Grave Clinicopathologic Correlation: A Case of Hyperthyroxinemia
Bibliographic record
Abstract
A family physician ordered a set of laboratory investigations to rule out treatable causes of fatigue and a sensation of coldness in a 16-year-old female who had been previously well. The investigations included a borderline low thyroid-stimulating hormone (TSH)3 [0.41 mU/L, reference interval (RI) 0.51–4.3 mU/L] and increased free thyroxine (fT4) measurement of 3.42 ng/dL (44 pmol/L) (RI 0.85–1.71 ng/dL). On the basis of the fT4 result, the family doctor repeated the tests and sent the patient to an endocrinologist for evaluation. The results on a sample collected 6 days later were similar, with a TSH of 0.49 mU/L and fT4 of 3.57 ng/dL (46 pmol/L). The endocrinologist assessed the patient 2 weeks later and found her to be clinically euthyroid with neither goiter nor Graves' ophthalmopathy. Nevertheless, the endocrinologist ordered repeated investigations of TSH and fT4 as well as free triiodothyronine (fT3) and markers of those autoimmune thyroid disorders, which could be associated with suppressed TSH and increased fT4. The new sample was collected 8 weeks after the original and results were as follows: TSH 0.68 mU/L, fT4 2.10 ng/dL (27 pmol/L), fT3 0.61 ng/dL (9.3 pmol/L) (RI 0.23–0.43 ng/dL), TSH receptor antibody (TSHRa) of 5 U/L (RI <1.8 U/L), and undetectable anti-thyroid peroxidase (anti-TPO) antibody. The clinical laboratory was …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".