The DOI matches its Crossref record.
Thyroid hormone excess and glucose intolerance
Abstract
The elevated plasma glucose levels in hyperthyroidism may be explained by increased rates of endogenous glucose production, due mainly to increased gluconeogenesis. The rates of insulin-stimulated glucose disposal in peripheral tissues in hyperthyroidism have been found, in general, either normal or increased. Skeletal muscle is the most important tissue for the disposal of glucose in response to insulin. In this tissue, insulin increases glucose disposal by stimulating glucose transport, glucose phosphorylation/glycolysis, glycogen synthesis and glucose oxidation. Studies examining insulin-stimulated glucose metabolism in skeletal muscle have suggested that, in the hyperthyroid state, it may be of primary importance to increase the rates of glycolysis and lactate formation relative to glucose oxidation in this tissue in order to provide substrate for gluconeogenesis (increase Cori cycle activity). This effect will be achieved primarily by a decrease in glycogen synthesis and an increase in glycogenolysis. When hyperthyroidism becomes more severe, an increased rate of glucose uptake into muscle may then be necessary since the increased conversion of glycogen to lactate could not be sustained for prolonged periods and might lead to a depletion in glycogen stores. This mechanism would ensure that the level of glucose in plasma is kept normal or slightly increased. Thus, an increased Cori cycle activity may be a necessary mechanism to provide optimal conditions in hyperthyroidism for the control of glucose utilization without increasing the risk of hypoglycemia. In addition to lactate, increased rates of gluconeogenesis in hyperthyroidism can also be sustained by increased plasma concentrations of amino acids (mostly glutamine and alanine) and glycerol, as well as by increased plasma concentrations of free fatty acids.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Increased secretion of insulin and elevated fasting insulin are observed in hyperthyroidism (60, 61).”
From The progression of secondary diabetes: A review of modeling studies (2022) · cites this paper as [60]
In the citing paper
“Increased secretion of insulin and elevated fasting insulin are observed in hyperthyroidism (60, 61).”
From The progression of secondary diabetes: A review of modeling studies (2022) · cites this paper as [60]
Citations
Cited by
Sorted by citations
Items 101–180 of 180
The Effects of Thyroid Hormones and Their Abnormalities on Intestinal and Hepatic Glucose Metabolism
Al-bayati, A. A. H., & Al-Khateeb, S. M. J. (2021) · Scholars International Journal of Biochemistry · doi:10.36348/sijb.2021.v04i03.002 · Cited by 12
Fetuin-A levels in hyperthyroidism
Pamuk, B. Ö., Yilmaz, H., Topcuoglu, T., Bilgir, O., Çalan, Ö. G., Pamuk, G., & Ertuğrul, D. T. (2013) · Clinics · doi:10.6061/clinics/2013(03)oa15 · Cited by 12
“Hyperthyroidism is also associated with insulin resistance and elevated blood glucose levels (11-12).”
BackgroundTorimoto, K., Okada, Y., Arao, T., et al. (2014) · Endocrine Journal · doi:10.1507/endocrj.ej13-0410 · Cited by 11
Gao, G., Li, F.-F., Hu, Y., Yan, R., Liu, B.-L., Liu, X., Su, X., Ma, J., & Hu, G. (2018) · Endocrine · doi:10.1007/s12020-018-1820-0 · Cited by 11
Martinez, B., Soñanez‐Organis, J. G., Godoy-Lugo, J. A., Horin, L. J., Crocker, D. E., & Ortiz, R. M. (2016) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00395.2016 · Cited by 10
“Given the contributions of TH signaling to substrate metabolism, including lipid and glucose mobilization (4, 14, 16, 39, 45), this study investigated the potential of increased cellular TH-mediated events during prolonged fasting to drive tissue-specific metabolism.”
Hyperthyroidism presenting with hyperglycemia in an adolescent female
Wintergerst, K. A., Rogers, E. S., & Foster, M. B. (2011) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2011.032 · Cited by 9
Experimental Hyperthyroidism Decreases Gene Expression and Serum Levels of Adipokines in Obesity
Luvizotto, R. D. A. M., do Nascimento, A. F., Síbio, M. T. D., et al. (2012) · The Scientific World JOURNAL · doi:10.1100/2012/780890 · Cited by 9
Ha, J., Lee, J., Lim, D., Lee, J., Chang, S., Kang, M.-I., & Kim, M. (2020) · The Korean Journal of Internal Medicine · doi:10.3904/kjim.2019.160 · Cited by 9
“Thyroid hormones are important determinants of glucose and lipid metabolism [13,23].”
BackgroundApathetic thyrotoxicosis presenting with diabetes mellitus
Poudel, R. R., Belbase, B., Belbase, B., et al. (2014) · Journal of Community Hospital Internal Medicine Perspectives · doi:10.3402/jchimp.v4.25502 · Cited by 8
“intolerance by increasing the hepatic glucose output via glycogenolysis and gluconeogenesis (3), and by lowering both insulin secretion and peripheral insulin sensitivity (4).”
BackgroundFarasat, T., Cheema, A. M., & Khan, M. N. (2011) · Pakistan Journal of Zoology · Cited by 8
Bhatt, P. A., Makwana, D., Santani, D. D., & Goyal, R. K. (2007) · Canadian Journal of Physiology and Pharmacology · doi:10.1139/y07-031 · Cited by 8
“of endogenous glucose production mainly owing to increased gluconeogenesis (Dimitriadis and Raptis 2001).”
BackgroundSchott, M. (2009) · Yearbook of Endocrinology · doi:10.1016/s0084-3741(09)79341-2 · Cited by 8
Panveloski-Costa, A. C., Kuwabara, W. M. T., Munhoz, A. C., Lucena, C. F., Curi, R., Carpinelli, Â. R., & Nunes, M. T. (2020) · Endocrine · doi:10.1007/s12020-020-02208-5 · Cited by 8
Hu, Y., Gao, G., Yan, R., et al. (2017) · Biomedical Reports · doi:10.3892/br.2017.932 · Cited by 8
The Intricate Relationship Between Thyroid Disorders and Type 2 Diabetes—A Narrative Review
Tilici, D.-M., Păun, D. L., Arnautu, A. M., Mirică, A., Duţă, C., Costea, M., & Guja, C. (2025) · Diabetology · doi:10.3390/diabetology6050041 · Cited by 7
“Postprandial lipolysis suppression facilitates glucose utilization by insulin-resistant muscle, preserving fat stores [63,67–69].”
Ho, W.-E., Sun, L., Goh, H. J., Tint, M. T., Sun, L., & Leow, M. K. S. (2022) · Adipocyte · doi:10.1080/21623945.2022.2104509 · Cited by 7
“This might have caused our measured BAT activity to be lower compared to a standard cold-induced BAT activation [3].”
BackgroundType 2 diabetes mellitus and thyroid dysfunction: an intertwined duo
Nicholas, A. K. (2014) · Cited by 7
The progression of secondary diabetes: A review of modeling studies
Yang, B., Li, J., Haller, M. J., Schatz, D. A., & Rong, L. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1070979 · Cited by 6
“Increased secretion of insulin and elevated fasting insulin are observed in hyperthyroidism (60, 61).”
BackgroundImportance of Screening Type-II Diabetics for Thyroid Dysfunction and Dyslipidemia
Yadav, P., Kaushik, G. G., & Sharma, S. (2015) · International Journal of Biochemistry and Biophysics · doi:10.13189/ijbb.2015.030201 · Cited by 6
Biochemical isthmus [nexus] between type 2 diabetes mellitus and thyroid status—an update
Rajendran, J., & Srinivasan, A. R. (2019) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2019.01.037 · Cited by 6
Shin, J. H., Seong, J. K., & Yi, S. S. (2014) · Journal of Veterinary Science · doi:10.4142/jvs.2014.15.1.19 · Cited by 6
“We have previously examined the GR and its involvement in gluconeogenesis along with glucose transport in cases of diabetes [11,16,20].”
BackgroundThyroid hormone Beta receptor agonists for treatment of kidney disease: A promising agent?
Çöpür, S., Yavuz, F., & Kanbay, M. (2022) · European Journal of Clinical Investigation · doi:10.1111/eci.13939 · Cited by 5
Sujata, S., Gayathri, B., & Thakur, R. (2023) · Value in Health Regional Issues · doi:10.1016/j.vhri.2023.09.009 · Cited by 5
Type 2 Deiodinase and Brown Fat: The Heat Is On—or Off
Fliers, E., & Boelen, A. (2010) · Endocrinology · doi:10.1210/en.2010-0712 · Cited by 5
“Are there any similarities between the effects of thyroid hormone in BAT with effects of thyroid hormone in other key metabolic organs? Clinical studies have shown that effects of thyrotoxicosis on the liver include increased hepatic glucose production and reduced hepatic insulin sensitivity (14, 15).”
BackgroundReduced insulin sensitivity in differentiated thyroid cancer patients with suppressed TSH
de Melo, T. G., de Souza, A. L., Ficher, E., Fernandes, A. M. D. S., da Assumpção, L. V. M., Alegre, S. M., & Zantut‐Wittmann, D. E. (2017) · Endocrine Research · doi:10.1080/07435800.2017.1390673 · Cited by 4
“However, such relationship is not totally understood in subclinical thyrotoxicosis status.(17,21,22) In an attempt to clarify the relationship between TSH suppression and glucose metabolism, Rezzonico et al.”
BackgroundKurozumi, A., Okada, Y., & Tanaka, Y. (2022) · Internal Medicine · doi:10.2169/internalmedicine.0364-22 · Cited by 4
Okada, S., Isoda, A., Hoshi, H., Okada, J., Okada, K., Yamada, E., Saito, T., Watanabe, T., Kikkawa, K., & Ohshima, K. (2023) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2022.102704 · Cited by 5
Atrooz, O. M., Hiresh, M., Dlewan, A., Atrooz, M., Hiresh, G., Alasoufi, A., & Atrooz, I. (2023) · Journal of Medical Biochemistry · doi:10.5937/jomb0-40504 · Cited by 4
“Also, Dimitriadis et al. (18) and Klein et al. (19) reviewed the impacts on the cardio-vascular system.”
BackgroundBhatt, P. A., & Makwana, D. (2008) · Fundamental and Clinical Pharmacology · doi:10.1111/j.1472-8206.2007.00559.x · Cited by 4
Doghaither, H. A. A., Alshaikh, E. M., Omar, U. M., Alsufiani, H. M., Mansouri, R. A., Tarbiah, N. I., Alshaikh, A. A., & Alshaikh, A. M. (2019) · Europe PMC (PubMed Central) · Cited by 4
Pharmacodynamic and Therapeutic Actions of Levothyroxine
Hennessey, J. V. (2021) · 70 Years of Levothyroxine · doi:10.1007/978-3-030-63277-9_3 · Cited by 4
Han, L., Yang, X., Wang, W., Yang, X., Dong, L., Lin, S., Li, J., & Liu, X. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04564-8 · Cited by 3
“While increased activity of the glucose-alanine cycle was beneficial in the control of glucose utilization without increasing the risk of hypoglycemia in hyperthyroidism [53], thyroid hormone enhanced the Warburg Effect in breast cancer [54].”
BackgroundHsieh, Y.-S. (2023) · Cureus · doi:10.7759/cureus.41017 · Cited by 3
“Thyroid hormones can stimulate insulin-dependent glucose uptake, gluconeogenesis, and glycogenolysis in thyrotoxicosis [4].”
BackgroundLee, C. W., Mathew, H., & Steenkamp, D. (2018) · AACE Clinical Case Reports · doi:10.4158/accr-2017-0158 · Cited by 3
Thesis submitted in partial fulfilment of the requirements for the degree of
Aslani, S. (2018) · Cited by 3
Missaoui, A. M., Belabed, W., & Mnif, F. (2025) · The Egyptian Journal of Internal Medicine · doi:10.1186/s43162-025-00458-1 · Cited by 2
“In overt hyperthyroidism, glucose intolerance and insulin resistance are frequent findings [29].”
Central sensitivity to thyroid hormone indices and glucose metabolism disorders
Zhang, Y., Wang, S., & Li, P. (2025) · Clinica Chimica Acta · doi:10.1016/j.cca.2025.120690 · Cited by 2
Molecular Mechanisms of the Relationship between Thyroid Dysfunctions and Diabetes Mellitus
Shpakov, A. O. (2018) · Journal of Evolutionary Biochemistry and Physiology · doi:10.1134/s0022093018040014 · Cited by 2
Gopal, N., Pune, A. S., Takhelmayum, R., & Ahirwar, A. K. (2021) · Hormone Molecular Biology and Clinical Investigation · doi:10.1515/hmbci-2021-0021 · Cited by 2
The Effects of Thyroid Dysfunctions on Insulin Resistance in Patients with Hepatosteatosis
Keşkek, Ş. Ö., Kırım, S., Kaya, R., & Canataroğlu, A. (2014) · Advances in Clinical and Experimental Medicine · doi:10.17219/acem/37335 · Cited by 2
“The data on insulin levels in patients with thyroid dysfunction is conflicting [5, 14].”
BackgroundInfluentialCompensatory Increase of Serum Hepassocin Protects Hyperthyroidism-Induced Hepatic Dysfunction
Wang, C., Lin, C., Chou, H., Wang, C., Liang, Y.-C., Wu, H., & Ou, H. (2023) · Biomedicines · doi:10.3390/biomedicines11071936 · Cited by 1
Gao, L., Cui, W., Pan, F., Mu, D., Zhou, W., & Hu, Y. F. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1526198 · Cited by 2
“Importantly, excess triiodothyronine impairs insulin signaling by inhibiting IRS-1 phosphorylation and PI3K/ Akt activation, promoting insulin resistance (14).”
Another pleiotropic effect of SGLT2 inhibitors: Is it a new frontier in thyroid function regulation?
Szklarz, M., Wołos-Kłosowicz, K., Szulc, J., Górny, J. M., Modzelewski, R., & Matuszewski, W. (2026) · Thyroid Research · doi:10.1186/s13044-025-00282-3 · Cited by 1
“When compared to euthyroid rats, in hyperthyroid rats, a two-fold increase in the activity of pyruvate kinase, which catalyses the synthesis of oxaloacetate from pyruvate, was observed (34).”
Physiological Changes in Patients with Hyperthyroidism
Muhammadi, M. O. K. A., & AL-Watify, D. G. O. (2009) · Medical Journal of Babylon · Cited by 1
Zahediasl, S., Farahani, H., Ghasemi, A., & Shahrivar, F. F. (2009) · Cited by 1
A review on association between diabetes and thyroid disease
Sharma, P., Shrestha, S., & Kumar, P. (2020) · Santosh University Journal of Health Sciences · doi:10.18231/j.sujhs.2019.013 · Cited by 1
“Further, hypothyroidism induced receptor defect has also been proposed to be a possible mechanism for decreased insulin mediated peripheral utilisation of glucose.(20) All these increase the risk of recurrent hypoglycaemia in diabetic patients.”
BackgroundGLP-1 and GIP Levels in Patients With Hyperthyroidism: The Effect of Antithyroid Treatment
Cira, D. K., Sarı, R., Özdem, S., et al. (2017) · Annals of Pharmacotherapy · doi:10.1177/1060028017707221 · Cited by 1
“Thyroid hormones have significant effects on glucose homeostasis and insulin secretion.(1,2,10-12) Therefore, we investigated glucose levels and insulin secretion in patients with hyperthyroidism by performing OGTT during both in hyperthyroid and antithyroid medication-induced euthyroid states.”
BackgroundResultInfluentialPhysiology of the Hypothalamus Pituitary Unit
Seoane, L. M., Tovar, S. A., & Diéguez, C. (2017) · Endocrinology · doi:10.1007/978-3-319-38681-2_1-1 · Cited by 1
Abdel Gayoum, A. A. (2017) · British Biomedical Bulletin · doi:10.21767/2347-5447.1000308 · Cited by 1
“Introduction The thyroid hormones, T3 and T4, enhance body metabolism by activating peripheral glucose oxidation and facilitating the release of free fatty acids into circulation [1].”
BackgroundIkegami, T., Yamamoto, Y., Goto, M., Kawagoe, R., Kawada, Y., & Kusuhara, K. (2018) · Journal of UOEH · doi:10.7888/juoeh.40.231 · Cited by 1
Parlițeanu, O.-A., Cheţa, D., Universitatea de Medicină şi Farmacie „Carol Davila“, B., et al. (2019) · Romanian Medical Journal · doi:10.37897/rmj.2019.1.11 · Cited by 1
Al-Mousawi, N. H., Ahmed, T. H., & AL-Attabi, M. R. S. (2020) · Eurasian Journal of Biosciences · Cited by 1
Cardiovascular risk factors, autoimmunity and insulin resistance in Graves' disease
Ferreira, C., Neves, C., Neves, J. S., Oliveira, S. C., Sokhatska, O., Pereira, M. F., Oliveira, A., Medina, J. L., Delgado, L., & Carvalho, D. M. (2020) · Revista Portuguesa de Endocrinologia Diabetes e Metabolismo · doi:10.26497/ao190010 · Cited by 1
“15 No nosso estudo verificou--se uma correlação negativa entre os níveis de T3L e triglicerídeos no subgrupo TRAb positivo.”
Physiology of the Hypothalamus Pituitary Unit
Seoane, L. M., Tovar, S. A., & Diéguez, C. (2018) · Endocrinology · doi:10.1007/978-3-319-44444-4_1 · Cited by 1
Shpakov, A. O. (2018) · Журнал эволюционной биохимии и физиологии · doi:10.7868/s0044452918040014 · Cited by 1
Balakrishnan, S., & Paulose, C. S. (2008) · Dyuthi Digital Repository (Cochin University of Science and Technology)
Hyperglycaemia in Hyperthyroidism Predictive Factors
Azzoug, S., Chentli, F., Fellah, S., et al. (2015) · International Journal of Clinical Case Reports · doi:10.5376/ijccr.2015.05.0006
“Our diabetes mellitus frequency is higher than the literature one: 2-8% (Dimitriadis and Raptis, 2001), maybe because some of our patients had an unknown diabetes before their hyperthyroidism.”
BackgroundNagai, T., Kotake, M., Takahashi, G., Tonouchi, K., & Tonooka, N. (2010) · The Kitakanto Medical Journal · doi:10.2974/kmj.60.151
Schlienger, J.-L. (2010) · Elsevier eBooks · doi:10.1016/b978-2-294-70868-8.50021-9
NOVEL GENES IN THE LIVER OF DIABETIC PSAMMOMYS OBESUS
Southon, A. G. (2002)
Review DIABETES AND THYROID DISEASES - A REVIEW
Sathish, R., & Mohan, V. (2003)
Hypothyroidism Caused by a Mutant Thyroid Hormone Receptor α1
Sjogren, M. H. (2008)
Schlienger, J.-L. (2014) · Elsevier eBooks · doi:10.1016/b978-2-294-73954-5.00022-6
RELATIONSHIP BETWEEN THYROID DISEASES AND TYPE 2 DIABETES MELLITUS
Shpakov, A. O. (2017) · Translational Medicine · doi:10.18705/2311-4495-2017-4-2-29-39
Thyroid Crisis and Hyperosmolar Hyperglycemic State in a Hyperthyroid Patient
Rezkitha, Y. A. A., Wironegoro, R., Susanto, H., Adi, S., & Sutjahjo, A. (2017) · Surabaya International Physiology Seminar (SIPS) · doi:10.5220/0007338803360341
“plasma amino acid concentrations such as glutamine and alanine (Dimitriadis and Raptis, 2001; Hage, Zantout, and Azar, 2011).”
BackgroundKeskin, M., Ademoglu, E. N., Koca, A. O., & Ertuğrul, D. T. (2019) · Ankara Medical Journal · doi:10.17098/amj.581991
Meena, K. K., Sharma, P., Srivastava, S., & Meena, U. K. (2021) · International Journal of Medical and Biomedical Studies · doi:10.32553/ijmbs.v5i12.2341
Schlienger, J.-L. (2019) · Elsevier eBooks · doi:10.1016/b978-2-294-75889-8.00025-7
Schott, M. (2009) · Yearbook of Medicine · doi:10.1016/s0084-3873(09)79485-4
(2011) · Elsevier eBooks · doi:10.1016/b978-1-4377-0660-4.00035-1
Baudry, C., Waintrop, C., & Mosnier-Pudar, H. (2011) · EMC - Endocrinologie - Nutrition · doi:10.1016/s1155-1941(11)53860-0
Alterações do Funcionamento da Glândula da Tiróide
Silva, C. C. (2013) · Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT)
Little, S. E. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-49687-2.00037-0
(2000) · Time to knit · doi:10.1016/s1155-1941(19)82702-6
Li, T., Li, L., Wang, X., Li, Y., Gong, Y., Zhou, H., & Zheng, X. (2025) · Endocrine Connections · doi:10.1530/ec-25-0078
“Impaired glucose tolerance and hepatic insulin action and increased hepatic glucose output have been observed in patients with hyperthyroidism (12).”
Hyperthyroidism in Disguise: A Case of New-Onset Atrial Fibrillation and Acute Reversible Paralysis
Shahid, U., Ashin, N. T., & Dara, S. I. (2025) · JCEM Case Reports · doi:10.1210/jcemcr/luaf193
“The elevated lactate may also reflect altered carbohydrate metabolism in thyrotoxicosis, where excess thyroid hormone promotes glycolysis and glycogenolysis, favoring lactate production over complete glucose oxidation [9-11].”
Manohar, M. (2026) · Research Square · doi:10.21203/rs.3.rs-9659714/v1
Metadata
- Authors
- Dimitriadis, G., & Raptis, S.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- Venue
- Experimental and Clinical Endocrinology & Diabetes
- Publisher
- Georg Thieme Verlag KG
- Published
- 2001-11-23
- Volume
- 109
- Issue
- Suppl 2
- Pages
- S225-S239
- ISSN
- 0947-7349 (ISSN-L)
- 1439-3646
- OpenAlex
- W2016021698
- Cited by
- 179
- References
- 0
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 3 · 2023: 8 · 2022: 9 · 2021: 8 · 2020: 11 · 2019: 8 · 2018: 11 · 2017: 13 · 2016: 9 · 2015: 7 · 2014: 10 · 2013: 9 · 2012: 6
- FWCI
- 1.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Experimental and Clinical Endocrinology & Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Keywords
- hyperthyroidism, impaired glucose tolerance, hyperglycemia, gluconeogenesis, insulin-stimulated glucose disposal, skeletal muscle glucose metabolism, Cori cycle, glycogenolysis, glycogen synthesis, lactate, hypoglycemia, amino acids, glycerol, free fatty acids
- MeSH terms
- Insulin Secretion, Animals, Gastric Emptying, Glucose, Humans, Insulin, Thyroid Hormones, Glucose Intolerance, Lipid Metabolism
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
