document_title: Thyroid

question_text: ct is produced by which cells of the thyroid gland

question_tokens: ct is produced by which cells of the thyroid gland

root

text: Thyroid

text: Structure[edit]

text: The thyroid gland is a butterfly-shaped organ that sits at the front of the neck. It is composed of two lobes, left and right, connected by a narrow isthmus.[4] The thyroid weighs 25 grams in adults,[4] with each lobe being about 5 cm long, 3 cm wide and 2 cm thick, and the isthmus about 1.25 cm in height and width.[4] The gland is usually larger in women, and increases in size in pregnancy.[4][5]

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text: The thyroid sits near the front of the neck, lying against and around the front of the larynx and trachea.[4] The thyroid cartilage and cricoid cartilage lie just above the gland, below the Adam's apple. The isthmus extends from the second to third rings of the trachea, with the uppermost part of the lobes extending to the thyroid cartilage, and the lowermost around the fourth to sixth tracheal rings.[6] The thyroid gland is covered by a thin fibrous capsule,[4] which has an inner and an outer layer. The outer layer is continuous with the pretracheal fascia, attaching the gland to the cricoid and thyroid cartilages,[5] via a thickening of the fascia to form the posterior suspensory ligament of thyroid gland also known as Berry's ligament.[5] This causes the thyroid to move up and down with swallowing.[5] The inner layer extrudes into the gland and forms the septae that divides the thyroid tissue into microscopic lobules.[4] Typically four parathyroid glands, two on each side, lie on each side between the two layers of the capsule, at the back of the thyroid lobes.[4]

text: The infrahyoid muscles lie in front of the gland and the sternocleidomastoid muscle to the side.[7] Behind the outer wings of the thyroid lie the two carotid arteries. The trachea, larynx, lower pharynx and esophagus all lie behind the thyroid.[5] In this region, the recurrent laryngeal nerve[8] and the inferior thyroid artery pass next to or in the ligament.[9]

text: Blood, lymph and nerve supply[edit]

text: The thyroid is supplied with arterial blood from the superior thyroid artery, a branch of the external carotid artery, and the inferior thyroid artery, a branch of the thyrocervical trunk, and sometimes by an anatomical variant the thyroid ima artery,[4] which has a variable origin.[10] The superior thyroid artery splits into anterior and posterior branches supplying the thyroid, and the inferior thyroid artery splits into superior and inferior branches.[4] The superior and inferior thyroid arteries join together behind the outer part of the thyroid lobes.[10] The venous blood is drained via superior and middle thyroid veins, which drain to the internal jugular vein, and via the inferior thyroid veins. The inferior thyroid veins originate in a network of veins and drain into the left and right brachiocephalic veins.[4] Both arteries and veins form a plexus between the two layers of the capsule of the thyroid gland.[10]

text: Lymphatic drainage frequently passes the prelaryngeal lymph nodes (located just above the isthmus), and the pretracheal and paratracheal lymph nodes.[4] The gland receives sympathetic nerve supply from the superior, middle and inferior cervical ganglion of the sympathetic trunk.[4] The gland receives parasympathetic nerve supply from the superior laryngeal nerve and the recurrent laryngeal nerve.[4]

text: Variation[edit]

text: There are many variants in the size and shape of the thyroid gland, and in the position of the embedded parathyroid glands.[5]

text: Sometimes there is a third lobe present called the pyramidal lobe.[5] When present, this lobe often stretches up the hyoid bone from the thyroid isthmus and may be one to several divided lobes.[4] The presence of this lobe ranges in reported studies from 18.3%[11] to 44.6%.[12] It was shown to more often arise from the left side and occasionally separated.[11] The pyramidal lobe is also known as Lalouette's pyramid.[13] The pyramidal lobe is a remnant of the thyroglossal duct which usually wastes away during the thyroid gland's descent.[5] Small accessory thyroid glands may in fact occur anywhere along the thyroglossal duct, from the foramen cecum of the tongue to the position of the thyroid in the adult.[4] A small horn at the back of the thyroid lobes, usually close to the recurrent laryngeal nerve and the inferior thyroid artery, is called Zuckerkandl's tubercle.[9]

text: Other variants include a levator muscle of thyroid gland, connecting the isthmus to the body of the hyoid bone,[5] and the presence of the small thyroid ima artery.[5]

text: Microanatomy[edit]

text: At the microscopic level, there are three primary features of the thyroid—follicles, follicular cells, and parafollicular cells, first discovered by Geoffery Websterson in 1664.[14]

text: Thyroid follicles are small spherical groupings of cells 0.02–0.9mm in diameter that play the main role in thyroid function.[4] They consist of a rim that has a rich blood supply, nerve and lymphatic presence, that surrounds a core of colloid that consists mostly of thyroid hormone precursor proteins called thyroglobulin, an iodinated glycoprotein.[4][15]

text: The core of a follicle is surrounded by a single layer of follicular cells. When stimulated by thyroid stimulating hormone (TSH), these secrete the thyroid hormones T3 and T4. They do this by transporting and metabolising the thyroglobulin contained in the colloid.[4] Follicular cells vary in shape from flat to cuboid to columnar, depending on how active they are.[4][15]

text: Scattered among follicular cells and in spaces between the spherical follicles are another type of thyroid cell, parafollicular cells.[4] These cells secrete calcitonin and so are also called C cells.[16]

text: Development[edit]

text: In the development of the embryo, at 3–4 weeks gestational age, the thyroid gland appears as an epithelial proliferation in the floor of the pharynx at the base of the tongue between the tuberculum impar and the copula linguae. The copula soon becomes covered over by the hypopharyngeal eminence [17] at a point later indicated by the foramen cecum. The thyroid then descends in front of the pharyngeal gut as a bilobed diverticulum through the thyroglossal duct. Over the next few weeks, it migrates to the base of the neck, passing in front of the hyoid bone. During migration, the thyroid remains connected to the tongue by a narrow canal, the thyroglossal duct. At the end of the fifth week the thyroglossal duct degenerates and the detached thyroid continues on to its final position over the following two weeks.[17]

text: The fetal hypothalamus and pituitary start to secrete thyrotropin-releasing hormone (TRH) and thyroid-stimulating hormone (TSH). TSH is first measurable at 11 weeks.[18] By 18–20 weeks, the production of thyroxine (T4) reaches a clinically significant and self-sufficient level.[18][19] Fetal triiodothyronine (T3) remains low, less than 15 ng/dL until 30 weeks, and increases to 50 ng/dL at full-term.[19] The fetus needs to be self-sufficient in thyroid hormones in order to guard against neurodevelopmental disorders that would arise from maternal hypothyroidism.[20] The presence of sufficient iodine is essential for healthy neurodevelopment.[21]

text: The neuroendocrine parafollicular cells, also known as C cells, responsible for the production of calcitonin, are derived from neural crest cells, which migrate to the pharyngeal arches. This part of the thyroid then first forms as the ultimopharyngeal body, which begins in the ventral fourth pharyngeal pouch and joins the primordial thyroid gland during its descent to its final location.[22]

text: Aberrations in prenatal development can result in various forms of thyroid dysgenesis which can cause congenital hypothyroidism, and if untreated this can lead to cretinism.[18]

text: Function[edit]

text: Thyroid hormones[edit]

text: The primary function of the thyroid is the production of the iodine-containing thyroid hormones, triiodothyronine (T3) and thyroxine (T4) and the peptide hormone calcitonin.[23] T3 is so named because it contains three atoms of iodine per molecule and T4 contains four atoms of iodine per molecule.[24] The thyroid hormones have a wide range of effects on the human body. These include:

text:
Metabolic. The thyroid hormones increase the basal metabolic rate and have effects on almost all body tissues.[25] Appetite, the absorption of substances, and gut motility are all influenced by thyroid hormones.[26] They increase the absorption in the gut, generation, uptake by cells, and breakdown of glucose.[27] They stimulate the breakdown of fats, and increase the number of free fatty acids.[27] Despite increasing free fatty acids, thyroid hormones decrease cholesterol levels, perhaps by increasing the rate of secretion of cholesterol in bile.[27]
Cardiovascular. The hormones increase the rate and strength of the heartbeat. They increase the rate of breathing, intake and consumption of oxygen, and increase the activity of mitochondria.[26] Combined, these factors increase blood flow and the body's temperature.[26]
Developmental. Thyroid hormones are important for normal development.[27] They increase the growth rate of young people,[28] and cells of the developing brain are a major target for the thyroid hormones T3 and T4. Thyroid hormones play a particularly crucial role in brain maturation during fetal development.[27]
The thyroid hormones also play a role in maintaining normal sexual function, sleep, and thought patterns. Increased levels are associated with increased speed of thought generation but decreased focus.[26] Sexual function, including libido and the maintenance of a normal menstrual cycle, are influenced by thyroid hormones.[26]

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text: After secretion, only a very small proportion of the thyroid hormones travel freely in the blood. Most are bound to thyroxine-binding globulin (about 70%), transthyretin (10%), and albumin (15%).[29] Only the 0.03% of T4 and 0.3% of T3 traveling freely have hormonal activity.[30] In addition, up to 85% of the T3 in blood is produced following conversion from T4 by iodothyronine deiodinases in organs around the body.[23]

text: Thyroid hormones act by crossing the cell membrane and binding to intracellular nuclear thyroid hormone receptors TR-α1,TR-α2,TR-β1 and TR-β2, which bind with hormone response elements and transcription factors to modulate DNA transcription.[30][31] In addition to these actions on DNA, the thyroid hormones also act within the cell membrane or within cytoplasm via reactions with enzymes, including calcium ATPase, adenylyl cyclase, and glucose transporters.[18]

text: Hormone production[edit]

text: The thyroid hormones are created from thyroglobulin. This is a protein within the follicular space that is originally created within the rough endoplasmic reticulum of follicular cells and then transported into the follicular space. Thyroglobulin contains 123 units of tyrosine, which reacts with iodine within the follicular space.[33]

text: Iodine is essential for the production of the thyroid hormones. Iodine (I0) travels in the blood as iodide (I−), which is taken up into the follicular cells by a sodium-iodide symporter. This is an ion channel on the cell membrane which in the same action transports two sodium ions and an iodide ion into the cell.[34] Iodide then travels from within the cell into the follicular space, through the action of pendrin, an iodide-chloride antiporter. In the follicular space, the iodide is then oxidized to iodine. This makes it more reactive,[32] and the iodine is attached to the active tyrosine units in thyroglobulin by the enzyme thyroid peroxidase. This forms the precursors of thyroid hormones monoiodotyrosine (MIT), and diiodotyrosine (DIT).[2]

text: When the follicular cells are stimulated by thyroid-stimulating hormone, the follicular cells reabsorb thyroglobulin from the follicular space. The iodinated tyrosines are cleaved, forming the thyroid hormones T4, T3, DIT, MIT, and traces of reverse triiodothyronine. T3 and T4 are released into the blood. The hormones secreted from the gland are about 80–90% T4 and about 10–20% T3.[35][36] Deiodinase enzymes in peripheral tissues remove the iodine from MIT and DIT and convert T4 to T3 and RT3. [33] This is a major source of both RT3 (95%) and T3 (87%) in peripheral tissues.[37]

text: Regulation[edit]

text: The production of thyroxine and triiodothyronine is primarily regulated by thyroid-stimulating hormone (TSH), released by the anterior pituitary gland. TSH release in turn is stimulated by thyrotropin releasing hormone (TRH), released in a pulsatile manner from the hypothalamus.[38] The thyroid hormones provide negative feedback to the thyrotropes TSH and TRH: when the thyroid hormones are high, TSH production is suppressed. This negative feedback also occurs when levels of TSH are high, causing TRH production to be suppressed.[39]

text: TRH is secreted at an increased rate in situations such as cold exposure in order to stimulate thermogenesis.[40] In addition to being suppressed by the presence of thyroid hormones, TSH production is blunted by dopamine, somatostatin, and glucocorticoids.[41]

text: Calcitonin[edit]

text: The thyroid gland also produces the hormone calcitonin, which helps regulate blood calcium levels. Parafollicular cells produce calcitonin in response to high blood calcium. Calcitonin decreases the release of calcium from bone, by decreasing the activity of osteoclasts, cells which break down bone. Bone is constantly reabsorbed by osteoclasts and created by osteoblasts, so calcitonin effectively stimulates movement of calcium into bone. The effects of calcitonin are opposite those of the parathyroid hormone (PTH) produced in the parathyroid glands. However, calcitonin seems far less essential than PTH, as calcium metabolism remains clinically normal after removal of the thyroid (thyroidectomy), but not the parathyroid glands.[42]

text: Gene and protein expression[edit]

text: About 20,000 protein coding genes are expressed in human cells and 70% of these genes are expressed in the normal thyroid.[43][44] Some 250 of these genes are more specifically expressed in the thyroid with about 20 genes being highly thyroid specific. The corresponding specific proteins are mainly involved in thyroid hormone synthesis, such as thyroglobulin, TPO and IYD, and expressed in follicular cells. Other proteins elevated in the thyroid are calcitonin related proteins such as CALCA and CALCB, expressed in the parafollicular c-cells.

text: Clinical significance[edit]

text: Symptoms[edit]

text: Hyperthyroidism[edit]

text: Excessive production of the thyroid hormones is called hyperthyroidism, which is most commonly a result of Graves' disease, a toxic multinodular goitre, a solitary thyroid adenoma, or inflammation. Other causes include drug-induced excess of iodine, particularly from amiodarone, an antiarrhythmic medication; an excess caused by the preferential uptake of iodine by the thyroid following iodinated contrast imaging; or from pituitary adenomas which may cause an overproduction of thyroid stimulating hormone.[45] Hyperthyroidism often causes a variety of non-specific symptoms including weight loss, increased appetite, insomnia, decreased tolerance of heat, tremor, palpitations, anxiety and nervousness. In some cases it can cause chest pain, diarrhoea, hair loss and muscle weakness.[46] Such symptoms may be managed temporarily with drugs such as beta blockers.[47]

text: Long-term management of hyperthyroidism may include drugs that suppress thyroid function such as propylthiouracil, carbimazole and methimazole.[48] Radioactive iodine-131 can be used to destroy thyroid tissue. Radioactive iodine is selectively taken up by the thyroid, which over time destroys the cells involved in its uptake. The chosen first-line treatment will depend on the individual and on the country where being treated. Surgery to remove the thyroid can sometimes be performed as a transoral thyroidectomy, a minimally-invasive procedure.[49] Surgery does however carry a risk of damage to the parathyroid glands and the nerves controlling the vocal cords. If the entire thyroid gland is removed, hypothyroidism will naturally result, and thyroid hormone substitutes will be needed.[50][47]

text: Hypothyroidism[edit]

text: An underactive thyroid gland results in hypothyroidism. Typical symptoms are abnormal weight gain, tiredness, constipation, heavy menstrual bleeding, hair loss, cold intolerance, and a slow heart rate.[46] Iodine deficiency is the most common cause of hypothyroidism worldwide,[51] and the autoimmune disease Hashimoto's thyroiditis is the most common cause in the developed world.[52] Other causes include congenital abnormalities, diseases causing transient inflammation, surgical removal or radioablation of the thyroid, the drugs amiodarone and lithium, amyloidosis, and sarcoidosis.[53] Some forms of hypothyroidism can result in myxedema and severe cases can result in myxedema coma.[54]

text: Hypothyroidism is managed with replacement of the hormone thyroxine. This is usually given daily as an oral supplement, and may take a few weeks to become effective.[54] Some causes of hypothyroidism, such as Postpartum thyroiditis and Subacute thyroiditis may be transient and pass over time, and other causes such as iodine deficiency may be able to be rectified with dietary supplementation.[55]

text: Nodules[edit]

text: Thyroid nodules are often found on the gland, with a prevalence of 4–7%.[56] The majority of nodules do not cause any symptoms and are non-cancerous.[57] Non-cancerous cases include simple cysts, colloid nodules, and thyroid adenomas. Malignant nodules, which only occur in about 5% of nodules, include follicular, papillary, medullary carcinomas and metastases from other sites [58] Nodules are more likely in females, those who are exposed to radiation, and in those who are iodine deficient.[56]

text: When a nodule is present, thyroid function tests are performed and reveal whether a person has a normal amount of thyroid hormones ("euthyroid") or an excess of hormones, usually secreted by the nodule, causing hyperthyroidism.[57] When the thyroid function tests are normal, an ultrasound is often used to investigate the nodule, and provide information such as whether the nodule is fluid-filled or a solid mass, and whether the appearance is suggestive of a benign or malignant cancer.[56] A needle aspiration biopsy may then be performed, and the sample undergoes cytology, in which the appearance of cells is viewed to determine whether they resemble normal or cancerous cells.[58]

text: There can be many nodules, which is termed a multinodular goitre, and this can sometimes be a toxic multinodular goitre.[58]

text: Swelling[edit]

text: An enlarged thyroid gland is called a goitre.[59] Goitres are present in some form in about 5% of people,[58] and are the result of a large number of causes, including iodine deficiency, autoimmune disease (both Grave's disease and Hashimoto's thyroiditis), infection, inflammation, and infltrative disease such as sarcoidosis and amyloidosis. Sometimes no cause can be found, a state called "simple goitre".[60]

text: Some forms of goitre are associated with pain, whereas many do not cause any symptoms. Enlarged goitres may extend beyond the normal position of the thyroid gland to below the sternum, around the airway or esophagus.[58] Goitres may be associated with hyperthyoidism or hypothyroidism, relating to the underlying cause of the goitre.[58] Thyroid function tests may be done to investigate the cause and effects of the goitre. The underlying cause of the goitre may be treated, however many goitres with no associated symptoms are simply monitored.[58]

text: Disease[edit]

text: Disorders of the thyroid are functional–caused by dysfunction in the production of hormones, and nodes and tumors either benign or malignant. Functional disorders can cause inflammation as can some other forms of thyroiditis. Functional disorders can result in the overproduction or underproduction of hormones. Any of the functional thyroid disorders can result in the gland's enlargement and cause a swollen neck termed a goitre.

text: Inflammation[edit]

text: Inflammation of the thyroid is called thyroiditis. Inflamed thyroids may cause symptoms of hyperthyroidism or hypothyroidism. Two types thyroiditis initially present with hyperthyroidism and are sometimes followed by a period of hypothyroidism – Hashimoto's thyroiditis and postpartum thyroiditis. There are other disorders that cause inflammation of the thyroid, and these include subacute thyroiditis, acute thyroiditis, silent thyroiditis, Riedel's thyroiditis and traumatic injury, including palpation thyroiditis.[61]

text: Hashimoto's thyroiditis is an autoimmune disorder in which the thyroid gland is infltrated by the lymphocytes B-cell and T-cells. These progressively destroy the thyroid gland.[62] In this way, Hasimoto's thyroiditis may have occurred insidiously, and only be noticed when thyroid hormone production decreases, causing symptoms of hypothyroidism.[62] Hashimoto's is more common in females than males, much more common after the age of 60, and has known genetic risk factors.[62] Also more common in individuals with Hashimoto's thyroiditis are type 1 diabetes, pernicious anaemia, Addison's disease vitiligo.[62]

text: Postpartum thyroiditis occurs in some females following childbirth. After delivery, the gland becomes inflamed and the condition initially presents with a period of hyperthyroidism followed by hypothyroidism and, usually, a return to normal function. [63] The course of the illness takes place over several months, and is characterised by a painless goitre. Antibodies against thyroid peroxidase can be found on testing. The inflammation usually resolves without treatment, although thyroid hormone replacement may be needed during the period of hypothyroidism.[63]

text: Cancer[edit]

text: The most common neoplasm affecting the thyroid gland is a benign adenoma, usually presenting as a painless mass in the neck.[64] Malignant thyroid cancers are most often carcinomas, although cancer can occur in any tissue that the thyroid consists of, including cancer of C-cells and lymphomas. Cancers from other sites also rarely lodge in the thyroid.[64] Radiation of the head and neck presents a risk factor for thyroid cancer, and cancer is more common in women than men, occurring at a rate of about 2:1.[64]

text: In most cases, thyroid cancer presents as a painless mass in the neck. It is very unusual for thyroid cancers to present with other symptoms, although in some cases cancer may cause hyperthyroidism.[65] Most malignant thyroid cancers are papillary, followed by follicular, medullary, and thyroid lymphoma.[64][65] Because of the prominence of the thyroid gland, cancer is often detected earlier in the course of disease as the cause of a nodule, which may undergo fine needle aspiration. Thyroid function tests will help reveal whether the nodule produces excess thyroid hormones. A radioactive iodine uptake test can help reveal the activity and location of the cancer and metastases.[64][66]

text: Thyroid cancers are treated by removing the whole or part of thyroid gland. Radioactive Iodine 131 may be given to radioablate the thyroid. Thyroxine is given to replace the hormones lost and to suppress TSH production, as TSH may stimulate recurrence.[66] With the exception of the rare anaplastic thyroid cancer, which carries a very poor prognosis, most thyroid cancers carry an excellent prognosis and can even be considered curable.[67]

text: Congenital[edit]

text: A persistent thyroglossal duct is the most common clinically significant congenital disorder of the thyroid gland. A persistent sinus tract may remain as a vestigial remnant of the tubular development of the thyroid gland. Parts of this tube may be obliterated, leaving small segments to form thyroglossal cysts.[22] Preterm neonates are at risk of hypothyroidism as their thyroid glands are insufficiently developed to meet their postnatal needs.[68] In order to detect hypothyroidism in newborn babies, to prevent growth and development abnormalities in later life, many countries have newborn screening programs at birth.[69]

text: Infants with thyroid hormone deficiency (congenital hypothyroidism) can manifest problems of physical growth and development as well as brain development, termed cretinism.[70][21] Children with congenital hypothyroidism are treated supplementally with levothyroxine, which facilitates normal growth and development.[71]

text: Mucinous, clear secretions may collect within these cysts to form either spherical masses or fusiform swellings, rarely larger than 2 to 3 cm in diameter. These are present in the midline of the neck anterior to the trachea. Segments of the duct and cysts that occur high in the neck are lined by stratified squamous epithelium, which is essentially identical to that covering the posterior portion of the tongue in the region of the foramen cecum. The disorders that occur in the lower neck more proximal to the thyroid gland are lined by epithelium resembling the thyroidal acinar epithelium. Characteristically, next to the lining epithelium, there is an intense lymphocytic infiltrate. Superimposed infection may convert these lesions into abscess cavities, and rarely, give rise to cancers.[citation needed]

text: Another disorder is that of thyroid dysgenesis which can result in various presentations of one or more misplaced accessory thyroid glands.[4] These can be asymptomatic.

text: Iodine[edit]

text: Iodine deficiency, most common in inland and mountainous areas, can predispose to goitre – if widespread, known as endemic goitre.[70] Pregnant women deficient of iodine can give birth to infants with thyroid hormone deficiency.[70][21] The use of iodised salt used to add iodine to the diet[21] has eliminated endemic cretinism in most developed countries,[73] and over 120 countries have made the iodination of salt mandatory.[74]

text: Because the thyroid concentrates iodine, it also concentrates the various radioactive isotopes of iodine produced by nuclear fission. In the event of large accidental releases of such material into the environment, the uptake of radioactive iodine isotopes by the thyroid can, in theory, be blocked by saturating the uptake mechanism with a large surplus of non-radioactive iodine, taken in the form of potassium iodide tablets. One consequence of the Chernobyl disaster was an increase in thyroid cancers in children in the years following the accident.[75]

text: As with most substances, either too much or too little can cause problems. Recent studies on some populations are showing that excess iodine intake could cause an increased prevalence of autoimmune thyroid disease, resulting in permanent hypothyroidism.[76]

text: Graves' disease[edit]

text: Graves' disease is an autoimmune disorder that is the most common cause of hyperthyroidism.[77] In Graves' disease, for an unknown reason autoantibodies develop against the thyroid stimulating hormone receptor. These antibodies activate the receptor, leading to development of a goitre and symptoms of hyperthyroidism, such as heat intolerance, weight loss, diarrhoea and palpitations. Occasionally such antibodies block but do not activate the receptor, leading to symptoms associated with hypothyroidism.[77] In addition, gradual protrusion of the eyes may occur, called Graves' ophthalmopathy, as may swelling of the front of the shins.[77] Graves' disease can be diagnosed by the presence of pathomnomonic features such as involvement of the eyes and shins, or isolation of autoantibodies, or by results of a radiolabelled uptake scan. Graves' disease is treated with anti-thyroid drugs such as propylthiouracil, which decrease the production of thyroid hormones, but hold a high rate of relapse. If there is no involvement of the eyes, then use of radioactive isotopes to ablate the gland may be considered. Surgical removal of the gland with subsequent thyroid hormone replacement may be considered, however this will not control symptoms associated with the eye or skin.[77]

text: Examination[edit]

text: Physicians who specialise in the treatment of thyroid disorders are known generally as endocrinologists, thyroid specialists or thyroidologists. Thyroid surgeon or otolaryngologistss may play a role in the surgical management of thyroid disease and general practitioners and family physicians may play a role in monitoring for and identifying symptoms related to thyroid disease.

text: The thyroid itself is examined by observation of the gland and surrounding neck for swelling or enlargement.[78] It is then felt, usually from behind, and a person is often asked to swallow to better feel the gland against the fingers of the examiner.[78] The gland moves up and down with swallowing because of its attachments to the thyroid and cricoid cartilages.[5] In a healthy person the gland is not visible yet is palpable as a soft mass. Examination of the thyroid gland includes the search for abnormal masses and the assessment of overall thyroid size.[79] The character of the thyroid, swellings, nodules, and their consistency may all be able to be felt. If a goitre is present, an examiner may also feel down the neck consider tapping the upper part of the chest to check for extension. Further tests may include raising the arms (Pemberton's sign), listening to the gland with a stethoscope for bruits, testing of reflexes, and palpation of the lymph nodes in the head and neck. A medical examination of the thyroid will also include observation of the person as a whole, to look for systemic signs such as weight gain or loss, hair loss, and signs in other locations – such as protrusion of the eyes or swelling of the calves in Grave's disease.[80][78]

text: Tests[edit]

text: A number of tests that can be used to test the function of the thyroid, for the presence of diseases, and for the success or failure of treatment. Blood tests in general aim to measure thyroid function or determine the cause of thyroid dysfunction. Thyroid function tests include a battery of blood tests including the measurement of the thyroid hormones T3 and T4, as well as the measurement of TSH.[81] They may reveal hyperthyroidism (high T3 and T4), hypothyroidism (low T3, T4), or subclinical hyperthyroidism (normal T3 and T4 with a low TSH).[81]

text: TSH levels are considered the most sensitive marker of thyroid dysfunction.[81] They are however not always accurate, particularly if the cause of hypothyroidism is thought to be related to insufficient TRH secretion, in which case it may be low or falsely normal. In such a case a TRH stimulation test, in which TRH is given and TSH levels are measured at 30 and 60-minutes after, may be conducted.[81]

text: T3 and T4 can be measured directly. However, as the two thyroid hormones travel bound to other molecules, and it is the "free" component that is biologically active, free T3 and free T4 levels can be measured.[81] T4 is preferred, because in hypothyroidism T3 levels may be normal.[81] The ratio of bound to unbound thyroid hormones is known as the thyroid hormone binding ratio (THBR).[82] It is also possible to measure directly the main carriers of the thyroid hormones, thryoglobulin and throxine-binding globulin.[83] Thyroglobulin will also be measurable in a healthy thyroid, and will increase with inflammation, and may also be used to measure the success of thyroid removal or ablation. If successful, thyroglobulin should be undetectable.[82] Lastly, antibodies against components of the thyroid, particularly anti-TPO and anti-thyroglobulin, can be measured. These may be present in normal individuals but are highly sensitive for autoimmune-related disease.[82]

text: Ultrasound of the thyroid may be used to reveal whether structures are solid or filled with fluid, helping to differentiate between nodules and goitres and cysts. It may also help differentiate between malignant and benign lesions.[84] A fine needle aspiration biopsy may be taken concurrently of thyroid tissue to determine the nature of a lesion. These biopsies are then sent for histopathology and cytology.[85] When further imaging is required, a radiolabelled iodine-123 or technetium-99 uptake scan may take place. This can determine the size and shape of lesions, reveal whether nodules or goitres are metabolically active, and reveal and monitor sites of thyroid disease or cancer deposits outside the thyroid.[86]

text: History[edit]

text: The presence and diseases of the thyroid have been noted and treated for thousands of years, although the gland itself has only been described and named since the renaissance.[87] The first recorded mention of the thyroid is in terms of goitre in Chinese texts circa 2700 BCE, of which there is general agreement.[87][88] In 1600 BCE burnt sponge and seaweed were used within China for the treatment of goitres, a practice which has developed in many parts of the world.[87][88] In Ayurvedic medicine, the book Sushruta Samhita written about 1400 BCE describes hyperthyroidism, hypothyroidism and goitre.[88] Aristotle and Xenophon in the fifth century BCE describe cases of Grave's disease, which receives its name over two millennia later owing to descriptions provided by Robert James Graves in 1834,[88] Hippocrates and Plato in the fourth century BCE provided some of the first descriptions of the gland itself, proposing its function as a salivary gland.[88] Pliny the Elder in the first century BCE referred to epidemics of goitre in the Alps and proposed treatment with burnt seaweed,[87] a practice also referred to by Galen in the second century, referred to burnt sponge for the treatment of goitre.[87]

text: In 1500 polymath Leonardo da Vinci provides the first illustration of the thyroid.[87] In 1543 Anatomist Andreas Vesalius gave the first anatomic description and illustration of the gland.[87] In 1656 the thyroid received its name, by the anatomist Thomas Wharton.[87] The gland was named thyroid, meaning shield, as its shape resembled the shields commonly used in Ancient Greece.[87] The English name thyroid gland[89] is derived from the medical Latin used by Wharton – glandula thyreoidea.[90] Glandula means gland in Latin,[91] and thyreoidea can be traced back to the Ancient Greek word θυρεοειδής, meaning shield-like/shield-shaped.[92]

text: French chemist Bernard Courtois discovered Iodine in 1811,[88] and in 1896 Eugen Baumann documented it as the central ingredient in the thryoid gland. He did this by boiling the thyroid glands of a thousand sheep, and named the precipitate, a combination of the thyroid hormones, 'iodothyrin'.[88] David Marine in 1907 provided iodine is necessary for thyroid function.[88][87] Thyroxine itself was first isolated in 1914 and synthesized in 1927, and trirodothyroxine in 1952.[88][93] The conversion of T4 to T3 was discovered in 1970.[87] The process of discovering TSH took place over the early to mid twentieth century.[94] TRH was discovered by Polish endocrinologist Andrew Schally in 1970, contributing in part to his Nobel Prize in Medicine in 1977.[87][95]

text: Either Aetius in the sixth century CE[88] or Persian Ali ibn Abbas al-Magusi in 990 CE conducted the first recorded thyroidectomy as a treatment for goitre.[87][96] Operations remained risky and generally were not successful until the 19th century, when descriptions emerged from a number of authors including Prussian surgeon Theodor Billroth, Swiss surgeon and physiologist Theodor Kocher, American physician Charles Mayo, William Halsted and George Crile. These descriptions provided the basis for modern thyroid surgery.[97] Theodor Kocher went on to win the Nobel Prize in Physiology or Medicine in 1909 "for his work on the physiology, pathology and surgery of the thyroid gland".[98]

text: Numerous authors described cretinism, myxoedema their relationship with the thyroid in the nineteenth century.[88] Charles Mayo coined the term hyperthyroidism in 1910,[87] Hakaru Hashimoto documented a case of Hashimoto's thyroiditis in 1912, and autoantibodies were demonstrated in 1956.[88] Knowledge of the thyroid and its conditions developed throughout the late nineteenth and twentieth centuries, with many modern treatments and investigative modalities evolving throughout the mid twentieth century, including the use of radioactive iodine, thiouracil and fine needle aspiration.[87]

text: Other animals[edit]

text: The thyroid gland is found in all vertebrates. In fish, it is usually located below the gills and is not always divided into distinct lobes. However, in some teleosts, patches of thyroid tissue are found elsewhere in the body, associated with the kidneys, spleen, heart, or eyes.[99]

text: In tetrapods, the thyroid is always found somewhere in the neck region. In most tetrapod species, there are two paired thyroid glands – that is, the right and left lobes are not joined together. However, there is only ever a single thyroid gland in most mammals, and the shape found in humans is common to many other species.[99]

text: In larval lampreys, the thyroid originates as an exocrine gland, secreting its hormones into the gut, and associated with the larva's filter-feeding apparatus. In the adult lamprey, the gland separates from the gut, and becomes endocrine, but this path of development may reflect the evolutionary origin of the thyroid. For instance, the closest living relatives of vertebrates, the tunicates and Amphioxus, have a structure very similar to that of larval lampreys (the endostyle), and this also secretes iodine-containing compounds (albeit not thyroxine).[99]

text: Thyroxine is critical to the regulation of metabolism and growth throughout the animal kingdom. For example, Iodine and T4 trigger the change from a plant-eating water-dwelling tadpole into a meat-eating land-dwelling frog, with better neurological, visuospatial, smell and cognitive abilities for hunting, as seen in other predatory animals. A similar phenomenon happens in the neotenic amphibian salamanders, which, without introducing iodine, don't transform into land-dwelling adults, and live and reproduce in the larval form of aquatic axolotl. Among amphibians, administering a thyroid-blocking agent such as propylthiouracil (PTU) can prevent tadpoles from metamorphosing into frogs; in contrast, administering thyroxine will trigger metamorphosis. In amphibian metamorphosis, thyroxine and iodine also exert a well-studied experimental model of apoptosis on the cells of gills, tail, and fins of tadpoles. Iodine, via iodolipids, has favored the evolution of terrestrial animal species and has likely played a crucial role in the evolution of the human brain.[100][101]


document_title: The Elf on the Shelf

question_text: when was the elf on the shelf movie made

text: The Elf on the Shelf

text: Plot[edit]

text: This story describes how Santa's "scout elves" hide in people's homes to watch over events. Once everyone goes to bed, the scout elf flies back to the North Pole to report to Santa the activities, good and bad, that have taken place throughout the day. Before the family wakes up each morning, the scout elf flies back from the North Pole and hides. By hiding in a new spot each morning around the house, the scout elf plays an ongoing game of hide and seek with the family.

text: The Elf on the Shelf explains that scout elves get their magic by being named and being loved by a child. In the back of each book, families have an opportunity to write their elf's name and the date that they adopted it. Once the elf is named, the scout elf receives its special Christmas magic, which allows it to fly to and from the North Pole.

text: The book tells how the magic might disappear if the scout elf is touched, so the rule for The Elf on the Shelf states, "There's only one rule that you have to follow, so I will come back and be here tomorrow: Please do not touch me. My magic might go, and Santa won't hear all I've seen or I know." Although families are told not to touch their scout elf, they can speak to it and tell it all their Christmas wishes so that it can report back to Santa accurately.

text: The story ends on Christmas Day with the elf leaving to stay with Santa for the rest of the year until the following Christmas season.

text: History[edit]

text: The Elf on the Shelf was written in 2004 by Carol Aebersold and daughter Chanda Bell over a cup of tea. Bell suggested they write a book about an old tradition of an elf sent from Santa who came to watch over them at Christmas time. Aebersold's other daughter, Christa Pitts, was recruited by the family to share her expertise in sales and marketing. Together, the trio devoted the next three years promoting their self-published book and attending book signings and trade shows.

text: The Elf on the Shelf won the Best Toy Award by Learning Express, won Book of the Year Award from Creative Child Awards and National Best Books Award sponsored by USA Book News in 2008. In 2012, The Elf on the Shelf made its first appearance in the Macy's Thanksgiving Day Parade alongside fellow parade newcomers Hello Kitty and Papa Smurf. In 2013, The Elf on the Shelf hit the #1 spot on the USA Today Bestsellers List.[1]

text: On 26 November 2011, the book aired on CBS as a 30-minute animated TV show, An Elf's Story: The Elf on the Shelf, directed by Chad Eikhoff.[2][3] The Washington Post criticized the quality of the animation and dismissed it as "just a half-hour advertisement for a book and a toy", which it felt would not join "the canon of prime-time animated Christmas specials that actually move the spirit".[3] Common Sense Media disagreed, calling the special "a great addition to families' holiday TV traditions";[4] however, they also warn parents about the consumer-driven nature of the story, and make note of its lack of educational value.

text: In October 2013, The Elf on the Shelf: A Birthday Tradition was released. Written and illustrated by the same team that created the first book, it offers instructions for inviting a scout elf to visit for a child's birthday party and describes how the elf decorates a chair for the child.[citation needed] In April 2014, two supplemental birthday products were released: The Elf on the Shelf Birthday Countdown Game and The Elf on the Shelf Birthday Chair Decoration Kit.[citation needed]

text: The Elf on the Shelf was parodied as "The Gnome in the Home" in "The Nightmare After Krustmas," a 2016 episode of The Simpsons.

text: Mensch on a Bench[edit]

text: A Jewish counterpart to Elf On The Shelf was created: "Mensch on a Bench," a stuffed toy that looks a bit like a rabbi or a Hasidic Jew.[5][6][7] Jewish father Neal Hoffman, a former Hasbro Toys toy marketing executive, raised more than $20,000, using the crowdfunding website Kickstarter to fund creation of the toy in the Spring of 2011.[6][8][9][10] "Mensch", in Yiddish, means a person of integrity or honor.[5][11][12]

text: Cody Decker, the starting left fielder for Team Israel at the 2017 World Baseball Classic, brought the team's mascot, a five-foot version of "Mensch on a Bench," with him to Asia from the United States for the World Baseball Classic.[5][13][14] Decker said he "tried getting him a first-class ticket. But that didn’t fly, so he was put in a duffel bag and checked."[15] The mascot proved to be a big hit.[5][13] He has his own locker, sits on Team Israel's bench in the dugout during every game, and sat alongside Decker at a press conference in South Korea.[11][15][16] Decker said:

text: "He’s a mascot, he’s a friend, he’s a teammate, he’s a borderline deity to our team.... He brings a lot to the table.... Every team needs their Jobu. He was ours. He had his own locker, and we even gave him offerings: Manischewitz, gelt, and gefilte fish... He is everywhere and nowhere all at once. His actual location is irrelevant because he exists in higher metaphysical planes. But he’s always near."[11]

text: Team Israel Manager Jerry Weinstein said: "He’s on the team. Everybody brings something to the team, and certainly The Mensch is a unifying factor for the ball club."[5] Pitcher Gabe Cramer said: "The Mensch on a Bench is ... a symbol we can rally around as a team. We are proud to be Jewish, but we know how to make and take a joke, something Jews have a long history of doing. The Mensch is a great way to have fun in the dugout while reminding us of why we’re here and who we’re representing."[17]

text: Criticism[edit]

text: The Elf has received some criticism from cultural reviewers. The Atlantic columnist Kate Tuttle calls it "a marketing juggernaut dressed up as a tradition" whose purpose is "to spy on kids" and that one shouldn't "bully your child into thinking that good behavior equals gifts."[18] Washington Post reviewer Hank Stuever characterized the concept as "just another nannycam in a nanny state obsessed with penal codes".[3] Writing for Psychology Today, Dr. David Kyle Johnston calls it a "dangerous parental crutch", with much the same reasoning as what he terms the "Santa lie".[19] Professor Laura Pinto suggests that it conditions kids to accept the surveillance state and that it communicates to children that "it's okay for other people to spy on you, and you're not entitled to privacy."[20] She argues that "if you grow up thinking it's cool for the elves to watch me and report back to Santa, well, then it's cool for the NSA to watch me and report back to the government ... The rule of play is that kids get to interact with a doll or video game or what have you, but not so with the Elf on the Shelf: The rule is that you don't touch the elf. Think about the message that sends."[21][22]


document_title: List of NFL quarterbacks with 5,000 passing yards in a season

question_text: who has the passing record in the nfl

question_tokens: who has the passing record in the nfl

text:
NFL lists
Current season[show]
2018 season

Quarterbacks[show]
 Starting quarterbacks by touchdowns / touchdowns (playoffs) / yardage / 5000 yard seasons / completion / winsby team  BUFMIANENYJ BALCINCLEPIT HOUINDJAXTEN DENKCLACOAK DALNYGPHIWAS CHIDETGBMIN ATLCARNOTB ARILARSFSEAMost winsPlayoff records
Most consecutive starts
Most consecutive gameswith touchdown pass

Running backs[show]
Career rushing attempts leaders
Career rushing yards leaders
Career rushing touchdowns leaders
Annual rushing yards leaders
Annual rushing touchdowns leaders
2,000-yard club
1,000-yard duos

Receivers[show]
Career receptions leaders
Career receiving yards leaders
Career receiving touchdowns leaders
Annual receptions leaders
Annual receiving yards leaders
Annual receiving touchdowns leaders

Defense[show]
Career sacks leaders
Annual sacks leaders
Career interceptions leaders
Annual interceptions leaders

Special teams[show]
Longest field goals
Career field goals leaders
Career punting yards leaders
Career punt return yards leaders
Career kickoff return yards leaders
Annual field goals leaders
Annual punting yards leaders
Annual punt return yards leaders
Annual kickoff return yards leaders

Other lists[show]
Most consecutive starts(and games played)
Career all-purpose yards leaders
Career scoring leaders
Brett Favre'scareer achievements
Peyton Manning'scareer achievements
vte

tag: table

text: Passing for 5,000 yards in a single regular season is a rare achievement in the National Football League (NFL).  Dan Marino was the first player to reach the 5,000 mark when he set an NFL record with 5,084 yards passing in 1984.[1]   Marino's record remained intact for over a decade after his retirement in 1999.[2] Peyton Manning currently holds the record with 5,477 passing yards in 2013. Drew Brees is the only NFL quarterback to reach 5,000 yards more than once, having done so five times.[3] In 2011 three different players, Tom Brady, Drew Brees, and Matt Stafford threw for over 5,000 yards.

text: NFL players with 5,000 passing yards in a season[edit]

text:
Quarterback

Team

Passing yards

Season

Notes

Dan Marino

Miami Dolphins

5,084

1984

1st in NFL history, AP MVP & Offensive Player of the Year[4]

Drew Brees

New Orleans Saints

5,069

2008

Offensive Player of the Year[5]

Drew Brees

New Orleans Saints

5,476

2011

2nd 5,000-yard season,  Offensive Player of the Year

Tom Brady

New England Patriots

5,235

2011

[6]

Matthew Stafford

Detroit Lions

5,038

2011

Comeback Player of the Year[7]

Drew Brees

New Orleans Saints

5,177

2012

3rd 5,000-yard season, 2nd consecutive

Peyton Manning

Denver Broncos

5,477

2013

NFL record, AP MVP & Offensive Player of the Year

Drew Brees

New Orleans Saints

5,162

2013

4th 5,000-yard season, 3rd consecutive

Drew Brees

New Orleans Saints

5,208

2016

5th 5,000-yard season

text: 4,000 passing yards in a season[edit]

text: 4,000 yards passing in a season was once considered a very rare feat but has lost a bit of significance over the years.  During the 14 game era, only Joe Namath passed for over 4,000 yards in a season with 4,007 yards passing in the 1967 AFL season.  During the 1980s and 1990s, 4,000 yards became the standard for the league leaders in the NFL.  Over the last decade, 4,000 yards has become almost commonplace in the NFL.  In the 2012 season, eleven quarterbacks passed for over 4,000 yards.[8] Peyton Manning has had the most 4,000 yard seasons (14).[9]


document_title: Spencer Reid

question_text: who plays reid's mom on criminal minds

question_tokens: who plays reid 's mom on criminal minds

text: Spencer Reid

text: Development[edit]

text: Reid was born in 1981 and is a genius and autodidact who graduated from a Las Vegas public high school at age 12. He has an IQ of 187,[2] an eidetic memory, and can read 20,000 words per minute[2] (an average American adult reads prose text at 200–300 words per minute).[3] He holds B.A.s in Psychology, Sociology, and Philosophy, a Ph.D. in Chemistry and Engineering as well as a Ph.D. in Mathematics from Caltech.[4]

text: Reid is 23 in the pilot episode,[5] having joined the unit when he was 22.[4][6] His fellow team members almost always introduce him as Dr. Reid. Hotch reveals in the first season that Gideon insists on introducing him as Dr. Reid because Gideon fears that, because of his age, Reid will not be taken seriously as an FBI agent.[2] This was a genuine concern, both for in-universe and for audience acceptance, since in real life the minimum age to become an FBI Special Agent is 23,[7] with at least three more years to obtain Supervisory Special Agent status, and appointments to the BAU do not usually occur until after at least eight to ten years in the FBI.[8] While filming the pilot, the show's FBI consultant informed Matthew Gray Gubler that there was nothing realistic about his character.[9]

text: Before Gubler was cast in the role, the character was envisioned as more like Data from Star Trek. However, the producers liked Gubler's softer interpretation, despite telling the actor he was wrong for the part. After several callbacks, he was hired.[10]

text: During October 2012, series creator Jeff Davis tweeted that Reid was originally envisioned to be bisexual, but the network shut the idea down by the fourth episode when Reid develops a crush on his colleague, Jennifer "JJ" Jareau.[11]

text: Personality[edit]

text: As a common characteristic of people with Asperger's syndrome, Reid is socially awkward. Reid has a hard time dealing with his emotions. He often fixates on things (prompting Morgan and other team members to have to tell him to be quiet), and misses social cues at times (for example, unknowingly changing the subject of a conversation). The Unknown Subject ("UnSub") in "Broken Mirror"[12] notes this, and Gubler stated in an interview in the show's second season "[Reid]'s an eccentric genius, with hints of schizophrenia and minor autism, Asperger's syndrome. Reid is 24 years old with three Ph.D.s and one cannot usually achieve that without some form of autism."[13] Writer Sharon Lee Watson stated in a Twitter chat that Reid's Asperger traits make the character more lovable.[14]

text: Gubler has commented on the differences between Reid and similarly odd character Penelope Garcia: "She represents everything he's not, she's very tech oriented and I would like to imagine he is more like 1920s smart, books and reading etc". Kirsten Vangsness agreed, adding that Garcia is more extroverted and available emotionally, whereas Reid struggles with his emotions.[9] Reid is a technophobe, using neither email nor the new iPads. Gubler tweeted that Reid is also germaphobic.[15] In general, Reid dislikes shaking hands,[16] and shows adverse reactions when touched by strangers.[17] It is speculated the character may also have slight obsessive compulsive disorder, particularly from a scene in "Out of the Light"[18] where Derek Morgan slightly moves an item in the home of an UnSub afflicted with OCD, and Reid immediately places it back to its previous spot.

text: Reid is a good map-reader, and therefore does the geographic profiling and map-related activities for the team. He also has a talent with words, and is the team's go-to linguistic profiler, as well as their unofficial discourse analyst. He is rarely seen behind the wheel – one time when Morgan hands him the keys, JJ and Emily exchange horrified expressions – but in "Lo-Fi" he is seen getting into the driver's side of a vehicle and even driving that same vehicle in one scene, as well as driving to Gideon's cabin in "In Name and Blood," and in "Nelson's Sparrow." However, he is usually seen as a backseat passenger during car scenes, and he commutes to work using the Metro,[19] and presumably the VRE.

text: Storylines[edit]

text: Backstory[edit]

text: Spencer Walter Reid was born in Las Vegas to William Reid (Taylor Nichols), a lawyer, and Diana Reid (Jane Lynch), a former professor of 15th century literature. Diana also has paranoid schizophrenia, and went off her medication during her pregnancy.[4] Reid and his mother have a very close relationship despite her condition.

text: At age four, Spencer was approached by a man, Gary Michaels, while playing chess at a local park. Although Spencer was unharmed, Diana insisted the family move because she believed her son was in danger. Shortly thereafter, Spencer's six-year-old neighbor, Riley Jenkins, was sexually abused and murdered. Diana told Lou Jenkins, Riley's father, about the park incident. Diana then followed Jenkins and witnessed him beat Michaels to death with a baseball bat, getting blood on her clothes in the process. In order to protect his wife, William burned Diana's clothes, which Spencer inadvertently witnessed. Jenkins avoided arrest because Michaels "disappeared", and as he had a criminal history as a sexual predator, the police didn't look very hard into the case.[4] Years later, Reid starts having nightmares about the incident, initially leading him to believe his own father was Riley's killer. Rossi and Morgan help him investigate. After undergoing hypnosis to recover his memories, Reid mistakenly believes he saw his father burning Riley's clothes, not Diana's. He pursues his father as a suspect, even after it becomes clear that Michaels is the more likely perpetrator. Michaels' body is found, and DNA confirms his killer was Lou Jenkins, who is arrested. While Reid is interviewing Jenkins, demanding to know how his father was involved, his parents interrupt and confess to their son the whole story.[4]

text: At ten years old,[20] Reid's father abandoned the family. The Michaels incident had already started the rift, and as Diana's mental state continued to deteriorate due to her paranoid schizophrenia, William left, refusing to take Spencer with him.[21] He moved ten miles away, and never contacted his son. Reid finds out his father's address from Lou Jenkins seventeen years later, as well as the fact that his father never changed jobs. William later states that the reason he never returned was because he was too ashamed, and felt too much time had passed for him to re-enter Reid's life, although he did keep electronic tabs on his son.[4] When his father was leaving, young Spencer tried to convince him to stay by using a statistic that children of parents who remain together receive more education. This angered William: "We're not statistics."[21] Reid states that one way he gets back at his father is to collect more educational degrees.[22]

text: Due to his young age and genius IQ, Reid was a victim of severe bullying in high school. In "Elephant's Memory", he recounts one instance where he was stripped naked and tied to a goalpost in front of other students, remaining there for hours. In "L.D.S.K.", Hotchner is forced to kick Reid in order to allow him access to a gun in order to shoot a suspect. When Hotch says he is sorry if he hurt him, Reid points out that he was a child prodigy in a Las Vegas school and tells Hotch, "you kick like a nine-year-old girl". Reid's social standing as a child increased when he started winning games as the coach of his high school's basketball team, using statistics to break down the opposing teams' shooting strategies.[23]

text: At age twelve, Reid graduated from high school. He attended Caltech, where he rode his bike to classes. He finished his undergraduate degree at sixteen, and received his first doctorate (in Mathematics) the following year.[4] It has also been stated that he attended MIT, but episode writer Breen Frazier admitted the MIT line was a mistake,[24] although it has not yet been corrected onscreen. Yale University was Reid's "safety school". Between the ages of 17 and 21, he completed two more doctorates (Chemistry and Engineering), and two more Bachelor's degrees (psychology and sociology).

text: When Reid was eighteen, he realized his mother's condition had deteriorated to the point where she could no longer take care of herself and had her committed involuntarily to a psychiatric institution, Bennington Sanitarium.[21] Diana still resides in the same institution, and Reid says that he sends her letters every day, in part because of the guilt he feels for not visiting her.[25] He worries about the fact that his mother's illness can be passed on genetically; telling Morgan: "I know what it's like to be afraid of your own mind".[19]

text: Currently, Reid resides in an apartment[26] in the District of Columbia, possibly near the Van Ness-UDC Metro stop.[27]

text: Behavioral Analysis Unit[edit]

text: Reid joined the FBI at either the age 21 or 22, depending upon what age he entered the FBI Academy. While there was "no psychological exam or test the FBI could put in front of him he could not ace inside of an hour",[4] he did struggle with the more physical aspects of training, and ultimately received waivers for those requirements.[28] Even after a year in the field, Reid still struggles to pass his gun qualifications.[29] He is often left behind during takedowns, has never given chase, and jokes that it's Morgan's job to kick down the doors.[30] This does not bother the team, because while he has shown an ability to physically disarm unsubs, his true talent is psychologically disarming them, as well as his abilities to solve the cases behind the scenes.

text: Profiling is the only profession Reid considered, and he was groomed specifically for the BAU.[31] Upon graduation from the Academy, he was placed in the BAU at age 22, and given the title Supervisory Special Agent. His first case in the field was the Blue Ridge Strangler.[6]

text: Gideon is Reid's closest confidante on the team during the first two seasons, and often serves as a mentor to Reid. Gideon's departure affects Reid deeply. He tries playing all possible chess moves in order to understand.[32]

text: Reid is close to JJ, Morgan, and Emily Prentiss. JJ asks him to be godfather to her new born son Henry, and is the only one on the team who calls him "Spence." It is implied in "Plain Sight" that Reid may have a slight crush on JJ, and Gideon even prods him to ask out JJ after giving him Washington Redskins football tickets for his birthday, but nothing comes from it, and they continue with their brother-sister relationship. However, Reid is very protective of her, and often blames himself if she is injured; even if there was nothing he could have done to prevent it. In "Closing Time", after she arrests an unsub, but gets hurt in the process, Spencer is seen counting her injuries as she sits in the ambulance and tells the paramedic that she should be going to get a CAT scan. Reid also shares a brotherly friendship with Derek Morgan. In season seven, he is comfortable enough to start a joke war with him, something that he probably would never do with anyone else, and he occasionally confides his secrets to Morgan. It is suggested in the episode "Epilogue" that Reid told Derek details about what Tobias Hankel did to him when he makes a remark about seeing the afterlife before Tobias saved him. Morgan looks surprised and says "You never told me that." In the episode "Elephant's Memory", when approached by a fully armed Owen Savage, the unsub whom Reid identifies with, Reid gives Prentiss his gun and trusts her enough to back him up and not shoot at Owen as he tries talking Owen down. Although not shown, it is implied Reid and Prentiss spend time together outside of work heavily, along with riding the train home together when they return from cases. Prentiss is the only one who has beat Reid at poker, even correcting his statistic about her particular poker move. Reid and Prentiss are held hostage by a cult led by Benjamin Cyrus (portrayed by Luke Perry). Though he is not injured, Reid struggles with guilt over "allowing" Prentiss's beating at the hands of Cyrus in "Minimal Loss". Reid later becomes close to Alex Blake, whose forensic linguistics class he guest lectures in. Blake serves as a maternal figure within the BAU.

text: Reid contracts anthrax during an outbreak in Maryland,[33] and is later shot in the leg protecting a doctor whose life is being threatened.[30]

text: During "Corazon", Reid begins to suffer from severe headaches and hallucinations. He goes to see a doctor in order to find out the source of his headaches, but the doctor says there is no physical cause for his headaches, and they may be psychosomatic. Reid refuses to believe this, afraid that he may be suffering from the same illness as his mother.[34] It is not mentioned again until "Coda", when he is seen once again wearing sunglasses and is carrying a book on migraines. In the same episode, Reid bonds with a young autistic boy, Sammy Sparks.[27] A cut line from the episode has Rossi stating that Sammy and Reid are two of the most fascinating minds he's ever encountered.[citation needed] In the episode "Valhalla", Reid tells Prentiss about his headaches. By then, Reid has gone to several doctors, but no one has been able to diagnose what is wrong with him. He tells Prentiss that he has not told any of the team members because he is afraid that they will "make him feel like a baby."[35]

text: In "Lauren", it is Reid and Garcia who react most strongly to the news of Emily's death. Reid's reaction is to run out of the room, and he ends up sobbing into JJ's shoulder telling her that he "never got a chance to say goodbye."[36] In season seven, when Emily returns and Reid discovers Hotch and JJ faked her death, he is upset, especially with JJ. He tells her he feels betrayed because he came to her house "for 10 weeks in a row, crying over losing a friend" and "not once did you have the decency to tell me the truth." She doesn't say anything. He asks J.J. "what if" he had started using Dilaudid again after Emily "died."[37]

text: In "True Genius", Reid doubts his reasons for being in the BAU and wonders if he should be doing more with his 'genius'. This is caused by the unsub sending him taunting messages and challenging Reid to find him. In this episode, he also reveals that the team missed his 30th birthday. At the end of the episode, the team throw him a mini birthday party.

text: Drug addiction[edit]

text: After being kidnapped by a serial killer with multiple personalities, Tobias Hankel (James Van Der Beek), Reid is tortured and drugged over the course of two days in "Revelations". This leads him to develop an addiction to the narcotic painkiller Dilaudid. While the BAU team members have their suspicions about Spencer's addiction, none of them confront him about it. An old friend of Reid's in New Orleans is also aware that Reid suffers from 'problems' in "Jones".

text: Reid gets clean and attends a support group meeting for addicts in law enforcement in "Elephant's Memory", at which he admits struggling with cravings as well as with traumatic memories, including a young adult suspect's shooting death in his presence. When he contracts anthrax in "Amplification", he strictly refused to take any narcotic painkillers in an attempt to remain clean. Memories of his torture under Hankel later allow him to empathize with other victims.

text: Personal life[edit]

text: Throughout the show, Reid shows a lack of interest when interacting with women. The only three exceptions are Lila Archer, a young actress he is assigned to protect; Austin (Courtney Ford), a bartender he "woos" with magic tricks while showing her a sketch of a potential suspect; and Maeve, a geneticist he first meets through correspondence, then later weekly phone calls. In "Memoriam", a prostitute hits on Reid in a Las Vegas casino, but he is oblivious to her intentions.

text: In "Somebody's Watching", with the team on a case to protect a TV starlet, Reid saves Lila Archer (Amber Heard) from being harmed by a serial killer. Reid and Lila kindle a short-lived romance, beginning when Lila pulls Reid, fully clothed, into her pool for a kiss. At the end of the episode, they go their separate ways, and Lila is not seen in further episodes.

text: In another episode, Reid and Morgan are in a nightclub trying to find a serial murderer who picks up women in nightclubs. Reid is having trouble talking to the women in these clubs, especially since he is spouting facts about club-related deaths, but Morgan helps him out. Reid starts a conversation with the female bartender, and proceeds to do a magic trick in which he appears to jab a pen through the eye of a police sketch, but pulls it through, leaving the paper unscathed. She expresses interest in him, and he gives her his business card in case she hears something about the killer. Later, she sees the killer with another potential victim and intentionally spills her drink on the lady, pulling her away. The killer seems to disappear, and while the bartender goes outside to phone Reid, he grabs her. The team responds quickly and saves her before she is harmed. At the end of the episode, she and Reid are talking over the phone, and he opens a package at his desk that contains the card that he gave her—with a lipstick kiss on the back.

text: In "God Complex", Reid begins calling a mystery woman on a pay phone and they talk about his progress with his headaches and sleep deprivation. It is revealed that she is in danger and doesn't want someone to know about her and Reid. While on a case in New Mexico, Alex Blake drops Reid off at a phone booth, unaware that he is going to call the mystery woman. Blake later returns and questions his motives. The two agents have a heated discussion, and he tells her the mystery woman is a geneticist he contacted about his headaches during season six, whom he believes can help on the case. Thanks to her, they are able to find the unsub and save his latest victim. At the end of the episode, Reid thanks her for her help and tells her that he and the BAU can help her in her situation. However, she refuses because she doesn't want him to hurt Reid. She ends the phone call by telling him that she loves him. Left shocked and speechless, he starts walking to his left but then turns around and walks to his right. Sometime after "The Lesson", Reid continues calling his mystery woman, and it is revealed that her name is Maeve (portrayed by Beth Riesgraf). She tells Reid that her stalker might be gone and because of this, she wants to meet him. During a case in Arizona, Blake confronts him about "phone booth girl". Reid tells Blake that he's nervous to meet her because he already believes she's the most beautiful girl in the world, and he is afraid that she won't like him because of his looks. Blake encourages him to meet her. After Reid gets back from the case, they plan to meet at a fancy restaurant until Reid sees a man gazing over at him. Thinking him to be Maeve's stalker, Reid calls her to cancel while she is right outside. Spencer realizes that the man is not the stalker, and Maeve has already left. The hostess gives him a bag that she left for him. It turns out to be the very same book he was going to give to her by Sir Arthur Conan Doyle. Inside, she has written a quote by Thomas Merton; "Love is our true destiny. We do not find the meaning of life by ourselves alone. We find it with another."

text: In "Zugzwang", Reid discovers that Maeve has been kidnapped by her stalker. In the investigation, he meets Maeve's former fiance, the man he believed to be her stalker. Reid becomes more and more distressed by the situation and discovers that her kidnapper is not her ex-fiance, but the man's girlfriend. Reid searches excessively to find her, and even offers to take her place. He discovers that the stalker wants attention from him and to be seen as an equal. He gets a clue from the stalker leading him to her location, where he tricks the unsub into believing that he is in love with her. Reid finally meets Maeve face-to-face during the situation and is able to briefly subdue the stalker, only to have her hold Maeve at gunpoint. He once again offers to take Maeve's place, but the unsub kills herself and Maeve in one shot.

text: Reid spends two weeks alone in his apartment after Maeve's death. The team constantly tries to help him, but he refuses to answer the door. While Reid remains at home, the team travel to another case. They call him for help a few times before he joins the team in person. Once the case is complete, Reid asks Morgan, Penelope, and JJ to help clean up his apartment. He picks up The Narrative of John Smith (given to him by Maeve) with the Thomas Merton quote and places it on the bookshelf.

text: In the months following, Reid throws himself into his work when he is not able to sleep because of a recurring dream where Maeve asks him to dance with her, but forces himself to wake up before he answers. By the end of "Alchemy", Reid is able to complete the dream by accepting Maeve's request to dance with her. In "The Inspiration", Reid admits that, had Maeve not died, he might have had kids. In the season nine finale, it is revealed that he still carries a copy of The Narrative of John Smith in his bag.


document_title: Sun path

question_text: in the middle latitudes of the northern hemisphere on june 22 the sun

text: Sun path

text: Effect of the Earth's axial tilt[edit]

text: This section is too long. Consider splitting it into new pages, adding subheadings, or condensing it.  (June 2017)

text: Sun paths at any latitude and any time of the year can be determined from basic geometry.[4] The Earth's axis of rotation tilts about 23.5 degrees, relative to the plane of Earth's orbit around the Sun. As the Earth orbits the Sun, this creates the 47° declination difference between the solstice sun paths, as well as the hemisphere-specific difference between summer and winter.

text: In the Northern Hemisphere, the winter sun (November, December, January) rises in the southeast, transits the celestial meridian at a low angle in the south (more than 43° above the southern horizon in the tropics), and then sets in the southwest. It is on the south (equator) side of the house all day long. A vertical window facing south (equator side) is effective for capturing solar thermal energy. For comparison, the winter sun in the Southern Hemisphere (May, June, July) rises in the northeast, peaks out at a low angle in the north (more than halfway up from the horizon in the tropics), and then sets in the northwest. There, the north-facing window would let in plenty of solar thermal energy to the house.

text: In the Northern Hemisphere in summer (May, June, July), the Sun rises in the northeast, peaks out slightly south of overhead point (lower in the south at higher latitude), and then sets in the northwest, whereas in the Southern Hemisphere in summer (November, December, January), the Sun rises in the southeast, peaks out slightly north of overhead point (lower in the north at higher latitude), and then sets in the southwest. A simple latitude-dependent equator-side overhang can easily be designed to block 100% of the direct solar gain from entering vertical equator-facing windows on the hottest days of the year. Roll-down exterior shade screens, interior translucent-or-opaque window quilts, drapes, shutters, movable trellises, etc. can be used for hourly, daily or seasonal sun and heat transfer control (without any active electrical air conditioning).

text: Everywhere around the world during the equinoxes (March 20/21 and September 22/23) except for the poles, the sun rises due east and sets due west. In the Northern Hemisphere, the equinox sun peaks in the southern half (about halfway up from the horizon at mid latitude) of the sky, while in the Southern Hemisphere, that sun peaks in the northern half of the sky. When facing the equator, the sun appears to move from left to right in the Northern Hemisphere and from right to left in the Southern Hemisphere.

text: The latitude (and hemisphere)-specific solar path differences are critical to effective passive solar building design. They are essential data for optimal window and overhang seasonal design. Solar designers must know the precise solar path angles for each location they design for, and how they compare to place-based seasonal heating and cooling requirements.

text: In the U.S., the precise location-specific altitude-and-azimuth seasonal solar path numbers are available from NOAA – the "equator side" of a building is south in the Northern Hemisphere, and north in the Southern Hemisphere, where the peak summer solstice solar altitude occurs on December 21.

text: Shadow of Vertical Stick at Solar Noon[edit]

text: On the equator, the sun will be straight overhead and a vertical stick will cast no shadow at solar noon on the equinoxes. On the vernal equinox, north of the subsolar point (on the equator) the vertical stick's shadow will point a little westwards of true north (NNW) reading 336.5° from true north and little eastwards of true south (SSE) reading 156.5° from true north. On the autumnal equinox, north of the subsolar point (on the equator), the shadow will point a little eastwards of true north (NNE) reading 23.5° from true north (and south of the subsolar, the shadow will point a little westward of true south (SSW) reading 203.5° from true north).

text: The same stick will cast no shadow on the summer solstice in the Northern Hemisphere when the subsolar point is on the Tropic of Cancer 23.44° north of equator. Although north of 23.44°N the shadow will point towards true north and south of 23.44°N the shadow will point towards true south. The reverse occurs on the winter solstice in the Northern Hemisphere when the subsolar point will be on the Tropic of Capricorn 23.44°S and a vertical stick will cast no shadow along that point. But north of the Tropic of Capricorn solar noon shadows will point towards true north and south of the Tropic of Capricorn shadows will point towards true south.

text: The solar noon shadows of objects on points beyond and below subsolar points will point towards true north and true south respectively only when the solar declination has its maximum positive (δ☉ = +23.44°) or maximum negative (δ☉ = −23.44°) value. On the other hand, on the equinoxes when the sun is neither declined north nor south (δ☉ = 0°) and solar time noon shadows point NNW north of the equator and SSE south of the equator on the vernal equinox (and point NNE north of the equator and SSW south of the equator on the autumnal equinox).

text: Duration of daylight[edit]

text: Within the polar circles (north of the Arctic Circle and south of the Antarctic Circle), each year will experience at least one day when the Sun remains below the horizon for 24 hours (on the winter solstice), and at least one day when the Sun remains above the horizon for 24 hours (on the summer solstice).

text: In the middle latitudes (between the tropics and the polar circles, where most humans live), the length of daytime, as well as solar altitude and azimuth, vary from one day to the next, and from season to season. The difference between the lengths of a long summer day and of a short winter day increases as one moves farther away from the Equator.[2]

text: Building design simulation[edit]

text: This section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (September 2013) (Learn how and when to remove this template message)

text: Before the days of modern, inexpensive, 3D computer graphics, a heliodon (precisely-movable light source) was used to show the angle of the sun on a physical model of a proposed building. Today, mathematical computer models calculate location-specific solar gain (shading) and seasonal thermal performance, with the ability to rotate and animate a 3D color graphic model of a proposed building design.

text: Heating and cooling issues in passive solar building design can be counterintuitive. Precise performance calculations and simulations are essential to avoid reinventing the wheel and duplicating expensive experimental design errors, such as skylights that turn a building into a solar furnace in summer (see Daylighting#Sawtooth roof).

text: Visualization[edit]

text: The pictures below show the following perspectives from Earth, marking the hourly positions of the Sun on both solstice days. When connected, the suns form two day arcs, the paths along which the Sun appears to follow on the celestial sphere in its diurnal motion. The longer arc is always the midsummer path while the shorter arc the midwinter path. The two arcs are 46.88° (2 × 23.44°) apart, indicating the declination difference between the solstice suns.

text: In addition, some "ghost" suns are visible below the horizon, as much as 18° down, during which twilight occurs. The pictures can be used for both the northern and the southern hemispheres of Earth. A theoretical observer is supposed to stand near the tree on a small island in the middle of the sea. The green arrows represent the cardinal directions.

text:
In the Northern Hemisphere, north is to the left. The Sun rises in the east (far arrow), culminates in the south (to the right) while moving to the right, and sets in the west (near arrow). Both rise and set positions are displaced towards the north in midsummer and the south in midwinter.
In the Southern Hemisphere, south is to the left. The Sun rises in the east (near arrow), culminates in the north (to the right) while moving to the left, and sets in the west (far arrow). Both rise and set positions are displaced towards the south in midsummer and the north in midwinter.

text: The following selected cases are depicted.

text:
On the abstract line of the Equator (90° latitude), the Sun's maximum altitude is great during the entire year, but it does not form a perfect right angle with the ground at noon everyday. In fact it happens two days of the year, during the equinoxes. The solstices are the dates that the Sun stays farthest away from the zenith but anyway also in those cases it's high in the sky, reaching an altitude of 66.56° either to the north or the south. All days of the year, solstices included, have the same length of 12 hours.
Solstice day arcs as viewed from 20° latitude. The Sun culminates at 46.56° altitude in winter and 93.44° altitude in summer. In this case an angle larger than 90° means that the culmination takes place at an altitude of 86.56° in the opposite cardinal direction. For example, in the southern hemisphere, the Sun remains in the north during winter, but can reach over the zenith to the south in midsummer. Summer days are longer than winter days, but approximately the difference is no more than only two and a half hours. The daily path of the Sun is steep at the horizon the whole year round, resulting in a twilight of only about one hour and 20 minutes in the morning and in the evening.
Solstice day arcs as viewed from 50° latitude. During the winter solstice Sun does not rise more than 16.56° above the horizon at midday, but 63.44° in summer solstice above the same horizon direction. The difference in the length of the day between summer and winter, from here to the north, begin to be striking – slightly more than 8 hours at winter solstice, to more than 16 hours during the summer solstice. Likewise is the difference in direction of sunrise and sunset.  At this latitude at midnight (around 1 a.m. with summer legal hour) the summer sun is 16.56° below the horizon, which means that astronomical twilight continues the whole night. This phenomenon is known as the grey nights, nights when it does not get dark enough for astronomers to do their observations of the deep sky. Above 60° latitude, the Sun would be even closer to the horizon, only 6.56° away from it. Then civil twilight continues almost all night, only a little bit of nautical twilight obviously around the local midnight. And above 66.56° latitude, there is no sunset at all, a phenomenon referred to as the midnight sun.
Solstice day arcs as viewed from 70° latitude. At local noon the winter Sun culminates at −3.44°, and the summer Sun at 43.44°. Said another way, during the winter the Sun does not rise above the horizon, it is the polar night. There will be still a strong twilight though. At local midnight the summer Sun culminates at 3.44°, said another way, it does not set, it is the polar day.
Solstice day arcs as viewed from either pole (90° latitude). At the time of the summer or winter solstices, the Sun is 23.44° degrees above or below the horizon, respectively, irrespective of time of day. Whilst the Sun is up (during summer months) it will circle around the whole sky (clockwise from the North Pole and counter-clockwise from the South Pole), appearing to stay at the same angle from the horizon, therefore the concept of day or night is meaningless. The angle of elevation will gradually change on an annual cycle, with the Sun reaching its highest point at the summer solstice, and rising or setting at the equinox, with extended periods of twilight lasting several days after the autumn equinox and before the spring equinox.

text:
0° latitude (the Equator)

20° latitude

50° latitude

70° latitude

90° latitude (either pole)


document_title: The Return of a Man Called Horse

question_text: where was return of a man called horse filmed

text: The Return of a Man Called Horse

text: Plot[edit]

text: Trappers with government support force the Yellow Hands Sioux off their sacred land. The Indians retreat, but await supernatural punishment to descend on their usurpers. John Morgan, 8th Earl of Kildare, who had lived with the tribe for years and is known as Horse, leaves his English fiancée and estate and returns to America, where he discovers the Yellow Hand people have been largely massacred or put into slavery by the unscrupulous white traders and their Indian cohorts. The few survivors, including wise old Running Bull and stubborn old Elk Woman (Gale Sondergaard) have gone into the Badlands and been forced to eat their dogs. "Why did you return?" asks Elk Woman. "I had to come back," says Morgan. "I had to prove something to myself... there was an empty place in my soul. I could not forget." He finds the tribe dispirited, because of the actions of the trappers, and he begins to devise a strategy to overpower the trappers' stronghold, convincing the Indians to take direct action. Soon even the Indian women and boys are assigned tasks to aid the assault to regain their ancestral land.

text: Cast[edit]

text:
Richard Harris as John Morgan
Gale Sondergaard as Elk Woman
Geoffrey Lewis as Zenas
William Lucking as Tom Gryce
Jorge Luke as Running Bull
Jorge Russek as Blacksmith
Claudio Brook as Chemin De Fer
Enrique Lucero as Raven
Regino Herrera as Lame Wolf
Pedro Damián as Standing Bear
Humberto López as Thin Dog
Alberto Mariscal as Red Cloud
Eugenia Dolores as Brown Dove
Patricia Reyes Spíndola as Gray Thorn
Ana De Sade as Moon Star

text: Filming[edit]

text: Much of the film was shot in 1975 in South Dakota in the United States. Other scenes were filmed in the United Kingdom and Mexico.[1]

text: Reception[edit]

text: The film received mixed reviews on its release. Roger Ebert, while not highly critical of the film, noted that the film attempted to take itself too seriously and paid unnecessary attention to detail. According to Ebert "The film reveals its basic white-chauvinist bias, but it certainly seems to take itself seriously. It's of average length, but paced like an epic. There are four main movements in the plot: Return, Reconciliation, Revenge and Rebirth. If this seems a little thin for a two-hour movie, believe me, it is, even with all that portentous music trying to make it seem momentous."[2]

text: Ebert also criticized the repetition in the film from the original A Man Called Horse. Ebert commented that "What gets me is that initiation rite, which is repeated in this film in such grim and bloody detail you'd think people didn't have enough of it the last time. First Morgan has his pectoral muscles pierced with knife blades. Then eagle's talons are drawn through the wounds and tied to leather thongs. Then he hangs by the thongs until sufficiently purified. You'd think one ceremony like that would do the trick, without any booster shots."[2]

text: DVD[edit]

text: The Return of a Man Called Horse was released to DVD by MGM Home Video on April 1st, 2003 as a Region 1 widescreen DVD.