Volume 24, No. 4 Winter 2004

Thyroid Foundation of Canada

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

ContentsReport of Thyroid Update Forum/Forum mis à jour thyroïde ..................................... 3Jack Tarantello ........................................................ 5A brief history of the thyroid .................................. 6Letters to the doctor ............................................... 7Chapter news ......................................................... 8Chapter coming events .......................................... 9Financial Statements ....................................... 10-11

Highlights of 23rd AGM weekend ........................ 12Foundation�s mailbox ........................................... 13Thyroid disease and silent celiac disease ......... 14Effects of combining T3 & T4 for thetreatment of hypothyroidism ............................... 15My thyroid cancer journey ................................... 16Call for nominations 2004-2005 ........................... 17Grief and depression ............................................ 18

Message du président

thyrobulletin, Winter 2004 3

by /parDagmar Van Beselaere

Report of Thyroid Update Forum

O n Saturday, November 1, 2003as part of the 23rd AGM week-end activities, the Thyroid

Foundation of Canada sponsored top re-searchers, scientists and medical doctorsto gather in Toronto to update the publicin a forum on thyroid disease. The daylong forum was packed full of new andrelevant information in a very patient ori-ented manner.

The morning was devoted to increas-ing understanding of thyroid cancer, theincidence of which is the fastest growingcancer in Canada. The morning startedwith a panel of patients expressing theirneeds in dealing with this illness. This setthe tone for the rest of the morning dur-ing which presentations were made, notonly to medical colleagues, but also tothyroid patients in an understandablemanner. It started with a presentation onCytopathology by Dr. Scott Boerner whoshowed how fine needle aspiration (FNA)

L

suite à la page 5

e 1er novembre, 2003 LaFondation canadienne de laThyroïde a commanditée un

rassemblement à Toronto d�importantschercheurs, scientifiques et médecinspour mettre le public à jour durant un fo-rum sur les affections thyroidiennes. Leforum a durée toute une journée et étaitremplis de nouveaux et importantsrenseignements d�une façon orientée auxpatients.

L�avant-midi était dévoué àl�accroissement de discernement du can-cer thyroïdien, l�incidence duquel est leplus progressif au Canada. L�avant-midicommençait avec un panneau de patients

DagmarVan Beselaere,member Ottawa

Area Chapteris done and how the results are interpretedto indicate malignancy/no malignancy.Dr. Marsha Werb talked about the pro-cess that a physician goes through to de-termine a patient�s risk of having thyroidcancer, i.e. how a doctor reaches such adiagnosis.

The treatment of thyroid cancer re-quires surgery, usually the complete re-moval of the thyroid gland. Two doctors,Dr. Roger Tabah and Dr. Ralph Gilbert,addressed this issue, often with slidesshowing the actual surgery. To completethe destruction of the thyroid gland, ra-dioactive iodine is usually needed as afinal step and Dr. Albert Dreidger spokeabout this, showing slides of the radioac-tive iodine attack on residual cancer cells.

The afternoon was devoted to a sam-pling of the many other thyroid disorders.Dr. Donald Morrish talked about radia-tion and Graves� disease, giving a histori-cal perspective on the treatment of thisdisorder and the newest research on thepossible effects of radiation on the illness.Dr. Jay Silverberg addressed the issue ofhypothyroidism, again reviewing some ofthe more recent research which indicatesthat patients with borderline hypothyroid-

ism seemed to feel better with treatmentand that the band of TSH levels for opti-mal �feeling better� patient reaction ismuch narrower than previously thought.It should fall between 0.3 to 3.5milliunits/L. Dr. John Chan explored therelationship between thyroid disease anddiabetes, both of which are autoimmunedisorders.

After a short break, Dr. JamesOestreicher showed how reconstructivesurgery can return eyes to near normalafter the devastating effects of thyroid eyedisease. Dr. Ivy Fettes spoke about theimportance of controlling thyroid levelsduring pregnancy to avoid damage to thefoetus. Last, but not least, Dr. ArnoldBayley discussed the effects thyroid dis-orders can have on bone maintenance andtheir influence on the development ofosteoporosis.

Through the sponsorship of the ThyroidFoundation of Canada, the day was filledwith information, some already known butbrought to the awareness of thyroid pa-tients with doctors translating the medicalshorthand they would use with colleaguesso that patients were able to understand,as well as some of the most recent researchresults. At the end of the day thyroid pa-tients left exhausted with the volume ofinformation absorbed and incrediblybetter informed about their illness.

Forum mis à jour thyroïdequi exprimaient leurs besoins en faisantface à cette maladie.

Ceci a fixé le ton pour le restant del�avant-midi durant laquelle desprésentations étaient données, nonseulement aux collègues médicaux maisaussi aux patients thyroïdiens dans unemanière compréhensible. On commençaitavec une présentation sur la Cytobiologiepar le Dr Scott Boerner qui montrait com-ment une biopsie à l�aiguille fine (BAF)est accomplie et comment les résultatssont interprétés pour indiquer malin/nonmalin. La Dr Marsha Werb parlait du pro-cessus qu�un physicien emploi pourdéterminer le risque au patient d�avoir un

cancer thyroïdien, c à d, comment il ar-rive à ce diagnostic.

Le traitement du cancer thyroïdiennécessite la chirurgie, d�habitudel�enlèvement complet de la glandethyroïde. Les deux docteurs, Roger Tabahet Ralph Gilbert adressaient ce sujet,souvent avec illustrations de la chirurgieactuelle. Pour compléter la destructionde la glande thyroïde, l�iode radioactiveest habituellement nécessaire et le DrAlbert Dreidger discourait sur ceci avecillustration de l�attaque d�iode radioac-tive sur les cellules cancéreuses résidus.

4 thyrobulletin, l�hiver 2004

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Office Staff

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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: March 15, 2004

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 mars, 2004

Thyroid Foundation of Canada

thyrobulletinLa Fondation canadienne de la Thyroïde

Important Notice:The information contained

within is for general informationonly and consequently cannot

be considered as medicaladvice to any person.

For individual treatment ordiagnosis consult your health

care professional.

Thyroid Foundation of CanadaLa Fondation canadienne de la ThyroïdeFounded in/Fondée à Kingston, Ontario, in 1980

FounderDiana Meltzer Abramsky, CM, BA

(1915 � 2000)

Board of DirectorsPresident of each ChapterPresident Secretary � Joan DeVille

Treasurer Vice-Presidents

Chapter Organization & Development � Mabel MillerEducation & Research �

Publicity & Fundraising � Gary WinkelmanOperations � David MorrisPast President � Ed Antosz

Members-at-LargeRick Choma, Dianne Dodd, Lottie Garfield, Rita Wales

Annual AppointmentsInternational Liaison � National President

Legal Adviser � Cunningham, Swan, Carty, Little & Bonham LLPMedical Adviser � Robert Volpé, OC, 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 ChomaFax: (613) 542-4719

E-mail: rchoma@sympatico.ca

thyrobulletin team

Avis Important:Les renseignements contenus

à l�intérieur sont à titred�information générale etconséquemment personne

ne doit les considérer commeconseils médicaux. Pourtraitement ou diagnostic

individuel veuillez consultervotre médecin.

thyrobulletin, Winter 2004 5

Forum mis à jour thyroïde . . . suite de la page 3

Monthly DrawBy renewing your membership now youbecome eligible for our monthly draw.

Every month one renewing memberreceives a book on thyroid disease.

September 2003 winnerMrs. Helene Calvert

Ottawa, Ontariowho received a copy of

�Thyroid Problems; a guide for patients�by Dr. Ivy Fettes

October 2003 winnerMs. Eva Reti

Whitby, Ontariowho received a copy of

�Thyroid Problems; a guide for patients�by Dr. Ivy Fettes

November 2003 winnerMrs. Jewel Comstock

Rosebud, Albertawho received a copy of

�Your Thyroid: a home reference�by Dr. L. Wood

� 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 fondspour la recherche sur lesmaladies thyroïdiennes.

The objectives of theFoundation are:

L�après-midi était dévoué à desexemples d�un grand nombresd�affections thyroïdiens. Le Dr DonaldMorrish articulait de la radiation et lamaladie Graves, donnant une perspectivehistorique sur le traitement de cettemaladie et des plus nouvelles recherchessur les effets possibles de la radiation surla maladie. Le Dr Jay Silverberg adressaitle sujet de l�hypothyroïdie, encore en ex-aminant quelques-unes des plus nouvellesrecherches qui indiquent que les patientsavec un cas limite d�hypothyroïdie sesemblent « sentir mieux » avec traitementet que la bande du niveau TSH pour uneréaction idéale « sent mieux » du patientest bien plus étroite que l�on pensaitauparavant et devrait tomber entre 0,3 et3,5 milliunités/L. Le Dr John Chanexplorait les relations entre les affectionsthyroidiennes et la diabètes, qui sont tousdeux des affections auto-immunes.

Après une courte pause, le Dr JamesOestreicher démontrait comment lachirurgie reconstructrice peut normaliserles yeux après les effets ravageant de lamaladie thyroïdienne des yeux.

La Dr Ivy Fettes expliquaitl�importance de controler les niveauxthyroidiens durant la grossesse pourempecher endommager le f�tus. Le DrArnold Bayley terminait la journée endiscutant les effets les affectionsthyroidiens peuvent avoir sur le maintiendes os et leur influence sur le développentde l�ostéoporose.

La journée était saturée derenseignements, quelques-uns déjàconnus mais rappelés à la conscience despatients thyroidiens. Les médecins onttraduit le « grec » médical qu�ilsutiliseraient avec leurs collègues enfinque les patients puissent comprendre lesrenseignements ainsi que les toutesnouvelles recherches sur les affectionsthyroidiennes. A la fin de la journée, parle commanditaire de La Fondationcanadienne de la Thyroïde, les patientsthyroidiens départaient épuisés avec levolume de renseignements etincroyablement plus informés de leurmaladie.

It is with great sadness that theFoundation announces the untimelydeath of the Foundation�s long-timeaccountant Jack Tarantello, whodied peacefully from leukemia atthe Kingston General Hospital onTuesday, December 2nd, 2003.

Jack had been a long-time supporterof the Foundation. In its early days,he was recruited as the Foundation�ssecond treasurer and was a greatsupport to Diana Abramsky in as-sisting with accounting details onsome of her early projects. In 1990,the Foundation received TrilliumFunding for contractual accountingservices and Jack was hired for thisposition. For over thirteen years hegave volunteer service above andbeyond the paid duties and respon-sibilities of this position and was oftremendous assistance to the na-tional office staff, national treasur-ers and auditors during this time.The reliability of TFC�s financialrecords and monthly statements wasdue to Jack�s expertise and dedica-tion to the Foundation.

Jack will be missed by his daugh-ter, his grandchildren, great grand-daughter, sisters and brother, as wellas his many friends in the account-ing community, in Kingston and inthe Foundation.

Jack Tarantello CGAFormer TFC Accountant

6 thyrobulletin, l�hiver 2004

nlargements of the thyroid, pro-ducing a swelling in the neck,are called goitres and have been

recognized since ancient times. TheGreeks apparently attributed goitres to thetype of water people drank. They were atleast partly correct because we know thatiodine deficiency in the diet predisposespeople to the development of goitres, andiodine is frequently found dissolved inwater. It has been claimed that seaweed,which contains iodine, was used in treat-ing goitres in ancient China. (The addi-tion of iodized salt to our diets in the lastfifty years has resulted in a dramatic de-crease in the prevalence of goitre.)

Our understanding of the role of thethyroid gland has evolved over manythousands of years. Hippocrates (460-370B.C.) is called the �father of medicine�and many medical students throughoutthe world take the �Hippocratic Oath� atgraduation. Hippocrates vastly expandedthe art of studying the patient by urgingphysicians to check the person�s appear-ance, temperature, respiration and pulse.This facilitated our knowledge of anatomy,physiology, and internal medicine and re-mains a foundation in medical practice.Hippocrates is considered to have first rec-ognized endocrinology because he de-scribed concepts of �too much� or �toolittle� as a cause of disease.

It was the great physician Galen (130-200 A.D.) who described the anatomicallocation of the thyroid gland. Much later,

A brief history of the thyroidby

Dr. Ivy Fettes

E

Reprinted with permission from ThyroidProblems: A guide for patients by Dr. Ivy Fettes.

Paracelsus (1493-1541) described en-demic cretinism in children � a mental de-ficiency due to severe thyroid hormonedeficiency from lack of iodine in the diet.

Thomas Wharton (1614-1673) was thefirst to describe the ductless glands (nowcalled endocrine glands) and to specifi-cally name the thyroid gland. In 1661Neils Stensen made the clear distinctionbetween the ductless (endocrine) glandsand the lymph nodes, which are some-times called glands, although they are notpart of the endocrine glandular system.

The purpose of the thyroid gland re-mained unknown in the seventeenth cen-tury. Wharton thought it might be presentto round out and beautify the neck. Suchwas the state of medicine at the time.

In the nineteenth century, RobertGraves (1796-1853) gave an excellentdescription of a combination of thyroidenlargement, eyeball �enlargement,� anda variety of signs and symptoms that werecognize today as characteristic of anoveractive thyroid gland (hyperthyroid-ism). Graves attributed the clinical disor-der to the thyroid and henceforth the mostcommon form of hyperthyroidism, whichis due to an autoimmune disorder, iscalled Graves� disease.

Sir William Gull (1816-1890) was thefirst to describe the adult �cretinoid state�(myxedema or hypothyroidism). The dis-ease had long been recognized in children,but he was the first to recognize it in anadult. Gull had a major interest in neuro-logic disease and thought myxedema wasa disorder of the nervous system. He was,of course, only partially correct.

The late nineteenth century and thetwentieth century were marked by majorleaps forward in our understanding of thethyroid gland. George Murray deducedthat myxedema was due to lack of a par-ticular substance in the body and decidedthat it was a rational approach to makeup that deficiency. He first injected thy-roid extract into patients in 1891 andthereby became a pioneer of thyroid re-placement therapy.

The most common cause of hypothy-roidism is recognized to be due to an au-toimmune chronic thyroiditis. The con-dition was described by HakuruHashimoto in 1912 and bears his name(Hashimoto�s thyroiditis).

One of the major events to facilitate ourunderstanding of the thyroid in the twen-tieth century was the radioimmunoassaytechnique by Rosalyn Yalow and SolomonBerson in the 1960s. The ability to detectminute amounts of thyroid hormones in theblood enables doctors to detect an excessor deficiency of the hormones. These mea-surements have become more and moresensitive and are considered standard pro-cedure in making the diagnosis of hyper-thyroidism and hypothyroidism.

In the 1970s a pituitary hormone calledthyrotropin or thyroid stimulating hor-mone (TSH) and a hypothalamic hormonecalled thyrotropin releasing hormone(TRH) were extracted from brain tissue.This enabled scientists to begin to under-stand the complex interactions betweenthe brain and the thyroid. Research hasdemonstrated a hierarchical system ofstimulation from the hypothalamus to thepituitary and then to the thyroid, whichin turn exerts negative feedback on thepituitary and hypothalamus.

The term �hormone�was first coined in about1902 and comes from theGreek word hormaino,which means �to stir intoaction.� Ernest Starlingdeveloped the concept ofhormones being chemi-cal messengers that aresecreted into the blood-stream from endocrineglands.

continued on page 7

Dr. Ivy Fettes

thyrobulletin, Winter 2004 7

D

Lettersto thedoctor

Robert Volpé, OC, MD,FRCPC, MACP,

Medical Adviser tothe Foundation

I have been feeling fatigued formany years. I also complain of con-stipation, lethargy, inability to con-

centrate and weight gain. I have seen sev-eral doctors including an endocrinologist;they have tested my thyroid with bloodtests on many occasions. The blood testsalways come back completely normal.Yet, I have been reading that these testsare not accurate and that measurementsof body temperature are more accurate.Moreover, I understand I should be tak-ing thyroid medication for these symp-toms despite normal thyroid functiontests.

Actually the routine blood tests for thy-roid function are extremely accurate andprecise. Moreover, the blood test for thy-roid stimulating hormone (TSH) (whichis the pituitary hormone that stimulatesthe thyroid gland even more when it isfailing) is extremely accurate. It is the firsttest to rise when thyroid function is at alllow. Indeed, it will go up even before thethyroid hormone levels are detectablylower. This is a category termed �com-pensated� hypothyroidism. In that state,the thyroid hormone levels are still nor-mal, the patient still feels normal but theTSH is already an indicator that the thy-roid gland itself is in trouble. In your case,with a normal TSH, hypothyroidism iscompletely ruled out.

It is important to remember that manyother conditions can mimic hypothyroid-ism, most particularly chronic anxiety,depression and stress. Some psychiatristsuse T3 (Cytomel, triiodothyronine) butusually not thyroxine, with antidepres-sants. How useful this combination is,remains to be proven.

It is true, however, that such peoplewho do not have thyroid disease can�benefit� from taking thyroid medication.The reason they are benefitting is that thethyroid medication is a �placebo�. Thedrug itself has no intrinsic benefit to them,

but if people think it is going to help them,then it does. It is like fooling yourself bytaking a pill that looks identical but iscompletely inert. If we convince ourselvesthat there is some good in it, then we feelmuch better. Sometimes this placebo ef-fect is truly remarkable and long lasting.More often, however, it lasts for only ashort time and disappears. Taking thyrox-ine when you do not need it, is also ofsome danger and cannot be encouraged.

Finally, skin temperatures are of novalue in diagnosing hypothyroidism de-spite assertions to the contrary by some.It has been clearly proven they are to-tally misleading and really useless. Whileit is true that patients with hypothyroid-ism do have cool skin, so do people withmany other conditions. These includepeople with poor blood supply, severestress, anemia and others.

*****

oes a person�s age affect the re-covery rate from thyroid diseaseor the amount of supplemental

thyroid medication needed? What is con-sidered a �normal range� for thyroidstimulating hormone (TSH), and totalserum triiodothyronine (T3 radioimmu-noassay (RIA) readings?

Certainly age will affect the recoveryrate from thyroid disease, both hyperthy-roidism and hypothyroidism. The olderthe person, the slower the recovery rateand indeed with hypothyroidism, it is nec-essary to be extremely careful in olderpeople about increasing the dosage ofthyroxine.

The normal range for TSH depends onthe type of assay utilized. Currently withthe sensitive assays now available, theusual normal range is between 0.3 and3.5 milliunits/L. For the total serum tri-iodothyronine (T3RAI) once again assaysvary a little bit from laboratory to labo-ratory but the average range is 1.2 to 3.4nmol/L.

Thyroid Foundation of Canadagratefully acknowledges the support ofthe Head & Neck Cancer Foundationin sponsoring Letters to the doctor.

With the rapid evolution of mo-lecular biological techniques in the1970s, �80s and �90s we have devel-oped a more comprehensive knowl-edge base of how thyroid hormonesexert their multiple and diverse ef-fects. Worldwide there are thousandsof thyroid researchers contributing tothis effort. We continue to learn anddevelop more effective means of di-agnosing and treating thyroid dis-ease.

A brief history . . . continued from page 6

Axis of Regulation of ThyroidHormones

Ivy Fettes, PhD, MD, FRCPC, is anAssociate Professor in the Department ofMedicine, University of Toronto, and anEndocrinologist at Sunnybrook andWomen�s College Health Sciences Centre,Toronto. Her book is published by ProsperoBooks, 2001, Toronto.

Note 1: If too much T4 and T3 are presentin the body, then TSH will be turned off(this is called negative feedback).

Note 2: If too little T4 and T3 are present inthe body, then TSH will increase to tryand drive the thyroid to produce morehormone.

�Negative� feedback means thathigh levels turn off the stimulationand low levels turn on the stimula-tion. (Just like a thermostat respondsto high temperatures by turning off afurnace and to low temperatures byturning it on.)

8 thyrobulletin, l�hiver 2004

Burlington/HamiltonOn November 4, in Burlington, Dr.

Sarah Capes gave an excellent presenta-tion on Graves� disease. We are lookingforward to more talks by Dr. Capes.

Kitchener/WaterlooKitchener/Waterloo area chapter is in

the happy position of having been offereda meeting room free of charge. It is in thedowntown area, making it easier for thosewho use the buses. Last spring, at theWomen�s Day Health Fair, CassandraHowarth chapter president, was intro-duced to Anne Celestine, Health Coordi-nator from the Kitchener Public Library,who was setting up a health link on theircomputer site, a new Health InformationSection in the library, and a series of spe-cial talks on Women�s Health issues. Anneasked if we could help by being involvedin her program. Needless to say she didnot need to ask us twice. We are saving$25 per meeting. We donated one of ourbooks to be used as a reference book intheir new health section, and put thechapter�s name inside.

The first meeting at the new locationwas last October with Dr. CameronPurdon conducting an open forum ofquestions and answers. These forums arevery well received and we had lots of newpatients in attendance - more than usual.The meeting night has been changed fromTuesday to Wednesday to see if that willalso improve attendance.

Chapter newsTo look at the information the library

has posted for the chapter, seewww.kpl.org. Their e-mail reference isaskus@kpl.org.

SudburyLois Lawrence, President of the Sudburyarea chapter, forwarded the happy newsthat Sudbury now has its first ever endo-crinologist, Dr. B. Varghese, MD, MRCP(UK) FRCPC. Just a reminder that if youwish to make an appointment with Dr.Varghese it is necessary to be referred byyour family physician.

TorontoOn Friday and Saturday, January 15

and 16, the Toronto chapter participatedin the 2004 Women�s Health Matters Fo-rum and Expo. A booth was set up, theFoundation�s literature was distributedand Toronto chapter volunteers talked tomany individuals and representatives ofother health organizations. On Saturday,at 12:30 pm, Dr. Ivy Fettes, ofSunnybrook and Women�s College HealthSciences Centre, a frequent speaker atThyroid Foundation of Canada events,gave a very informative talk on Thyroiddisease in women as part of the Forumspeakers series. The Women�s HealthMatters Forum and Expo is a yearly eventthat draws approximately 10,000 visitorsfrom the Toronto area and beyond.

For educational literature about thyroiddisease call our Helpline: 416-398-6184.

A Thyroid in Pregnancy Study is being conducted at the Hospital for SickChildren in Toronto. The study is evaluating the vision and neurodevelopment ofbabies whose mothers were hypothyroid or hyperthyroid during their pregnancy.We are looking for women who:

� are pregnant or recently delivered� had no other illness� can read English

Parking and transportation costs will be provided.

Volunteers wantedAre you pregnant and being treated for a thyroid problem?

If you are interested and would like more information, please contact:Laura Kenton or Lara Rosenberg at: 416-813-8285

Hospital for Sick Children, Toronto

This comprehensive book by ElaineA. Moore, author of Graves� Disease,A Practical Guide, is written in plainlanguage for patients with ThyroidEye Disease. It describes all facets ofthyroid eye disease including:� genetic, environmental and

lifestyle factors that contrib-ute to understanding Graves�Ophthalmology (GO)

� signs, symptoms� diagnostic tests� risk factors� complications� psychosocial issue of living

with GO

Elaine is a Medical Technologist,MT (ASCP), with more than 30years experience working in hospitallaboratories. She is the author ofnumerous books. Visit Elaine at herwebsite at http://daisyelaine_co.tripod.com/gravesdsease.

Published in Canada in 2003 bySarahealthPress, a Division ofSarahealth Inc. ISBN 1-4120-0911-1.This paperback book has 185 pages,including index, and sells for $24.95Cdn, $19.50 US.

For more information visit:www.thyroid-eye-disease.com

Hot off the press!Thyroid Eye DiseaseUnderstanding Graves� Ophthalmopathy

thyrobulletin, Winter 2004 9

Chapter coming eventsFree admission � everyone welcome.

Please mark your calendars

Burlington/Hamilton� Location: Burlington Art Centre,

Shoreline Room, 1333 LakeshoreRoad, Burlington. Tuesday, April 13,2004, 6:30 pm. Member social and an-nual general meeting. Displays,meet other members, learn about pro-grams, resources of Foundation.

� Location: Hamilton, in partnershipwith St. Joseph�s Healthcare,Healthstyles/Spring Series 2004. June2004. Date & speaker: TBA. Topic:Hypothyroidism.

� Location: TBA. In partnership withHalton HealthCare, October 2004. Date& speaker TBA. Displays and refresh-ments 6:30 Topic: Hypothyroidism.

� Location: Burlington Art Centre,Shoreline Room, 1333 LakeshoreRoad, Burlington. Tuesday, November9, 2004, 7:00 pm. Speaker TBA. Topic:Thyroid disease and the family.

� Mayor�s Walk for Volunteerism �Hamilton�s Bayfront Park Trail in May(date TBA). Support the ThyroidFoundation programs by participatingin the Mayor�s Walk.

� 4th Annual Spring Flower Sale � 33Alterra Blvd, Ancaster, on SaturdayMay 29 and Sunday May 30, 8:00 amto 3:00 pm. Shop early as last year wasa sell-out.

For information for all these events call tollfree: 1-866-377-4447 or 905-381-0475.

KingstonLocation: Loblaws Upstairs, KingstonCentre, Princess Street at Sir John A.

� Fourth Sunday each month, 3-4 pm.January 25, February 22, March 28,April 25, Winter season of informalthyroid information sessions. BoPopovic, pharmacist and a representa-tive from Kingston chapter will bepresent.

For information call: 613-530-3414.

Kitchener/WaterlooLocation: Kitchener Public Library, lowerlevel. 85 Queen Street North, Kitchener.Wheelchair accessible.

� Wednesday, February 24, 2004, 7:00pm. Dr. Arshad Khan, Psychiatrist,Kitchener. Topic: The thyroid mind andemotions.

� Wednesday, April 28, 2004, 7:00 pm.Dr. Terri Paul, Endocrinologist, Assis-tant professor, Endocrinology & Me-tabolism, St. Joseph�s Health Centre,London. Topic: Obesity: what you andyour thyroid can do. Annual meeting.

For information call: 519-884-6423.

LondonLocation: Central Library, Galleria, 251Dundas Street, London. Two hours freeparking for library patrons.

� Tuesday, March 23, 2004. 7:30 pm.Dr. John Wojcik, Endocrinologist.Topic: Thyroid cancer.

� Tuesday, May 18, 2004, 7:30 pm.Sheila Grose, Dietitian, St. Joseph�sHealth Centre. Topic: Food forthought! New nutrition labellingguidelines, cholesterol and fat infor-mation in relation to weight control,healthy food choices and concerns re-garding pre-diabetic diet.

For information call: 519-649-1145 orvisit our website: www.thyroidlondon.ca.

� Chapter Major Fundraiser, 4thAnnual Dinner/Fashion Show �Thursday, April 22, 2004. HellenicCommunity Centre, 133 SouthdaleRoad West, London, ON. Door prizes,draws, silent auction. Tickets now onsale for an evening full of fun. Buytickets early to avoid disappointment.

Information and tickets call: 519-649-1145.

TorontoThe chapter is planning its spring

event. For details and more informationcall the Helpline: 416-398-6184.

Annual General MeetingThe Canadian Thyroid Cancer Sup-port Group (Thry�vors) Inc. will holdits AGM at Wellspring, Oakville,Ontario on Saturday, May 1, 2004.For more information contactThry�vors at PO Box 23007, 550Eglinton Avenue, Toronto, M5N 3A8.

Helpful hint fromThry�vors:

Are you taking Cytomel (T3) becauseof an upcoming radioactive iodine(RAI) scan? Cytomel is faster actingthan levothyroxine (Eltroxin,Synthroid, etc). If you find you get abig �buzz� from it or have troublesleeping, ask your doctor if you candivide your dose into smaller quanti-ties and take it several times a dayinstead of once or twice.

Thry�vors

Has youraddress or

telephone numberchanged?

To ensure you receive yourthyrobulletin and

correspondence promptly,please send changes to:

Thyroid Foundation ofCanada

PO Box 1919 Stn MainKingston ON K7L 5J7

Tel: 613-544-8364

Fax: 613-544-9731

E-mail: thyroid@on.aibn.com

We need toknow!!

10 thyrobulletin, l�hiver 2004

Auditors� Report

To the Members of Thyroid Foundation ofCanada, La Fondation canadienne de laThyroïde

We have audited the statement of financialposition of Thyroid Foundation of Canada,La Fondation canadienne de la Thyroide as atMarch 31, 2003 and the statements ofoperations and changes in fund balances andcash flow for the year then ended. Thesefinancial statements are the responsibility ofthe foundation�s management. Ourresponsibility is to express an opinion onthese financial statements based on our audit.

Except as explained in the followingparagraph, we conducted our audit inaccordance with Canadian generally acceptedauditing standards. Those standards requirethat we plan and perform an audit to obtainreasonable assurance whether the financialstatements are free of material misstatement.An audit includes examining, on a test basis,evidence supporting the amounts anddisclosures in the financial statements. Anaudit also includes assessing the accountingprinciples used and significant estimatesmade by management, as well as evaluatingthe overall financial statement presentation.

In common with many charitableorganizations, the foundation derives revenuefrom donations and memberships, thecompleteness of which is not susceptible tosatisfactory audit verification. Accordingly,our verification of these revenues waslimited to the amounts recorded in therecords of the foundation and we were notable to determine whether any adjustmentsmight be necessary to donation andmembership revenue and fund balances.

In our opinion, except for the effect ofadjustments, if any, which we might havedetermined to be necessary had we been ableto completely verify donation and membershiprevenue as explained in the precedingparagraph, these financial statements presentfairly, in all material respects, the financialposition of the foundation as at March 31,2003 and the results of its operations andcash flow for the year then ended inaccordance with Canadian generally acceptedaccounting principles.

Secker, Ross & PerryChartered AccountantsKingston, OntarioOctober 15, 2003

Financial StatementsThyroid Foundation of Canada/La Fondation canadienne de la Thyroïde

Year Ended March 31, 2003

continued on page 11

Cash Flow from Operating ActivitiesCash received from grants and donations $ 50,202 $ 71,745Cash received from class action settlement 50,820Cash received from membership fees 48,359 54,988Cash received from Thyrobulletin funding 14,749Cash received from Nevada sales (net) 13,439Cash received from rental 2,052Cash received from Hedberg bequest 7,612Cash received from AGM 120 5,749Cash received from books and education material 569 1,342Interest and other 19,583 29,865Cash paid for education, services and awards (176,706) (233,119)

Net cash from (used in) operating activities 30,799 (69,430)

Cash Flow from (used in) Financing ActivitiesSale (purchase) of investments 121,155 (120,319)

Net increase (decrease) in cash 151,954 (189,749)Cash at beginning of year 229,404 419,153

Cash at End of Year $ 381,358 $ 229,404

Cash is comprised as follows:Cash and term deposits $ 381,358 $ 236,495Bank overdraft ( 7,091)

$ 381,358 $ 229,404

Statement of Financial Position as at March 31, 2003

Statement of Cash FlowYear Ended March 31, 2003

2003 2002

Operating Research Total TotalFund Fund 2003 2002

AssetsCurrent Assets

Cash and term deposits $53,139 $328,219 $381,358 $ 236,495 Accrued interest 4,927 4,927 8,348 Accounts receivable 7,558 7,558 2,307 Prepaid expense 9,882 9,882 1,837

70,579 333,146 403,725 248,987

Investments Bonds (market value - $102,039; $225,082 in 2002) 100,906 100,906 222,061

$70,579 $434,052 $504,631 $ 471,048Liabilities and Fund BalancesCurrent Liabilities

Bank overdraft caused by outstanding cheques $ 7,091Accounts payable $15,005 $ 15,005 14,691Deferred revenue 42,311 42,311 34,578

57,316 57,316 56,360

Fund BalancesRestricted fund � research $434,052 434,052 466,904Unrestricted operating fund (deficiency) 13,263 13,263 ( 52,216)

13,263 434,052 447,315 414,688

$70,579 $434,052 $504,631 $ 471,048

Research Fund Commitments (note 3)Lease Commitment (note 4)Approved by the Board:Member, Ed Antosz, PresidentMember, Joan DeVille, Secretary

thyrobulletin, Winter 2004 11

Statement of Operations And Changes in Fund BalancesYear Ended March 31, 2003

RevenueGrant � Health Canada $ 15,120AGM revenue $ 120 $ 120 5,749Membership 47,834 47,834 54,488Class action settlement 50,820 50,820Donations 45,738 $ 4,464 50,202 54,596Books and education material 569 569 1,342Associate member organizations 525 525 500Summer student grant 2,029Administration fee � research 5,063 5,063 5,063Interest and other 691 15,471 16,162 23,239Thyrobulletin funding 14,749 14,749Nevada sales 38,420 38,420Rental income 2,052 2,052Hedberg bequest 7,612 7,612

214,193 19,935 234,128 162,126ExpenditureEducation

Health Canada projects 7,786Chapter rebates � membership fees 18,087 18,087 22,047Educational material 3,180 3,180 2,143Publicity 817 817 817Purchases for resale 29 29 389Thyrobulletin (including mailing costs) 18,868 18,868 17,179Meetings � annual 513 513 18,233

� other 1,317 1,317 883

Total Education 42,811 42,811 69,477

ServicesNevada 24,981 24,981Office supplies and expenses 6,011 6,011 5,339Postage and mailing 4,700 4,700 4,731Professional fees � audit 1,700 1,700 1,700Professional fees � contract accounting 3,850 3,850 3,250Professional development � staff 594 594 180Professional development � volunteers 250Bank charges 1,138 1,138 531Computer 1,122 1,122 2,651G.S.T. expense 1,744 1,744 2,135Insurance 3,390 3,390 2,405Rent (includes services) 10,645 10,645 11,019Salaries and benefits � office staff 40,861 40,861 39,936Salaries and benefits � student 2,251Telephone and fax 5,167 5,167 4,225

Total Services 105,903 105,903 80,603

AwardsDoctoral award 10,224 10,224 9,765Fellowship award � D.M. Abramsky 37,500 37,500 60,000Student awards 9,000Administration � operating 5,063 5,063 5,063

Total Awards 52,787 52,787 83,828

Total Expenditure 148,714 52,787 201,501 233,908

Excess of Revenue over Expenditure(Expenditure over Revenue) 65,479 ( 32,852) 32,627 ( 71,782)

Fund balances (deficiency) at beginning of year ( 52,216) 466,904 414,688 486,470

Fund Balances at End of Year $ 13,263 $ 434,052 $447,315 $ 414,688

OperatingFund

ResearchFund TotalTotal

20022003

Financial StatementsThyroid Foundation of Canada/La Fondation canadienne de la Thyroïde

Year Ended March 31, 2003

1. Purpose of OrganizationThe Thyroid Foundation of Canada is incorpo-rated under the laws of Canada and is a regis-tered charity. The purpose of the organizationis to awaken public interest in and awarenessof thyroid disease, lend moral support to thy-roid patients and their families, and assist infund-raising for thyroid disease research.

2. Significant Accounting Policies

Fund Accounting � Revenues and expendi-tures related to education and services are re-ported in the Operating Fund.

The Research Fund was established withexternal donations to provide financial supportin helping to uncover the fundamental causesof thyroid disease.

Revenue Recognition � The Thyroid Founda-tion of Canada follows the deferral method ofaccounting for contributions. Restricted con-tributions are recognized as revenue in the yearin which the related expenses are incurred.Unrestricted contributions are recognized asrevenue when received or receivable if theamount to be received can be reasonably esti-mated and collection is reasonably assured.

Investments � Bonds are recorded at cost. In-terest is reported as income on an accrual basis.

Capital Assets � No value is accorded to capi-tal assets for reporting purposes. Purchases ofcapital assets are charged as expenditure in theyear of acquisition.

3. Research Fund CommitmentsAn amount of $30,000 has been committed toResearch Fellowships. In addition, an amountof up to $8,000 has been committed forsummer student thyroid research depending onthe availability of funds.

4. Lease CommitmentThe foundation leases its office premises undera five year lease expiring March 31, 2008which calls for a monthly payment of $1,145.

Notes to Financial StatementsYear Ended March 31, 2003

12 thyrobulletin, l�hiver 2004

he first day of the conference wasdevoted to a workshop examin-ing the role and governance of

the Thyroid Foundation ofCanada (TFC). With the helpof Dr. Donald Pierson of South-town Consulting, we examinedour strengths (there are many)and looked at his recommenda-tions for improvements. Weproceeded to prioritize the im-provements he suggested,which was not an easy task asthere are many areas where weneed to start new and innovativestructures and modus operandi.

RecommendationsThe TFC would take on a

different structure and operat-ing method. One of Dr.Pierson�s major recommenda-tions was to decrease the sizeof the board to make opera-tions, communications, etc.smoother. The suggestion wasthat the existing board reinventitself by asking certain boardmembers to voluntarily with-draw from the board. These

Highlights of 23rd AGM weekendOctober 30 - November 1, 2003, Toronto, Ontario

members, although no longer members ofthe board, would still be needed. Theircontributions and work would be invalu-able to support the board. Chapter presi-dents would contribute through chaptercouncil. A transition board would beformed consisting of:

� president� one vice-president� secretary� treasurer� three chapter presidents� past president

This would make communicationeasier, decision making more efficientand would allow the board to focus onpolicy rather than operations. The transi-tion board would have the task of address-ing the changes recommended in Dr.Pierson�s report and presenting them forapproval at the 2004 annual general meet-ing (AGM) in Toronto.

From Dr. Pierson�s report the top fiverecommendations to be reviewed are asfollows:

1. A standing ad hoc board development/governance committee should be es-tablished to address the findings of thisreview.

2. The board should hire an executive di-rector or CEO and delegate operationalresponsibility within establishedguidelines or limitations; staff descrip-tions should be reviewed and revisedif appropriate.

3. Suggest including articles related toethical guidelines for corporate spon-sorship, loyalty and confidentiality forboard members and staff and conflictof interest. A code of conduct shouldbe established and all board and staffmembers and volunteers should sign apledge or oath of confidentiality andloyalty as part of their orientationprocess.

4. Suggest decreasing the board size toapproximately 10 members to allow forinclusion of needed skills and distribu-tion of workload. As initials steps, theboard should review the need for inclu-sion of members-at-large and reduce oreliminate most chapter presidents as na-

tional board members and makeuse of the established gover-nance representative body forchapters (i.e. chapter council es-tablished in 1989).5. The board should develop acollectively shared multi-yearplan, within the context ofcommon values and guidingprinciples, that describes thevision of where it wants theFoundation to be in the future,a mission statement that indi-cates how the organization willget there, and strategic direc-tions or goals that allow for anannual evaluation process tomeasure progress towardsthese goals. The intent of recommenda-tion No.1 will be met by thepresent executive who will ap-point the ad hoc committee.

TDr. Donald Pierson,

Southtown Counsulting

Ed Antosz, Rick Choma and David Morrisat the AGM 2003. continued on page 13

thyrobulletin, Winter 2004 13

This leaves us, in our top five priorities,with the recommendation to:

� Hire an executive director or CEO;

� Develop ethical guidelines for corpo-rate sponsorship and a code of conduct;

� Develop a multi-year plan;

� Reduce the size of the present board.

The first priority could be implementedreasonably soon with the new positionbecoming financially sustainable throughits own fundraising activity.

Some work has been done in the pastto meet the requirement of developingethical guidelines and the transition boardwill be able to build on this. Anyone whohas done this type of work and has spe-cific input is strongly urged to submitthese ideas to the executive committee.

Development of the multi-year plan forthe future of the organization will requirethe most work by the transition board.

Important progress was already madeat the AGM workshop in the developmentof a vision statement letting the publicknow what we stand for and fulfilling thewishes of our founder, Diana MeltzerAbramsky.

With the election of the new president, the Foundation ac-quires a knowledgeable businessman tohelp us restructure and take us in the di-rection of our goal. Under his direction,we will be able to provide the leadershipto continue to reach the one in twentyCanadians who have thyroid disease, toeducate, and to raise the funds for the re-search that is needed to reach our goal ofeliminating thyroid disease.

Friday, October 31 was taken up byboard meetings for normal Foundationbusiness and the 23rd AGM. During theAGM the new officers and members-at-large were elected (see masthead, page4). The new board was elected with thesame structure as provided for in By-LawNo.1. The audited financial statements forthe year ended March 31, 2003 were dis-tributed and approved.

A vision statement was agreed upon:

�To provide leadership to eliminatethyroid disease�

Highlights . . . continued from page 12

W e are preparing a book onThyroid Cancer for patientsand read with interest the

vignette by Diane Patching in the sum-mer edition of thyrobulletin. I wouldlike to reprint the brief article in the sec-tion of our book in which patients re-count their experience with thyroid can-cer. May we have permission to do so?

Incidentally, we are listing your or-ganization on the back of the book as aresource for patients.

Leonard Wartofsky, MD, MACPChairman, Department of Medicine

Washington Hospital CenterWashington, DC, U.S.A.

Diane Patching and the Foundationwere happy to comply. Editor

*****

his is in reference to issue 24,No 1, Spring 2003. In the ar-ticle Complimentary and al-

ternative medical therapies for thyroiddisorders, by Dr. Merrill Edmonds andDr. John Wojcik, horseradish is dis-cussed �in very large amounts, how-ever, it contains a substance whichblocks the thyroid and can cause hy-pothyroidism�.

I am hypothyroid and take 100 mcgplus one lactaid pill daily six times aweek. I love horseradish.

1. What do you mean large amounts?2. How much can one eat daily?

Isabelle LeibovitchToronto, ON

There is no simple response to thequestions in your e-mail. A lot dependson whether the person has a underly-ing thyroid disease such as Hashimoto�sthyroiditis since this would increase thesusceptibility to anything that wouldtend to block the thyroid. Taking somehorseradish every day might be justenough to push such a person into hy-pothyroidism. If the thyroid gland isnormal though, it is very unlikely thata person would be able to eat enough

Foundation�s mailbox

T

horseradish every day to block the thy-roid. If the person is taking a full doseof thyroid hormone by mouth (75-150micrograms daily) the horseradishshould have little effect since the dailyrequirements will be met by the thyroidtablet. If a small dose of thyroid hor-mone is prescribed (less than 75 micro-grams) the person�s own thyroid wouldhave to be making some thyroid hor-mone to keep the blood levels normal.This could, theoretically, be blockedthus necessitating an increase in thedose of the tablet to return the thyroidlevels to normal.

Merrill W. Edmonds,MD, FRCPC FACP

St. Joseph�s Health Care CentreLondon ON

*****

just wanted to let you know thatI received the information pack-age and found the literature re-

ally helpful. I signed my daughter upfor the thyroid newsletter, picked up acouple of books on the suggested read-ing list, read everything and then gaveit all to my daughter. We were discour-aged because of all the conflicting in-formation we had been getting. Thepamphlets and books put a lot of issuesinto perspective. My daughter really ap-preciated the material too. She is feel-ing much better now that her medica-tion finally kicked in � it�s amazingwhat havoc one small gland can makewhen it�s out of whack. Thank you forsending the thyroid information to me.

Linda LombardMontreal, QC

I

14 thyrobulletin, l�hiver 2004

would like to tell you my personalmedical story because there may beother members of the Thyroid Foun-

dation with similar conditions who couldbenefit from my experiences. I was diag-nosed as hypothyroid in 1996. This wasa relief as I had been feeling very tiredand depressed for some time. The pre-scribed l-thyroxine helped, but I still didnot feel really well. After joining the Thy-roid Foundation and attending some ofthe meetings in Ottawa, I realized fromthe questions and discussions that manyof the hypothyroid people were still feel-ing tired even if their TSH readings werein the normal range. This was my case,too. The experts continue to say that ifthe TSH is normal, your problem is notthe thyroid gland.

My problem turned out to be celiac dis-ease. I was diagnosed last May, much tomy surprise, as I don�t have the usualsymptoms of celiac disease (CD). Celiacdisease is a genetically mediated autoim-mune disease that affects the small intes-tine. The common symptoms are gas-trointestinal problems (often diarrhea andbloating), iron and folate deficiency ane-mias, weight loss, extreme fatigue, de-pression etc. In adults, the symptoms canbe quite varied. The lining of the smallintestine is damaged by gluten (a proteinfraction) in wheat, barley, and rye, andso cannot absorb nutrients properly. Af-ter diagnosis by a biopsy of the smallbowel, the only treatment is a strict glu-ten-free (GF) diet for life. Much moreinformation on celiac disease and the GFdiet is available at <www.celiac.ca>. TheCanadian Celiac Association, like theThyroid Foundation, helps sufferers adaptto living with a chronic condition.

My diagnosis was made only becauseI am married to a celiac (diagnosed in1981), and we have always taken a greatinterest in following the latest researchinto CD. The relatively new tissuetransglutaminase blood test made my di-agnosis possible. I would never have beensent to a gastroenterologist, as I had nogastrointestinal symptoms. No doctorwould have recommended a small bowelbiopsy for me without the positive bloodtest. I consider myself extremely fortu-nate to have been diagnosed before myhealth deteriorated any further. (My main

Thyroid disease and silent celiac diseaseby

Willow WightI

symptom was extreme fatigue. I have os-teoporosis and am hypothyroid. My regu-lar blood tests were normal.) I convincedmy GP to order the tissue transglutam-inase blood test � just in case. This test isquite new and not well known among fam-ily practitioners. But I spelled it out, andwent to the lab to have blood drawn; theyhad not heard of it, but it was listed in theirbook. The test is not covered by OHIP, andcost me $43. I am so glad it was available;a cheap and simple blood test has savedme years of misery. I had a small bowelbiopsy about three months later, and thediagnosis was celiac disease. Since then, Ihave been on the gluten-free diet, havegained 15 pounds, and am feeling muchmore like a normal human being.

I do not have the classic form of CD,but �silent celiac disease� � the commongastrointestinal symptoms are absent.With silent CD, another autoimmune dis-order such as thyroid disease, type I dia-betes, anemia, chronic fatigue, osteoporo-sis, etc. is usually present. There are sev-eral informative articles available throughthe internet: in particular the excellentstudy done at the University of Maryland,< w w w. u m m . e d u / n e w s / r e l e a s e s /celiac_study.html>, published in Febru-ary, 2003. This large study by Dr. Fasanoand colleagues screened more than13,000 people in the United States. Onein 133 people who were NOT considered

at risk for CD actually had celiac disease.The prevalence of CD in first-degree rela-tives of celiacs was 1:22; in second-de-gree relatives, 1:39; and in symptomaticpatients (with either gastrointestinalsymptoms or a disorder associated withCD) 1:56.

Another very important article is �Ce-liac Disease � How to Handle a ClinicalChameleon�, an editorial by Dr. Fasanoin the New England Journal of Medicine,348; 25, p. 2568�2570; June 19, 2003.Written for physicians, this article pre-sents new information on the atypical as-pects of CD and its diagnosis. On theinternet, this is available at<www.celiaccenter.org/news.asp> or<www.nejm.org>. It might be helpful totake a copy of these articles to your fam-ily doctor, as many GPs are not familiarwith the latest information on CD.

Screening is recommended for peoplewith a number of conditions (type I dia-betes, thyroid and other autoimmune dis-eases, osteoporosis, etc.), who are athigher risk for CD than the general popu-lation. The newest blood test to screenfor CD is the tissue transglutaminase test.It detects antibodies that are in the bloodof celiacs who are consuming gluten. Theavailability of the blood test varies acrossthe country. In Ontario, Gamma-Dynacare has it on their listing of avail-able tests; it is not covered by OHIP andcosts $43.

A positive blood test must be followedup by a visit to a gastroenterologist for asmall bowel biopsy BEFORE the gluten-free diet is started. If gluten is removedfrom the diet, the intestine will begin toheal and the biopsy will be inconclusive.

Because my husband had CD, it hadalways seemed very unlikely that I wouldhave it too. But today we know that CDis not a rare disease! One gastroenterolo-gist said recently that most of her patientsnow are diagnosed with CD after theyhave already developed another autoim-mune disease. It seems that if you haveone autoimmune disease you are at higherrisk of developing another autoimmunedisease. I suggest that others who haveautoimmune thyroid disease and are stillnot feeling well even with a normal TSHshould ask their doctors to consider ce-liac disease. It is not a rare disease.

Willow Wightmember Ottawa Area Chapter

thyrobulletin, Winter 2004 15

C ombining two hormone thera-pies to treat the psychologicalaffects of hypothyroidism may

not be more effective than using a singletherapy, according to new research ar-ticles published this month in the Jour-nal of Clinical Endocrinology & Metabo-lism. Two new studies and an editorialquestion whether a combination of thy-roxine (T4) and T3 is superior to T4 alonefor the treatment of patients with hypothy-roidism.

The new findings will be of great im-portance to the five to 10 percent ofAmericans who suffer from hypothyroid-ism, which occurs when the thyroid glanddoes not produce enough thyroid hor-mone. Symptoms of hypothyroidism caninclude fatigue, weight gain, thinned hair,decreased cardiac function, menstrual ir-regularities, sluggishness, dry skin andconstipation.

One study, which was led by researchersfrom McMaster University in Hamilton,Ontario, specifically examined whethera combination of T4 and T3 therapy im-proved mood and sense of well being inhypothyroid patients who also sufferedfrom depressive symptoms. In the pro-spective, double-blinded, randomizedcontrolled trial, forty patients were ran-domized to receive either T4 therapyalone or a combination of T3 and T4therapy. The results showed that whencompared with T4 alone, the combinationtherapy did not improve either mood orpersonal sense of well being in the pa-tients. The 15-week study was longer thanany other previously published studies onthis subject.

Effects of combining T3 & T4 for thetreatment of hypothyroidism

Combination hormone therapy does not benefit hypothyroid patients, says new study

�Data does not support the routine useof T3 in addition to T4 to maintain euthy-roidism in hypothyroid patients who areon stable doses of levothyroxine hormone,but who complain of depressive symp-toms. Until a future large, multicentre,blinded, randomized, controlled trialproves otherwise, there is insufficientevidence to support changing the currentapproach of routinely using T4 alone tomaintain euthyroidism in hypothyroidindividuals,� explained Dr. Anna Sawka,the first author of the study.

A second study published this monthin JCEM also compared a combinationT4 and T3 therapy with T4. In the secondstudy, which was a double-blind, randomorder, crossover trial, researchers from SirCharles Gairdner Hospital in Perth, Aus-tralia compared the impact of the twotreatments on quality of life, cognitivefunction and subjective satisfaction in 110hypothyroid patients. In this study, ap-proximately one-half of the subjects re-ceived T4 therapy for 10 weeks and thenT4 and T3 therapy for 10 weeks. Theother half of the subjects received thecombination therapy first.

Once again, the researchers found nosignificant benefits for combinationtherapy compared to T4 alone. However,they did find that anxiety and nausea weresignificantly worse for patients on thecombined therapy.

�At the conclusion of our trial, we foundno benefit of combining T4 and T3 therapyon quality of life, hypothyroid symptoms,cognitive function, subjective satisfactionwith therapy or treatment preference,�notes Dr. John P. Walsh, the senior authorof the study. �Furthermore, we could notidentify a specific subgroup of patientswho benefitted from the combined therapy.Based on these findings, we believe thatT4 alone should remain the standard treat-ment for hypothyroidism.�

In addition to the two new studies, theOctober issue of JCEM also includes aneditorial by Drs. Michael Kaplan, DavidSarne and Arthur Schneider, which dis-cusses the use of T4 and T3 therapy totreat hypothyroid patients. In the edito-rial, the authors discuss the two new stud-

ies as well as previous research that ex-amined T4 and T3 therapy. The authorswrite that based on past and current re-search, �evidence is fading that addingT3 to T4 is beneficial in the long-termtreatment of hypothyroid patients withautoimmune thyroiditis.�

JCEM is one of four journals publishedby The Endocrine Society. Founded in1916, The Endocrine Society is the world�soldest, largest and most active organiza-tion devoted to research on hormones, andthe clinical practice of endocrinology. En-docrinologists are specially trained doc-tors who diagnose, treat and conduct ba-sic and clinical research on complex hor-monal disorders such as diabetes, thyroiddisease, osteoporosis, obesity, hyperten-sion, cholesterol and reproductive disor-ders. Today, The Endocrine Society�smembership consists of over 11,000 sci-entists, physicians, educators, nurses andstudents, in more than 80 countries. To-gether these members represent all basic,applied, and clinical interests in endocri-nology. The Endocrine Society is based inChevy Chase, Maryland. To learn moreabout the Society, and the field of endo-crinology, visit the Society�s website atwww.endo-society.org.

Two articles in the current issue of the Journalof Clinical Endocrinology and Metabolism(JCEM) assess the effects of combining T3 andthyroxine (T4) supplementation for the treatmentof hypothyroidism. The press release from TheEndocrine Society describing these papers isreproduced below, dated October 3, 2003.Thepress release was reprinted from the website ofDr. Daniel Drucker, FRCPC, University ofToronto and Toronto General Hospital. DrDrucker maintains a comprehensive websitedevoted to all aspects of thyroid disease �www.mythyroid.com.

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, 2004 (Spring)June 15, 2004 (Summer)

September 15, 2004 (Autumn)December 15, 2004 (Winter)

Contributions to:Rick Choma, Editor

Fax: (613) 542-4719E-mail: rchoma@sympatico.ca

16 thyrobulletin, l�hiver 2004

D uring a physical exam in the fallof 2001, my family doctor founda lump in the left side of my

neck. That would be the beginning of mythyroid cancer �journey�. I often wonderhow long it would have taken for me tonotice the lump, had I not seen my doc-tor that day.

I was sent to see a highly recom-mended surgeon in Cambridge. Shortlyafter the initial visit, the surgeon per-formed a fine needle biopsy of the lump.When I met with him again, he confirmedthat I had papillary carcinoma and thathe wanted to surgically remove the leftlobe only.

I was extremely naive and never evenconsidered a second opinion. My men-tality was that he was the expert and thata partial thyroidectomy was the best pos-sible option (and the norm)! My first sur-gery was performed on December 14,2001 at Cambridge Memorial Hospital. Ithink that it went very well, consideringI was eating muffins the following morn-ing! After the pathology was completedon the goitre, I soon found out that theright lobe would have to be removed aswell. My second surgery was two monthsafter the first, on February 13, 2002. Thistime around, my recovery was even bet-ter than before. The surgeon also told methat my right lobe contained a few smallergoitres. I was now thyroid-less.

In March, I found myself in Londonto see Dr. Tom McDonald for a follow-up appointment. After my discussion withhim, I was sent for a routine ultrasoundof my neck. Then, I was off to my homein Kitchener.

Dr. MacDonald called me at home acouple of evenings later. I knew it had tobe bad news. First, he was calling me di-rectly and second, it was in the evening.Dr. MacDonald told me that I was goingto need another surgery. Apparently myright lobe was still there! I never eventhought to ask him what it was they DIDremove, if not my right lobe?

Surgery #3 was a whole new ballgame. I went to the London Hospital andhad Dr. John Yoo as my surgeon. Dr. Yooexplained that they may have removedeither scar or fatty tissue during the sec-ond surgery. I was also told that I wouldbe monitored very closely after this sur-gery, to make sure that my calcium lev-

My thyroid cancer journey

byKim Graham

test. Because of this mistake, it was notknown what effect the radioactive iodinehad on my remaining thyroid tissue. Testresults are not very often mixed up, infact, I am only the second case that Dr.Driedger�s office has seen this happen to.

I received a test dose of radioactiveiodine this past September, and my thy-roglobulin was below one. Now, my ra-dioactive iodine chapter is over. I amguessing that those of us who get thyroidcancer are never done living chapters ofthe journey. By far, the most valuable les-son this experience has taught me is thatno one is ever alone in their experience.In addition to the support and love of myfamily, I have found invaluable supportfrom the �Thry�vors� listserve. Throughreading the stories of others, I realize thatI have been very lucky.

If anyone wants to contact me, my e-mail address is: kakes1969@rogers.com.

Meaningful words

els didn�t plummet. Following the sur-gery, my recovery went very well, and mycalcium levels didn�t even move.

My surgeries now officially over, itwas time for radioactive iodine treatmentthrough Dr. Al Driedger of London HealthSciences. Due to my history of depres-sion, it was decided that I would be usingThyrogen to become hypothyroid. InNovember, two weeks after starting thelow-iodine diet, I had my first radioac-tive iodine treatment.

I did not stay at the hospital for myseclusion. Instead, my mom and I�swapped� homes, and she looked aftermy 2 ½ year-old son. During this time, Iread a lot and watched movies, but it wasa very lonely experience. After five days,I was ready to go back home.

My son has always been good aboutseparating from me, so he has been ex-tremely accommodating with mommy�sabsences. When he initially saw my scar,and asked what it was, I told him mommyhad an �ouchie�. After that, he wanted tokiss it better. Aren�t kids the best?

After my treatment, it was discoveredthat the lab ordered the wrong blood testafterwards. Instead of a thyroglobulintest, they performed an antithyroglobulin

Kim Graham with her son Nicholas

Sometimes in our busy lives it isall too easy to forget the importantwords which can mean so muchto those around us.

The six most important words:I admit I made a mistake

The five most important words:You did a great job

The four most important words:What is your opinion

The three most important words:If you please

The two most important words:Thank you

The one most important word:We

The least important word:I

thyrobulletin, Winter 2004 17

Call for nominations2004-2005

Deadline: Monday March 15, 2004

Saturday morningJune 5

Patient ThyroidUpdate Forum

SaturdayJune 52:00 pm

Annual General Meeting

Thyroid Foundation of CanadaLa Fondation canadienne de la

Thyroïde

Joan DeVille,National Secretary

Saturday

June 5, 20042:00 pm

Toronto, Ontario

24th AGM

Members of the Foundationand the general public are

welcome to attend.

Annual General Meeting

Mark your 2004calendars . . .

Details to follow!

FridayNovember 122nd Annual Gala

SaturdayNovember 13

ProfessionalDay for Family Medicine

N Officers of the Foundation(executive committee members)� President� V-P Publicity & Fundraising� V-P Chapter Organization &

Development� V-P Education & Research� V-P Operations� Secretary� Treasurer

National members-at-large (6)three of whom shall be:� Editor, thyrobulletin� Liaison, Medical Research� Archivist

2003-2004 Nominating Committee:

Ed Antosz, Chair, Windsor, ONBarbara Cobbe, London, ONGary Winkleman, Richmond, BCName, TBAName, TBA

Please contact the Chair at the ad-dress below if you wish to nominatesomeone, or if you are interested inserving as an officer of the Foundation,as a member-at-large or in assisting ona national committee. Nominationforms are available from your chapter,nominating committee members or thenational office.

Please forward completed forms to:Ed AntoszNominating Committee Chair1508 - 75 Riverside DriveWindsor, ON N9A 7C4Tel: 519-253-2885Fax: 519-971-3694E-mail: antosz@uwindsor.ca

ominations are invited for theelection of the officers andmembers-at-large on the Foun-

dation�s 2004-2005 national board ofdirectors.

The nominating committee shall pro-pose a nominee for the position of eachofficer and member-at-large to beelected (By-Law No. 1, clause 53). Theslate of the nominating committee willbe circulated to the members of theFoundation in the next issue of thyrob-ulletin. Additional nominations may bemade from the floor at the time of theelection which shall occur at the annualmeeting of the members (AGM) on Sat-urday June 5, 2004.

The Board of Directors is comprised of:1) officers who shall be elected annu-

ally by the members at the annualmeeting;

2) the president of each chapter or a rep-resentative appointed by the chap-ter president, who shall be electedor appointed annually at the chapterlevel;

3) six (6) members-at-large who shallbe elected by the members annuallyat the annual meeting;

4) the past president.

Officers of the organization areelected annually and shall hold thesame office for no more than three (3)consecutive years (By-Law No.1,clauses 29 & 38).

Chapter presidents and members-at-large are elected annually for a term ofone year and shall hold office until theirsuccessors are elected or appointed(By-Law No.1, clauses 18 & 20).

The current board has been chal-lenged to review its current structure,consequently the slate presented by thenominating committee may constitutemore positions than will be available.

18 thyrobulletin, l�hiver 2004

G byDr. Nicole Phillips

rief is the feeling generated bya loss and is a process. The typi-cal pattern can give us a picture

of �normal� depression. In the commu-nity there is still a tendency to think ofgrief solely as a response to death, espe-cially of someone we love, but in recentdecades the understanding of human psy-chological processes has grown enor-mously and we now know that loss of anykind can provoke a grief reaction. Lossof health such as in Chronic Fatigue Syn-drome, loss of a body part due to surgeryor accident, loss of a job due to redun-dancy or retirement are all obvious ex-amples of loss. Less obvious losses caninclude infertility (loss of the expectationsof rearing your own children) and divorce(loss of the expectations of a life-timeshared in marriage which may also beassociated with financial loss and loss ofexpected lifestyle).

Psychology experts have put togetherthe following pattern of grief reactions.It must be emphasized however that yourown experience is unique and there aregreat variations, both in the pattern ofgrief and in the time it takes to workthrough.

� Disbelief � There is an initial responseof shock, numbness and disbelief whichis usually short-lived and followed by;

� Preoccupation � Longing and yearn-ing for what you have lost fills your mind.

There may also be;

� Denial � Acting as though the loss hadnot occurred (keeping a bedroom readyfor a dead child) or if retrenched (gettingdressed and going �to work� every morn-ing) or in Chronic Fatigue Syndrome(pushing yourself past the point of whatyou know is appropriate);

� Anger and guilt � Intense emotionswhich may be expressed in statementssuch as �Why has this happened to me?�;�It�s not fair!�, or �If I had only done suchand such this would not have happened�.This usually settles to be slowly replacedby acceptance of the loss;

� Acceptance of the loss � with contin-ued grieving and, finally,

� Depression.

Grief and depression

continued on page 19

The depression associated with griefusually lessens although at times it mayseem that it will never lift. Anniversariesof the death or of a distressing event,birthdays and other reminders may reac-tivate your feelings but gradually thestrands of life are picked up again andyou return to normal functioning (this ofcourse not being applicable to ChronicFatigue Syndrome patients). This usuallyoccurs around a period of 13 months andmost people feel they are coping muchbetter in the second year. The importantmessage here is that grief and the depres-sion accompanying it should heal overtime. If you remain depressed and unableto get on with life it could indicate unre-solved issues related to the loss and pos-sibly the onset of a depressive illness.

DepressionThe number and severity of the losses

that accompany the diagnosis of ChronicFatigue Syndrome, in my experience,cause a very high incidence of co-exist-ing depression along with the ChronicFatigue Syndrome symptoms. Becausemany of the symptoms of depression andChronic Fatigue Syndrome overlap ittakes someone knowledgeable aboutboth these conditions to tease out whatis what and make appropriate diagnoses.The symptoms that overlap include fa-tigue, sleep disturbance, difficulty con-centrating and remembering things, lossof libido, bodily aches and pains. How-ever, in my experience the essential dif-ferences are:

1. In Chronic Fatigue Syndrome withoutdepression the patient�s mood tends tobe more that of frustration and angerwhereas in depression the patient�smood drops markedly and has a qual-ity of hopelessness and negativitymuch more severe than in the non-de-pressed person. There is an overallsense of inability to cope, tearfulness,heightened sensitivity to perceivedcriticism and difficulties in interper-sonal relationship.

2. In depression, anxiety is a major symp-tom and so if anxiety levels are raisedsubstantially this is usually a good in-dicator of depression.

3. Thoughts of death or suicide are also agood indicator of depression. Some-times these are more passive such asthoughts of �I�d rather not be here� or�It wouldn�t matter if I was run overby a bus� rather than active thoughtsand plans.

4. Importantly, in depression there is al-ways a substantial loss of pleasure orinterest in things that previouslypeople enjoyed. The important thinghere is that in Chronic Fatigue Syn-drome many or most of these previ-ously enjoyed activities can no longerbe undertaken due to illness. The give-away though is that if someone is ex-periencing depression they don�t evenhave the desire to be doing these thingsany more such as seeing people, go-ing to a movie or doing the things theyenjoyed doing previously, as opposedto people with Chronic Fatigue Syn-drome without depression who saythey would still love to do these thingsif only they were feeling better.From my experience, if there is any un-

certainty about whether depression existsor not in someone with Chronic FatigueSyndrome, a trial of antidepressants isuseful. Much of the emotional sufferingin the illness can be relieved by the useof antidepressants if there is a concurrentdepression present. If they cannot be tol-erated or in fact make no difference, thennothing has been lost and they can beceased.

Making a diagnosis of depressionshould not in anyway take away from theconcurrent diagnosis of Chronic FatigueSyndrome. Unfortunately there are stillmany false and hurtful beliefs about de-pression such as the sufferer can pull him-self or herself together which only addsto the burden of guilt that people are al-ready experiencing or that a diagnosis ofdepression means that you are weak-minded or mentally incompetent or thatthere is no visible problem therefore thereis no problem at all. Often the depressed

thyrobulletin, Winter 2004 19

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Time To Renew?Grief and depression . . . continued frompage 18

person feels that someone has �caused�the depression and often a parent, siblingor important role model gets the blame.Sometimes the depressed person feels thatthey have in fact committed an unforgiv-able sin and is being punished. There aremany other myths and fallacies about de-pression which is a treatable illness likeany other medical illness.

Reprinted with permission from Thyroid Flyernewsletter of Thyroid Australia Ltd.Originally published in Emerge, Journal ofThe ME/Chronic Fatigue Syndrome Society ofVictoria Inc.

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