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Since I am running a TSH of 3.43 (0.34 - 4.82) indicating hypothyroid can anyone explain my feeling warmer/hotter than everyone esle in the room. Also the slightest activity will cause me to start to sweat. I thought those were a symptom of hyperthyroid. I have many of the other classic hypo symptoms but many of these overlap with low T. I've also read in several places that low T can lead to hypothyroid. Can anyone confirm this?
Junior Member
When I first had my thyroid tested my TSH was around 23.00. I always felt cold. The only time I have ever felt hotter is when I started my testosterone therapy, and after a while I think my temperature went back to normal... Also there is a link between low T and hypothyroidism. Other more knowledgeable members can probably help define the link.
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Something else to add. I have been this way even as a child.
HRT
A. Wayne Meikle
Division of Endocrinology, University of Utah School of Medicine, Endocrine Testing Laboratory ARUP, Salt Lake City, Utah
ABSTRACT
Thyroid hormone deficiency affects all tissues of the body, including multiple endocrine changes that alter growth hormone, corticotrophin, glucocorticoids, and gonadal function. Primary hypothyroidism is associated with hypogonadotropic hypogonadism, which is reversible with thyroid hormone replacement therapy. In male children follicle-stimulating hormone (FSH) is elevated and associated with testicular enlargement without virilization. Men with primary hypothyroidism have subnormal responses of luteinizing hormone (LH) to gonadotropin-releasing hormone (GnRH) administration and normal response to human chorionic gonadotropin (hCG). Free testosterone concentrations are reduced in men with primary hypothyroidism and thyroid hormone replacement normalizes free testosterone concentrations. In men with primary hypothyroidism, prolactin is not consistently elevated (except in men and children with longstanding severe primary hypothyroidism), but prolactin declines following thyroid hormone replacement therapy. Thyroid hormone is known to affect sex hormone-binding hormonal globulin (SHBG) concentrations. Men with hyperthyroidism have elevated concentrations of testosterone and SHBG. Thyroid hormone therapy in normal men may also duplicate this elevation. In addition estradiol elevations are observed in men with hyperthyroidism, and gynecomastia is common in them as well. In contrast to patients with primary hypothyroidism, men with hyperthyroidism exhibit hyperresponsiveness of LH to GnRH administration and subnormal responses to hCG. Radioactive iodine therapy (RAI) of men treated for thyroid cancer produces a dose-dependent impairment of spermatogenesis and elevation of FSH up to approximately 2 years. Permanent testicular germ cell damage may occur in men treated with high doses of RAI. RAI commonly increases serum concentrations of FSH and LH while reducing inhibin B levels without affecting serum concentrations of testosterone. Thus, radioiodine therapy transiently impairs both germinal and Leydig cell function that usually recover by 18 months posttherapy.
Testicular dysfunction in men with primary hypothyroidism; reversal of hypogonadotrophic hypogonadism with replacement thyroxine.
Donnelly P, White C.
Source
Royal Prince Alfred Hospital, Camperdown; Liverpool District Hospital; Prince of Wales Hospital, Sydney, Australia.
Abstract
OBJECTIVE:
Primary hypothyroidism can cause disturbances in normal gonadal function. The aim of this study was to investigate the relationship in men between hypogonadism and primary hypothyroidism and the extent to which free and total testosterone levels rose after introduction of replacement thyroxine.
DESIGN:
Paired study of patients in a hypothyroid and thyroxine treated state.
PATIENTS:
Ten men with primary hypothyroidism.
MEASUREMENTS:
Free and total testosterone, gonadotrophin and prolactin levels before and after thyroxine replacement therapy.
RESULTS:
Low free testosterone levels (161 +/- 62 pmol/l) demonstrated at the time the men were hypothyroid rose significantly with the commencement of thyroxine replacement (315 +/- 141 pmol/l; P < 0.001). Gonadotrophin levels were not elevated consistent with hypogonadotrophic hypogonadism. Hyperprolactinaemia, which can occur in primary hypothyroidism and cause hypogonadotrophic hypogonadism, was not present in the majority of these patients. However a reduction in prolactin level was evident with thyroxine replacement and a rise in free testosterone levels.
CONCLUSION:
This suggests an effect of hypothyroidism on gonadotrophin secretion at the level of the hypothalamus-pituitary, either directly or through modulation of prolactin secretion. Low free testosterone may also be a contributing factor to some of the symptoms and signs of hypothyroidism in men.
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Thanks for the info. So the question I should be asking is; should I actively work on only one problem (and see if it corrects the other) or actively work both at the same time?Originally Posted by gdevine
Anabolic Member
A tsh of 3.45 is not hypo... Too much thyroid, hyper cause your temp to rise. Too little thyroid hormone, hypo, cause temp drop.
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That is what I thought originally also. But high TSH reading indicate hypothyroid and low TSH = hyperthyroid. TSH is high because your body is saying it needs more thyroid and uses TSH to tell the thyroid to make more. I think.
Anabolic Member
Right! your tsh is in the normal range.. that means that you are not hypo......
HRT
This is an error.
Thyroid Stimulating Hormone (produced by the Pituitary Gland) reference range is inverse to what we typically see.
The higher the TSH assay the lower Thyroid serum levels.
So a TSH assay of 3.45 is suggesting Hypothyroidism.
Anabolic Member
No bro. His tsh is in the normal range. Lab range he sites was 0.34-4.82.. he would be hypo with a higher tsh, over 4.82... since his tsh levels are in the range he is most likely not hypo.
HRT
Do some research on current understandings of TSH levels and lab reference ranges.
What you will see is that most now consider the current TSH reference lab ranges not reliable for proper diagnosis.
Anything over 2 suggests a problem and anything over 3 needs to be investigated.
Just do a Google search on "TSH Reference Ranges" and you will see for yourself.
Go to http://www.stopthethyroidmadness.com/ as well for additional information...http://www.stopthethyroidmadness.com...y-its-useless/
Read: http://thyroid.about.com/cs/testsfor...a/newrange.htm
Anabolic Member
Bro i dont need any research.. I have graves disease and have been dealing with this my whole life..
You are not paying attention to what I am saying.. We can talk all day about the accuracy of Lab ranges for TSH. When his TSH is above the top of the normal range, in this case above 4.82, he would be considered clinically hypo. the higher the tsh the more hypo. Some people are hypo at 3 some are hyper at 2? whats your point? His tsh is 3. ? . If it were me, i would want it a little lower but thats me. Based on the labs he is in the normal range! this is not rocket science not sure what you are arguing here.??
Anabolic Member
See bold.
What I am saying here is that you cannot make a general statement that anyone that has a tsh level of 3 is hypo! That is an uninformed satement. Diagnosis of thyroid hormone insufficiency, when levels are within the normal range, depends largely on more specific tests. ie, free t3 free t4. Then its about symptomology....
Junior Member
Not only are you wrong about everything else, your wrong about this too! I have Hypothyroidism and I am constantly overheated and sweat at the drop of a hat. My Dr. and I specifically discussed this as being the cause of my always being hot. Why do you insist on spouting your bs when you obviously don't know what your talking about. You can really mess someone up talking out your ass on a board like this. People need the advice of 'KNOWLEDGEABLE' members only.
Anabolic Member
It is a fact that hyper raises body temp! So many people that have hyper sweat constantly. That's not up for debate. People with hypo are usually cold! Go research that before you make statements like this. I have had hyperthyroidism my whole life so I too have experience in this.
I am not wrong about what I said in terms of tsh levels. You can find case after case of people with normal tsh levels who have hypo symptoms thru the roof! Why? Because you cannot accurately assess the thyroid condition without looking at other hormones as well! I know people who have hyper symptoms with a tsh of 2.. And I know people who are hypo at 2. It is not all about tsh levels it also has to do with the free t 3 and free t4 levels.
So I am not sure what you are saying I am wrong about?... But I don't really care!
Last edited by tboney; 06-24-2012 at 09:02 AM. Reason: Not a productive statement
HRT
In the Fall of 2002, the American Association of Clinical Endocrinologists (AACE) announced that what was normal the year before, thyroid-wise, would now be considered abnormal.
According to the AACE, doctors had typically been basing their diagnoses on the "normal" range for the TSH test. The typical normal reference range levels at most laboratories ran in the 0.5 to 5.0 range.
The new guidelines narrowed the range for acceptable thyroid function, and the AACE was encouraging doctors to consider thyroid treatment for patients who test outside the target TSH reference range of 0.3 to 3.0, a far narrower range. AACE believed that use of the new range would result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated.
At a press conference, Hossein Gharib, MD, FACE, and president of AACE, said: "This means that there are more people with minor thyroid abnormalities than previously perceived."
Anabolic Member
Jesus man.. I dont disagree with that! Ofcourse the ranges have long been too broad and outdated.. That is not what I am saying. People can have hypo symptoms with tsh levels at 2... Docs need to run other specific tests. They could have issues with converting t4 hormone into t3 which causes hypo symptoms. I am specificall taking issue with your statement that the op's tsh reading absolutely makes him clinically hypo. If his tsh was 5 or say 9 then yea, hes probably hypo. Non of us should be making a statement like that! not you, not me! A qualified doc should determine that after extensive blood work.doblood work is indicated. I am not going to argue this anymore, especially when you act like an insulting little ass-hat!
Banned
Decent points made on both ends. Guess it prompts one to really research this subject much deeper.
GD, just curious if you know what the TSH threshold is for Dr. Crisler to consider and treat it as hypothyroidism? Not that his standard is the one and only leading medical authority, but obviously his discussions do carry some weight.
Anabolic Member
Agreed! its a complicate issue that requires extensive tests, other than tsh.
Hadnt been on the boards for a while.. congrats on the monitor position! well deserved.
HRT
My Doc, an A4M Physician like Crisler, subscribes to The American Association of Clinical Endocrinologists who now recommend an upper limit of 3.0 mIU/L.
"The guidelines for diagnosing thyroid disease from The National Academy of Clinical Biochemistry point out that “more than 95% of normal individuals have TSH levels below 2.5 [mIU/L]. This panel suggests that the upper limit of TSH should be reduced to 2.5 mIU/L."
Dr. Gaines believes anything over 2.5 to be elevated TSH and 3.0+ as a Hypo state (especially when symptoms are present) and he does further testing.
Dr. Crisler was interviewed by Carol Lanore on Thyroid Function and Optimization Vette and he speaks clearly to why TSH is such an inaccurate panel to measure Thyroid function.
If you go to allthingsmale .com you will find the link to this interview in the stickies...very interesting indeed.
The reality is that most people are mis or under diagnosed because of the current TSH reference ranges which are horribly obsolete and Docs who just don't know any better...it's the same thing we see here when men see physicians who will not prescribe a TRT protocol when a man is 20 points above the bottom of the reference range for Total Testosterone yet the man presents with all the symptoms of low Testosterone.
The OP needs a complete and thorough Thyroid panel done and I am willing to bet at 3.45, and presenting with symptoms, that his T3 is in the bottom of the reference range = Hypothyroidism.
Last edited by steroid.com 1; 06-22-2012 at 02:26 PM.
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I will be getting a full thyroid panel in the near future. Hopefully this will give the lowdown on my slightly elevated TSH. I suppose it could have just been an anomoly but based on how I have been feeling I don't think it is. Low T and Hypo T have many of the same symptoms. I just wonder why I have always felt like I'm running a few degrees warmer than the people around me...
Should I work both problems (if my thyroid actually is a problem) at the same time or can fixing the low T fix the hypo T? Or, conversley will fixing potential thyroid issue fix low T?
Anabolic Member
Sorry about the diversion! I would get them both addressed. An endo deals with both of those issues.
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Diversion...what diversion? This is the internet after all. I will look into both of them. Thanks.
HRT
More then just "the same symptoms" but Hypothyroidism will cause Hypogonadism.
Many times just fixing Hypothyroidism will correct Hypogonadism.
Just an FYI...Feeling cold is one of many symptoms of Hypothyroidism; not warm.
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Roger that on the cold. Which is confusing because my whole life I've always been on the hot side of things. I have started taking Lugol's iodine along with the supporting vitamins and minerals (ATP cofactors, sea salt, selenium, magnesium, vit. C) and it would seem if I were hyper T that the iodine would cause some kind of "hyper"-like activity but after 3 days at 3.1 mgs and one day at 6.2 mgs I don't feel hyper. Actually today I did not feel as if I needed my afternoon "crash" nap. Which was a nice surprise. Not sure why. I did start the Androgel 7.5 yesterday so maybe that helped. I slept through the night the night before last. Haven't done that since starting on the Androgel packets about a month ago. But I did wake up several time again last night...Still, today has been one of my better days in some time. I'm even in the mood for some fun tonight. Been feeling it all day. So maybe something is helping!
HRT
Excellent!
Nutrition can go a long way to correct hypothyroidism.
Go the website Stop the Thyroid Madness and read and study as much as you can...it's probably the best website on the Internet for Thyroid disease and management.
HRT
This is from Dr. Mariano on Thyroid from 2009:
My current rule of thumb as a target for thyroid hormone:
1. Raise Total T4 to between 8-12 ug/dL (most important)
2. Free T3 between 330 to 420 pg/dL (multiple factors determine free T3, not just thyroid dosing).
3. TSH < 1.0
Using Total T4 for Levothyroxine dosing is like using Total Testosterone to determine testosterone dosing. Just as one doesn't use LH to determine testosterone dosing, one doesn't necessarily need to use TSH to determine thyroid hormone dosing.
Using TSH is complicated in that one assumes a well-functioning thyroid transporter (which depends on adequate ATP production - and thus a well-functioning citric acid cycle) to transport thyroid hormone across the blood brain barrier so that it can reach the neurons in the hypothalamus and to transport thyroid hormone through the cell membrane so it can reach its nuclear receptors. It also assumes the neurons of the hypothalamus and pituitary are working well - and are not subject to aging and other metabolic problems - which is not true if one has other major illnesses such as diabetes and heart disease.
Adequate nutrition is necessary to optimize metabolism so that thyroid hormone can work. For example, without adequate iron and vitamin A and other vitamins and minerals, thyroid hormone has difficulty functioning. Without adequate cellular iron, for example, thyroid hormone may not even pass through the cell membrane to reach its receptors. Nutrition has to be optimized to optimize thyroid function.
Interestingly, if the rest of the system is optimized (e.g. psychological, psychiatric, neurologic, neuroendocrine, psychoimmunologic, metabolic, nutritional) , generally, the usual dose for Levothyroxine ends up being 100 to 200 mcg a day.
Problems in optimizing thyroid occur when there are problems in the rest of the system. For example, excessive immune system activity predisposes a person to increase sympathetic nervous system activity, palpitations, suppressed adrenal function on treatment with thyroid hormone.
HRT Specialist ~ AR-Platinum Elite-Hall of Famer ~ No Source Checks
Very interesting point-counter-point. Well spoken by both, well 99% anyway!
Banned
Just because you "feel" hot doesn't mean your body temperature is high. In fact, it's usually a sign that you have poor adrenal function, and thus you have more adrenaline being released. See my thread on thyroid treatment and why it fails, as well as check out Dr. Rind's website on metabolic health and temperature plotting.
http://forums.steroid.com/showthread...t-Why-it-fails
Anabolic Member
Well said! People need comprehensive testing to determine whether or not they are hypo or hyper.
Myself and others I know had some of the more typical symptoms of hyper... Hot all the time, high Bp, weightless, etc.
I am not suggesting that everyone has the same symptoms.
HRT
Oscar - That thread you started on Why it Fails should be considered for a sticky.
We need a sticky here on Thyroid Optimization and Health as it's so critical to androgen health and plays such a vital role.
Banned
Cool, thanks. Yeah it just breaks the ice about the relationship between adrenals and exogenous thyroid hormone uptake and utilization. Adrenals are a huge topic of their own, and I wish I knew more about them. There's a lot of science and only so much time! Guess I'll be a student for life in some respects.
Adrenal medulla is the part of the adrenal gland that releases epinepherine, or adrenaline, and it's the "short-term" stress hormone, which I am sure we all know, relates to the acute, and epic "fight-or-flight" type response. Cortex is responsible for cortisol, which is the chronic stress hormone that reduces inflammation, etc. This is the important one want to correct and by healing the cortex of the adrenals, or allowing them to function at optimal health, will in turn create a balance for the medulla and adrenaline release, which plays a huge roll on many metabolic factors, obviously, and most importantly the direct sense of well being.
It's really about balance. Keep stressful environment down so we don't "fight-or-flight" as often and diet in a healthy manner (stay away from chlorinated hydrocarbons and neurotoxins that are metabolized through artificial sweetener consumption, i.e. sucralose and aspartame) to name a couple factors. Oh there's just so much!
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Most of the time when I went to the doc and they checked my temp it typically runs about a .5 degree on the low side. Even though my TSH was in range, based on what I have been researching it is definately trending towards hypo. My wife is also hypo and she is always freezing. She sits on the couch wrapped up in a blanket with the heating pad and I am half naked and need the fan on me...Don't tell me God does not have a sense of humor!
HRT
Here's a good list of the more common symptoms of Hypothyroidism (look familiar TRT guys) from our friends at Stop The Thyroid Madness:
■Less stamina than others
■Less energy than others
■Long recovery period after any activity
■Inability to hold children for very long
■Arms feeling like dead weights after activity
■Chronic Low Grade Depression
■Suicidal Thoughts
■Often feeling cold
■Cold hands and feet
■High or rising cholesterol
■Heart disease
■Palpitations
■Fibrillations
■Plaque buildup
■Bizarre and Debilitating reaction to exercise
■Hard stools
■Constipation
■No eyebrows or thinning outer eyebrows
■Dry Hair
■Hair Loss
■White hairs growing in
■No hair growth, breaks faster than it grows
■Dry cracking skin
■Nodding off easily
■Requires naps in the afternoon
■Sleep Apnea (which can also be associated with low cortisol)
■Air Hunger (feeling like you can’t get enough air)
■Inability to concentrate or read long periods of time
■Forgetfulness
■Foggy thinking
■Inability to lose weight
■Always gaining weight
■Inability to function in a relationship with anyone
■NO sex drive
■Failure to ovulate and/or constant bleeding (see Rainbow’s story)
■Moody periods
■PMS
■Inability to get pregnant; miscarriages
■Excruciating pain during period
■Nausea
■Swelling/edema/puffiness
■Aching bones/muscles
■Osteoporosis
■Bumps on legs
■Acne on face and in hair
■Breakout on chest and arms
■Hives
■Exhaustion in every dimension–physical, mental, spiritual, emotional
■Inability to work full-time
■Inability to stand on feet for long periods
■Complete lack of motivation
■Slowing to a snail’s pace when walking up slight grade
■Extremely crabby, irritable, intolerant of others
■Handwriting nearly illegible
■Internal itching of ears
■Broken/peeling fingernails
■Dry skin or snake skin
■Major anxiety/worry
■Ringing in ears
■Lactose Intolerance
■Inability to eat in the mornings
■Joint pain
■Carpal tunnel symptoms
■No Appetite
■Fluid retention to the point of Congestive Heart Failure
■Swollen legs that prevented walking
■Blood Pressure problems
■Varicose Veins
■Dizziness from fluid on the inner ear
■Low body temperature
■Raised temperature
■Tightness in throat; sore throat
■Swollen lymph glands
■Allergies (which can also be a result of low cortisol–common with hypothyroid patients)
■Headaches and Migraines
■Sore feet (plantar fascitis); painful soles of feet
■now how do I put this one politely….a cold bum, butt, derriere, fanny, gluteus maximus, haunches, hindquarters, posterior, rear, and/or cheeks. Yup, really exists.
■colitis
■irritable bowel syndrome
■painful bladder
■Extreme hunger, especially at nighttime
■Dysphagia, which is nerve damage and causes the inability to swallow fluid, food or your own saliva and leads to “aspiration pneumonia”.
Banned
That's a great thyroid book! Another that's on my bookshelf, that I find myself referencing often is "Hormones, Health, and Happiness" by Steven F. Hotze, M.D.Here's a good list of the more common symptoms of Hypothyroidism (look familiar TRT guys
■Less stamina than others
■Less energy than others
■Long recovery period after any activity
■Inability to hold children for very long
■Arms feeling like dead weights after activity
■Chronic Low Grade Depression
■Suicidal Thoughts
■Often feeling cold
■Cold hands and feet
■High or rising cholesterol
■Heart disease
■Palpitations
■Fibrillations
■Plaque buildup
■Bizarre and Debilitating reaction to exercise
■Hard stools
■Constipation
■No eyebrows or thinning outer eyebrows
■Dry Hair
■Hair Loss
■White hairs growing in
■No hair growth, breaks faster than it grows
■Dry cracking skin
■Nodding off easily
■Requires naps in the afternoon
■Sleep Apnea (which can also be associated with low cortisol)
■Air Hunger (feeling like you can’t get enough air)
■Inability to concentrate or read long periods of time
■Forgetfulness
■Foggy thinking
■Inability to lose weight
■Always gaining weight
■Inability to function in a relationship with anyone
■NO sex drive
■Failure to ovulate and/or constant bleeding (see Rainbow’s story)
■Moody periods
■PMS
■Inability to get pregnant; miscarriages
■Excruciating pain during period
■Nausea
■Swelling/edema/puffiness
■Aching bones/muscles
■Osteoporosis
■Bumps on legs
■Acne on face and in hair
■Breakout on chest and arms
■Hives
■Exhaustion in every dimension–physical, mental, spiritual, emotional
■Inability to work full-time
■Inability to stand on feet for long periods
■Complete lack of motivation
■Slowing to a snail’s pace when walking up slight grade
■Extremely crabby, irritable, intolerant of others
■Handwriting nearly illegible
■Internal itching of ears
■Broken/peeling fingernails
■Dry skin or snake skin
■Major anxiety/worry
■Ringing in ears
■Lactose Intolerance
■Inability to eat in the mornings
■Joint pain
■Carpal tunnel symptoms
■No Appetite
■Fluid retention to the point of Congestive Heart Failure
■Swollen legs that prevented walking
■Blood Pressure problems
■Varicose Veins
■Dizziness from fluid on the inner ear
■Low body temperature
■Raised temperature
■Tightness in throat; sore throat
■Swollen lymph glands
■Allergies (which can also be a result of low cortisol–common with hypothyroid patients)
■Headaches and Migraines
■Sore feet (plantar fascitis); painful soles of feet
■now how do I put this one politely….a cold bum, butt, derriere, fanny, gluteus maximus, haunches, hindquarters, posterior, rear, and/or cheeks. Yup, really exists.
■colitis
■irritable bowel syndrome
■painful bladder
■Extreme hunger, especially at nighttime
■Dysphagia, which is nerve damage and causes the inability to swallow fluid, food or your own saliva and leads to “aspiration pneumonia”.
HRT
tboney - This is where I got concerned in this thread:
"A tsh of 3.45 is not hypo..."
I totally agree with you that TSH is not accurate or reliable for making a proper diagnosis of Hypothyroidism...we agree here.
My concern is that most of the men here seeking help may be lucky to get a TSH panel on thier BW and they need to know that the reference ranges on labs today are grossly obsolete.
Most Doc's "in the know" understand anything over 2 is elevated and anything over 3 (presented with symptoms) is a red flag for Hypothyroidism and additional panels needed to be tested.
Statements like "3.45 is not hypo" and "within range" need to be defined and clarified relative to the current understanding of the new TSH reference range is all I am saying.
Like you, I want to make sure that the men visiting here or new members get the correct information to make the right healthcare decisions.
That's all my friend.
Peace
Last edited by steroid.com 1; 06-24-2012 at 11:03 AM.
Anabolic Member
I see you point. I should have clarified what I meant. I try to be clear when I respond to people but in this case I failed to do so. I think we were saying the same thing in essence... My statement should have reflected that his tsh reading doesn't automatically define his condition as being hypo. I only meant to say that there are other hormones that need to be looked at and considered that's all. You said it better than I...tboney - This is where I got concerned in this thread:
"A tsh of 3.45 is not hypo..."
I totally agree with you that TSH is not accurate or reliable for making a proper diagnosis of Hypothyroidism...we agree here.
My concern is that most of the men here seeking help may be lucky to get a TSH panel on thier BW and they need to know that the reference ranges on labs today are grossly obsolete.
Most Doc's "in the know" understand anything over 2 is elevated and anything over 3 (presented with symptoms) is a red flag for Hypothyroidism and additional panels needed to be tested.
Statements like "3.45 is not hypo" and "within range" need to be defined and clarified relative to the current understanding of the new TSH reference range is all I am saying.
Like you, I want to make sure that the men visiting here or new members get the correct information to make the right healthcare decisions.
That's all my friend.
Peace
It's all good you are obviously well informed and a valuable source of info.
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I have many of those symptoms. Not all but many. And like you mentioned many of them are also symptoms for low T.
HRT
Hypothyroidism ----> Hypogonadism
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I just ordered this book from Amazon. Should get a lot of good info from it!
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