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Volume 23, No. 3 Autumn 2002

Thyroid Foundation of Canada

t h y r o b u l l e t i nLa Fondation canadienne de la Thyroïde

continued on page 2

ContentsMonthly Draw ...................................................... 2President’s message/Message du président ....... 5Letters to the doctor ........................................... 6The torch has passed .......................................... 7Your thyroid factory ........................................... 7My thyroid/parathyroid adventure ....................... 8Correction – Dr. Mazzaferri Article ...................... 9A momemt with Carl Lewis ................................ 10

Doctor-Patient communication .......................... 11Chapter news ..................................................... 12National Office Christmas hours ........................ 12Chapter coming events ...................................... 13Men’s thyroid problems ..................................... 13Foundation’s mailbox ........................................ 14Health Guides on Thyroid Disease ..................... 15

ypothyroidism, or underactive thyroid, occurs whenthe thyroid gland fails to produce sufficient amountsof the thyroid hormones T4 and T3. There are four

main causes:

1) treatment of Graves’ hyperthyroidism with radioactive iodineor by thyroidectomy;

2) end result of Hashimoto’s thyroiditis, an inflammatoryprocess of the thyroid gland; this may occur spontaneouslyduring the course of Graves’ disease;

3) a baby born without a thyroid gland (congenital hypo-thyroidism);

4) surgical removal of the thyroid gland as a treatment forthyroid cancer.

Hypothyroidism can also be caused by disease of either thepituitary gland or the hypothalamus. This is because normalfunction of the thyroid gland depends on the carefully regulatedsecretion of thyroid stimulating hormone (TSH) from thepituitary gland and thyrotropin releasing hormone (TRH) fromthe hypothalamus. Another important, but transient form ofhypothyroidism occurs with postpartum thyroiditis or subacutethyroiditis.

Clinical FeaturesHypothyroidism affects approximately 2 persons in 100. The

signs and symptoms of overt hypothyroidism are opposite tothose of hyperthyroidism since there is a deficiency of thyroidhormone secretion and all metabolic processes “slow down”.The patient has poor appetite, intolerance to cold, dry, coarseskin, brittle hair, tiredness, a croaky, hoarse voice, constipation,and muscle weakness. Examination may reveal an absence ofthe thyroid gland, dry scaly, cold, pale skin, a thickening of the

’hypothyroïdie (activité insuffisante de la thyroïde) semanifeste par la production insuffisante d’hormonesthyroïdiennes T4 et T3. Elle peut avoir quatre causes

principales:

1) traitement du goitre exophtalmique par iode radioactif oupar thyroïdectomie;

2) stade terminal de la thyroïdite chronique d’Hashimoto(inflammation de la glande thyroïde); cela peut se présenterspontanément au cours du goitre exophtalmique;

3) défaut congénital (absence de glande thyroïde à la naissance);

4) ablation chirurgicale de la glande thyroïde (traitement ducancer de la thyroïde).

L’hypothyroïdie peut également provenir d’une affection del’hypophyse ou de l’hypothalamus, le fonctionnement normalde la glande thyroïde reposant sur l’équilibre délicat de lasécrétion d’hormone thyréotrope (TSH) par l’hypophyse et del’hormone de libération de la thyréostimuline (TRH) parl’hypothalamus. Une autre forme importante, mais éphémère,de l’hypothyroïdie se présente avec la thyroïdie post-partum.

Tableau cliniqueL’hypothyroïdie affecte environ deux pour cent de la

population. Les signes et symptômes de cette maladie diffèrentde ceux de l’hyperthyroïdie: la sécrétion d’hormonesthyroïdiennes est insuffisante, et le métabolisme est “ralenti”.Le patient n’a pas d’appétit, ne supporte pas le froid, a la peausèche et rugueuse, les cheveux cassants, se fatigue vite, a lavoix rauque, souffre de constipation et de faiblesse musculaire.

Hypothyroidism Hypothyroïdie

LH

suite à la page 3

2 thyrobulletin, automne 2002

Hypothyroidism . . . con't from page 1

skin and underlying tissues (calledmyxedema), very slow reflexes and aslow heart rate. The patient can have poormemory retention. The diagnosis ofhypothyroidism is confirmed by findingvery low levels of thyroid hormones (T4and T3) in the blood.

Neonatal HypothyroidismNewborn babies are tested using a

“heelpad bloodspot test”. Neonatalhypothyroidism is caused, for unknownreasons, by an absence of the baby’sthyroid gland at birth. Thyroid hormonesare essential for brain development andgrowth. Newborn infants withhypothyroidism that is not treated, arecalled cretins and have severe body andmental defects. These include mentalretardation, poor vision, thick, dry skin,protrudent tongue, muscle weakness,severe lethargy and tiredness. Ifdiagnosed and treated soon after birth,growth and mental development canproceed relatively normally.

Much of the research work in makingan early diagnosis of neonatalhypothyroidism was carried out inCanada by Dr. J.H. Dussault at LavalUniversity.

“Borderline Hypothyroidism”(Compensated Hypothyroidism)

Borderline Hypothyroidism (Compen-sated Hypothyroidism) is quite common,and almost impossible to diagnoseclinically. The hallmark is that of anelevated TSH concentration, with normalor only slightly reduced thyroid hormonelevels. There may be no symptoms, orvery vague symptoms, associated withthis condition.

It is important to make the correctdiagnosis because once treatment isstarted it usually continues for life as itbecomes very difficult to stop treatmentto determine whether the originaldiagnosis was correct. The measurementof TSH in the blood helps to define evenminor degrees of hypothyroidism.

TreatmentTreatment of hypothyroidism is to take

thyroid hormone replacement in the formof a small pill, daily, for life. This is nowgiven in the form of thyroxine (“Eltroxin”or “Synthroid”), a synthetic hormonewhich has few impurities, very few sideeffects and produces almost no allergicreaction. The dose of thyroxine in adultsranges from 0.1 to 0.2 mg per day. Mostpatients require between 0.125-0.15 mgbut a few require less and a few requiremore. There is no need to add T3, sinceT4 breaks down to T3, and the dosage isset to provide a normal T3 level. Oncethe dose has been established, it is usuallystable for life and patients treated withthyroxine need only have blood tests oncea year. Major stress or illness cansometimes increase the need for thyroidhormone. Infants and children requiresmaller doses. Adult doses are given forteenage patients. Too much thyroxinecauses symptoms of hyperthyroidismwhereas symptoms of hypothyroidismpersist with too little. The correct dose isdetermined from blood tests of thyroidhormone levels, particularly the totalserum triiodothyronine and TSH tests,and from clinical examination.

Other Forms of Thyroid HormoneThere are many other forms of thyroid

hormone but it is very unusual toprescribe any of these. Impurepreparations such as thyroid extract,thyroglobulin, and crude thyroidpreparations contain variable amounts ofthyroid hormones. They produce variableeffects and an unpredictable response totreatment. Triiodothyronine (T3), whichis much more potent than thyroxine is alsogiven on occasion. This drug has a short

life span in the blood and causes irregularstimulation of the heart. Therefore, T3(“cytomel”) should not be given topatients with heart disease or to olderpatients.

Duration of TreatmentAssuming that the diagnosis of

hypothyroidism was correct, treatment forthyroid hormone should almost always becontinued for life. The cause of thyroidfailure is likely to be progressive andpermanent.

Many patients are given thyroxine forthe wrong reasons (such as obesity ortiredness). Therefore, it is essential thatblood tests be carried out and that thyroidhormone levels are clearly shown to bebelow the normal range. Additionally,patients must have symptoms and signsof hypothyroidism.

Hypothyroid patients should not stoptaking thyroid hormone. Thyroidhormone treatment must be continuedeven when the patient develops otherillnesses, although the dosage may haveto be altered.

Treatment of Pituitary orHypothalamic Hypothyroidism

The treatment of hypothyroidismcaused by failure of the pituitary or thehypothalamus is also thyroxine. Pituitaryor hypothalamic failure are both very rarecompared to failure of the thyroid gland.In these cases, other hormone deficienciesmay exist which must be identified andtreated as well.

The foregoing information appears in TFC’sHealth Guide #3. For a complete list of HealthGuides available from the national office or yourlocal chapter, see page 15.

Renew your Membership now andbecome eligible for our Monthly Draw.

Every month one renewing memberreceives a book on thyroid disease.

Our June 2002 winner was:Ms. Stephanie Bach

Seaforth, Ontariowho received

“How your Thyroid Works”by H. J. Baskin

Our July 2002 winner was:Mrs. Elizabeth MiddletonVictoria, British Columbia

who received“The Thyroid Gland

A Book for Thyroid Patients”by Joel I Hamburger, MD, FACP

Our August 2002 winner was:Ms. Rae Odishaw

Saskatoon, Saskatchewanwho received

“The Thyroid GlandA Book for Thyroid Patients”

by Joel I Hamburger, MD, FACP

Monthly Draw

Your membership in the Foundationexpires on the date that is printed on

the address label on yourthyrobulletin.

Please use theMembership/Donation Form

on page 15 or our secure paymentsystem at www.thyroid.ca/english/

membership.html.

You may renew early – and for one ortwo years! You will be credited with

renewal on the date that you are dueto renew.

Donations are always welcome.

NOTICE TO ALL MEMBERS

thyrobulletin, Autumn 2002 3

L’examen peut révéler les symptômessuivants: atrophie de la glande thyroïde,peau sèche, écailleuse, froide et pâle,épaississement de la peau et des tissussous-cutanés (myxœdème),ralentissement des réflexes et despulsations cardiaques, parfois même unemauvaise mémoire. Le diagnosticd’hypothyroïdie peut être confirmé par letaux réduit des hormones thyroïdiennes(T4 et T3) dans le sang.

Hypothyroïdie néonataleUne épreuve laboratoire (heelpad

bloodspot test) permet de dépister chezles nouveau-nés l’hypothyroïdienéonatale, causé par l’absenceinexplicable de la glande thyroïde à lanaissance. Les hormones thyroïdiennessont essentielles à la croissance et audéveloppement du cerveau. Sil’hypothyroïdie n’est pas traitée, lesnouveau-nés, appelés crétins, souffrent dedéficiences physiques et mentales graves:arriération mentale, mauvaise vision,peau sèche et épaisse, langueproéminente, faiblesse musculaire,léthargie grave et fatigue. Si la maladieest diagnostiquée et traitée dès lanaissance, la croissance et ledéveloppement mental de l’enfant se fontde façon normale.

Au Canada, le docteur J.H. Dussault,de l’Université Laval, a effectué denombreux travaux de recherche portantsur le dépistage précoce de cette maladie.

Cas limites d’hypothyroïdie(l’hypothyroïdie compensée)

Les cas limites sont tout à faitcommuns et presque impossibles àdiagnostiquer médicalement. La marqueest celle d’un niveau élève de TSH avecles niveaux normaux ou seulementlégèrement réduits d’hormonesthyroïdiennes. Parfois, aucun symptômene se présente ou il ne se présente quedes vagues symptômes associés à cettecondition.

Il est très important de faire undiagnostic correct; une fois le traitementcommencé, on doit le continuer à viepuisqu’il est très difficile de l’arrêter pourdéterminer si le diagnostic original étaitcorrect. La mesure des taux sanguins deTSH aide à diagnostiquer même dans lescas peu graves d’hypothyroïdie.

TraitementL’hypothyroïdie se traite par

l’administration quotidienne d’hormonesthyroïdiennes, sous forme de comprimés,à vie. On administre aujourd’hui de lathyroxine synthétique(Eltroxin ouSynthroid) qui contient peu d’impuretés,a très peu d’effets secondaires et neproduit presque jamais de réactionallergique. La dose quotidienne pour unadulte est de 0,1 à 0,2 mg. La plupart despatients requièrent entre 0,125 et 0,15 mg,plus ou moins selon le cas. Il n’est pasnécessaire d’ajouter le T3 puisque le T4se dégage en T3 et le dosage est fixé pourfournir un niveau T3 normal. La doseétablie reste généralement toujours lamême, et les patients n’ont pas besoin depasser une épreuve sanguine qu’une foisl’an. Un stress important ou une maladiepeut parfois accroître la quantitéd’hormones thyroïdiennes nécessaire.Chez les nouveau-nés et les enfants, ladose est plus faible; les adolescentsreçoivent une dose d’adulte. Si la doseest trop forte, la thyroxine provoquera unehyperthyroïdie; si elle est trop faible, lessymptômes d’hypothyroïdie persisteront.La dose exacte est déterminée à partir dudosage sanguin d’hormonesthyroïdiennes, particulièrement desexamens du TSH et de la thyroxine totale,et d’un examen médical.

Hypothyroïdie . . . suite de la page 1

thyrobulletin is published fourtimes a year: the first week of

May (Spring), August (Summer),November (Autumn) and

February (Winter).

Deadline for contributions are:

March 15, 2003 (Spring)June 15, 2003 (Summer)

September 15, 2003 (Autumn)December 15, 2002 (Winter)

Contributions to:Rick Choma, BA, Editor

PO Box 488Verona, ON K0H 2W0

Fax: (613) 542-4719E-mail: [email protected]

Autres types d’extraits thyroïdiensIl existe bien d’autres types

d’hormones thyroïdiennes, qui sontrarement prescrits: préparationscomportant des impuretés (extrait dethyroïde), thyroglobuline et préparationsbrutes de thyroïde (comportant desquantités variables d’hormones,thyroïdiennes). Leurs effets sont variableset imprévisibles. On administre parfois dela triiodothyronine (T3), bien pluspuissante que la thyroxine mais qui a unedemi-vie beaucoup plus courte dans lesang et entraîne la stimulation irrégulièredu cœur. Ce produit (Cytomel) neconvient donc pas aux patients atteints detroubles cardiaques, ni aux patients âgés.

Durée du traitementSi le diagnostic d’hypothyroïdie est

juste, le traitement à l’hormonethyroïdienne se poursuit durant toute lavie du patient; l’insuffisance thyroïdienneest généralement progressive etpermanente.

Dans certains cas, comme l’obésité oula fatigue, de la thyroxine est administréeà tort aux malades. Il importe donc d’avoirrecours à des épreuves sanguines et dedéterminer clairement si le tauxd’hormones thyroïdiennes est inférieur àla normale. Les patients doiventégalement présenter les signes etsymptômes de l’hypothyroïdie.

Les patients atteints d’hypothyroïdiene doivent pas interrompre leurmédication. Le traitement doit sepoursuivre, même si le malade est atteintd’autres affectations, bien que laposologie puisse être modifiée.

Traitement de l’hypothyroïdiehypophysaire ou hypothalamique

La thyroxine permet aussi de traiterl’hypothyroïdie provoquée par uneinsuffisance hypophysaire ouhypothalamique. Ces affections sontcependant très rares par rapport auxdéficiences de la glande thyroïde elle-même. Dans ces cas, le patient peutsouffrir d’autres déficiences hormonalesqui doivent être dépistées et traitées.

Les informations précédentes sont contenuesdans les dépliants santé de la FCT. Pour uneliste complète des dépliants disponibles dubureau national ou de votre section locale, voyezla page 15.


ISSN 0832-7076 Canadian Publications Mail Product Sales Agreement #139122

thyrobulletin is published four times a year: the first week of May (Spring), August(Summer), November (Autumn) and February (Winter)

Deadline for contributions for next issue: December 15, 2002

Le thyrobulletin est publié quatre fois par année: la première semaine de mai(printemps), août (été), novembre (automne) et février (hiver).

La date limite pour les articles pour le prochain numéro: le 15 décembre, 2002

• to awaken public interest in,and awareness of, thyroiddisease;

• to lend moral support tothyroid patients and theirfamilies;

• to assist in fund raising forthyroid disease research.

* * * * *

Les buts de laFondation sont:

• éveiller l’intérêt du public etl’éclairer au sujet des maladiesthyroïdiennes;

• fournir un soutien moral auxmalades et à leur proches;

• aider à ramasser les fonds pourla recherche sur les maladiesthyroïdiennes.

The objectives of theFoundation are:


thyrobulletinLa Fondation canadienne de la Thyroïde

Please note:

The information in thyrobulletinis for educational purposes only.It should not be relied upon for

personal diagnosis, treatment, orany other medical purpose. For

questions about individualtreatment consult your

personal physician.

Notez bien:

Les renseignements contenusdans le thyrobulletin sont pour

fins éducationelles seulement. Onne doit pas s’y fier pour des

diagnostics personnels,traitements ou tout autre raison

médicale. Pour questionstouchant les traitements

individuels, veuillez consultervotre médecin.

Thyroid Foundation of CanadaLa Fondation canadienne de la Thyroïde

Founded in/Fondée à Kingston, Ontario, in 1980

Founder

Diana Meltzer Abramsky, CM, BA(1915 – 2000)

Board of Directors

President of each Chapter (currently 22)President – Ed Antosz, EdD

Secretary – Joan DeVilleTreasurer – Terry Brady, BComm

Vice-PresidentsChapter Organization & Development – Nathalie Gifford, CA

Education & Research – Lottie GarfieldPublicity & Fundraising – Gary Winkelman, MA

Operations – David Morris, MBAPast President – Irene Britton

Members-at-LargeMarc Abramsky, Rick Choma, BA, Dianne Dodd, PhD,

Ellen Garfield, Marvin Goodman, Rita Wales

Annual Appointments

International Liaison – National President – Ed Antosz, EdDLegal Adviser – Cunningham, Swan, Carty, Little & Bonham LLP

Medical Adviser – Robert Volpé, MD, FRCPC, MACP

Thyroid Foundation of Canada is a registered charitynumber 11926 4422 RR0001.

La Fondation canadienne de la Thyroïde est un organisme debienfaisance enregistré numéro 11926 4422 RR0001.

Contributions to/à – Editor/Rédacteur:Rick Choma, BA

PO Box 488, Verona, ON K0H 2W0Fax: (613) 542-4719

E-mail: [email protected]


President’s message

T he Thyroid Foundation of Canadahas reached an age where self-examination and possibly atransformation in some areas is warranted. Asyou know our mandate is that of educationand research. We certainly are doing aresponsible job of maintaining researchendeavours, but could we be doing a betterjob in fund raising and in the delivery ofeducation? In order to answer these questionssatisfactorily we need to take a good hard lookat how we are currently doing things. To thisend, the executive committee struck asub-committee to report back on these issues.

At the national level, our education functionis to publish thyrobulletin, maintain ourwebsite, provide educational material andsupport the chapters. At the local level, help lines, chaptermeetings and special events constitute the major part of oureducational services. Can we do more? Is there a better way toget the information in thyrobulletin to the public? How can wereach more people? What can we do to better support thechapters? Should our chapters have a different mandate?

Please don’t hear me suggesting that the Foundation shouldbe restructured. However, I do think we need to examine wherewe are going and how we are going to get there. That doesn’tmean we should do away with a structure which has served usso well all these years.

In this issue you will find an article, The torch has passedaddressing the financial crisis we are facing at the operationallevel. Gary Winkelman (VP Publicity and Fund-raising) isheading up a team whose task is to look at fund-raising. Wehope to have a long-term plan in place by the end of our fiscalyear. In the shorter term, Ted Hawkins, newly retired Presidentand CEO of Theramed Corporation, is working on a project toraise $30,000 over the next 18 months to cover the cost ofproduction, printing and distribution of thyrobulletin.

We are doing more than asking for money. On the publicityside, Gary Winkelman has arranged for the folks at COSTCOto publish an article on thyroid disease in the new year. Theirnewsletter has over one million readers. Also a small article onThyroid disease in women of childbearing age will appear inan upcoming issue of Chatelaine magazine.

We are now in November and I have the distinct pleasure ofbeing the first to convey seasons greetings to you.

To all our members, families and friends, from staff, thenational board and myself, I wish you a happy holiday and aprosperous and healthy new year. To all, the Best of theSeason.

Message du présidenta Fondation canadienne de laThyroïde est d’un âge où un examende soi et possiblement une

transformation dans certains domaines sontdus. Comme vous le savez sans doute, notremandat est l’éducation et la recherche. Nousfaisons certainement un travail responsabledans nos efforts d’entretien vers la recherchemais pourrions nous peut-être en faire mieuxdans les domaines de ramassage de fonds etde la distribution d’éducation? Pour bienrépondre à ces questions nous devons bienexaminer comment nous faisons les chosesmaintenant. Dans ce but, le comité a établi unsous-comité enfin de faire un rapport sur cesquestions.Au niveau national, notre fonction éducativeest de publier le thyrobulletin, maintenir notre

site web, fournir les matériaux éducationnels et de supporterles sections. Au niveau local, les lignes de soutiens, réunionsde sections et les évènements spéciaux constituent la partmajeure de nos services éducationnels. Pouvons-nous en faireplus? Y a-t-il une meilleure manière de faire parvenir lesinformations du thyrobulletin au publique? Comment pouvonsnous atteindre le plus grand nombre de personnes? Que pouvonsnous faire pour porter plus de support aux sections? Est-ce quenos sections devraient avoir un mandat différent?

Ne pensez pas que je suggère restructurer la Fondation. Maisje pense que nous devons examiner où nous allons et comments’y rendre. Ceci ne veut pas dire que nous devrions éliminerune structure qui nous a si bien servit pendant toutes ces années.

Dans ce numéro vous trouverez un article The torch haspassed adressant la crise financière que nous faisons face auniveau d’administration. Gary Winkelman (vp publicité etramasseur de fonds) est à la tête d’une équipe qui a pour tâched’adresser le ramassage de fonds. Nous espérons avoir un planà long terme en place à la fin de notre année fiscale. Au coursterme, Ted Hawkins, ancien président de TheramedCorporation, maintenant en retraite, travail sur un projet quipourrait ramasser 30 000$ durant les prochains 18 mois pourrecouvrir les coûts de production, d’imprimerie et de distributiondu thyrobulletin.

Nous faisons plus que de demander de l’argent. GaryWinkelman arrangea pour les gens chez COSTCO de publierun article sur les affections thyroïdiennes dans le nouvel an.Leur bulletin a plus d’un million de lecteurs. Aussi, un petitarticle sur «les affections thyroïdiennes dans les femmes d’âged’accouchement » apparaîtra dans un prochain numéro de larevue Chatelaine.

Nous sommes maintenant au mois de novembre et j’ai le plaisird’être premier à vous communiquer nos meilleurs vœux de lasaison.

Je souhaite de joyeuses fêtes et une nouvelle année prospèreet saine à tous nos membres, familles, amis et amies de la partde notre personnel, le conseil national et de moi-même. A tous,nos meilleurs vœux de la saison.

L

Ed Antosz, National President/Président national


Lettersto thedoctor

Robert Volpé, MD,FRCPC, MACP,

Medical Adviser tothe Foundation

The following questions were provided bythyroid cancer patients.

Psychological Impact of Thyroid CancerDiagnosis

he diagnosis of cancer incombination with the hormonalchanges that occur with thyroid

cancer treatment can have manyemotional impacts. What kinds ofsymptoms are a normal part of treatmentand when should a patient seek additionalprofessional support for depression?

The diagnosis of cancer, whether incombination with other hormonalchanges or not, can have major emotionalimpact, and this depends upon thepatient’s own initial temperament morethan on the type of surgery, its magnitude,or other hormonal changes. It isrelatively common for there to be at leastsome degree of depression, and inpatients who are emotionally fragile, thiscan be quite severe. Depending on thepatient’s reaction to being told about thediagnosis, the attending physician shouldmake a judgment as to whether the patientrequires additional professional supportfor depression.

*****

Radioactive iodine (RAI)

hen a patient’s TSH risesquickly, why must they wait6 weeks for RAI? Is this justfor treatment scheduling

reasons? Is there any danger for patientsto have an elevated TSH for longer thanabsolutely necessary? What can be doneto minimize the time a patient must behypothyroid before treatment?

If the TSH rises quickly, there is noneed to wait six weeks. However,generally speaking, it does take about sixweeks for maximal elevations of the TSH,and this is why a six-week interval hasbeen selected as a reasonable time to waitfor all patients. This is largely because

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patients cannot be seen every day, andbeds have to be scheduled well inadvance. There is no danger for patientsto have an elevated TSH for any lengthof time; it is only the severity of thehypothyroidism that brings aboutsymptoms. This is also why patients aregiven Cytomel (Triiodothyronine, T3) forthe initial four of these six weeks, whichkeeps the patient feeling quite well, andthus there is only a relatively brief periodof time when they are off all thyroidhormones.

*****

ow is the RAI dose determined?Are doses below 100 mCi usedin Canada? Why or why not?

A dose of 100 millicuries has beenshown to cause virtually completedestruction of all of the remaining thyroidtissue, and it is for this reason that thisdosage has been selected. Doses below100 millicuries have been employed inCanada, but such doses are associatedwith less severe destruction of thyroidtissue.

*****

hy do some physiciansrecommend the low iodinediet prior to RAI and others

don’t feel that it is useful?

A low iodine diet will, of course,increase the uptake of the radioactiveiodine into the thyroid gland and thusmaximize the effect of such doses onthyroid function. However, this is not amajor effect and thus many physicians donot bother to prescribe a low iodine dietin this fashion.

*****

f a patient wishes to follow the lowiodine diet, which calciumsupplements are permitted on the diet?

Any calcium supplement that does notalso contain iodine can be permitted withthe low iodine diet.

*****

hat are the possible sideeffects of RAI? What canpatients do to minimize theseside effects? How long can

these symptoms last? Can some of thembe permanent - (e.g. salivary glanddamage, gastric upset, nausea)?

Radioactive iodine can be associatedwith early nausea and vomiting, and later

dryness of the mouth due to damage ofthe salivary glands. The nausea andvomiting generally last only 24 hours orless and are not permanent. However,damage to the salivary glands can bepermanent.

*****

run about 10 km per week and liftweights 3 times a week. Whilepreparing for a RAI scan, when or

how should I modify my workoutschedule?

There is no need to modify an exerciseregimen while preparing for a radioactiveiodine scan.

*****

External Beam Radiation/Chemotherapy

nder what circumstances isexternal beam radiation atreatment option for thyroid

cancer?

Where the thyroid carcinoma has beenshown to be highly aggressivehistorically, with evidence of localmetastases, external beam radiationmight be considered a reasonabletreatment option.

*****

nder what circumstances ischemotherapy a treatment optionfor thyroid cancer? What type of

chemotherapy is used and what are thesuccess rates?

Chemotherapy is generally a treatmentoption for very aggressive or anaplasticthyroid carcinoma. It has not beenconsidered very successful under thesecircumstances.

*****

Recurrence

ow is thyroid cancer recurrencedetected? Is it possible to have aclean scan but elevated

thyroglobulin? What diagnostic steps areindicated in this case of contradictoryfindings?

Thyroid cancer may be considered tobe recurring when it can be shown bypalpation or by imaging to have recurred.However, a rising serum thyroglobulin,even in the absence of an abnormal scan,would be sufficient evidence. Suchlaboratory aids as CAT scans or MRI’swould be useful.

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he Christmas movie It’s aWonderful Life is about thepower of one individual doing

something ‘ordinary’ over a period oftime, and the power of many ‘ordinary’people to make a seemingly impossibledifference in a crisis. Diana MeltzerAbramsky realized a need and in a fewyears she had created a Canada-wideThyroid Foundation, a model for theworld.

She wanted money for researchprimarily, but also for education andsupport for thyroid sufferers.“Operations” were simply carried out onher old typewriter in her modest home.She soon surrounded herself with adedicated and visionary pioneer groupwho gathered others one by one (you!)and put in place the structure and modeof operation that any organization needs,first the national organization and thenthe chapters. Some of those pioneers arestill carrying the ‘torch’. It is this formalorganization that allows us to continueto attract funds from public andgovernment sources.

The torch has passedor did Diana do it all for nothing?

byRita and Dr. Roger WalesTWe seem to have a great deal of money

but most of it is in the Research Fund.We still have a crisis in the Education andServices Fund. What can we doindividually? There are upwards of 3,500members in the Thyroid Foundation. Ifwe each contributed $10 annually, overand above membership, that wouldproduce $35,000 minimum to keep theFoundation going. That is easy to say, butwe are human. We all have bills to pay,think our contribution would not makemuch difference or just keep putting it off.

So here are small but powerful stepsthat we can all take to make a bigdifference. Do not say this is silly orinsulting unless you just want to gostraight to Step 6.

1. DECIDE to help (vital).

2. WRITE down your goal.

3. GET a small container and put it whereyou will see it.

4. MAKE a sacrifice (actually go withoutthat cup of coffee or simply pay doublefor it). Decide against a small impulsepurchase.

5. Actually PUT the dollar, five dollarsor whatever in the container.

(TELL friends what you are doing andwhy. Invite them to give a dollar (theymay give you five).

6. After TWO weeks maximum, put amoney order or a cheque in anenvelope and mail it to the nationaloffice.

7. Include a stamped self-addressedenvelope for your receipt. This wouldsave the Foundation about $1,700 inpostage alone. Think that YOUpersonally donated that much. You alldid!

8. Feel GOOD! (very important).

9. WAIT to hear the results.

10. Maybe do it AGAIN.

It is YOUR Foundation now –remember why you joined! It is not up tosomeone else to fix it if we want it to bethere for others in the future.

here is a tiny little factory in thefront of your neck called yourthyroid gland. It makes

mysterious little chemical messengerscalled thyroid hormones which travel inthe bloodstream to every cell in the body.If it sends out too many, or not enough ofthese hormones, you will get sick. Youwill have too much energy when youwant to rest, or not enough energy whenyou want to have fun. You will feel tootired and sleepy to play or too jumpywhen you want to sleep. Sometimes yourhair and nails are affected, sometimes youget so thin people think you don’t haveenough to eat. They would be surprisedto know that you almost never stop eating.A really strange thing happens when yourthyroid isn’t doing what it is supposed todo. In the summer time, on the hottestdays, you feel cold and need a sweater orin the winter, when everyone is freezing

Your thyroid factorycold, you walk around with your coatopen, you feel too warm. Can youimagine turning up the furnace thermostatin your home in the summer, and turningit down in the winter? That is what ishappening to your body when yourthyroid factory needs repairs; a lot ofother things can happen too, but they canall be fixed up by your doctor, withouttoo much trouble.

Diana Meltzer Abramsky, FounderThyroid Foundation of Canada

This explanation, written by Diana, wasenclosed in the program of a children’sconcert sponsored in the 1980’s by theKingston Area Chapter

T

Member Order of CanadaFounder, Thyroid Foundation of Canada

Passed away October 9, 2000

Her good deeds and visionbenefitted all humanity.

Diana Hains Meltzer Abramsky1915 - 2000

A loving wife, mother andgrandmother.

In MemoriamIn Memoriam


hen I was in my mid 20’s, mythyroid became swollen, butmy TSH was still in the

normal range. My family doctor didn’tknow what was wrong. No one knew itat the time, but I had started developingantibodies (Hashimoto’s autoimmunethyroiditis).

A few years later, in 1998, I wasreferred to an endocrinologist for anelevated prolactin level. When he sent mefor a thyroid ultrasound, the resultsshowed that I had several nodules(multinodular goiter). The largest was 2cm. I had never heard of thyroid nodulesbefore and barely even knew what athyroid was. Although I could feel a softmass beside my trachea, I resisted thesuggestion of going for a biopsy out offear. Besides, he told me the chances ofit being malignant were remote and thatwas good enough for me. As far as Iknew, cancer didn’t often happen tosomeone in their 30’s.

Only a few days later, I discovered thatI was working with someone who had hadthyroid cancer surgery three years earlier,just months before I joined thedepartment. I was stunned. She was onlya few years older than I was. Listening toher story really hit close to home.

I went back for an ultrasound every 6months. My nodules didn’t grow and to

My thyroid/parathyroid adventureby

Theresa de Jeu

W

me that was conclusive evidence that theycouldn’t be cancerous.

In the spring of 2000, a year and a halflater, my endocrinologist again asked meto have the largest nodule biopsied. Mymind started racing. It didn’t make anysense, especially now, since they weren’tgrowing. But I agreed to go as aprecaution.

I had an ultrasound guided fine needleaspiration biopsy (FNAB). I had to waitseveral weeks for the appointment, butwhen I arrived at the hospital, it suddenlydawned on me that I wasn’t prepared, thatI couldn’t handle the results. I felt reallyvulnerable.

Being told that it was likely benigndidn’t help. I had already heard from myco-worker that she had been told the samething, but wasn’t so lucky. If it couldhappen to her, it could definitely happento me. I wanted to believe them, but keptthinking, “That’s what they tell every-one!” Obviously someone thought therewas a good chance it could be cancer or Iwouldn’t be here.

Although I knew by this time thatthyroid cancer is usually survivable, Ididn’t want to go for surgery, have treat-ment, or spend time in the hospital. Ididn’t want any disruption in my life.

I had assumed the diagnosis would beeither benign or malignant, so when theoutcome was “inconclusive”, I didn’tknow what to make of it. I was completelybewildered. But by the time my secondbiopsy turned out to be “suspicious”, Iwas ready to deal with the results.

I was lucky because I had people toanswer my questions, even if they didn’talways give me the answers I wanted. Itwas comforting to know someone whohad had the surgery, but finding out shewas left with permanent hypo-parathyroidism (HPTH) increased myanxiety level tremendously.

Doctors quote really low levels ofpermanent HPTH, but hearing some reallife stories made me nervous. If it’s sorare, then what are the odds that I wouldwork with someone who not only has it,but has also met others with the samething? I questioned whom to believe more

– doctors or patients, and I becamefrustrated because no one really knowsthe answer. I’ve concluded that theparathyroids must be one of the leastunderstood glands in the entire body.

I had a total thyroidectomy inSeptember of 2000, at the age of 32. Ispent a lot of time worrying about whatthe scar was going to look like, how tohide it, and whether I could handle havingtemporary or permanent HPTH, thesymptoms of which range from tinglingand numbness in the extremities (lips,hands and feet) to seizures. I accepted thata lot of patients have temporary problems,but permanent problems? When and howdo you know it’s permanent? How bad isthis going to be?

I could tell my calcium level haddropped (hypocalcemia) while inrecovery. My surgeon and his residentsreported seeing two parathyroid glandsduring the surgery and that neither hadturned gray, something that parathyroidglands often do. None of my parathyroidglands were removed (later confirmed bythe pathology report), so it is reallyunexplainable why my calcium leveldropped so low. While in the hospital, Ihad intravenous calcium, but also startedtaking calcium supplements with a drugcalled Rocaltrol (synthetic calcitriol), themost activated known form of vitaminD3. Normally the vitamin D3 that thebody produces from sunlight or absorbsfrom milk is inactivated and needs to beconverted into calcitriol in the liver andkidneys. If the body has insufficient levelsof parathyroid hormones, which aid thisprocess, then supplementation withRocaltrol may be necessary.

Not only do I have to worry about mycalcium level dropping too low, but I’vealso been warned not to let it get too high.Parathyroid hormones help the kidneyskeep calcium from filtering out of theblood. With insufficient parathyroidlevels, too much calcium flows out of theblood, causing the possibility of kidneystones.

Over the next several months, Isuffered from paresthesias, a burningsensation that felt like a bug crawling onmy lips, a lot of twitching, especially inmy legs, and some obscure symptomssuch as tremors inside my eyeballs, and

Theresa de Jeu with her niece Claire

continued on page 9


seizures in my tongue and nose. Eventhough I was taking large amounts ofcalcium and Rocaltrol, I still suffered. Ispent a lot of time asking my colleaguequestions like: what her symptoms wereafter surgery; how long it took her bodyto stabilize; whether she still hassymptoms while taking medication; howlong before she develops symptoms if sheforgets to take her medication, etc.

At first I wanted to hear stories aboutpeople whose temporary hypocalcemiadisappeared, who were able to get offtheir medication, but as time wore on, Irealized I had a permanent problem. Ididn’t want to hear any more about the“lucky” ones. It wasn’t fair.

I started taking levothyroxine (T4)right after surgery. I wasn’t sure I waswilling to have radioactive iodine (RAI).My final pathology report indicated thatmy lump actually measured 1.5 cm,papillary thyroid cancer, follicularvariant. Because I was generallyconsidered to be borderline low risk, Iwondered if I would be able to skip RAItreatment altogether, without having arecurrence. I worried about the sideeffects, and was in no hurry to add to mysuffering.

My parathyroid problems bothered mefor a long time. It was an emotional rollercoaster. I couldn’t get away from thetwitching and it drove me to distraction.At one point, I was thinking about timing

the seconds between twitches because Iwas sure that I had a twitch somewherein my body every 30 seconds. Months hadgone by and I still didn’t want to thinkabout RAI treatment and luckily, no onetried to push me into it. There was no rush.The one thing I knew was that if I decidedto have it, I wanted to take Thyrogen, anew drug I heard about from myendocrinologist.

In general, patients preparing for RAItreatment try to increase their TSH tostimulate 131I absorption and enable amore accurate measurement ofthyroglobulin (Tg), a protein produced bythyroid cells. In the past, the only waypatients could increase their TSH was tostop taking T4 and suffer throughhypothyroidism (“hypo-hell”), but nowthere is a new synthetic drug calledThyrogen or recombinant TSH thatelevates patients’ TSH level withoutstopping T4.

In the fall of 2000, Thyrogen wasneither fully approved nor widely usedin Canada, but I was fortunate to live in acity that has a nuclear medicine specialistwho is familiar with it. Although the bestcourse of action is anyone’s guess, I optedto have RAI in February of 2001.

My diagnostic scan (about 2 mCi RAI,with Thyrogen) showed I had remnantsof thyroid tissue in my thyroid bed whichwere likely normal cells left behindduring surgery. A week later, I underwentRAI remnant ablation (about 100 mCi131I, again with Thyrogen). I didn’t have

My thyroid . . . continued from page 8 to stay in the hospital. I was able to gohome as long as I arranged to be inisolation for three days. I had stocked upon lemon candy because I knew thatsucking on something sour was the bestway to prevent damage to my salivaryglands. I also drank a lot of water to flushthe excess RAI out of my system asquickly as possible. I didn’t suffer fromany side effects.

Normally, thyroglobulin (Tg) bloodtests are done to determine if there arestill thyroid cells left somewhere in thebody; but doctors are unable to rely onTg tests in the presence of antibodies. Myantibody levels are still high, but appearto be receding, which is a good sign. Itcould take years for them to disappear.In the meantime, we have to rely entirelyon RAI scanning, ultrasounds andphysical exams.

Over time, I have been able to get onwith my life and have come to accept myhypoparathyroidism. As long as I take mymedication on time, I have few, butoccasional symptoms. My scar is nolonger noticeable, so the pills I take arereally my only reminder of the wholeordeal.

I learned a lot from my experience andas a way of helping others, I have beenvolunteering with the newly incorporatedCanadian Thyroid Cancer Support Group(Thry’vors) Inc. Thry’vors can be reachedat [email protected] or by writingPO Box 23007, 550 Eglinton Ave. West,Toronto ON M5N 3A8

In the recent article by Ernest L. Mazzaferri (cover story Summer 2002, Volume23, No.2) entitled Thyrogen – Recombinant Human Thyrotropin in themanagement of papillary and follicular thyroid cancer, there is a typographicalerror in the second paragraph. It should read:

“The good news is that while the incidence of thyroid carcinoma hasincreased by 50%, thyroid cancer mortality rates among persons living inthe United States have declined nearly 20% (not 50% as stated) over thepast 30 years.”

Correction –Dr. Mazzaferri Article

Correction – article duDr. Mazzaferri

Dans un article récent par Ernest L. Mazzaferri (article de la première page, été2002, Vol 23, No 2) intitulé Thyrogen – recombinant humain Thyrotropin dansla gestion du cancer papillaire et folliculaire, il y a une erreur typographiquedans le 2ième paragraphe. On aurait du dire :

« La bonne nouvelle est que, pendant que l’incidence de carcinomethyroïdien augmentait de 50%, le taux de mortalité par le cancer thyroïdien,parmi les personnes demeurant aux États Unis, diminuait de presque 20%( et non pas de 50% comme déclaré) durant les 30 années passées. »

*****

Ernest L. Mazzaferri, MD, MACP


ince the 1984 Los AngelesOlympic Games, when CarlLewis matched Jesse Owens’

record of winning four gold medalsduring one Olympiad, Lewis haddemonstrated seemingly boundlessenergy and strength. As an Olympic andWorld championship medalist in the longjump, the 100 and 200 metre races, andthe 4 x 100 relay, the record-setting Lewishas won the attention and admiration offans around the world. His amazingphysical abilities and his longevity in afield where the average participant’s ageis 26, have kept sport writers andcommentators buzzing.

Five months before he was to competeat the relatively old age of 35 in his fifthand final Olympics, Carl Lewis receivedsome unexpected news. Blood workordered by his endocrinologist revealedthat Lewis had hypothyroidism, or, assome people refer to it, an underactivethyroid. In his recently released book OneMore Victory Lap Lewis said he felt, ”...a moment of panic...when I wondered ifmy season was about to be declared over... I was much less concerned aboutrunning and jumping than I was about mybasic health.”

Like most people when they are firsttold they have a thyroid disease, Lewisasked, “Who would even know about thethyroid gland unless something goeswrong with it?” The thyroid gland,located in the neck, produces, stores, andsecretes two thyroid hormones, thyroxine(T4) and triiodothyronine (T3). Thesehormones travel through the blood andtell the body how fast to work and useenergy. When there is too little thyroidhormone circulating in the bloodstream,hypothyroidism occurs.

The wide range of signs and symptomsof hypothyroidism can vary from patientto patient and can be confused easily withthe symptoms of other diseases.Symptoms develop slowly and can easilybe dismissed or attributed to other factors.An individual hypothyroid patient mayhave none, some, or all of the signs andsymptoms of hypothyroidism, dependingon the severity of the disease. In Lewis’case, he had been unaware of any signsor symptoms, he simply went for aroutine check-up, and blood workrevealed his condition. However, a fewweeks after his diagnosis, Lewis realizedthat he had put on a few pounds. He knewthat hypothyroidism could be responsible

SA moment with Carl Lewis

for some of the weight gain, but he alsoknew he had been lifting weights, whichcan cause an increase in muscledevelopment, and eating more. Heimmediately went on a diet regimen hehad used successfully in the past. Withintwo weeks he lost seven pounds.

Hypothyroidism can be permanent andrequire a lifetime of treatment, or it maybe temporary and require little, if any,treatment. Further laboratory testsrevealed that Hashimoto’s thyroiditis, achronic inflammation of the thyroidgland, was the underlying cause of Lewis’condition, and therefore, the conditionwould be permanent. Hashimoto’sthyroiditis is an autoimmune disease andthe most common cause of hypo-thyroidism in the United States, affecting5% of the adult population. Whensomeone has an autoimmune disease,their body’s immune system incorrectlyidentifies the cells of normal body tissueas ‘invaders’ and then producesantibodies to attack these cells. In the caseof Hashimoto’s thyroiditis, auto-antibodies are formed against chemicalsin the thyroid gland. The result of thisattack is painless inflammation andenlargement of the thyroid gland.Eventually the inflammation subsides,and the thyroid gland decreases in size.At any stage in this process, the patientmay become hypothyroid.

Although no one knows the exactcause of autoimmune diseases such asHashimoto’s thyroiditis, studies indicatethat they:

• Tend to run in families

• Affect women five to ten times moreoften than men

• Sometimes occur together, e.g:diabetes, pernicious anaemia

The incidence of Hashimoto’sthyroiditis increases with age, especiallyamong women. One in five women overthe age of 75 have antithyroid antibodies.Because Hashimoto’s thyroiditis tends torun in families, patients diagnosed withit should tell members of their familyespecially their mothers, sisters, aunts andnieces so that they will be aware that thereis a hereditary disease in the family.

As Carl Lewis discovered, thetreatment for hypothyroidism is simple,safe, and very effective – thyroidhormone replacement. He began takingbrand-name levothyroxine once a day,every day on an empty stomach. Being a

true champion, he continued his strenuousschedule of training, participating inmeets and promotional activities. He hadsome of the same concerns as otherpatients. He worried about how long itwould be before he was 100% recoveredand if, indeed, he would ever completelyrecover. In addition, Lewis had the addedpressure of wondering if he couldeffectively compete in such a demandingarena. Would he be able to fulfil his dreamof leaving the track and field events atthe Atlanta Olympics, “ on my own terms... with a bang, with passion” so thatpeople (will) always remember me at mybest”?

Reading more about the thyroid glandand hypothyroidism reinforced whatLewis’ doctors had told him and alsohelped him develop a better under-standing of his condition. He found Dr.Sheldon Rubenfeld’s book Could It BeMy Thyroid? extremely reassuring.Within four weeks of beginninglevothyroxine, he started feeling better,and after six weeks of taking this thyroidhormone replacement, he realized he feltas good as ever. Hypothyroid patientsshould not expect immediate improve-ment. Just as the symptoms ofhypothyroidism develop slowly, a fullresponse to treatment occurs gradually,it can take six weeks or longer. If theinitial dose of levothyroxine needs to beadjusted, improvement takes longer.

Lewis decided he would not talkpublicly about his thyroid disease untilafter the Olympic Games in Atlanta. Hedid not want the added distraction of hiswhole year being turned into a medicalstory. He is also not the type of person tomake excuses. And, as he showed thewhole world on July 28, 1996, fivemonths after being diagnosed withhypothyroidism, he needed no excuses,he was back. Soaring through the air inthe long jump to fulfil his dream and winone more gold medal, he became one ofonly two people in the history of thegames to win nine gold medals during anOlympic career.

You can read more about Carl Lewis’Olympic preparation and his experiencewith hypothyroidism in his book OneMore Victory Lap: My Personal Diary ofan Olympic Year, published by AthleticsInternational

Reprinted with permission from Thyroid Flyer,newsletter of Thyroid Australia Ltd.


hese days health-care can beviewed as a partnership betweenpatient and provider, with both

parties responsible for ensuring aconstructive relationship. Patients – alsonow referred to as health-care consumers– are taking a more active role than everin this regard.

Good communication is essential, ofcourse, to any positive doctor-patientrelationship, whether it involves yourfamily physician or a specialist recom-mended by him or her. Following aresome ways you can do your part to makethe most of medical visits.

Before an appointment• Make a list of things you want to

discuss, in order of priority. Also jotdown any symptoms you areexperiencing, including their fre-quency, duration and intensity, andhow they are affecting your daily life.Note, too, any treatments you havetried. Always take a list of themedications you’re taking – prescrip-tion and over-the-counter drugs as wellas any natural remedies – including thedose.

• Take along note pad and pen to jotdown key information.

• Consider asking a good friend orfamily member to accompany you,they can help with processing informa-tion and remembering instructions.They may also have questions thathadn’t occurred to you.

During the visit• If you have a hearing or visual

impairment, let the doctor know at theoutset of the visit. If you have alanguage impairment from a stroke orother condition, such that it’s hard forothers to understand you, bring alongsomeone who knows you well and caninterpret your responses if necessary,or ask questions on your behalf.

• Share information. Provide as muchdetail as possible about any problemsyou are experiencing and how theseare affecting you. Don’t leave anythingout – let the doctor decide what’srelevant. Share your list of medi-cations, too.

Doctor-Patient communicationPractical advice for improving the conversations you have with your doctor

T• Be honest about your lifestyle and

habits. For example, if you’re diabetic,but you don’t stick to the recom-mended diet, or you haven’t beentaking medications as prescribed. Letthe doctor know about anything goingon in your life that may be contributingto your situation – for example, arecent loss or other traumatic eventthat’s causing significant stress.

• Write down important informationprovided to you. If you have broughtsomeone along ask him or her to dothis so you can give the doctor yourundivided attention.

• Ask for details. If you’re diagnosedwith a medical condition, inquire aboutwhat to expect, including how long it’slikely to last, treatment or managementoptions, and where you can get moreinformation. For any recommendedtest or treatment, inquire about cost,where it must be done, what’sinvolved, benefits and risks, andalternatives.

• Request a layman’s explanation if youdon’t understand the medical jargonused by the doctor. Summarize aloudthe information he or she gives you,to check if you have interpreted itcorrectly.

• Don’t try to be an expert. While there’sa wealth of medical informationreadily available to consumers thesedays (especially over the Internet), andit’s good to be informed, don’t act asif you know more than the doctor does.Be tactful if you wish to challengefindings or recommendations. Forexample, it’s much less threatening tosay, “I’ve read about a new medicationcalled X; what do you think of it formy situation?” rather than, “Whyaren’t you prescribing X?”

• Don’t hesitate to voice your doubts,worries or fears. If, after your doctoraddresses them you’re stilluncomfortable with a diagnosis or thetreatment options presented to you,request a second opinion.

• Don’t worry about taking up too muchof your doctor’s time. Ask all of yourquestions and express any concerns.However, prioritize your issues (lowerpriority ones may have to wait foranother appointment), be concise anddon’t get off topic.

• Before leaving, make sure you areclear about any next steps – forexample, whether you should scheduleanother appointment, when and howyou’ll learn of test results, and whatyou should do if your conditionworsens or you experience an adversereaction to a new medication.

• Ask about the best time to call if anymore questions occur to you after youleave the office.

Lisa M. Petsche is a geriatric socialworker and freelance writer who lives inStoney Creek, OntarioReprinted with permission by GeorgeCoyle, Publisher of Fifty-Five PlusMagazine.

Points to consider whentalking to your doctor

When you go for a regular check-up,your doctor will ask you the sameseries of questions each time. Thenext time you’re at the doctor’soffice, be ready with answers. Here’swhat to think about before theappointment date.

• Activity level

• Smoking habits

• Diet changes

• Alcohol consumption

• Blood pressure measurements

• Cholesterol and triglycerides tests

• Diphtheria, tetanus, polio booster(when was the last time youreceived a booster shot?)

• Changes in skin

• Weight

• Stressful situations

• Height and body type

• Blood sugar testing

Source: City of Ottawa

byLisa M. Petsche


Chapter newsAvalon/St. John’s

Amelia Hodder and a few volunteersare working to restore the Avalon Chapterto an active status. Anyone willing tohelp, please contact Amelia by telephoneat 709-726-5479 or by e-mail: [email protected]

Burlington/HamiltonOn Sunday, July 14, the chapter held

a used book sale in conjunction with amajor Neighbourhood CommunityGarage Sale. In spite of the 95 degreeweather our volunteers did a wonderfuljob. The site provided great exposure forour chapter and we are planning to repeatthe sale next year. Thanks to all whodonated books; the unsold books weredonated to seniors’ homes and othergroups.

Our special series Living Well withThyroid Medication sponsored by DellPharmacies has been a great success. Thispast September the chapter held its firstpublic education meetings in St.Catharines and Brantford. These meetingswere warmly received and we are lookingforward to repeating them again nextyear.

As of June 02, our membership hadincreased 23% over last year. We wouldbe pleased to hear from any of ourmembers with suggestions for topics theywould like to hear. Suggestions forfundraising are always welcome. Wewish everyone all the best for theholidays. Please feel free to contact me,Tammy (your president) 905-304-1464.

GanderMarilyn Anthony and Mabel Miller are

very pleased to have the Gander AreaChapter up and running again. Activityhas not been very brisk the past coupleof years due to unforeseen circumstances.

Monday, September 30, Heather Paul,a psychologist and a thyroid patientherself, very aptly relayed her experiencesin dealing with thyroid disease and thecoping skills she uses. Those inattendance appreciated her story, heradvice of looking after yourself andknowing about your condition. AfterHeather’s talk, she answered questionsand discussed the many ways of coping,especially for those whose medication for

thyroid disease has not been stabilized.Education materials were distributed,especially to those who were new to theorganization.

Bunda gave her presentation on TuesdayOctober 22, 2002 in the amphitheatre ofthe Civic Campus, Ottawa Hospital. Hertopic was an introduction to naturopathicmedicine and support for your thyroid.The new approach generated considerableinterest and attendance.Volunteers aredesperately needed to help us continuewith our excellent programs. Please help.Call 613-729-9089.

TorontoAt the fall meeting, October 19,

Toronto members had the pleasure ofhearing Dr. William Singer, Endocrin-ologist, St. Michael’s Hospital, Torontospeak on Thyroid dysfunction: when, howand how often to test?

KingstonM. Sara Rosenthal’s Thyroid Town

Meeting, September 17, was mostinteresting and generated a great deal oflively discussion. Much of the discussionwas about depression. Sara put forth thesuggestion that, in addition to takingmedication, those suffering fromdepression might find it helpful to go forcounselling.

Kitchener/WaterlooThe chapter held a successful 20 th

anniversary party on October 15. Formerand current members and many newpeople enjoyed a delicious dinner. Priorto dining the guests heard an excellent talkentitled Questions and answers aboutcommon thyroid disorders by Dr. DanielDrucker, Endocrinologist, TorontoGeneral Hospital, University HealthNetwork. The evening concluded with asilent auction and the distribution of doorprizes.

OttawaAfter some difficult times the OttawaChapter of the Thyroid Foundation ofCanada is back in business again. Weopened our public education meeting withan innovative presentation by Dr. AnnaBunda on naturopathic medicine. Dr

The National Officewill be closed from

FridayDecember 20, 2002

at 4:30 pm toThursday

January 2, 2003at 9:00 am

Heather Paul, Psychologist speaking on“Living and Coping with Thyroid Disease” at a

meeting of the Gander Area Chapter onSeptember 30, 2002.

With Christmas comingup, why not give a gift

that keeps on giving? Itis often difficult to

choose a gift for adultrelatives and friends,so this year why not

give a gift membershipto the Thyroid

Foundation – or makea contribution to the

Foundation’s Researchor Education Funds ina relative’s or friend’s

honour?

A gift thatkeeps on

giving


Chapter coming eventsFree admission – everyone welcome

Burlington/HamiltonLocation: Joseph Brant MemorialHospital, Bodkin Auditorium, 1230 NorthShore Blvd, Burlington.• Tuesday November 12, 2002, 7:30 pm

Dr. G. Perez, Internist. HamiltonHealth Sciences. Topic: A generaloverview of hypo and hyper thyroiddisease. Please bring parking ticket forvalidation.

For information call 905-304-1464.

GanderGander Chapter hopes to visit other

towns in the area soon to provideeducation materials and generalinformation regarding the ThyroidFoundation of Canada. The next meetingof the Gander Chapter will be inNovember. Information will be availablethrough the local media. Anyone willingto assist with the programs or help in anyway is asked to get in touch with Mabelat 709-256-3073 or Marilyn at 709-256-7687.

KingstonLocation: Ongwanada Resource Centre,191 Portsmouth Avenue, Kingston• Tuesday, November 19, 2002, 7:30 pm.

Speaker TBA.

For information call 613-545 2327.

Monthly thyroid discussionLocation: Loblaws Market, Upstairs,Kingston Centre• Fourth Sunday of each month, 3:00 -

4:00 pm. Discussion led by pharmacistBozica Popovic, Manager. Sponsoredby Loblaws Pharmacy.


Kitchener-WaterlooLocation: Community Room, AlbertMcCormick Arena, 500 Parkside Drive,Waterloo.

• Tuesday, November 26, 2002, 7:30 pm.Dr. Merrill Edmonds , Endocrin-ologist, St. Joseph’s Health Centre,

London. Topic: Alternative therapiesfor the thyroid.


LondonLocation: NEW! Central Library,Galleria, 251 Dundas Street, London.Two hours free parking for library patrons

• Tuesday, November 19, 2002, 7:30 pm.Dr. Merrill Edmonds , Endocrin-ologist, St. Joseph’s Health Centre ,London. Topic: Alternate therapies forthe thyroid.


London Spring FundraiserLocation: Hellenic Community Centre,Southdale Road West, London• 3rd Annual Fashion Show, Thursday,

April 10, 2003, Dinner and FashionShow.

A wonderful evening, lots of fun, join usin supporting this worthwhile event.Tickets available for Christmas Gifts. Forticket information call 519-649-1145.

Montreal• Please reserve the following dates for

public education meetings:

- November 13, 2002,

- February 12, 2003,

- March 12, 2003.

Speakers and topics TBA.

• The annual art show will take placeApril 5 to April 11, 2003.


OttawaLocation: Amphitheatre, Civic Campus,Ottawa Hospital

• Tuesday November 19, 2002, 7:30 pm.Don’t miss thyroid quiz evening withDr. Mark Silverman, Endocrinologist.


omen have eight to tentimes the thyroid prob-lems that men do. But

men have their difficulties.Being sub-thyroid (hypothy-

roidism) means the whole system isdragging, lethargy and depression arecommon, and a decreased libido ispart of that. Muscles sometimes lookbigger but they are weaker. If causedby a thyroid problem, these problemsgo away with proper treatment.

Having too much thyroid hormone(hyperthyroidism) can lead to musclewasting and weakness, especially inthighs and upper arms. It can alsoupset the balance between theprincipal male sex hormone (testos-terone) and the female sex hormone(estradiol) in the body; Spermproduction may be impaired. Theremay be breast tenderness orenlargement. Libido is reduced anddifficulty with erection is common.If the thyroid gland is the culprit,these problems clear up when thethyroid hormone balance is restoredto normal.

Thyroid cancer is rare, 1.6% of allcancers in women, and 0.6% of allcancers in men. However, if there arenodules in the thyroid gland, in menthey are more likely to be cancerous.

Be sure your physician examinesyour thyroid (in the front of yourneck) and orders a thyroid stimu-lating hormone (TSH) blood test if itseems possible your thyroid is notworking right. This is especially trueif you have a close relative with athyroid problem or related immunedisorder such as pernicious anaemia,rheumatoid arthritis or Type 1diabetes. It is also likely that your riskis also higher if you or a close relativebegin to get gray hair before age 30.

Published by The Thyroid Foundation ofAmerica Inc. Reproduced with permissionfrom Thyroid Flyer, newsletter of ThyroidAustralia Ltd.

W

Men’s thyroidproblems


ear Eileen Davidson:

Two days ago I received theSummer 2002 thyrobulletin. I

joined the Thyroid Foundation of Canadafrom the first advertisement in theMontreal Star. During all those years Iread and bought most of the books thatused to be available, and I rememberwhen I returned in 1986 to Israel and sawmy GP and told him all my knowledgeof the thyroid he told me, “You knowmore than me”.

Now I was happy to read that you area stamp collector and pen friend. For over28 years I had, and still have, pen friendsall over the globe, and I used to collectused stamps. I will be happy to send youa lot of stamps for you and your clubmembers, and I would be happy to get inreturn Canadian used stamps. Please sendme the address where to send the usedstamps.

Also I would like to have someCanadian Pen Friends. Sorry, I don’twrite or speak French although I lived inMontreal from 1953 to 1986.

I think that next year it would be nicefor the Thyroid Foundation of Canada towish all its Jewish members a HappyNew Year – September 6, 2002 – 5763years. Shalom

Betty Pivko, PO Box 6952,Ramat-Gan 52168, Israel

*****

o the Foundation:

I wish to respond to the letterfrom Emilia Moon-de-Kemp

(thyrobulletin Summer 2002). I hope thismakes sense to the reader in support ofthis publication. If it does not perhaps it’sbecause I do not feel too well!

As a member I regret that you feel youhave not benefitted from thyrobulletinand have chosen not to renew yourmembership. On the contrary, I feel Ihave benefitted enormously from mymembership and all copies ofthyrobulletin. I have renewed since 1995.

The knowledge and education I havereceived regarding my disease came overa period of time in each edition. I feel Idid gain something from eachpublication. I did not gain everything Ihave learned from one issue but overseveral years of renewing my

Foundation’s mailbox

D

Tto

Dr. and Mrs. Paul Walfishupon the accidental death

of their daughter MarciJuly 5, 2002

Dr. Walfish is the author of severalof the Foundation’s Health Guideson Thyroid Disease, a long-timemember of the Peer ReviewCommittee and a strong supporterof the Foundation.


SincereCondolences

membership. I read each copy thoroughlyeven though it may not have applied tome specifically, took what was applicableand useful to me in managing this diseaseand stored it in my memory bank. Thetime came when I was able to impart thatuseful information to someone who didnot have my specific type of thyroidcondition and did not know this sourceof valuable information was available tothem. Hopefully it helped to provide themwith the answers they were looking for,as their doctor did not provide them witheither.

The information sharing is priceless!Not all of it applies to me as an individualbut to a membership of several peoplewho share common concerns.

Medical professionals impartknowledge to me in a very inexpensiveway through thyrobulletin. Anyinformation I have gained throughthyrobulletin about my disease did notcome through my family physician or thespecialist who treated me. Had I notreceived thyrobulletin through mymembership I would not have known, forexample, the following:

• Education in understanding thisdisease helps me to manage iteffectively. No doctor provided this tome at the time of diagnosis.

• Iron supplements – the two hourabsorption time in conjunction withthyroxine intake can affect how youfeel. Patients have been known tosupplement with iron to counteractsymptoms of fatigue associated withthyroid disease. No doctor told me this.

• Diet and nutrition advice contained inthyrobulletin is very important inmanaging this disease. I took what wasapplicable to my condition and try tofollow it. It helps to offset the cost ofhealth care so my physical and mentalwell-being are not affected by poor dietand nutrition.

• Support through little tidbit articlesfrom other members interspersedthroughout the pages of thyrobulletinmake it interesting to read.

• Medication management throughcontributory articles by professionalsin research relate the importance ofknowing how drug interactions from

other medication you may be takingcan affect your thyroid condition,requiring adjustments in thyroxineintake. This is extremely important toknow in managing this disease or wecan become desperately ill withoutknowing the reasons. Learn your drugprofiles.

• Any medical information I have gainedregarding self-care and management ofmy thyroid condition did not comefrom the doctor who diagnosed mythyroid condition in 1994. It came fromdoctors, other medical professionalsand information sharing from thememberships who contributed articlesto thyrobulletin.

As a constructive project of my own, Ihave taken my several years collection ofthyrobulletins, extracted those articlesapplicable to myself, making it a littleeasier to keep track of managing myspecific condition by making a smallbooklet of my own. I find it very helpful.

In support of the Thyroid Foundationof Canada who provide thyrobulletin tome at a relatively inexpensive annual costof only $20 I have gladly renewed mymembership. I could not manage mydisease without it.

Thank you for allowing me to expressmy opinion and experiences through theFoundation Mailbox.

Sharon A. Lloyd, Hamilton


New memberships run for one or two years from the receipt of this membership application.All members receive thyrobulletin, the Foundation's quarterly publication.

I will be paying my donation/membership by:

q Personal Cheque (enclosed and payable to Thyroid Foundation of Canada) or,q Visa or q MC #: Expiry Date: Signature:

Name:

Address:

City: Province: Postal Code:

Tel: Fax: E-mail:

Type of Membership: q New q Renewal • Language Preferred: q English q French

Yes!I will support the

Thyroid Foundationof Canada!

Please Continue Your Support—We Need You!

Donations – The only gift too small is no gift at all. $

Membership Level One Year Two Year

q Regular $20.00 $35.00 $ q Senior 65+ $15.00 $25.00 $ q Student $15.00 $25.00 $ q Family $25.00 $45.00 $

Total: $

We accept your membership fees and donations by mail, fax or online at our website.All donations and membership fees qualify for a tax receipt. Please send your application and payment to:

THYROID FOUNDATION OF CANADA, PO Box/CP 1919 Stn Main, Kingston ON K7L 5J7Tel: (613) 544-8364 or (800) 267-8822 • Fax: (613) 544-9731 • Website: www.thyroid.ca

Membership/Donation Form

The following Health Guides onThyroid Disease are available inEnglish and French.

The information in these HealthGuides was provided by Drs. JodyGinsberg, Ian R. Hart, Irving B. Rosen,Sonia R. Salisbury, Robert Volpé, PaulG. Walfish and Jack R. Wall. Themedical information in these brochuresis for general patient education. Forindividual treatment or diagnosisconsult your personal physician.

1. The Thyroid Gland: A GeneralIntroduction

2. To Confirm the Clinical Diagnosis

Health Guides on Thyroid Disease3. Hypothyroidism

4. Thyroid Nodules

5. Thyroiditis

6. Graves’ Hyperthyroidism (Thyro-toxicosis)

7. Graves’ Eye Disease (Ophthal-mopathy)

8. Thyroid Disease, Pregnancy andFertility

9. Thyroid Disease in Childhood

10. Thyroid Disease in Late Life

11. Surgical Treatment of ThyroidDisease

12. Thyroid Cancer

13. Common Concerns of ThyroidPatients

All Health Guides are availablethrough the Foundation’s nationaloffice or from your local chapter (seeback page). Please send a self-addressed business size envelopestamped with two 48 cents stamps.

Tous les Dépliants Santé sur lesaffections thyroïdiennes sontdisponibles auprès du bureau nationalde la Fondation ou de votre sectionlocale. Veuillez nous faire parvenir uneenveloppe d’affaires adressée à soi etaffranchie de deux timbres de 48 cents.

Thyroid Foundation of CanadaLa Fondation canadienne de la ThyroïdePO BOX/CP 1919 STN MAINKINGSTON ON K7L 5J7

Awareness • Support • Research Éclaircissement • Soutien • Recherche

Staff/équipe Katherine Keen, National Office Coordinator/Coordinatrice du bureau nationalHelen Smith, Membership Services Coordinator/Coordinatrice des services aux membres

Office Hours/ Tues.- Fri., 9:00 am - 12:00 pm/1:00 pm - 4:30 pmHeures du bureau Mardi à vendredi, 9h00 à 12h00/13h00 à 16h30

Tel: (613) 544-8364 / (800) 267-8822 • Fax: (613) 544-9731 • Website: www.thyroid.ca

National Office/Bureau national

BRITISH COLUMBIA/COLOMBIE-BRITANNIQUECowichan (250) 245-4041Vancouver (604) 266-0700

ALBERTACalgary (403) 271-7811Edmonton (780) 467-7962

SASKATCHEWANSaskatoon (306) 382-1492

MANITOBAWinnipeg (204) 489-8749

QUEBEC/QUÉBECMontréal (514) 482-5266

NEW BRUNSWICK/NOUVEAU BRUNSWICKMoncton (506) 855-7462Saint John (506) 633-5920

Chapter & Area Contacts/Liaisons pour les sections et districts

Has yourmembershipexpired?See Page 15

NOVA SCOTIA/NOUVELLE ÉCOSSEHalifax (902) 477-6606

PRINCE EDWARD ISLAND/ÎLE-DU-PRINCE ÉDOUARDCharlottetown (902) 566-1259

NEWFOUNDLAND/TERRE NEUVEAvalon/ St. John’s (709) 726-5479Gander (709) 256-3073Marystown (709) 279-2499

ONTARIOBurlington/Hamilton (905) 304-1464Kingston (613) 389-3691Kitchener/Waterloo (519) 884-6423London (519) 649-5478Ottawa (613) 729-9089Petawawa/Pembroke (613) 732-1416Sudbury (705) 983-2982Thunder Bay (807) 683-5419Toronto (416) 398-6184

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