Up Schmidt’s creek: When the right treatment goes wrong
Bibliographic record
Abstract
A 15-year-old girl, previously well, presented to her family physician with a 2-month history of fatigue and exercise intolerance. There was no history of fever, syncope, palpitations, wheezing, polyuria, polydipsia, constipation or cold intolerance. She had no sick contacts. Breast development began at 12 years but she had not experienced menarche. There were no medications or recreational drug use. Her father has type 1 diabetes mellitus and her maternal grandfather had acquired anemia. Investigations included elevated thyroid stimulating hormone (TSH) and low free T4. She was diagnosed with hypothyroidism. Levothyroxine was initiated at 50 μg (1.3 μg/kg) daily, thyroid function tests were repeated 6 weeks later without dose change. Over the ensuing 3 months, there was no symptomatic relief. Rather, she reported progressive fatigue, abdominal pain and 5 lbs weight loss. Three months later, she presented to our emergency department. Blood pressure was 92/60, heart rate was 90 bpm without orthostatic changes. Cardiovascular, respiratory, abdominal and neurologic exams were normal. TSH was 14 mIU/L (0.5 to 5.0); free T4 was 11.3 pmol/L (10.0 to 23.0). Complete blood count (CBC), C-reactive protein (CRP), glucose, electrolytes and urinalysis were normal. Levothyroxine was increased to 75 µg daily. Ten days later, she returned to the emergency department with hypotension and worsening fatigue. She was afebrile. Blood pressure was 72/44 without orthostatic change. Supine heart rate was 118 bpm and standing was 140 bpm. Thyroid examination was normal. Examination and further bloodwork confirmed the diagnosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.006 | 0.011 |
| Insufficient payload (model declined to judge) | 0.023 | 0.009 |
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 source (direct Gemma or distilled Codex), 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".