fui SC, Hoffenberg R, Maisey M, et al:  Serum thyroglobulin concentrations and whole-body radioiodine scan in follow-up of differentiated thyroid cancer after thyroid ablation . Br Med J 1979;;2:298-300.
15 +
Castagnoli A, Cappelli G, D'Agata A, et al:  Can thyroglobulin assay really supplant radioiodine scans in patients with differentiated thyroid cancer? Lancet 1982;;1:573-574.
16 +
Roitt IM, Torrigiani G:  Identification and estimation of undegraded thyroglobulin in human serum . Endocrinology 1967;;81:421-429.
17 +
Black EG, Cassoni A, Gimlette TMD, et al:  Serum thyroglobulin in thyroid cancer . Br Med J 1981;;3:443-445.
18 +
Pacini F, Pinchera A, Giani F, et al:  Serum thyroglobulin in thyroid carcinoma and other thyroid disorders . J Endocrinol Invest 1980;; 3:283-292.
19 +
Pezzino V, Vigneri R, Squatrito S, et al:  Increased serum thyroglobulin levels in patients with nontoxic goiter . J Clin Endocrinol Metabol 1978;;46:653-657.
20 +
Schneider AB, Favus MJ, Stachura ME, et al:  Plasma thyroglobulin in detecting thyroid carcinoma after childhood head and neck irradiation . Ann Intern Med 1977;;86:29-34.
21 +
Osotomehin B, Black EG, Hoffenberg R:  Thyroglobulin concentration in neonatal blood: A possible test for neonatal hypothyroidism . Br Med J 1978;;2:1467-1468.
22 +
Torrigiani G, Doniach D, Roitt IM:  Serum thyroglobulin levels in healthy subjects and in patients with thyroid disease . J Clin Endocrinol Metabol 1969;;29:305-314.
23 +
Pezzino V, Filetti S, Belfiore A, et al:  Serum thyroglobulin levels in the newborn . J Clin Endocrinol Metabol . 1981;;52:364-366.
24 +
Ket JL, de Vijlder JJM, Bikker H, et al:  Serum thyroglobulin levels: The physiological decrease in infancy and the absence in athyroidism . J Clin Endocrinol Metabol 1981;;58:1301-1303.
25 +
Shlossberg AH, Jacobson JC, Ibbertson HK:  Serum thyroglobulin in the diagnosis and management of thyroid carcinoma . Clin Endocrinol 1979;;10:17-27.
26 +
Greenspan FS, Lew W, Okerlund MD, et al:  Falsely positive bovine TSH radioimmunoassay responses in sera from patients with thyroid cancer . J Clin Endocrinol Metabol 1974;;38:1121-1122.
27 +
Van Herle AJ, Uller RP:  Elevated serum thyroglobulin: A marker of metastases in differentiated thyroid carcinoma . J Clin Invest 1975;; 56:272-277.
28 +
LoGerfo P, Collacchio T, Colacchio D, et al:  Thyroglobulin in benign and malignant thyroid disease . JAMA 1979;;241:923-925.
29 +
Shah DH, Dandekar SR, Jeevanram RK, et al:  Serum thyroglobulin in differentiated thyroid carcinoma: Histological and metastatic classification . Acta Endocrinol 1981;;98:222-226.
30 +
Schlumberger M, Charbord P, Fragu P, et al:  Circulating thyroglobulin and thyroid hormones in patients with metastases of differentiated thyroid carcinoma: Relationship to serum thyrotropin levels . J Clin Endocrinol Metabol 1980;;51:513-519.
31 +
Lever EG, Refetoff S, Scherberg NH, et al:  The influence of percutaneous fine needle aspiration on serum thyroglobulin . J Clin Endocrinol Metabol 1983;;56:26-29.
32 +
Bech K, Feldt-Rasmussen U, Bliddal H, et al:  The acute changes in thyroid stimulating immunoglobulins, thyroglobulin and thyroglobulin antibodies following subtotal thyroidectomy . Clin Endocrinol 1982;;16:235-242.
33 +
Schlumberger M, Fragu P, Parmentier C, et al:  Thyroglobulin assay in the follow-up of patients with differentiated thyroid carcinomas: Comparison of its value in patients with or without normal residual tissue . Acta Endocrinol 1981;;98:215-221.
34 +
Schneider AB, Line BR, Goldman JM, et al:  Sequential serum thyroglobulin determinations, 131I scans, and 131I uptakes after triiodothyronine withdrawal in patients with thyroid cancer . J Clin Endocrinol Metabol 1981;;53:1199-1206.
35 +
Colacchio TA, LoGerfo P, Colacchio DA, et al:  Radioiodine total body scan versus serum thyroglobulin levels in follow-up of patients with thyroid cancer . Surgery 1982;;91:42-45.
36 +
Barsano CP, Skosey C, DeGroot LJ, et al:  Serum thyroglobulin in the management of patients with thyroid cancer . Arch Intern Med 1982;;142:763-767.
37 +
Ashcraft MW, Van Herle AJ:  The comparative value of serum thyroglobulin measurements and iodine 131 total body scans in the follow-up study of patients with treated differentiated thyroid cancer . Am J Med 1981;;71:806-814.
38 +
Pacini F, Pinchera A, Giani C, et al:  Serum thyroglobulin concentrations and 131I whole body scans in the diagnosis of metastases from differentiated thyroid carcinoma (after thyroidectomy) . Clin Endocrinol 1980;;13:107-110.
39 +
Mariotti S, Martino E, Cupini C, et al:  Low serum thyroglobulin as a clue to the diagnosis of thyrotoxicosis factitia . N Engl J Med 1982;; 307:410-412.
40 +
Glinoer D, Puttemans N, Van Herle AJ:  Sequential study of the impairment of thyroid function in the early stages of subacute thyroiditis . Acta Endocrinol 1974;;77:26-34.
41 +
Izumi M, Larsen PR:  Correlation of sequential changes in serum thyroglobulin, triiodothyronine and thyroxine in patients with Graves' disease and subacute thyroiditis . Metabolism 1978;;27:449-460.
42 +
Fragu P, Rougier P, Schlumberger M, et al:  Evolution of thyroid 127I stores measured by x-ray fluorescence in subacute thyroiditis . J Clin Endocrinol Metabol 1982;;54:162-166.
43 +
Uller RP, Van Herle AJ:  Effect of therapy on serum thyroglobulin levels in patients with Graves' disease . J Clin Endocrinol Metabol 1978;; 46:747-755.
44 +
Gardner DF, Rothman J, Utiger RD:  Serum thyroglobulin in normal subjects and patients with hyperthyroidism due to Graves' disease: Effects of T3, iodide, 131I and antithyroid drugs . Clin Endocrinol 1979;;11:585-594.
45 +
Amino N, Hagen SR, Yamada N, et al:  Measurement of circulating thyroid microsomal antibodies by the tanned red cell hemagglutination technique: Its usefulness in the diagnosis of autoimmune thyroid diseases . Clin Endocrinol 1976;;5:115-125.
46 +
Van Herle AJ, Chopra IJ, Hershman JM, et al:  Serum thyroglobulin in inhabitants of an endemic goiter region of New Guinea . J Clin Endocrinol Metabol 1976;;43:512-516.
47 +
Van Voorthuizen WF, Dinsart C, Flavell RA, et al:  Abnormal cellular localization of thyroglobulin mRNA associated with hereditary congenital goiter and thyroglobulin deficiency . Proc Natl Acad Sci USA 1978;;75:74-78.
48 +
Lissitsky S, Torresani J, Burrow GN, et al:  Defective thyroglobulin export as a cause of congenital goiter . Clin Endocrinol 1975;;4:363-392.
49 +
Black EG, Bodden SJ, Hulse JA, et al:  Serum thyroglobulin in normal and hypothyroid neonates . Clin Endocrinol 1982;;16:267-274.
50 +
Uller RP, Van Herle AJ, Chopra IJ:  Comparison of alterations in circulating thyroglobulin, triiodothyronine and thyroxine in response to exogenous (bovine) and endogenous (human) thyrotropin . J Clin Endocrinol Metabol 1973;; 37:741-745.
51 +
Unger J, Van Heuverswyn B, Decoster C, et al:  Thyroglobulin and thyroid hormone release after intravenous administration of bovine thyrotropin in man . J Clin Endocrinol Metabol 1980;;51:590-593.
52 +
Van Herle AJ, Klandorf H, Uller RP:  A radioimmunoassay for serum rat thyroglobulin: Physiologic and pharmacological studies . J Clin Invest 1975;;56:1073-1081.
53 +
Sarne D, Bavokas K, Scherberg NH, et al:  Elevated serum thyroglobulin level in congenital thyroxine-binding globulin (TBG) deficiency . J Clin Endocrinol Metabol , in press.
54 +
Refetoff S, Salazar A, Smith TJ, et al:  The consequences of inappropriate treatment due to failure to recognize the syndrome of pituitary and peripheral tissue resistance to thyroid hormone . Metabolism , in press.

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