Page 2 - Free T3 Thyroid Test

Thyroid problems are prevalent in the United States and the entire world. In some cases, the thyroid makes too many hormones and patients take drugs for hyperthyroidism. In other cases, the thyroid is sluggish and makes insufficient amounts of T3 and T4. This is called hypothyroidism and there are drugs prescribed for this disease too. Although thyroid problems can be kept under control with thyroid drugs, other medications that patients might take can interfere with these drugs. 5% of people in the US are treated for thyroid problems, so it's important to know what drugs might affect these treatments. Keep reading this article to find out more, especially if you're currently taking thyroid medication for hypothyroidism or hyperthyroidism. Table of Contents What Drugs Are Used to Treat Thyroid Problems? How Do Meds Interfere with Thyroid Drugs? Medicines That Make the Body Eliminate Levothyroxine Too Quickly Drugs That Decrease the Absorption of Levothyroxine in the Body Medications That Might Increase Thyroxine-Binding Globulin (TBG Lab Test) Levels Blood Thinners Might Severely Interact with Levothyroxine Treatment Conclusion Always Keep Your Thyroid Hormones in Check What Drugs Are Used to Treat Thyroid Problems? If you're struggling with an underactive thyroid, your doctor might prescribe levothyroxine as an ongoing medication for your hypothyroidism. Levothyroxine is also known as Levoxyl, Levo-T, Thyro-Tabs, Unithroid, and so on as these are the brand names used to sell the drug. On the other hand, if you're dealing with a hyperactive thyroid, you need medication to reduce the amount of T3 and T4 produced by your thyroid. In this case, you might be prescribed propylthiouracil and/or methimazole. The latter drug is also known as Tapazole. How Do Meds Interfere with Thyroid Drugs? Various drugs and medications interfering with each other is a well-known fact. In many cases, the labels of various drugs instruct patients what meds or substances to avoid ensuring the efficiency of their treatment. This is also the case for thyroid drugs. For example: Some drugs might make the body eliminate levothyroxine from the body too quickly, reducing the effectiveness of the thyroid treatment Certain drugs might alter the way levothyroxine interacts with tissues in the body Other drugs might prevent tissues from absorbing levothyroxine properly Levothyroxine itself might increase the levels of other drugs in the blood, reducing their safety and efficiency As an analogy, it has been discovered that black pepper increases the absorption rate of various vitamins and minerals in the blood. That's why certain supplements such as curcumin are usually formulated with black pepper to be absorbed by the body more effectively. Similarly, certain drugs might make levothyroxine ineffective, so the efficiency of your thyroid treatment is decreased. It's recommended to keep a list of medicines you regularly take and run it by your doctor if your thyroid treatment is ineffective Medicines That Make the Body Eliminate Levothyroxine Too Quickly When the body has an excess of a substance, it eliminates it in several ways such as through perspiration, urine, or feces. Certain drugs can make the body produce more enzymes and accelerate the speed at which certain substances are eliminated. If you have a thyroid gland that functions properly, your body can compensate for this mechanism by making more thyroid hormones. However, people with hypothyroidism cannot make more T3 and T4, and the levothyroxine taken through medicine is eliminated from the body too quickly. Various drugs can make the body produce more enzymes such as antiseptic drugs that are prescribed to counteract seizures. For example,  phenobarbitals, primidone, and phenytoin (aka Dilantin) can increase the metabolism of levothyroxine in the body. Other drugs such as antimicrobial agents can also increase enzyme levels in the body and cause the elimination of levothyroxine too quickly. For example, rifampin, efavirenz, and nevirapine (aka Viramune) are enzyme inducers and some of them even cause hypothyroidism in patients on levothyroxine therapy. Some drugs that are used in the treatment of leukemia and certain cancers might also cause hypothyroidism when used in combination with levothyroxine. For example, imatinib, aka Gleevec, might have this effect on certain patients. Certain selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) might make levothyroxine treatment become ineffective. These are drugs used to treat depression and millions of Americans use them. Drugs That Decrease the Absorption of Levothyroxine in the Body Some drugs that are administered to treat a certain disease might make the body absorb less levothyroxine when the two medicines are combined. That's why it's advisable to take your thyroid drugs at least 4 or 6 hours before or after taking the other drugs. For example, antacids are a category of medicines that can reduce the effectiveness of levothyroxine. These drugs are administered to treat heartburn. Calcium products such as Rolaids can also interfere with the correct absorption of levothyroxine. Sucralfate, aka Carafate, is a drug given to treat stomach ulcers. It has been discovered that it reduces the absorption of levothyroxine in the body. However, if patients take their thyroid drugs 8 hours after taking sucralfate, this problem can be avoided. Iron supplements such as Feosol are another category of drugs that might interfere with levothyroxine absorption. Sevelamer, a drug administered to people with chronic kidney disease, has a similar effect. It should be given after at least 6 hours of taking levothyroxine medication to avoid negating the impact of the thyroid drug. Certain antibiotics can also reduce the absorption of levothyroxine. Although more research is needed, ciprofloxacin, levofloxacin, and lomefloxacin might interfere with a patient's thyroid medication, and these two categories of drugs should be separated by at least 4 hours. Drugs that help the body transform cholesterol into bile acids should also be separated from thyroid medications by at least 6 hours. For example, Cholestyramine, Colestipol (aka Colestid), and colesevelam are bile acid binders and shouldn't be combined with levothyroxine. Finally, drugs used to treat osteoporosis, such as Evista (Raloxifene), might also decrease the absorption rate of levothyroxine in the body. Although more evidence is needed, specialists recommend separating the two drugs by at least 12 hours. Medications That Might Increase Thyroxine-Binding Globulin (TBG Lab Test) Levels TBG is a particular type of protein that carries thyroid hormones through the body via your bloodstream. Tissues absorb the required amount of thyroid hormones as they "detach" from TBG. However, when TBG levels are high, more thyroid hormones remain bound to TBG, and they cannot reach the tissues where they are most needed. If a person has a normally functioning thyroid, this is not a problem. The thyroid gland makes more hormones to compensate. However, most people with hypothyroidism cannot "afford" to produce more thyroid hormones. Certain drugs or substances might increase TBG levels and reduce your levothyroxine treatment's effectiveness. For example, oral contraceptives contain estrogens that increase the levels of TBG in the bloodstream. Estrogen replacement therapy might also increase TBG levels, but this can be avoided by using transdermal estrogen medication. This administration method doesn't affect the TBG lab test and and it doesn't interfere with your thyroid drugs. Blood Thinners Might Severely Interact with Levothyroxine Treatment Blood thinners are medications administered to people who are at risk of developing blood clots. If a blood clot forms in an essential part of the body, it can be life-threatening. Strokes are good examples in this case. Those who struggle with pulmonary embolism, vein thrombosis, or heart disease might be on a dose of blood-thinning medication such as warfarin. This medication is an anticoagulant, and it might interact with levothyroxine treatment. For example, if a person has an overly active thyroid (hyperthyroidism), the warfarin dose might make the blood thinner than usual. This can lead to bleeding, and it can be life-threatening in some instances. The warfarin anticoagulant might be ineffective if a person has an underactive thyroid gland (hypothyroidism). In this case, the blood becomes somehow resistant to the effects of warfarin, and it remains too thick, increasing the risk of developing blood clots. That's why it's essential to carefully manage your intake of levothyroxine and warfarin or other types of blood thinners. If you feel your thyroid medication is ineffective, talk to your doctor and see if warfarin could interfere with it. Conclusion As mentioned earlier, levothyroxine is widely prescribed to patients, particularly in the United States. Although it can work wonders in the correct dosage for suitable patients, levothyroxine can easily interact with other drugs you might take daily. Your responsibility is to pay attention to potential symptoms and talk to your doctor if you feel your thyroid treatment should be more effective. Keep a list of all the drugs you take and show it to your doctor during your next meeting. This will help you make the proper adjustments and find a balance between levothyroxine and other drugs you might take. Always Keep Your Thyroid Hormones in Check The thyroid gland doesn't get as much credit as it deserves, but it's solely responsible for how much energy you have throughout the day and how your body metabolizes substances. It's recommended to keep your thyroid hormones in check using affordable blood tests from a reputable provider. For example, you can go to DiscountedLabs.com and look at the inexpensive thyroid panels available online. This test requires a single blood sample and gives you more details about your T3, T4, and TSH levels, so you know whether your thyroid is usually workingor not.    

Did you know that approximately 5 percent of all people in the US struggle with some form of Hashimoto's disease? This ailment seems to be quite prevalent and it leads to an underperforming thyroid gland. The thyroid gland controls most of the body's metabolic processes. If it gets damaged, you might feel a lack of energy, and your regular metabolism would slow down. However, there are differences between Hashimoto's disease and hypothyroidism. Keep reading to learn more about Hashimoto's disease, how to test for it and what you can do if you have it. Table of Contents What Is Hashimoto's Disease? What is Hypothyroidism? What Are the Differences Between Hashimoto's Disease and Hypothyroidism? What Are the Symptoms of Hashimoto's Disease? Free Triiodothyronine (T3) Free Thyroxine (T4) Thyroid Stimulating Hormone (TSH) Thyroid Peroxidase Antibody (TPO) Comprehensive Thyroid Panel What Are the Causes of Hashimoto's Disease? How is Hashimoto's Disease Treated? Order Your Thyroid Tests Today! What Is Hashimoto's Disease? Hashimoto's disease is a type of autoimmune disease. This means that the body doesn't recognize certain organs or tissues as its own and starts attacking them. In the case of Hashimoto's disease, the body attacks the thyroid gland. It does this by producing certain antibodies to hormones normally found in the thyroid gland. For example, thyroid peroxidase (TPO) is a hormone typically found in the thyroid gland. In Hashimoto's disease, your system starts to produce antibodies to thyroid peroxidase. What is Hypothyroidism? Hypothyroidism happens when your thyroid gland doesn't function properly. This can happen for various reasons and it might be caused by Hashimoto's disease. A doctor would run several tests to see why your thyroid gland is not producing thyroid hormones correctly. In some cases, your thyroid gland might fail to produce enough hormones because it doesn't receive enough TSH or thyroid-stimulating hormone. This substance is produced by the pituitary gland and it tells your thyroid gland how many hormones to produce. What Are the Differences Between Hashimoto's Disease and Hypothyroidism? It's important to know the main differences between these two types of health problems. For example: Hashimoto's disease is an autoimmune illness that affects the thyroid gland As the thyroid gland is affected by Hashimoto's disease, it starts producing fewer hormones Hypothyroidism happens when the thyroid gland doesn't produce enough hormones This could happen as a result of an underperforming pituitary or other factors As a similarity, both health issues (Hashimoto's disease and hypothyroidism) can lead to symptoms commonly associated with a poorly functioning thyroid gland. What Are the Symptoms of Hashimoto's Disease? Hashimoto's disease develops over years, so it's not something you acquire overnight. You will eventually notice some symptoms at first. Some people even develop swelling in the thyroid region of the neck. This is called goiter. Here are the main symptoms of Hashimoto's disease: Constipation and slow bowel movement Fatigue and lack of energy, even after a good night's sleep Dry skin that is prone to breaking Hair loss and brittle nails, especially in women Joint pain Weight gain without making major changes in diet Memory problems Confusion and lethargy that could lead to depression As you can see, the list of symptoms is pretty comprehensive. Many of these symptoms are common for other types of health problems, so the only way to accurately diagnose Hashimoto's disease is through a blood test. There are multiple types of blood tests available. All of them look at the hormones of your thyroid gland. For example: Free Triiodothyronine (T3) T3 is the active thyroid hormone. It gets secreted by the thyroid gland on a regular basis and it controls most of your metabolic and cellular processes. Low levels of T3 are commonly associated with hypothyroidism and could also indicate Hashimoto's disease, if other thyroid hormones are also deficient. You can order a free T3 blood test from DiscountedLabs.com and get the results back by mail in a few business days. Free Thyroxine (T4) This is another hormone produced by your thyroid gland. Doctors use this test in correlation with a T3 test to detect if your thyroid gland is underperforming. The thyroxine test is usually considered to be a more sensitive thyroid test, so it's paramount to diagnose hypothyroidism and potentially Hashimoto's disease. You can order a freeT4 test from DiscountedLabs.com as well. Thyroid Stimulating Hormone (TSH) As mentioned earlier, the pituitary gland produces the thyroid-stimulating hormone. This substance tells the thyroid to produce T3 and T4. If the thyroid gland is poorly functioning, doctors also look at the TSH to see if this is causing the problem. For example, too much TSH in the blood is commonly associated with low levels of T3 and T4 (hypothyroidism). This means that the pituitary is trying to make the thyroid gland produce more hormones, but it fails for some reason. Similarly, too little TSH is commonly associated with high levels of T3 and T4 which is known as hyperthyroidism. A TSH test is routine in diagnosing thyroid problems as well as Hashimoto's disease. You can check your TSH level on your own by ordering this TSH test from DiscountedLabs.com. Thyroid Peroxidase Antibody (TPO) Thyroid peroxidase is normally produced by your thyroid gland. In the case of some autoimmune disorders such as Hashimoto's disease, your system produces antibodies to thyroid peroxidase. These are known as TPOs and in most cases, they indicate the presence of an autoimmune disorder that affects the thyroid gland. Doctors run the TPO test to accurately determine if the patient's hypothyroidism is caused by Hashimoto's disease or not. You can also order this TPO test on your own from Discountedlabs.com. Comprehensive Thyroid Panel The above tests are individual and can be ordered separately. However, it's advisable to go for a comprehensive thyroid panel that looks at all these tests and others together. This is commonly known as the comprehensive thyroid panel and you can order one from DiscountedLabs.com. For example, this panel checks your T3, T4 as well as TSH levels. It also measures thyroid peroxidase antibodies and thyroglobulin antibodies. There are other adjacent thyroid tests included in the panel. They will help you get a clearer and broader picture related to the health of your thyroid gland. Your doctor might order some of these tests anyway to determine if you really have Hashimoto's disease or not. Ordering the comprehensive panel on your own might save you time and money. What Are the Causes of Hashimoto's Disease? It's unclear what exactly triggers Hashimoto's disease. Doctors believe that a virus or bacteria makes the body think that the thyroid gland is a foreign organ. This automatically kickstarts the production of antibodies and that's how the thyroid gland gets damaged. Some people are more likely to develop Hashimoto's disease than others. For example, this disease tends to run in families, so if your close relatives had it, you might develop Hashimoto's disease in the future too. At the same time, women are more likely to develop Hashimoto's disease and other types of autoimmune diseases in comparison with men. This ailment also runs more often in middle-aged men and women, but it can develop at any stage of life. If you have other types of autoimmune diseases such as celiac disease, lupus, or rheumatoid arthritis then you are more likely to develop Hashimoto's disease. One autoimmune problem usually facilitates the development of another, but you can prevent this with early blood tests and treatment. Finally, Hashimoto's disease might also appear as a result of radiation exposure. The thyroid gland is very sensitive, so mild exposure to dangerous radiation might trigger the abnormal production of hormones. How is Hashimoto's Disease Treated? Once your doctor runs a few thyroid tests, you will know for sure if you have Hashimoto's disease or not. If the diagnosis is positive, this problem is usually solved with certain types of medications such as Levoxyl or Synthroid. There are other types of thyroid medications as well. These drugs basically give your body synthetic thyroid hormones. You will continue to function normally and you need to take your medications daily. Contrary to the popular belief, you will not have your thyroid gland removed. Your doctor also needs to monitor your drug dosage and make small adjustments over time. You might need to check your T3, T4, and TSH levels once every 6 or 12 months. In some cases, certain medications or foods might reduce the effectiveness of your thyroid drugs. For example, iron supplements could interfere with Levoxyl or similar drugs. You should talk to your doctor to find the best approach in this case. At the same time, taking your drugs on an empty stomach or for at least 4 hours before consuming high-iron foods could be beneficial for the effectiveness of the treatment. Soy products and calcium supplements might also need to be reduced during the treatment. Order Your Thyroid Tests Today! Keep in mind that Hashimoto's disease doesn't cause a major disturbance in your life, but it can develop into serious complications if left untreated. For example, heart problems and life-threatening autoimmune disorders might result from untreated Hashimoto's disease. All you have to do to prevent this illness is to check your thyroid hormones regularly. Go to DiscountedLabs.com and order the thyroid tests you need. Based on the results you get; you will know for sure if you're at risk of developing Hashimoto's disease or not.    

Determining if you have an underlying thyroid issue can be difficult, as many of the symptoms associated with thyroid disease are also common to other medical conditions. However, a thyroglobulin antibody test can help determine whether you have an autoimmune disease that targets the thyroid, thyroid cancer, or other thyroid issues [1]. In this article, we will explore what thyroglobulin antibodies are, what a thyroglobulin antibody test entails, and how to interpret the results of such a test. Table of Contents What are Thyroglobulin Antibodies? Why You May Need This Test What is a Thyroglobulin Antibody Test? How to Interpret the Results of a Thyroglobulin Antibody Test Conclusion References: What are Thyroglobulin Antibodies? Thyroglobulin is a protein that the thyroid gland creates. This protein is responsible for helping the body create, store, and release thyroid hormone [4]. Thyroglobulin antibodies, on the other hand, are antibodies that the immune system creates to attack this specific protein [4]. While some people may have naturally occurring thyroglobulin antibodies, their presence can also suggest the presence of an autoimmune disease that targets the thyroid, thyroid cancer, or other thyroid issues [2]. Why You May Need This Test If your doctor suspects you have a thyroid issue, you might need this test. Those with thyroid issues may develop thyroglobulin antibodies. You can have an overactive thyroid or an underactive thyroid (hypothyroidism) (hyperthyroidism). The thyroid gland can be destroyed by thyroglobulin antibodies, which target thyroglobulin proteins. To verify the outcomes of a thyroglobulin test, you could undergo this examination. The thyroglobulin protein is measured in this assay. This test may be included in follow-up exams if you've had thyroid cancer treatment to monitor your health. Overactive thyroid symptoms include: I feel weak and exhausted. trembling fingers and hands shedding pounds Feeling uneasy, tense, or agitated sweating profusely rapid or erratic heartbeat low heat tolerance Underactive thyroid symptoms include: gastrointestinal issues, such as constipation issues with the menstrual cycle fatigue and a lack of enthusiasm Dry skin and hair inflammation around the eyes a persistent sensation of being chilled gaining weight Depression Forgetfulness aching joints What is a Thyroglobulin Antibody Test? A thyroglobulin antibody test, also known as a TgAb test, is a blood test that checks for the presence of thyroglobulin antibodies in the bloodstream [2]. The test is typically ordered by a physician if they suspect the presence of a thyroid issue based on symptoms, medical history, or other diagnostic tests. The test is simple and requires only a small sample of blood, typically taken from a vein in the arm. The sample is then sent to a laboratory for analysis. How to Interpret the Results of a Thyroglobulin Antibody Test Interpreting the results of a thyroglobulin antibody test can be complicated, as there are a number of factors to consider. In general, however, a positive result (i.e., the presence of thyroglobulin antibodies) can suggest the presence of an autoimmune disease that targets the thyroid, thyroid cancer, or other thyroid issues [2]. It is important to note, however, that a positive result does not necessarily mean that a person has a thyroid issue. Some people may have naturally occurring thyroglobulin antibodies without any underlying thyroid issues [4]. If a person receives a positive result on a thyroglobulin antibody test, their physician will likely order additional diagnostic tests to confirm or rule out the presence of a thyroid issue. These tests may include a thyroid function test, a thyroid ultrasound, or a biopsy of the thyroid gland [1]. Conclusion If you are experiencing symptoms associated with thyroid disease, such as fatigue, weight gain, or hair loss, it may be worth discussing a thyroglobulin antibody test with your physician. This simple blood test can help determine whether you have an autoimmune disease that targets the thyroid, thyroid cancer, or other thyroid issues. However, it is important to remember that a positive result on a thyroglobulin     References:   [1] "A thyroglobulin antibody test is used to determine if you have an underlying thyroid issue. The thyroid gland is a butterfly-shaped organ at the base of the front of your neck. It creates essential hormones for the body to function correctly. Thyroid hormones play a role in your bodys metabolism, growth, and development." Reference [2] "The TgAb test checks for the presence of thyroglobulin antibodies. These antibodies can suggest the presence of an autoimmune disease that targets the thyroid, thyroid cancer, or..." URL: Reference [3] "Thyroglobulin is a protein that your thyroid makes. Your thyroid is a small, butterfly-shaped gland in your neck. It makes hormones that control many activities in your body, including your heart rate and how fast you burn calories from food. A thyroglobulin test is a type of tumor marker test." URL: Reference [4] "Thyroglobulin is an important protein found directly in your thyroid gland. This protein plays an important role in helping your body CREATE thyroid hormone, STORE thyroid hormone, and RELEASE (1) thyroid hormone. Thyroglobulin antibodies are antibodies that your own immune system creates which ATTACK this particular protein." URL: Reference

Table of Contents Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study. The association between changes in thyroid hormones and incident type 2 diabetes: A 7-year longitudinal study Buy Thyroid Tests References: Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study. Perturbations in thyroid function are common in older individuals but their significance in the very old is not fully understood.A study called "Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study" published in the November 2016 edition of theJournal of Clinical Endocrinology and Metabolism sought to determine whether thyroid hormone status and variation of thyroid hormones within the reference range correlated with mortality and disability in a cohort of 85-year-olds.This study included a cohort of 85-year-old individuals were assessed in their own homes (community or institutional care) for health status and thyroid function, and followed for mortality and disability for up to 9 years. Six hundred and forty-three 85-year-olds registered with participating general practices in Newcastle and North Tyneside, United Kingdom.The study tracked all-cause mortality, cardiovascular mortality, and disability according to thyroid disease status and baseline thyroid hormone parameters (serum TSH, FT4, FT3, and rT3). The data were adjusted for age, sex, education, body mass index, smoking, and disease count. The study found that after adjustment for age and sex, all-cause mortality was associated with baseline serum rT3 and FT3 (both P < .001), but not free T4 or TSH. After additional adjustment for potential confounders, only  reverse T3 remained significantly associated with mortality. Baseline serum TSH and reverse T3 predicted future disability trajectories in men and women, respectively. In conclusion, this study is reassuring that individuals age 85 years old with both subclinical hypothyroidism and subclinical hyperthyroidism do not have a significantly worse survival over 9 years than their peers with normal thyroid function. However, thyroid function tests did predict disability, with higher serum TSH levels predicting better outcomes. These data strengthen the argument for routine use of age-specific thyroid function reference ranges.   The association between changes in thyroid hormones and incident type 2 diabetes: A 7-year longitudinal study Thyroid hormones are important regulators of glucose metabolism and stability; however, the association between thyroid hormones within the reference range and type 2 diabetes remains unclear. A study named "The association between changes in thyroid hormones and incident type 2 diabetes: A 7-year longitudinal study" published in the Thyroid Journal on November 201 was designed to clarify the incidence of type 2 diabetes according to the baseline levels and changes of thyroid stimulating hormone (TSH) and thyroid hormones (free thyroxine [FT4] and free triiodothyronine [T3]) in euthyroid (normal thyroid function) people. Among the participants who consecutively underwent thyroid function tests between 2006 and 2012 through a yearly health check-up program, 6,235 euthyroid subjects (3,619 men and 2,616 women) without diabetes were enrolled in the study. The change in each hormone was calculated by subtracting the baseline value from the level at the end of follow-up or 1 year before the diagnosis of diabetes.The study found that during 25,692 person-years of follow-up, there were 229 new cases of type 2 diabetes. After full adjustment for potential confounders including HbA1c and fasting glucose in Cox proportional hazards models, the individuals in the highest tertile of TSH change (2.5 to 4.2 μIU/mL) had a greater risk of incident type 2 diabetes  in comparison with individuals in the lowest tertile (-4.1 to -0.5 μIU/mL). Simultaneously, the highest tertile of T3 change (16.3 to 104.7 ng/dL) and  free T4 change (0.2 to 1.6 ng/dL) conferred protective effects against diabetes compared to those in the lowest tertile (-76.5 to -1.8 ng/dL and -0.6 to 0.0 ng/dL, respectively). These associations remained significant when each of the hormones was analyzed as a continuous variable. However, baseline levels or tertiles of TSH and thyroid hormones were not associated with the risk of diabetes. This study showed that individual changes in TSH and thyroid hormones even within the normal reference range were an additional risk factor of incident type 2 diabetes.   Buy Thyroid Tests   References:   1- J Clin Endocrinol Metab. 2016 Nov;101(11):4385-4394. Epub 2016 Aug 23 2- Thyroid. 2016 Nov 3.