Audit: QRS - Levothyroxine for Health & Longevity

Audit conducted on 07/08/2026 11:45 using AI4L / Opus 5

Summary

Items	Count
Total	91
Passed	81
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

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.	🟢	Spot-checked against the ER: 1.6 µg/kg and 100–112 µg for 70 kg (ER Therapeutic Protocol), 12.5–25 µg initiation and 25–75 µg in mild deficiency (ER Therapeutic Protocol), all 11 biomarker targets and cadence (ER Monitoring Protocol), all contraindications and interactions (ER Key Interactions & Contraindications).
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.	🟢	No empty-state or hedged ER passage is restated in the QRS with different phrasing; tier placement (Speculative) carries the ER’s own uncertainty framing.
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”).	🟢	Absolute contraindications remain absolute; “avoid or defer”, “extreme caution”, and “caution” classes are carried through unchanged.
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 and Key Interactions derive solely from the ER `Key Interactions & Contraindications` section; Benefits and Risks derive solely from their respective ER sections. No modifier-factor content leaked into the gates.
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.	🟢	The QRS contains no PMIDs, no NCT identifiers, no author names, and no brand names.
1.6	The QRS does not introduce new attributions.	🟢	No attributions of any kind appear in the QRS.

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.	🟢	Neutral, evidence-first framing matching the ER, including the ER’s central age asymmetry (“trials past the mid-sixties find no gain”).
2.2	The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging	🟢	Quantitative targets and ranges throughout, plain-language At-A-Glance, no alarmism.
2.3	The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor	🟢	Protocol cells describe established practice (“Used over 65, in known coronary disease…”) rather than instructing a patient.
2.4	The QRS avoids language that implies medical or clinical advice	🟢	No imperative clinical instructions; dosing and monitoring are presented as descriptions of practice.
2.5	The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising”	🟢	No occurrences of “recommend”, “advise”, “should”, or equivalent directive verbs.
2.6	The QRS never addresses “the reader” directly — it presents evidence, not guidance	🟢	No second-person pronouns anywhere in the document.
2.7	The QRS is written in plain language, avoiding unnecessary medical jargon	🟢	Technical terms are limited to those required as decision gates (drug class names, biomarker names); the At-A-Glance is fully plain.
2.8	Information is presented in a concise and very compact manner	🟢	All list items are noun-phrase fragments; no prose paragraphs outside At-A-Glance and the cadence line.
2.9	It DOES NOT address the reader directly	🟢	Confirmed: no direct address.
2.10	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.	🟢	Monitoring card carries the functional/optimization panel (free T3, reverse T3, SHBG, ferritin, vitamin D) rather than a conventional TSH-only panel.
2.11	The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort.	🟢	Fasting-window dosing, 4-hour supplement separation, biennial bone density, and 11-marker panel all assume a high-effort reader.
2.12	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.	🟢	Depth of the monitoring and interaction content exceeds general-population material.
2.13	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.	🟢	At-A-Glance and Risks foreground over-replacement harms (arrhythmia, bone loss, fracture), which is the signal that matters specifically to an optimizing reader.
2.14	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.	🟢	The string “anti-aging” does not appear; the title uses “Health & Longevity”.
2.15	The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language (e.g., “oral medication” not “pill(s)”; “injection” not “shot”; “adverse event” not “bad reaction”). Direct quotes from sources are exempt.	🟢	No colloquialisms; “tablet”/”pill” not used, formal terms (“hypothyroidism”, “atrial fibrillation”, “sympathomimetics”) used throughout the body.

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 strings verified verbatim (lines 446, 493, 543, 641, 673, 855, 577, 594, tier labels in Benefits/Risks, table headers 677–679).
3.2	All “…” from the [qrs_template] are present in the the QRS.	🟢	All template variable spans are present: page_title, header_topic, header_subline_date, header_subline_model, at_a_glance, action_1–3 (label/value/sub), time_1–3 (label/value/sub), benefits_, stop_items, caution_items, risks_, marker_1–11 (name/target/why), monitoring_cadence, qualitative_item_1–8.
3.3	Spans that are not addressed in a checklist item are left unchanged	🟢	The non-variable spans `<span website="evidence_review">`, `<span website="audit">`, and `<span website="full_review">` are intact and unmodified (lines 423, 426, 440).

4. Formatting

#	Description	Result	Comments
4.1	When the source ER section is empty, the QRS uses the ER’s own empty-state phrasing verbatim. Typical phrasings are “None documented in human trials to date” and “Not formally studied”	N/A	No source ER section that feeds the QRS is empty; every tier and every card has content.
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 (“Standard full-replacement dose”, “Conservative initiation dose”, “Best time of day”) and all eight qualitative-marker labels match the ER bold labels verbatim; interaction labels match after the em-dash clause is stripped per 9.4.
4.3	Labels are not paraphrased, abbreviated, or invented.	🟢	Marker names match the ER biomarker table verbatim; time-to-effect labels are lifted from the ER’s own wording (“energy and cognition”, “cholesterol”, “skin, hair, and body composition”).
4.4	The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels.	🟢	No emoji characters anywhere in the file; the ER’s 🟩/🟥/🟨 and ⚠️ markers were correctly dropped.
4.5	The QRS is designed to render on one A4 page. Any section that has more content in the ER than fits the per-section budget is condensed by the LLM, not extended onto a second page.	🟢	Content was condensed rather than transcribed: interaction bullets reduced to label plus a trimmed example list, benefit and risk tiers reduced to semicolon-joined noun phrases, ER parenthetical definitions dropped. Print rules and small-screen fallbacks are intact.

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.	🟢	Lines 2–14; the next comment (line 16) follows it.
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.	🟢	Opening `---` line 3, closing `---` line 13.
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.	🟢	Enclosed in an HTML comment; no metadata value is echoed in body content.
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.	🟢	Only `duration: "00:03"` is quoted, correctly so because it contains a colon.
5.5	The filename of the source ER is stated as “er_filename: [er_filename]”	🟢	`er_filename: levothyroxine_2026-0807-0855_Opus_ER.md` (line 4).
5.6	Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]”	🟢	`qrs_prompt_version: 26.7.02` (line 5), matching the QRS.md version badge.
5.7	Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430)	🟢	`qrs_creation_date: 2026-0807-1137` (line 6).
5.8	The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]”	🟢	`qrs_creator_ai_nickname: Opus` (line 7).
5.9	The nickname of the AI is just a single word model name without version, etc. (e.g., Opus, Sonnet, Grok, Gemini, ChatGPT)	🟢	“Opus” — single word, no version.
5.10	The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]”	🟢	`qrs_creator_ai_fullname: Opus 5` (line 8).
5.11	The full name of the AI consists of the [qrs_creator_ai_nickname] and the model version number and no additional qualifier (e.g., Opus 4.6, Sonnet 3.2, Grok 4.5, Gemini 3.1, ChatGPT 5.4)	🟢	“Opus 5” — nickname plus version, no qualifier.
5.12	The filename of the document is stated as “qrs_filename: [filename of this document]”	🟢	`qrs_filename: levothyroxine_2026-0807-0855_Opus_QRS.html` (line 9), matching the actual filename.
5.13	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.	🟢	Re-verified across all nine keys; no stray whitespace or unnecessary quoting.

#	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 `&`)	🟢	`Levothyroxine for Health & Longevity - Quick Reference Sheet` (line 22), matching ER `canonical_topic` with correct entity encoding.
6.2	[header_topic] is set to the [canonical_topic] of the ER `frontmatter`, with HTML entities encoded as needed (e.g., `&` for `&`)	🟢	`Levothyroxine for Health & Longevity` (line 417).
6.3	[header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY]	🟢	`08/07/2026` (line 421) from `qrs_creation_date: 2026-0807-1137`.
6.4	[header_subline_model] is set to [qrs_creator_ai_fullname]	🟢	`Opus 5` (line 425).
6.5	No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker.	🟢	Header contains only title and the template subline; the ER’s “Also known as” list was correctly not carried over.

7. At-A-Glance Section

#	Description	Result	Comments
7.1	[at_a_glance] is dense, execution-oriented summary of the ER `Conclusion` section	🟢	Mirrors the Conclusion’s three-part structure: what it is, clear benefit in genuine gland failure, null benefit past the mid-sixties in mild deficiency plus the over-replacement costs.
7.2	[at_a_glance] is no longer than 60 words	🟢	54 words.
7.3	Every fact in [at_a_glance] is supported by a distinct passage in the ER.	🟢	“hormone levels normalize, deficiency symptoms lift, cholesterol falls” and “past their mid-sixties… find no improvement” map to ER Conclusion paragraph 1; “irregular heart rhythm, faster bone loss, and fracture” to paragraph 2.
7.4	It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead	🟢	No acronyms; “underperforming”, “irregular heart rhythm”, and “faster bone loss” replace TSH, atrial fibrillation, and osteoporosis terminology.
7.5	It DOES NOT cite specific trials (names, years, sample sizes, p-values)	🟢	Only the generic word “trials”; no names, years, or sample sizes.
7.6	It DOES NOT cite effect sizes, relative risks, or statistical results	🟢	No numbers of any kind appear.

8. Contraindications

#	Description	Result	Comments
8.1	The section is derived from the ER `Key Interactions & Contraindications` section	🟢	All seven items trace to the “Populations who should avoid or defer this intervention” list in that ER section.
8.2	[stop_items] represent the Contraindications from the ER	🟢	Complete 7-for-7 match: adrenal insufficiency, thyrotoxicosis, weight-loss use, recent infarction/unstable angina, atrial fibrillation/osteoporosis, over-80 with TSH below 10, hypertrophic cardiomyopathy/severe hypertension.
8.3	Individual [stop_items] are formatted as <li></li>	🟢	Seven `<li>` elements inside the `stop_items` span (lines 580–589).
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.	🟢	ER consequence clauses (“Consequence is precipitated adrenal crisis”, “thyroid storm…”, the hypertrophic cardiomyopathy definition) are all stripped; no dashes carry trailing content.
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).	🟢	“within 90 days”, “T-score below −2.5”, “over 80 with TSH below 10 mIU/L” preserved; severity classes retained as trailing “(absolute)”, “(avoid or defer)”, “(extreme caution)”, “(caution)”.
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	The ER contraindication bullets contain no ranking notation inside parentheses.
8.7	If no [stop_items] are present the section is left empty	N/A	Seven stop_items are present.

9. Key Interactions

#	Description	Result	Comments
9.1	The section is derived from the ER `Key Interactions & Contraindications` section	🟢	All ten items trace to the ten interaction bullets in that ER section.
9.2	[caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications	🟢	Complete 10-for-10 match with no overlap against the seven contraindications.
9.3	Individual [caution_items] are formatted as <li></li>	🟢	Ten `<li>` elements inside the `caution_items` span (lines 597–631).
9.4	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.	🟢	The ER’s “— caution, separate dosing” / “— caution, monitor closely” suffixes and all Consequence/Mitigation prose are stripped; the ConsumerLab attribution and the 9-of-10 testing figure are absent.
9.5	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).	🟢	Every item that carried examples in the ER retains a trimmed parenthetical list (rifampin/phenytoin/carbamazepine/phenobarbital; digoxin/amiodarone/tyrosine kinase inhibitors; pseudoephedrine/amphetamine salts/methylphenidate/ketamine; “biotin above 5 mg” threshold preserved).
9.6	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	The ER interaction bullets contain no ranking notation inside parentheses.
9.7	If no [caution_items] are present the section is left empty	N/A	Ten caution_items are present.

10. Protocol

#	Description	Result	Comments
10.1	The section is derived from the ER `Protocol` section	🟢	All three cells trace to the ER `Therapeutic Protocol` bullets.
10.2	The three sets of [action] items cover the three most important actionable implementation aspects from the ER `Protocol` section	🟢	Full-replacement dose, conservative initiation/titration, and administration timing are the three execution-critical bullets; competing approaches and genotype-guided selection are correctly left out as non-actionable for the majority case.
10.3	If less that three distinct actionable implementation aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	The ER supplies more than three actionable aspects; all three sets are used.
10.4	All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER `Protocol` section.	🟢	All nine variables populated: 1.6 µg/kg with the 100–112 µg worked example, 12.5–25 µg with the 6–8 week titration step and the 25–75 µg mild-deficiency range, and fasting morning dosing with the validated bedtime alternative.

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	🟢	Energy/cognition (3–6 months), cholesterol (6–12 weeks), and skin/hair/body composition (6–12 months) are the three subjective and objective horizons given in the ER `Practical Considerations` time-to-effect bullet.
11.2	The sets are picked and ordered by the magnitude of the related benefit	🟢	Ordered to follow the ER’s High tier sequence: correction of overt hypothyroidism (symptom recovery) first, lipid improvement second, remaining somatic changes third.
11.3	If less that three distinct time-to-effect aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	The ER supplies more than three time-to-effect aspects; all three sets are used.
11.4	All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER.	🟢	All nine variables populated; the sub-cells carry the ER’s steady-state (about 6 weeks), pituitary-signal (4–6 weeks), and 6-month futility points.
11.5	If the ER does not provide any information on time to effect, the section is removed completely from the `Protocol Panel`	N/A	The ER provides an explicit time-to-effect bullet, so the section is correctly retained.

12. Benefits

#	Description	Result	Comments
12.1	The section is derived from the ER `Expected Benefits` section	🟢	All twelve entries map one-to-one onto the twelve ER benefit headings.
12.2	Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative]	🟢	All four spans present and populated (lines 545–570).
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.	🟢	Semicolon-joined noun phrases only; ER magnitudes (0.61 hazard ratio, 6–12 mg/dL, 0.05–0.10 mm) and author names (Razvi, Peng, Feller) are absent.
12.4	Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	The ER’s “(MASLD, fat accumulation in the liver…)” and similar parentheticals are stripped; the QRS renders “reduction of liver fat in metabolic fatty liver disease”.
12.5	If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “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 in the ER.

13. Risks

#	Description	Result	Comments
13.1	The section is derived from the ER `Potential Risks & Side Effects` section	🟢	All twelve entries map one-to-one onto the twelve ER risk headings.
13.2	Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative]	🟢	All four spans present and populated (lines 643–667).
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.	🟢	No frequencies (15–20%, 5–15%), no odds ratios (1.88, 3.45), no author names (Sawin, Flynn, Turner, Xu, Beltrão).
13.4	Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	ER parenthetical definitions (atrial fibrillation, osteoclast-mediated resorption, angioedema) are stripped throughout.
13.5	If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four risk tiers have items in the ER.

14. Monitoring

#	Description	Result	Comments
14.1	The section is derived from the ER `Monitoring` section	🟢	Table rows and cadence trace to the ER `Monitoring Protocol & Defining Success` section.
14.2	All measurable/quantifiable biomarkers from the `Monitoring` section are listed	🟢	All 11 ER table rows present in order: TSH, Free T4, Free T3, Reverse T3, TPO antibodies, LDL cholesterol, Ferritin, 25-hydroxyvitamin D, Sex hormone-binding globulin, Resting heart rate, Bone density T-score — with targets and “Why” text matching the ER.
14.3	[monitoring_cadence] is populated with the monitoring cadence/frequency derived from the ER `Monitoring` section. It is not left with placeholder text or empty.	🟢	Reproduces the ER cadence paragraph: 6–8 weeks after start and after every change, 6-monthly in year one, 12-monthly once stable, bone density every 2 years, annual electrocardiogram after 65.

15. Qualitative Assessment

#	Description	Result	Comments
15.1	The section is derived from the ER `Monitoring` section	🟢	All eight entries trace to the qualitative-marker list in the ER `Monitoring Protocol & Defining Success` section.
15.2	All subjective/qualitative biomarkers from the `Monitoring` section are listed	🟢	All 8 present verbatim: energy stability, cognitive clarity and word retrieval, cold tolerance, sleep quality, palpitations/tremor/restlessness, bowel regularity, skin/hair/nails, exercise recovery.

Issues 07/08/2026 11:45

Pass rate 100.00%. No issues found.