Audit: QRS - Levothyroxine for Health & Longevity

Audit conducted on 10/27/2026 21:07 using AI4L / Opus 5.5

Iterations

Summary

Items	Count
Total	97
Passed	87
Failed	0
N/A	10
Pass Rate	100.00%

• Total = Passed + Failed + N/A
• Pass Rate = Passed / (Passed + Failed) × 100
• N/A items are excluded from the pass rate calculation

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1. General Rules

#	Description	Result	Comments
1.1	Every claim, magnitude, label, recommendation, and statement in the QRS is literally supported by content in the source ER.	🟢	All lede, gate, protocol, time, tier, marker and cadence statements trace to ER text (e.g., Conclusion, Populations who should avoid, Therapeutic Protocol, Practical Considerations, Monitoring table).
1.2	Where the ER uses cautious phrasing (“not formally studied”, “None documented in human trials to date”, “theoretical concern”, “data are limited”), the QRS uses the same phrasing.	🟢	Cautious phrasing kept on non-tiered surfaces: “tied to longer survival”, “possibly not adults ≤30”, “Typically, when symptom changes occur”, “About 4.0–5.6%”.
1.3	The QRS never strengthens an ER claim (e.g., “not formally studied” → “not required”) or softens one (e.g., “do not use during pregnancy” → “use with caution during pregnancy”).	🟢	No strengthening or softening found; separation windows (“at least 4 hours”, “60 minutes after”, “at least 2 days”) match the ER.
1.4	The QRS does not relabel an ER fact under a different decision category. A “Benefit-Modifying Factor” from ER section is not surfaced as a “Caution”; a “Risk-Modifying Factor” is not surfaced as a “Side Effect”; etc.	🟢	Contraindications come from “Populations who should avoid”, interactions from “Documented”/”Theoretical” groups, tiers match ER tiers.
1.5	PubMed IDs, study citations, expert names, clinical trial identifiers (NCT*), and brand names appear in the QRS only if they appear in the source ER for the same fact.	🟢	Only European Thyroid Association and BMJ panel named (action_1_sub), both in ER Therapeutic Protocol for the same fact; no PMIDs, NCTs or brand names.

2. Focus, Tone & Audience

#	Description	Result	Comments
2.1	The QRS follows the tone of the ER, which is determined by the ER’s own language, phrasing, and framing.	🟢	Measured, evidence-weighted tone mirrors the ER Conclusion.
2.2	The tone of the QRS is expert, accessible, objective, and data-driven	🟢
2.3	The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor	🟢
2.4	The QRS avoids language that implies medical or clinical advice	🟢	Directive words (“avoid”) are ER severity classes carried with their labels.
2.5	The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising”	🟢	“a BMJ panel advises against” reports a source’s position, attributed as in the ER.
2.6	The QRS never addresses the reader directly — it presents evidence, not guidance	🟢
2.7	The QRS is written in plain language, avoiding unnecessary medical jargon	🟢	Technical terms (euthyroid, excipients, ischemic) sit inside ER labels/headings carried verbatim.
2.8	Information is presented in a concise and very compact manner	🟢
2.9	The target audience is health- and longevity-oriented adults who are risk-aware, proactive, and actively seeking to optimize health or apply the intervention under review.	🟢
2.10	The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort.	🟢
2.11	The document is NOT written for the general population, who are unwilling to employ lifestyle and behavioral changes or follow protocols that may be inconvenient, costly, or require effort.	🟢
2.12	Framing, takeaways, and risk/benefit weighting throughout the document reflect this audience, including where an intervention’s signal for the average person differs from its signal for this audience.	🟢	Lede addresses the optimization audience directly: no gain with normal tests, no evidence it slows aging, harms from excess.
2.13	The document’s own voice frames usage in longevity terms, not “anti-aging” (e.g., “anti-aging clinics”, “anti-aging community”, “anti-aging medicine”). Proper names that contain “anti-aging” (e.g., “American Academy of Anti-Aging Medicine”) are quoted verbatim.	🟢	No “anti-aging” wording.
2.14	The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language (e.g., “oral medication” not “pill(s)”; “oral” / “administered orally” not “taken by mouth” / “given by mouth”; “injection” not “shot”; “adverse event” not “bad reaction”). This holds on EVERY surface, including the QRS lede — the stricter plain-language bar (see 2.7) does not license lay phrasing for route of administration. Direct quotes from sources are exempt.	🟢	No colloquial route or event terms found.

3. Template Integrity

#	Description	Result	Comments
3.1	The following labels and headings on the QRS are fixed and not modified: Card and section headings: “Protocol”, “Time to effect”, “Benefits”, “Risk & Side Effects”, “Monitoring”, “Qualitative Assessment”; Gate headings: “Contraindications”, “Key Interactions”; Tier labels: “High”, “Medium”, “Low”, “Speculative”; Table column headers in Monitoring: “Marker”, “Target”, “Why”	🟢	All fixed headings, gate heads, tier labels and column headers match the template.
3.2	Every element carrying a data-qrs-var attribute in [qrs_template] is present in the QRS with the same name	🟢	All template data-qrs-var names present; marker_#/qualitative_item_# expanded per 14.2/15.2.
3.3	Everything outside the data-qrs-var spans — markup, text, styles, comments — is as in the template; spans that no checklist item addresses are left unchanged as well	🟢	Source diff against template shows changes only inside data-qrs-var spans, metadata values, and display:none on time_3 and risks_speculative spans.

4. Formatting

#	Description	Result	Comments
4.1	An empty ER section never produces visible empty-state text in the QRS: the corresponding region is hidden or left empty. Phrases such as “None documented in human trials to date” or “Not formally studied” appear only where the ER uses them for a fact the QRS carries over.	🟢	Empty time_3 and risks_speculative regions hidden; no empty-state phrases.
4.2	Where the ER presents a bulleted item as “Label: content”, the QRS uses the ER’s bold label verbatim as the cell or row label.	🟢	Protocol labels (“Who is treated”, “Full replacement dose”, “Time of day”), marker names and qualitative labels match ER bold labels.
4.3	Labels are not paraphrased, abbreviated, or invented.	🟢	Interaction and contraindication labels verbatim; time labels drawn from ER wording (“Peak effect of a dose”, “symptom changes”).
4.4	The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels.	🟢
4.5	The QRS is designed to render on one A4 page. It fails this item only for one of four things: a trailing clause after a dash, an optional gloss, an example list left untrimmed, or a repetition. Nothing else is cut to fit.	🟢	No trailing dash clauses, optional glosses or repetitions; example drug lists are ER bold labels and decision-gate content (4.2, 9.7).

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5. Metadata

#	Description	Result	Comments
5.1	The metadata is placed inside a single HTML comment that is the first element after “<!doctype html>” and before any other comment, head, or body content.	🟢
5.2	Inside that HTML comment the YAML block is delimited by a line “—” opening and a line “—” closing. Text before the opening “—” is permitted but is not parsed as YAML.	🟢
5.3	The metadata is not visible in any rendered view of the QRS and is not surfaced by any other element on the sheet.	🟢
5.4	All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting.	🟢	duration “00:02” quoted because it contains a colon.
5.5	The filename of the source ER is stated as “er_filename: [er_filename]”	🟢
5.6	Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]”	🟢	26.10.25 matches QRS.md version.
5.7	Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430)	🟢	2026-1027-2052
5.8	The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]”	🟢
5.9	The nickname of the AI is the full name without the version number, with all remaining words joined by hyphens (e.g., Opus, Sonnet, Grok, Gemini-Flash, GPT); when the full name has no version number or is “Unknown”, the nickname equals the full name	🟢	Opus
5.10	The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]”	🟢
5.11	The full name of the AI consists of the model name (the word or words directly before the version number, leaving out the first if there is more than one, e.g., Claude Opus 5.5 → Opus 5.5), the model version number and the variant (if any) as stated in the system prompt or developer instructions of the creating model, with every word capitalized and without product, effort or pricing names (e.g., Opus X.Y, Sonnet X.Y, Grok X.Y, Gemini X.Y Flash, GPT X.Y), the model name alone when the system prompt or developer instructions name a model without a version number (e.g., Grok), or “Unknown” when neither the system prompt nor the developer instructions of the creating model name a model	🟢	Opus 5.5
5.12	The filename of the document is stated as “qrs_filename: [filename of this document]”	🟢

6. Page Title & Header

#	Description	Result	Comments
6.1	[page_title] is set to the [canonical_topic] of the ER frontmatter followed by “ - Quick Reference Sheet” (e.g., “Intervention - Quick Reference Sheet”). The [canonical_topic] is HTML-entity-encoded as needed (e.g., & for &)	🟢
6.2	[header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., & for &)	🟢
6.3	[header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY]	🟢	10/27/2026
6.4	[header_subline_model] is set to [qrs_creator_ai_fullname]	🟢	Opus 5.5
6.5	No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker.	🟢

7. At-A-Glance Section

#	Description	Result	Comments
7.1	[at_a_glance] opens by saying what the intervention is — its kind (e.g., dietary supplement, prescription medication, peptide, plant, procedure, practice) — and what it is used for, in plain language, before any verdict on the evidence	🟢	Opens “Levothyroxine, a prescription medication that copies the body’s main thyroid hormone, replaces missing hormone when the thyroid fails”.
7.2	[at_a_glance] is dense, execution-oriented summary of the ER Conclusion section	🟢	Condenses the Conclusion’s benefit, null-result, aging and risk paragraphs.
7.3	[at_a_glance] is no longer than 70 words	🟢	68 words.
7.4	Every fact in [at_a_glance] is supported by a distinct passage in the ER.	🟢
7.5	It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead	🟢
7.6	It DOES NOT cite specific trials (names, years, sample sizes, p-values)	🟢
7.7	It DOES NOT cite effect sizes, relative risks, or statistical results	🟢

8. Contraindications

#	Description	Result	Comments
8.1	The section is derived from the ER Key Interactions & Contraindications section	🟢
8.2	[stop_items] represent the Contraindications from the ER	🟢	All five “Populations who should avoid” items present.
8.3	Individual [stop_items] are formatted as <li></li>	🟢
8.4	Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact.	🟢
8.5	Parenthetical qualifiers from the ER bullet — time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely).	🟢	Thresholds kept: “TSH below 20 mIU/L (possibly not adults ≤30 or with severe symptoms)”, “(≤0.03 mIU/L)”.
8.6	When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol.	N/A	ER uses no ranking notation in contraindication items.
8.7	The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no population, condition, or scenario for which the intervention should be avoided, deferred, or used only under specialist supervision.	🟢	Section populated; ER names five populations.
8.8	If the section is left empty, an HTML comment inside the [stop_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g.	N/A	Section not empty.

9. Key Interactions

#	Description	Result	Comments
9.1	The section is derived from the ER Key Interactions & Contraindications section	🟢
9.2	[caution_items] represent the ER’s documented interactions — the items under its “Documented interactions:” label — excluding any that are already listed as Contraindications and any entry phrased as no interaction found	🟢	All 22 documented interactions present; no-interaction entries (esomeprazole/famotidine, ezetimibe/metformin/alendronate, warfarin, soy isoflavones, fiber supplements) excluded.
9.3	[caution_theoretical_items] represent the ER’s theoretical interactions — the items under its “Theoretical interactions (inferred from mechanism, not studied in humans):” label	🟢	All four theoretical items present.
9.4	The ER placeholder “None identified” is never an item: it means that group is empty	🟢
9.5	Individual [caution_items] and [caution_theoretical_items] are formatted as <li></li>. The template’s bold “Theoretical (inferred from mechanism)” sub-heading is the only marker of the second list’s status: no item carries “(theoretical)”, “inferred from” or a mechanism clause	🟢
9.6	Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact.	🟢
9.7	Parenthetical qualifiers from the ER bullet — example drug lists, time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely).	🟢	Example lists, thresholds (propranolol >160 mg/day etc.), time windows and severity (“avoid for weight-loss use”, “avoid”) preserved.
9.8	When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol.	N/A	ER uses no ranking notation in interaction items.
9.9	If the ER’s theoretical group is empty, the whole Theoretical block — the caution_theoretical span with its sub-heading and list — is hidden with style="display:none", not removed: its spans stay in place, empty.	N/A	ER theoretical group is not empty.
9.10	The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no interaction, additive effect, or exposure that changes how the intervention is used.	🟢	Section populated.
9.11	If the section is left empty, an HTML comment inside the [caution_items] span records the ER basis for the absence, naming or quoting the ER text relied on, and the Theoretical block is hidden per 9.9. E.g.	N/A	Section not empty.

10. Protocol

#	Description	Result	Comments
10.1	The section is derived from the ER Therapeutic Protocol section	🟢
10.2	The three sets of [action] items cover the three most important actionable implementation aspects from that section	🟢	Who is treated, full replacement dose (with older/cardiac start and titration), and time of day.
10.3	If fewer than three distinct actionable implementation aspects are mentioned in the ER, the unused sets are left empty and hidden with style="display:none", not filled with placeholder text or empty-state phrasing.	N/A	Three aspects present.
10.4	All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from that section.	🟢

11. Time to Effect

#	Description	Result	Comments
11.1	The three sets of [time] items cover the three most important time-to-effect aspects from the ER	🟢	ER gives two time-to-effect aspects (Practical Considerations: peak effect 4–6 weeks; symptom changes over several months); both used.
11.2	The sets are picked and ordered by the magnitude of the related benefit	🟢
11.3	If fewer than three distinct time-to-effect aspects are mentioned in the ER, the unused sets are left empty and hidden with style="display:none", not filled with placeholder text or empty-state phrasing.	🟢	time_3 spans empty and hidden with display:none.
11.4	All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER.	🟢
11.5	If the ER provides no information on time to effect at all, the whole Time to effect block (its subhead and all three sets) is hidden with style="display:none", not removed: its spans stay in place, empty.	N/A	ER provides time-to-effect information.

12. Benefits

#	Description	Result	Comments
12.1	The section is derived from the ER Expected Benefits section	🟢
12.2	Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative]	🟢
12.3	Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact.	🟢	Items are ER headings; “Modest” dropped from nodule item; no effect sizes.
12.4	Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢
12.5	If a tier (high, medium, low, speculative) has no items, its span is hidden with style="display:none", not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four benefit tiers have items.

13. Risks

#	Description	Result	Comments
13.1	The section is derived from the ER Potential Risks & Side Effects section	🟢
13.2	Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative]	🟢
13.3	Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact.	🟢
13.4	Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢
13.5	If a tier (high, medium, low, speculative) has no items, its span is hidden with style="display:none", not filled with “None documented in human trials to date” or similar empty-state phrasing.	🟢	ER Speculative risk tier has no item; risks_speculative hidden with display:none.

14. Monitoring

#	Description	Result	Comments
14.1	The section is derived from the ER Monitoring Protocol & Defining Success section	🟢
14.2	All measurable/quantifiable biomarkers from that section are listed, one table row per marker; the template’s # row is the pattern, repeated with # replaced by 1, 2, 3 … in the data-qrs-var names	🟢	All six ER table biomarkers listed as marker_1 to marker_6.
14.3	[marker_#name] is the marker, [marker#target] its target value or range as given in the ER, [marker#_why] its purpose in a few words; a target the ER does not give is written “Not specified in the ER”	🟢	Targets match ER table, including “No established target…” wording the ER gives.
14.4	[monitoring_cadence] is populated with the monitoring cadence/frequency derived from that section. It is not left with placeholder text or empty.	🟢
14.5	If the ER names no measurable biomarker, the table is hidden with style="display:none" and the single # row is left as in the template	N/A	ER names measurable biomarkers.

15. Qualitative Assessment

#	Description	Result	Comments
15.1	The section is derived from the ER Monitoring Protocol & Defining Success section	🟢
15.2	All subjective/qualitative markers from that section are listed, one <li> per marker; the template’s # item is the pattern, repeated with # replaced by 1, 2, 3 …	🟢	All eight ER qualitative markers listed.
15.3	If the ER names no qualitative marker, the card’s list is hidden with style="display:none" and the single # item is left as in the template	N/A	ER names qualitative markers.

Issues 10/27/2026 21:07

Pass rate 100.00%. No issues found.

Issues 10/27/2026 21:04

1. 9.7 — Binding-drug time window dropped: The “Binding drugs (cholestyramine, colesevelam, colestipol, sevelamer, lanthanum, orlistat)” item at line 563 omits the 4-hour separation the ER states at line 346, while the parallel calcium and iron items keep theirs.
2. 12.3 — Magnitude qualifier in benefit: The Low benefit at line 534 reads “modest shrinkage of benign thyroid nodules”; “modest” is an effect-size qualifier the tier already carries.
3. 13.3 — Hedge qualifier in risk: The Low risk at line 614 reads “possible loss of a longevity-linked low-thyroid state”; “possible” is a qualifier the tier already carries.

Fixes 10/27/2026 21:04

1. 9.7 — Binding-drug time window restored: Changed the binding-drugs interaction to end with “: binders 4 hours apart”, carrying the ER’s 4-hour separation like the calcium and iron items.
2. 12.3 — Benefit qualifier removed: Changed “modest shrinkage of benign thyroid nodules” to “shrinkage of benign thyroid nodules” in the Low benefits tier.
3. 13.3 — Risk qualifier removed: Changed “possible loss of a longevity-linked low-thyroid state” to “loss of a longevity-linked low-thyroid state” in the Low risks tier.

Issues 10/27/2026 21:00

1. 2.6 — Imperative addresses the reader: The caution item at line 581 reads “Biotin: stop at least 2 days before testing”, a direct instruction to the reader; the ER phrases it as the label advising stopping biotin at least 2 days before testing.

Fixes 10/27/2026 21:00

1. 2.6 — Imperative addresses the reader: Changed the caution item “Biotin: stop at least 2 days before testing” to the non-imperative “Biotin: stopped at least 2 days before testing”.

Issues 10/27/2026 20:59

1. 14.3 — LDL target scope dropped: Line 661 marker_3_target reads “No established target; change from own pre-treatment value”, omitting the ER’s scope “for this use” from the Monitoring table LDL row, which implies LDL has no established target at all.

Fixes 10/27/2026 20:59

1. 14.3 — LDL target scope restored: Changed marker_3_target from “No established target; change from own pre-treatment value” to “No established target for this use; change from own pre-treatment value”, matching the ER.

Issues 10/27/2026 20:54

1. 4.5 — Repeated deficiency-only clause: time_2_sub at line 506 repeats “improvement expected only when true deficiency is corrected”, verbatim the content of qualitative_item_1 at line 713.

Fixes 10/27/2026 20:54

1. 4.5 — Repeated deficiency-only clause: Changed time_2_sub from “When they occur; improvement expected only when true deficiency is corrected” to “Typically, when symptom changes occur”, removing the repetition of qualitative_item_1 and keeping the ER’s “typically”.